DEMOGRAPHY FROM THE SOUL

Cultures of Populations Population Dynamics and Sustainable Development Gustav0 L6pez Ospina Subiha H. Syed Paul Nkwi Charles Chilimampunga Aida Mohammed Dharma Chandra Khairul Bashar Rashid Ahmed Khan Marat Khadjimukhamdov Mokhtar El Harras Waheeba Silvia Salinas Fare’e Mulder Marco Posso Zumarraga Elena Hurtado Ed. Sabiha H. Syed --- .------._ --.- 2 0 0 I T he field of Population Studies has expanded rapidly beyond its demographic core as researchersfrom many other disciplines in the social scienceshave been interested to devote their skills and contribute their perspectives on population issues.The study of population offers something for everyone: the daily events of birth and death, migration, are closely related to economics,politics, society and culture. The interlacing of individuals, young and old, men and women, in all their collectivities, their interactions with nature and culture, statisticsand diaries, self-interestand altruism form a challenging phenomena for improving the quality of life and sustainabledevelopment. Forachievingthe goalsof sustainable developmenr it isapparent that the world today presents an enormously diverse pattern of continuity and change, of unity and diversity. The adaptation of socio-cultural norms, values, beliefs, and behaviours to new patterns of production and consumption have been also varied, sometimesthe changes witnessed are monumental and sometimesimperceptible. We need to find innovative ways of measuring what is significant, qualitatively, for individuals, families and societieswho are confronted with constant changes. We also need to ascertain whether change has been predominantly positive, i.e. connoting progress or insinuating negative regress i.e. threat to identity of particular communities or groups. It is an important element of UNESCO’smission to identify “best practices” and “lessons learnt” and to promote the correct practiceswithin a more general programme for sustcrinable development. Cultures of Populations presents an analysisof an interregional research and training programme undertaken by UNESCOin twelve countries in the four major regions: Cameroon, Malawi and Mozambique in Africa; Fiji, Malaysia, Pakistan and Uzbekistan in Asia/Pacific; Morocco and Yemen in the Arab States;Bolivia, Guatemalaand Ecuador in Latin America. i Cultures of Poaulations: Foreword The researchand training work presented in this volume isa consolidation of activitiesundertaken by UNESCO’sPopulation and Development programme, with major financial support from UNFPA,through a project, “Understanding Socio-culrural FcrctorsAffecting Demographic Behaviour and Implications for the Formulation and Execution of Population Policies and Programmes” that carried out field researchesand policy analysisin twelve (12) countries. One of the core assumptionsfor UNFPAwas that socio-culturallyappropriate IECprogrammes can be more effective in meeting Population and Development goals as envisaged in the major UN Conferencesheld in the 1990s- the last decade of the 20th century - which would have major implications for the advent of the 21st century. UNESCO,however, expanded the scope of the researchto include a strong component of training and also to study the socio-cultural phenomena and its interaction with all the three major dynamics of Population i.e. Fertility, Mortal@ and Migration. While undertaking the researchat country level, training was included as a part of the activities.Thistraining was held at country, regional and interregional level to bring together researchers,policy makers and programme managers to deliberate upon the significance of socio-cultured research and its utilisation for policies and programmes. The research findings make it apparent that there is an enormous range of socio-cultural beliefs and norms, which influence practices related directly to demographic dynamics. An important policy goal obviously involvespromoting good practicesand endeavoursto change negative ones. Nevertheless,the book clearly demonstratesthat it is often complicatedto identify and to change behaviour which has deep socio-culturalroots. However,socio-cultural research needs to be promoted to evolve policies and methodologies, which can encompass the complexity of human behaviour in family, society and culture, drawing from the strengths of multi-disciplinary methods of investigation and analysis.Academiciansand socialscientistsfrom various disciplines were involved to impart training through a comprehensive package of Concepts, Methodologies and Researchtools to equip local level participants. Thiscertainly has contributed to the national capacity building in the field of socio-cultural research and its application. The country level studies clearly demonstrate that positive behaviour changes generally occur, only when policies are formulated, keeping in view peoples socio-culturalpreferences, their socio-culturalresourcebase and its sensitivitiesand adaptability to change. Along with the findings, the researchers,based on their analyses,have also made proposals for future action and research. ii Cultures offopulations: Foreword Thisvolume has been prepared and edited by Sabiha H. Syed, Principal Officer, Educating for SustainableDevelopment, in collaboration with the authors of the country level studies.She has also co-ordinated and guided the researchand training programme for the past five years. I would like to acknowledge the contributions made to this programme by all the principal investigators:Khairul Bashar,ExecutiveDirector, Asian Institute for Development Communication (AIDCOM),Kuala Lumpur,Malaysia;Dharma Chandra, Professor,Universityof South Pacific,Suva Fiji; Charles D. Chilimampunga, Professor,Chancellor College, University of Malawi, Zomba, Malawi; Mokhtar El Harras, Professor,Universite Mohamed V, Rabat Morocco: Waheeba G. Fare’e Rector, Queen Arwa University, Sana’a Yemen; Elena Hurtado, Consultant Hurtado Consultorias, Guatemala City, Guatemala; Rashid Ahmed Khan, Chairman, Department of Political Science, University of Punjab, Lahore, Pakistan;Marat Khadjimukhamedov, Member, Centre ljtimoy Fikr, Tashkent, Uzbekistan; Aida Mohammed, Ministry of Education, Maputo, Mozambique; Paul Nkwi, Professor,University of Yaounde, Yaounde, Cameroon; Silvia Salinas, Anthropologist, Specialist on Gender and Development Issues,Universidad Mayor de San Andres, La Paz,Bolivia;Marco PosseZumarraga,President,AsociacionEcuatorianade Poblacion, (AEPO),Quito Ecuador. Gusfavo L6pez Ospina Educating for Sustainable Development Director a.i., Division for the Promotion of Quality Education UNESCO ... III Cultures of Population TABLEOFCONTENTS Foreword: CusfavoL6pez Ospina .......................................................................................... i-iv Introduction: Culturesof Populations ....................................................................................... 1-24 Sabiho H. Syed Part 1 AFRICA Cameroon: Society,Culture and Population in Cameroon ................................................... 25-70 Paul Nkwi Malawi: DemographicBehaviourand its Socio-Cultural................................................... 71-96 Context in Malawi Charles Chilimampunga Mozambique: Socio-CultureFactorsAffecting Demographic ................................................... 97-122 Behaviourin Mozambique Aida Mohammed Part 11 ASIA/PACIFIC Fiji: 123-174 Socio-CulturalChangeand Demographyin Fiji ..**.......**.....**........*.......*........... Dharma Chandra Malaysia: Demography,Culture and Societyin Malaysia................................................ 175-226 Khairul Bashar Pakistan: Socio-CulturalFactorsand Demographic......................................................... 227-256 Trendsin Pakistan RashidAhmed Khan Uzbekistan: Socio-Culturalprofile and Demographic......................................................... 257-264 Behaviourin Uzbekistan Marat Khadjimukhamdov Cultures ofPopulations: Table of Contents Part 111 ARAB STATES Morocco: Culture and Demographic ........................................................................... 265-292 Behaviourin Morocco Mokhtur Yemen: El Hurrus Culture, Societyand Demographic ............................................................... 293-300 Trendsin Yemen Wuheeba Fure’e Part N LATIN AMERICA Bolivia: Demographyfrom the Soul ........................................................................... 301-362 Silvia SulinasMulder Ecuador: Socio-CulturalEnvironmentand Demographic .*.....a.....................................363-370 Behaviourin Ecuador Marco Posso Zumarruga Guatemala: UnderstandingSocio-CulturalFactorsand Demographic................................. 371-390 Behaviourin Guatemala- A caseof Adolescents Elena Hurfudo SOCIO-CULTURAL CONTEXTOF DEMOGRAPHICBEHAVIOUR: CHALLENGES FOR SUSTAINABLE DEVELOPMENT 0 ver the past three decades, the importance of understanding socio-culturalcontext of population dynamicshas become increasinglyapparent in order to improve the quality of life, and achieve sustainable development. There has been a broad base acknowledgement that the successor failure of varied population policies and programmes in shaping the population dynamics (fertility, mortality and migration) in different societies around the world is dependent upon the incorporation of appropriate socio-cultural information in them. The task of this volume is to study and highlight the issuesrelated to this phenomenon both globally and regionally, and also at some selected local levels. The regions covered by the study, namely Africa, Asia including Central Asia and the Pacific, Arab Statesand Latin America, indicate diversity within and between countries aswell as similarities extending beyond borders. This holds in the caseof resourcesas well as in all aspectsof culture, society,economy and politics. As a result of such enormous diversity,one of the few things we can assertwith confidence is that change and continuity mark the structure of population dynamics around the world. Change is exemplified by the brighter prospects made possible by decline in the death rate, increasedlife expectancy and also through increasesin higher educational attainment, accessto information and diverse markets,and opportunities for training and employment. Continuity is reflected, among other phenomena, by the universal prevalence of motherhood for women in most societies, i.e. fertility the inevitability of death, i.e. mortality - although the causes or its timing in the life cycle may have changed and the indefatigable willingness of people to move away from their homes in order to improve their lives i.e. migration. I -.-- - --_._.-. Cultures of Populations: Introduction Despite the fact that mostwomen become mothers, that all people die at the end of the life cycle, and that most are willing to migrate if need be, the details of how and when these events happen and what dictates them or delays them, varies considerably at different times and in different places. It is these differences and details that are the focal point of this book, for it is the numeroussocio-culturalcontextsaround the world and in each of the four regions that affect these universalpopulation dynamics. Socio-culturalcontexts are at least as numerous and diverse as the world’s societies,and it is clearly beyond the scope of this volume to represent them fully. Thisanalysisintends however to give a broad description of the major socio-culturalco-relateswhich prevail in these four regions and attemptsto identify their main characteristics.It is hoped that this processwill enable comparisonsbetween regions, underscoring the prominence of certain socio-culturalfactorsin specific regions or parts of regions. Basedon literature review and country level field studies,the analysis is organised according to the three dynamics of population, i.e. Fertility, Mortality and Migration, which are then subdivided into sections treating pertinent socio-cultural concepts and issues.Most of these areasare very familiar to population scientists.The aim is to show how the dynamics of demographic sciencemust be understood in the socio-culturalcontext for the design and implementationof policies.It is intimatelyrelated to particular demographic behaviour of individuals and societies. The findings of twelve Country level studies: Bolivia, (Salinas); Cameroon, (Nkwi); Ecuador, (Zumarraga); Guatemala, (Hurtado); Fiji, (Chandra); Malawi, (Chilimampunga); Malaysia, (Bashar); Morocco, (El Harras); Mozambique, (Mohammed); Pakistan,(Khan);Uzbekistan (Khadjimukhamedov)and Yemen (Fare’e)presented in the volume analysesthe critical role played by socio-culturalfactorsin affecting demographic behaviour. Thisvolumeintendsto encouragean audienceof policy makers,planners,educators,programme managers,and project personnel to move towards a better understanding of the socio-cultural realities they are addressing rather than viewing development of communities, families, and individuals from an outsider’s perspective. At a more practical level, programmes simply fail if they do not keep this context in mind. The researchagendas which take into account sociocultural factors suggest that researchers,policy planners and programme managers have to be both more imaginativeand sensitivein defining their goalsand purposesif they wish to be relevant by integrating knowledge of the socio-culturalcontext in a fruitful way into their work. The present volume attemptsto addresstwo complementary objectives:Firstlyto review how societiesand communitiesperceive and deal with population related socio-culturalphenomena around them; and secondly to discussas to how these phenomena can effectively be dealt with while designing and implementing sustainable Population and Development Policies and Programmes. 2 Cultures ofPopulations: Introduction SOCIO-CULTURAL FACrORS,POPULATIONSTUDIES AND SOCIALSCIENCE I n order to situate the conceptual issuesdiscussedin the volume, it is useful to review how socio-culturalfactorsare conceived, defined, and explained in the socialsciencesparticularly in Populationsciences.Within the socialsciences,“sociev is commonly understood to be constructed out of created institutionsand intangible beliefs, norms,valuesetc. In other words, society is made up of both institutions and culture. It is of course the relation and interaction between the two, which leadsto phenomena often, defined as“socio-cultural”milieu of people’s behaviour. There is no standard definition of socio-culturalfactors,and its use in the socialsciencesranges wide and cover from the fields of ethnography to cognitive anthropology to symbolic interactionism etc. And the setting of researchimplied is by nature that socio-culturalfactorshave,perforce, to define societyand culture for studying human behaviour. The approach to study socio-cultural factorsoften involvesthe researchersadhering to viewing socialphenomena through the culturally sensitiveeyes of the person under study, and avoid imposing premature and possibly inappropriate framesof reference on the people. In termsof population dynamics,it is clear that neither biology alone, nor cultural imperatives or beliefs,dictate human ferfiliry, human mortality, or human migration. Theway people function within biology and society is more of a socio-culturalconstruct. By this, we mean that it changes according to the particular socialand cultural systemof a specificsocialgroup, be this a modern nation-state, or a multi-cultural community. Cultural elementsmay passfreely from one socialsystemto another, and they increasingly do so in this age of communication technology, but the certain boundaries provided by the distinction makesit possible to study social systemsat any given time or over a period of time. Thus, the “socio-cultural” composite allows us to look at social systemsfrom a culturally specific viewpoint in terms of population dynamics,and also to focus on those factorswhich are deeply embedded in an individual or a group’s social systemas a culture (asopposed to the economy or politics of socio-economicsor socio-politics)which influence behaviour either in terms of fertility, mortality, or migration, or a combination of some or all of these dynamics. Eachhuman society has its own socio-culturalsystem,a particular and unique expressionof human culture as a whole. In turn, every socio-culturalsystempossessestechnological, sociological, and ideological elements, but socio-cultural systemsvary widely in their structure and organisation. Sincethe infant of the human speciesenters the world unmarked by culture, her behaviour, attitudes, values,ideals, and beliefs, aswell as her overt motor activity are powerfully influenced by the culture that surrounds her on all sides.The use of the female pronoun here is strategic, for one of the most significant contributions of researchinto socio-cultural factors has been the light it has shed on the construction of gender differences in various societies,and its 3 Cultures offopulations: Introduction interaction with the statusand roles that women have in such societies.It is, indeed, almost impossible to exaggerate the power of culture upon human beings. It is powerful enough to channel and organise the sexual instinct and achieve pre-marital chastity, and even life-long celibacy. It can causea person to starve,though nourishment is available, becausesome foods are considered impure by the culture. It can causea person to kill in order to defend his/her values.Culture is stronger than life, and stronger than death. No one will argue that some countries present a more complex ethnic variety than others. But the observation sometimesheard that “some countries do not seem to have large cultural variations” touches upon the very objective of the current researchproposed and is one of its major justifications. Social stratification leads to differentiation of value systemsand therefore callsinto existencesubcultureswithin a given society. Eachcountry and each of its sub-culturesisa separatesocio-culturaland religious phenomenon whereby statusand roles are determined by the behaviour rooted in the culture and religion of the people. Particularsocio-culturalvaluesevolve over an extended period of time, at multiple but interrelated levels,and in a manner, which is linked to the realities of the life and society where people live and function. For example, the country studies reiterate that there exist a variety of family systems,encompassingsuch elements as marriage and residence rules, norms about gender relations, family formation and organisation, transition from childhood to adolescence, motherhood and fatherhood and to the other stagesof the life course, gender preference of offspring, desired sizeof family, child birth, morbidity and mortality, community status, religious values,or even local political systems.All of these determinantsare interconnected and interwoven comprising a seamlessfabric correlated as well with people’s perceptions about themselves,their families,and society. As a result of these specificsit is clear that someof the branchesof socialsciencewill be more useful or relevant in some cultural contexts than in others. Thus anthropology and sociology which concentrate on systemsof social organisation will speak to us more fruitfully about communities than about decision-making within families.Similarlyeconomics,political scienceand socialpsychology may have more to sayabout decision-makingthan about the effectsof poverty on specific members of a population, a phenomenon more usefully addressedthrough a transdisciplinary approach. Therefore, it becomes clear that throughout the regions under study a variety of methodologies from the variousdisciplinesof the socialscienceshave been utilised by researchers. Cultures OfPopulations: Introduction IDENTIFYINGPOLICY-RELEVANT SOCIO-CULTURALFACTORS I n terms of population dynamics, socio-culturalfactorsare understood to be in many ways at the centre of birth, death, and human population movement. We know that none of these phenomena take place in a laboratory-style situation, and it is an understanding of the differential influences upon these dynamics of changing socio-cultural contexts which will eventually enable us to make both more appropriate generalisations and more accurate analysis. However, we also have to stressthe need to organise the findings of socio-culturalresearchin a systematicand scientificmanner, rather than a presentation of mere descriptionsor intuitive perceptions otherwise it would be difficult to focuson policy relevanceof culturally sensitiveissues. It must be reiterated, of course, that socio-culturalfactorsare very group-, nation- or regionspecific. Identification of some socio-culturalfactors in one setting might not necessarilyassure applicability in another. The problem of identifying the socio-culturalfactors,which are policy relevant, remains an enormous challenge for social scientists.For example, we may have a great deal of evidence as to how a patriarchal culture transmitsthe notion of an inferior statusfor women, but how do we translatethis into policy-relevantinformation?Programmesand studiesfrom the regions presented in thisvolume provide examplesof how sucha transitionfrom inert knowledge into usefulpractice can take place. For example, related studies in this volume by Salinas, (Bolivia); Nkwi, (Cameroon);El Harras,(Morocco)and Chilimampunga (Malawi) have brought forward pertinent issuesabout the “culture of acceptance” confirming what they have mentioned as the “culture of silence” in relation to pregnancy and post-partum illnessesand pain. Thisattitude is part and parcel of the low statusof women in many societies.It can be addressed through programmes that provide servicesand information to women in appropriate ways, places, and times. As a result, more women know better about how their bodies work, what is healthy? and what is unhealthy? etc. and hopefully, in future fewer women would die as a result of pregnancy and childbirth (Goodburn 1995, Osakue 1998). Another very simple and yet illuminating example of how complicated it is to obtain policyrelevant socio-culturalinformation is the fact that much of this information, in so far asit is related to the dynamicsof birth, death, and migration, is often of a taboo nature. The studiespresented by Salinas, (Bolivia); Chilimampunga, (Malawi); Chandra, (Fiji); El Harras, (Morocco); Nkwi, (Cameroon)and Khan (Pakistan)elucidate examples about how the lack of information about certain taboos, norms and practiceslead to the ineffectivenessof severalprogrammes. What an interpretation of these powerful factors and their relation to population dynamics makes apparent is that socio-cultural issuesmust be incorporated as they are at the heart of demographic behaviour. Researcherscan addressthis problem by supplementing and comple- 5 ___- . . .- .-.. .-_. ._- Cultures of Populations: Introduction menting the broad canvas provided by macro studies of demographic behaviour with the appropriate kind of detail that a socio-culturalanalysisand micro studiesprovide. Thiscan establish a much more realisticpicture of population dynamicsthat is of substantivepractical use to policy makersprogramme managersas well as researchers. METHODOLOGICALISSUES ocial scientists,including behavioural scientists,have endeavoured to study and analyse change in the context of individual and societal development. Population scientistshave benefited from methodologies of severaldisciplines and have studied the demographic dynamics in the context of development planning. Somelarge-scaleinternational surveyssuch as the World Fertility Surveys(WFS)and Demographic and Health Surveys(DHS)have attempted to integrate socio-cultural information in their analytical approach for the formulation, implementation, monitoring and evaluation of the demographic transition in general and fertility and mortality in particular; however migration has been a neglected area in these surveys. Fromthese macrostudiesit becomesevident that issuesof socio-culturalresearchare addressed best with a bottom-up or a micro-to-macrolevel collection of data sets. Sincespecificcultural contextsare often enumeratedasone of the factorsaffecting acceptance or rejection of innovations, language too becomes an important element of the specificity of culture. Experienceof native languages is essentialto document perceptions and attitude. Thus, the socio-cultural databasesshould include essentialinformation on language-related issues, becausecertain sensitivitiesare associatedwith local interpretations of certain terminology used by researchersalong with local meanings of certain phrasesthat have contextual significance. A commitment to the researchof socio-culturalfactorsdoes not however imply a commitment to innumeracy, or an abandonment of theory or validity and reliability as guiding principles in the research. In a technological and bureaucratic society, numbers are important and even researchersof socio-culturalissuescannot afford not to count - particularly if they want to move their researchout of the office and into the world. For example, a scientific base, along with a judicious use of quantitative methods can make it clear that a qualitative analysisis reasonably representative. Proponentsof qualitativeand quantitativeapproacheshavebeen involved in endlessdialogue about the versatility and effectivenessof their respectivemethodologies. We have no use here to resolve their academic and scholarly arguments. However, for planners and policy makers, who use the findings of such research, it is important to be aware of the inherent pitfalls of S 6 Cultures of Populations: Introduction different methods, in order to utilise the findings of policy-oriented socio-cultural research. Experience showsthat while studying socio-culturalfactors reposing confidence only on quantitative methods that provide considerableamounts of scientificdata may not be able to capture appropriate knowledge on socio-culturaland behavioural dynamics of society. In terms of researchmethods, it is being generally acknowledged that socio-cultural issues are understood better by generating qualitative data and ideally through a suitable mix of both qualitative and quantitative methodologies asthe mostappropriate choice to provide the knowledge of policy and its programme relevance. The studiesin this volume indicate that qualitative data are available in most countries in the shape of anthropological studies,casestudiesand community level situation analysis,especially in certain geographical areas.In some countries, non-governmental organisations (NGOs)have qualitativeinformation and recordsfrom their own projects,howeversuchinformation liesdormant and unanalysed due to lack of resourcesor professional help to prepare analytical reports. Providing the NCOswith appropriate technical inputs could strengthen the data collection and analysesat the grassroots level. Universitiesand researchcentres can play an important role by emphasisingscientific documentation of reliable socio-culturalresearchdata on population dynamics, in order to broaden the baseof policy-relevantknowledge. Thiscan enhance the national databaseson the important socio-culturalcharacteristicsof specific population groups. Policy-oriented researchgenerally depends on proper and comprehensiveassessmentof the needs that have been envisioned to initiate a change in attitude and behaviour of the particular population. This assessmentneeds to be initiated and supported by a multi-disciplinary approach. Therefore it is important for researchersto be able to work in a combination of inter/multi-disciplinary manner. This would provide the appropriate contribution on research methodologies, tools and instruments for both the design, at the implementation stages.The researchteams in all 12 countries have supported this view. The principal investigatorsworked with multi-disciplinary teamsof social scientiststo undertake the studies. The experience of those who have spent yearseither making policies or implementing these in the developing countries shows that the availability of social scienceresearchwith a specific policy orientation is rare and sporadic. Whatever research units that have been created often have been without adequate planning, and mostly with limited resources. Authors of the studies in this volume have proposed that if change is a continuous process, then it is in the fitness of things that researchmust also become a permanent feature of every chamber of policy making. Indeed, prior to adoption, most policies and plans ought to be weighted and assessedunder the torchlight of thoroughly researched socio-cultural insights. Researchin general, and socio-culturalresearchin particular, provesto be a time-consuming and 7 Cultures of Populations: Introduction cumbersome process,therefore unlessthere is enough incentive for conducting such research for policy making, it will remain neglected. In contrast,where demographic data collection and analysis have been well institutionalised there is a vast potential for incorporating coherent socio-cultural information to update data files and enrich data banks. Hence population programmemanagerswill want to encourageand promote a co-ordinatedschemefor programmerelated socio-culturalresearch. The proposals for research presented in the volume indicate that the technical issues surrounding socio-cultural research are very important; therefore the need for enhancing training opportunities and capacity building in the field must be recognised. High quality of socio-culturalresearchobviously contributes to our understanding of programme implications. Finally,the issuessurrounding the utilisation and disseminationof findings also needs to be addressedin a planned and meaningful manner becausemuch of the relevant information is not designed, collected, and analysed keeping in view the final stage, i.e. its proper utilisation by its users.Therefore it remains‘Buried’ and unutilised, resulting in a waste of time and resources. Thisshould be accorded the priority it deservesso that policy and programme do not fall victim to non-utilisation of available knowledge. SOCIO-CULTURALFACTORSAND POPULATIONDYNAMICS Fertility The transition from high to low fertility has been - in every society that has experienced it - a one-time event. It is a clear change with the past and so far has been quite a continuous process that occurs until low levelsof fertility are reached. The majority of the world’s population now live in countries in which mortality is relatively low and fertility is either also low or the transition to lower fertility has unambiguously begun. Fertility declines - completed or in progress - span the globe. They have begun in countries that differ widely in economicarrangements,socialstructures,political regimes,national histories, and culture, and they have begun in disparate international contexts (Chamie 1999).Thisnearubiquity neverthelesshas been achieved in a myriad of different ways and hasimplied different changesor continuities in different contexts (O’GaraETRobey 1998, PicheETPoirier 1996).It is in relation to these socio-cultural contexts and the dynamics of fertility that we observe in the various country level studies.In Bolivia, Salinashas reflected on ‘important fertility decline’, yet has skilfully demonstrated how entrenched the cultural values on fertility are when she quotes Cultures of Populations: Introduction someof the perceptions of women about themselvesthat “women are like frees; we give flowers and reproduce.” Shealso reports the sensitivityof parents towards fecundity and fertility in rural areas:“It is not always good to have children becausechildren make mothers suffer.Bur children also rake care of us.” Thisimplies that rural folk-wisdom on old age security is to invest in their children, even if it entails pain and hardship. However, bearing and raising children for women is of course more than a financial deduction for social security or an old age pension. Sexualbehaviour as a co-relate of fertility We are of course principally concerned with sexualbehaviour in the context of reproduction when considering fertility and now also in the scenarioof the spread of the HIV/AIDS pandemic. The most important issuesto be discussedin this context include age at first marriage, family formation and structure. For example, the norms and values of the religion and culture of a population affect age at entry into sexual unions. When considering religion- Hinduism (Fiji, Malaysia) or Christianity and Islam (Cameroon, Malawi, Pakistan, Morocco, Yemen, Bolivia, Guatemala,Mozambique, Ecuador, Bolivia, Malaysia)-a common factor that stands out is the concern that whether sexual activity should take place after, rather than before, marriage. In contrast, members of other religions sometimeshave a different attitude towards virginity, not associatingit so closelywith marriage in the category of sin or taboo. In terms of age, most people from the four regions begin their sexual lives relatively young, and this translatesinto young age at marriage, especially for women. In parts of some regions, such as in Asia, the practice of child marriage still existsalthough it is on the decline. In general, it can be said that broad social and economic changes have meant a corresponding cultural perception and change in the age at marriage throughout the regions, which has increased steadily.In turn, this has had an effect on family formation and structure, its economic well being and its social organisation. Marriage as an institution can be studied from a historical perspective in all the regions, and its evolution and change related to the evolution and changes undergone by the socio-cultural context. In Africa for example, the different systemsof marriage in the region, polygyny and polygamy, can be related to fertility demands and how certain marriage arrangementssuit some socio-economicand environmental contexts better than others (Klissou1995). Similarly,the enormous number of consensualunions in Latin America can be traced to both traditional practices,which developed in the early colonial period, and to the gradual weakening of marriage asa legal and religious institution (CastroMartin 1997).However Salinas(Bolivia)and Hurtado (Guatemala)haveexplained someof the prevalentsocio-culturalconceptsand perceptions associatedwith sexuality among adolescents,youths and adults. Another area of interest related to fertility is the acceptance of contraceptive use and how this has affected sexual behaviour. Modern contraception is well established in most of the 9 Cultures of Populations: Introduction regions,although availabilityisof coursestillsubjectto constraintssuchaspovertyand geographical remoteness.Acrossthe board, studiesshow that throughout the world there has been a general shift in contraceptive method use away from traditional contraception to some form of modern contraception. In most cases,this shift can be related both to socio-economicand socio-cultural variables.The latter includes the greater acceptability of those methods of contraception which do not interfere with the menstrual cycle and thus do not present a problem for traditional conceptions of purity and impurity related to the cycle. A delicate issue in relation to sexual behaviour is that of ‘promiscuity’. The pandemic of HIV/AIDS presents a serious health problem throughout the world, which is related to sexual behaviour. It is imperative for all to understand the socio-cultural context of sexual behaviour and its dictates as to what is ‘promiscuous’ behaviour? in order to combat the spread of HIV/AIDS and other sexually transmitted diseases.In this volume, most of the country studies have reported interesting and useful findings on the perceptions concerning ‘promiscuity’, in relation to culturally sanctioned forms of sexual behaviour. Furthermore, in other studies the impact of social change and modernisation upon sexuality has been discussedthat portrays the wide-ranging perceptions of sexual behaviour to the susceptibility towards HIV/AIDS (Bond 1997,Cleland 1995, Mboi 1996, Ntozi 1997,Orubuloye 1995, UNESCO2000). FamilyPlanninq, Birth Spacing At present, the majority of countries in the four regions have vigorous family planning programmes. All studies in the volume illustrate that governments have come to accept Reproductive Health, Education, Information, Communication and Services.The emphasison reproductive health rather than family planning ‘four coun’, have consequently broadened the scope of most family planning programmes. A wider look into the social and cultural context in which reproduction and contraception take place allowsa deeper understanding of why certain modern contraceptivesare unacceptable to certain societies.Sterilisation,to limit fertility, both male and female, is of courseasan example of a choice for voluntary “barrenness” is literally unthinkable in many cultures. There are also issuesconnected to women’s menstrual cycles in some societies.These cycles if disturbed by hormonal contraceptives,alsocausesdistressto usersand their partnersasthey confusecategories of “purity” and “impurity” which then in turn impact on women’s daily lives. The examination of the decision-making context in which contraceptive choices are made has been a factor for emphasisingthe socio-culturalcontext of decision making. In the studies reported in the volume, this has indicated to have a direct relevance on the statusof women in societies. Salinas,(Bolivia) Nkwi, (Cameroon) Chilimampunga, (Malawi) Chandra, (Fiji) and El Harras (Morocco) have stated certain psycho-socialissuesthat accompany the decision making process of couples and partners. It is, principally women who are responsible for using a 10 Cultures of Populations: Introduction contraceptive method, but often the decision to do so will not be exclusivelytheir own. This type of depiction of reality makesclear the degree of sensitivityneeded on the part of IEC,and Advocacy programmes aswell as on programme planners to innovate such reproductive health initiatives, which encourage the responsibility of both men and women. Unfortunately so far, men are often ignored from a specific focus,which is necessaryfor effectivenessand efficacy in reproductive health programmes (Becker 1996). Incidence of STDsand HIV/AIDS Throughout the globe, despite the many studiesand surveysmade of the patterns of sexual relations which may be contributing to the spread of STDsand HIV/AIDS, it is increasingly clear that the pandemic is not explicable solely in immunological terms.The knowledge continuously needs to be supplemented to improve comprehension of the socio-cultural context in which particular sexual behaviours take place. As all patterns of sexual relations are assigned meaning and value by society and culture, and as tendencies to male or female ‘promiscuity’ are at least in part socio-culturallyconstructed and/or supported, further investigation of the cultural factors permitting high risk sexual behaviour in men and women, young and old need to be carried out in all four regions. (UNESCO2000) HIV/AIDS awarenessprogrammes in some countries have suffered from the lack of interest and concern of governments. In many countries the AIDSepidemic was not regarded as a high priority - sometimesbecauseof the low prevalence of the disease,but more often becauseof its taboo nature.Thusthere islack of data on the incidenceand prevalenceof the disease.The reasons for paucity of information are self-evident. For example, the screening procedures require the consent of participation of subjects who may opt to decline this for fear of the social consequencesand medical implications of a positive result. Moreover, personssuffering from STDsand HIV/AIDS face legal aswell ascultural barriers to obtaining information and assistance.However, this is slowly changing. Studiesfrom all regions and especially the country studies of Guatemala,(Hurtado); Bolivia, (Salinas);Malaysia, (Bashar);Pakistan,(Khan);Malawi, (Chilimampunga);Cameroon, (Nkwi) and Fiji (Chandra)have been particularly good at pointing out the vulnerability of adolescentsand young people in relation to STDsand HIV/AIDS. Thesestudiesshow that young people are quite ignorant about reproductive health issuesgenerally, and particularly about the risks to which they expose themselvesthrough certain sexual practicesand behaviour. Thisis particularly true of young people and adolescents in urban environments where they are at high risk from violence and coercion. Someof these studieshave been particularly useful in pointing out sociocultural links between sexual tourism, prostitution and the spread of HIV/STD. The number of women, particularly in Africa and Asiainfected with HIV/AIDS is rising rapidly, many are monogamous yet have been infected by their one partner - their husband. New Cultures ofPopulations: Introduction programmes should take into consideration the sexualbehaviour of men and women in marital unions, partners, tourists,prostitutes etc. in a holistic manner. The reaction of the community to female infection vis-a-vismale infection to the disease also needs to be better understood. Servicesfor the infected personsshould not be confined exclusivelyto the provision of medical services(UNESCO2000). Status of Women, Empowerment of Women and Gender Roles The relationship between the statusof women and demographic change itself is a well-established one in population science.In relation to fertility, put very simply, this is believed to fall as the status of women improves. In traditional demography, this “improvement” has usually been interpreted in terms of educational, economic, and labour force participation. A sociocultural approach however has expanded this understanding of the statusof women, seeing that it is also linked to their power and freedom within the family as well as outside it, to their role in the community, etc. The need to protect women against sexualand domesticviolence is being recognised by an increasingnumber of individual countries.UNFPA(1997b)reports that severalcountriesincluding 4 of the participating countries(Bolivia,Malaysia,Ecuadorand Uzbekistan)haverecently adopted laws against domestic violence and similar measuresare under consideration in many other countries. The awarenesson the issueshas improved because global media is addressing rape, abuse and domesticviolence more widely. There is evidence, as recorded by the media and the NC0 community and civil society,to show that there is much greater public support than in the past for strong legal and judicial measuresto deal with acts of sexual and domestic violence. While in many countries laws already exist to deal with such acts of violence, the country study of Bolivia (Salinas)suggeststhat what is needed is, more determined and vigorous action on the part of the authorities. Both the media and civil society organisation, including population NGOs,women’s groups and parliamentary organisations, have an extremely important role to play in this context. Most of the societiesstudied are patriarchal. Whatever the culture or social background, a constant throughout them is the inferior and subordinate statusaccorded to women in spheres as varied as employment and family decision-making. This is manifest in such socio-cultural phenomena as son preference, lower school enrolment for girls, ‘girl child’ neglect and abuse, and discriminatory feeding practices. In some Asian and Arab societiesfor example, these are compounded by quasi-legal and legal regulations related to dowry, bride price, inheritance (including widow inheritance), and widow sacrifice. The impact of modernity on traditional conceptsof ‘women’ and what women can and cannot do is an important area of research.It is clear that a gradual change has taken over even in the more traditional notions of women’s status.In Africa for example, the Cameroon (Nkwi) study 12 Cultures of Populations: Introduction revealed that gradually changing family structures,like polygynous unions, along with contraceptive prevalenceand the acceptanceof a smallerfamily norm havepositivelyaffected the status of women. However, throughout all the regions, there remain many areas of concern about the empowerment of women, especially as highlighted in Bolivia, (Salinas);Malawi, (Chilimampunga); Morocco, (El Harras);Pakistan,(Khan) and Yemen, (Fare’e).A number of these are related to problems in the area of female reproductive health. It is clear that a greater input from women themselvesis needed in the development of socialsectorand particularly public health policies. Moreover, many women and their familiesin the regions continue to live in very poor conditions and the number of women who are heads of these very poor households is increasing. Sexual violence against women is also distressinglyevident in every region, both within and without the household. Thisexacerbatesthe poverty and vulnerability of women. Role of men As has been stated above and indicated in certain country studies (Bolivia, Cameroon, Malaysia, Morocco, Fiji), most of the societiesin the regions are patriarchal and thus assign a dominant role to men. Consequently,in relation to issuesof fertility, the discussionof the role of men is principally confined to issuesof family planning and family structure.The need to broaden this emphasisis as important for men as it is for women in these societies.Men’s sexual health and reproductive knowledge clearlyis intimatelyrelated to that of women and cannot be ignored. Given that most family planning and reproductive health programmes have neglected or ignored men, variouscountriesnow have examplesof progressiveattemptsto remedy this failure and recognise that women do not, and cannot, act in isolation regarding reproductive health matters. As a result, the role of men as responsible contraceptive acceptors is gradually being considered by family planning programmes and organisationsthroughout these regions. Acfolescents and Young People Adolescents and young people represent the future of generations. In Africa and parts of Asia, and Latin America for example, adolescents in fact constitute a large proportion of the region’s population. The life situation of all adolescentsand young people presentsboth opportunities and risks,and is influenced by socio-culturalfactors.Adolescentsand young people are at a moment in their life cycle in which they make choices, which will strongly influence the kinds of lives they will lead in the future. Despite enormous progress in recent years whereby information, education and health care have become greatly more available, the young people of the regions remain largely ignorant and have poor accessto education and health care facilities. Issuesof concern for both boys and girls in relation to fertility throughout the regions are the availability of contraception and the spread of STDsand HIV/AIDS. In all communitiesstudied in 13 Cultures of Populations: Introduction the volume indicate for example, that very young people are married and cohabit, usuallyusing no contraception. The lack of information, which tends to accompanythis early entry into reproduction and sexual activity usually resultsin unwanted pregnancies and often in the spread of STDs.For adolescent girls in these three regions, low age at marriage and early pregnancy are important issues,often having seriousconsequencesfor the health of these girls, in ways which will affect their entire lives aswomen. Till recently, most national family planning programmes targeted eligible (married) couples, and essentiallymarried women; many unmarried but sexuallyactive adolescentswere excluded from knowledge and services.All the country studies [particularly Bolivia, (Salinas);Malawi, (Chilimampunga); Malaysia, (Bashar)and Morocco (El Harras)]provided ample information to activate policy and programme responseto meet the enormous need to provide young people with this information in a way, which is acceptable and attractive to them. Another growing focusof concern with respectto adolescentsand young people, (especially in Latin America, Africa and Asia)is the number of children and young people who make up the majority of the very poor population in the peri-urban environmentsof theseregions [asdiscussed by Hurtado, (Guatemala)Salinas, (Bolivia) Nkwi, (Cameroon); Chilimampunga, (Malawi) and El Harras(Morocco)].Often theseyoung people are exposed to dangers of all kinds, and in terms of their reproductive and sexualhealth they often sufferby being obliged to work assex-workers. More generally, adolescentsand young people in these environments are disconnected from the securityand protection that family ties traditionally provide and the socialsectorsas reported by country studies is certainly not adequate to cater for their major needs. There is an urgent need for programmes, which cater for the needs of these street children by providing shelter, education, alternative employment and health servicesincluding psychological counselling. Mortality Morbidity and mortality reflect the life coursesof people, from birth to ageing, illness,and death. The particular association between patterns of mortality and demographic change is often referred to asthe “epidemiological transition”. Many regions of Africa and Asiafor example may be characterisedas being a different level of this transition and thus still having very high mortality levels among children under five, and maternal mortality. In the more economically prosperous countries of these regions, morbidity and mortality are relatively lower. Nevertheless,there are disparitieswithin countries and between groups of people. In general, for all four regions, it remains true that the mortality rates of women (and particularly for mothers),very young children, and indigenous minorities remain distressinglyhigh. Nutrition remains an important co-relate of morbidity and mortality. Food, its cultivation, its cooking, and its consumption is at the centre of the work, the relationships, and the practices that make up the socio-culturalcontext of severalcommunities.Many African societiesfor example, 14 Cultures of Poaulations: Introduction as indicated in the papers of Nkwi, (Cameroon); Chilimampunga, (Malawi) and Mohammed, (Mozambique) have noted a number of food taboos related to religion, wants in the life cycle etc. someof which may result in certain membersof a community being lessfed than others. All these practiceswhich, regulate food intake tend to have an impact on mortality in a community in the long run, this becomesthe responsibility of planners to see how, while safeguarding the socio-culturalvalue of practices,programmesare modified so asto encourage good food management and healthy nutrition among diverse communities. The changing mortality patterns and their relation to nutrition and diet in many countries is further evidence of the centrality of food practicesto human life. Resultsof studiesshow that in certain cases,the change from the traditional diet to a Westerntype diet has certainly reduced certain kinds of mortality, but it has also led to an increase in others. This type of information highlights the need for a culturally sensitivehealth education policy in each region, which will focus on nutritional issues.We need to establishhow much knowledge there is in communities about nutritional requirements, illnessesand parasites,etc. as well as about the proper storage or preparation of certain foods and how these are related to the eating of “traditional” and of “modern” foods. It is also noted that discriminatory feeding in favour of men, which is prevalent in various regions, clearly leads to a poor nutritional statusfor girls and women. Consequently,when these women become mothers, their ability to breastfeed is impaired, and this in turn endangers the life of their children. Furthermore,programmesand policies have increasinglycome to recognise through studies like these in this volume, that the majority of primary health care is dispensed from the home in most of these regions, and more precisely, from the kitchen of that home [Bolivia, (Salinas);Cameroon, (Nkwi); Fiji (Chandra)].As principal food managers in most of the cultures of the regions, women should be the priority group for policies seeking to ensure the hygienic preparation of food and the prevention and management of health of family members. Perhapsthe most important issueto be addressedfrom a socio-culturalperspective is how the values and norms, which seem to expose women to disease,may be changed. For example, studiesin this volume expressthat in the Arab Statesand in parts of Asia and Africa, the value of “modesty” which is highly prized in women and widely espousedby women is often responsible for delaying the seeking of health-care for themselves. Maternal mortality The maternal mortality ratesin majority of the countriesin the regions present a truly sobering picture, although there is some variation both within regions and within countries themselves. For most of the countries in the regions, it may be safelyassumedthat a large proportion of maternal deaths is preventable. A socio-cultural perspective would emphasisethat the most 15 Cultures of Populations: Introduction frequent causesof death are due to the poor health of the mother, and to inadequate health care provision during the antenatal and post-partum period. For many women, as indicated by Nkwi (Cameroon)and Salinas,(Bolivia)pregnancy and childbirth are strictly regulated by socio-cultural codes that may not accommodate modern medical practices, or may even make the seeking of medical attention for these conditions an irrelevance.More often, it isalsobrute poverty,which influencesthe health care-seekingbehaviour of pregnant women. In general, it could be said that there is a “culture of silence” surrounding pregnancy and childbirth and many women endure excruciating pain (sometimesfor many years)becausethey are simply unaware that things could be different. Clearly, this need for communication and information is one, which a sensitive reproductive health programme should aim to meet. Traditional health practitioners can easily become the allies of this kind of project. Throughout the regions they remain the primary providers of care to most women [and certainly to most rural women as in Bolivia, (Salinas);Pakistan,(Khan); Fiji, (Chandra);Morocco, (El Harras)and Yemen (Fare’e)]and through adequate training can meet both the requirement and respect of the community’s socio-culturalenvironment in order to provide modern health care. In termsof how actual cultural practicescan havean impact on mortality, the two main issues, which surfacefor consideration in the regions, are FemaleGenital Mutilation (FGM)and unsafe abortion. FemaleGenital Mutilation is still practised in some African countries and in the Arab world. Most procedures take place when girls are aged between 10 and 14and are performed by health workers such as trained midwives or traditional birth attendants. Female Genital Mutilation causesgrave damage to girls and women and its physical and psychological consequences will affect their normal sexualfunction and their reproductive health in a way that lasts all their lives,sincenone of its proceduresis reversible.Womenwho haveundergone FGMare at a greater risk of contracting STDsand of experiencing seriousobstetriccomplicationsin pregnancy, aswell as of dying from the immediate effectsof the operation itself. The practice of FGMhas roots in the traditions of a number of societiesand many women in those countries feel it necessaryto undergo the operation to make them acceptable to their communities.The subject, which touches upon relations between the sexesaswell ason notions of femininity, is clearly a sensitiveone, but it needs to be addressed. In the majority of surveys carried out in Africa, femalerespondentsfavourcontinuation and mostcite tradition astheir reason for approval. If the practice is to be changed or modified it clearly has to be done with the consent and co-operation of women themselves,as well as that of their health providers and their communities. While the studiesin this volume have not covered these practices,the issueof unsafeabortion has been analysed in severalstudies. Unsafeabortions and their complications have an impor- 16 Cultures ofPopulations: Introduction tant impact on maternal mortality ratesthroughout the regions. In most cases,these abortions are carried out by untrained practitioners in unsanitary conditions, and the complications of such unsafe abortions lead to unnecessaryhealth service costsin terms of money, personnel, drugs and other resourcesaswell as causing serioustrauma or even death to the mother. Women seek these servicesfor severalreasons,most, of which can best be understood in socio-culturalterms. Thishas been analysed by Salinas(Bolivia);Hurtado (Guatemala)and Nkwi (Cameroon). By assessingthe importance of these socio-cultural factors it becomes clear that addressingthe problem of unsafeabortion in the regions solely from a clinical or a public health perspective is inadequate and will not provide the best solution. Migration Historically, migration has been and continues to be an important dynamic in all of the regions. More recently, millions of people have been uprooted from their homes because of economic need, labour demands, and often tragically because of civil and ethnic conflict. In some regions this has led to highly distressingsituations. The socio-cultural implications of the fluidity brought by migration are immense.Mobility within social classeshas increased and the cultural value systemof societieshas been modified. Many works also stressthe socio-cultural consequencesupon the regions of the “brain drain” as qualified professionalsabandon their countries for the prospect of a better job or training outside it. Salinas(Bolivia)in her study aptly reports on the perceptions of the migrants: “If we don’t move we don’t know where luck is.” Push factors and pull factors The recent trends in migration throughout the regions can best be understood through a socio-culturalapproach, which allows us to consider both broad structural phenomena and the micro level of personal decision-making. Pushand pull factors associatedwith migratory flows are usually explained in exclusivelyeconomic terms. By examining socio-cultural factors as in Bolivia, (Salinas);Fiji, (Chandra); Cameroon, (Nkwi); Pakistan,(Khan); Morocco, (El Harras)and Malaysia,(Bashar);we can gain insight into the realmsof motivation (both negative and positive) which are difficult to trace in quantitative terms. Once we change our perspective on migration from a purely economic one the number of push and pull factorsinfluencing population movement is as big and asvaried as the number of migrants themselves.Nevertheless,it remains true that many migration flows are dictated by larger phenomena than individual likes and dislikes,and that many of these phenomena may be characterisedas socio-cultural.Thus,the changing context of and impact of migration can be associatedto such issuesas the brain or skill drain, the role of remittances and investment in changing host and origin communities, and impact of migration on inequality and uneven development. If we look at push and pull factors in this manner, we can see how closely linked migration is to social issues,including education and life cycle events. 17 Cultures ofPopulations: Introduction Throughout the regions the studies indicate that there is still a perception that migration provides opportunities which are not to be had at home. Thisis especiallytrue of rural to urban migration. Unfortunately, the reality of many urban centres, struck by economic and political crises,isvery different from this and many migrantsfind themselvesworse off in every sensethan before they moved. The position of Arab Statesas sending countries concerns principally Arab migration to Europe and to the United States,both of which tend to be permanent migratory flows. However, El Harras (Morocco) reports that some Europeans have come and settled in certain parts of Morocco. In relation to Europe, the economic and social roots of this immigration are linked to colonial ties and produce complex socio-culturaleffectsin relation to the relative integration of Arabs and Asiansinto the host communities. From Latin America, most migrant reported, go to the United States.Socio-culturalfactors which influence migratory strategiesand which are in turn influenced by migration itself include fertility rates, consumer behaviour and ideals, family structure, and educational ambitions. Unfortunately, for many migrants, emigration often leads to downward social mobility, especially with respect to the legal statusof household members, their type of employment, and their ownership of property. The value of casestudies in this field is enormous. Thiskind of in-depth qualitative research enables us to focus on the effects of migration on one particular community and its cultural context. It is only by looking at the particular combination of economic, social,cultural, and temporal factorsthat one can understand migration at the local level, and policy planners and strategistsmust work to incorporate these variables into the more general models of migration that they use. Internal Migration In relation to internal migration, the majority of studies focusing on socio-cultural factors attempt to assesswhy the urban impact of internal migration is so great in the regions. The speed with which urbanisationhasoccurred in many countriesisastonishing,and for traditional societies transformed so rapidly into urban societies,the changes undergone need to be understood as more than material, environmental or organisational. They are in fact profoundly linked to the very way human relations are conceived, to the way human identity is conceived, and to the way patterns of behaviour and belief are conceived. In all the country studies, urbanisation is highlighted as an increasing phenomenon. The fact that such large numbers of the world’s population must be considered as “urban” in character has important demographic and sociocultural consequences. One could saythat the most salient featuresof rural to urban migration in socio-culturalterms is the change from a labour market geared to an agricultural economy to the much more diverse 18 Cultures of Populations: Introduction labour marketsof the urban context, At a personal level, this means the learning of new skills and the abandonment of old ones, In many cases,especiallyfor women, it impliesthe first formal contact with education and entry into literacy. At a community level, it implies huge social and cultural changes as groups of people move from working in the lessdeveloped industries providing exports of primary products to the more developed ones producing manufactured goods. Moreover,thesecommunitiesthemselvesbegin to change asconsumers,and thesechanges in desiresand attitudesare often accompaniedby changesin reproductive behaviour or migratory behaviour, and thus have a direct impact on population. International migration The vast majority of international migratory flows from the regions are to the developed countries of the North. In this they reveal the economic push and pull factors at work, but also the broader socio-culturalattractionsand negative factorswhich influence people’s decisionsto move. In general, the degree of assimilationexperienced by migrants is often connected to their skill level and the kind of employment they are thus able to enter in the host country. African migrants for example moving to the North often do not have opportunities to obtain qualifications and are precluded from upward mobility in the receiving countries. In terms of the international migration of skilled workers from the regions, this is correctly characterised by most studies as a “brain drain”. In Africa, Asia, the Arab Statesand Latin America,the exodus of qualified professionalsoften leavescountriesin the contradictory situation in which they are obliged to import the professionaland technicallabour which their own nationals could supply were it not for their migration. 19 Cultures ofPopulations: Introduction ISSUESADDRESSED IN THEVOLUME T he questions addressed in the present volume deal with the salient socio-culturalfactors affecting demographic behaviour in the selectedcountrieswhere studieswere conducted. These show how socio-cultural research in general and qualitative research in particular can enhance the understanding of perceptions and actions of sub-populations and local communities. Specificrecommendationshave been made through the analysisof these studiesfor guiding future researchand interventions in the participating countries. The regional and interregional review manifeststhe kinds of initiativestaking place in these regions, which will hopefully be of use in planning more effective socio-culturaland policy relevant research. Researchershaveargued that the initial stagesof researchi.e. its design and its final stage i.e. its utilisation are a continuum link through a technical process.If the intention is to base certain policies and programmes on research,then it needs to be the priority at the design, as well as at the implementation process.This ensuresthe participatory nature of research in which the policy makersand the people at grassroot levelsparticipate in a ethical and responsiblemanner. Academiciansargue that more often than not, pieces of researchare selected to put forward a policy goal without realising whether it is policy oriented, while in other instances,certain analysesare singled out to show its policy relevance. In brief, the issuepresented in the volume stressesthat the researchprocessfrom design to the utilisation of its findings are linked spherically. The volume representsthe need to come to a fruitful balance at the onset of 21st century between more traditional demographic studies and socio-cultural studies, in order to take a careful account of realities that are closer to people’s lives. This kind of work will be able to provide valuable information on people’s motivation, perceptions and decision making since there has been tremendous development in Information Technologies,more and more software programmes have become available, which make it possiblefor qualitative data to be incorporated in macro level data sets.The researchersduring the analysisof the studieswere able to use some of these techniques. However, there is a need to develop and strengthen the utilisation of qualitative and quantitative research in a dynamic manner. In this respect, the studies in the volume assistin establishing a tradition of some excellent examples, which use qualitative methodologies that easily compliment quantitative information in order to examine the demographic dynamics, their shape, size and magnitude. Clearly, as indicated above, this type of work should be very policy oriented to develop a genuine and sustainableprocessof population programmes. 20 Cultures of Populations: Introduction The book is divided in four parts, the first section presentsthe findings of country level sociocultural researchstudies in African countries, Cameroon, (Nkwi); Malawi (Chilimampunga)and Mozambique (Mohammed) Part two movesto study the socio-culturalphenomena and demographic behaviour in four countries in the Asia/Pacific, Fiji, (Chandra);Malaysia, (Bashar);Pakistan(Khan) and Uzbekistan (Khadjimukhamedov). Part three presents the contributions from two Arab StatesMorocco (El Harras)and Yemen (Fare’e)and part four presents the socio-cultural milieu and its interaction with demographic behaviour in three countries of South America, Bolivia, (Salinas);Ecuador (Zumarraga) and Guatemala(Hurtado). The contributions to the volume on the country level analyseshave been made by the principal investigators of these studies who also have guided the training process during the research.Training of local level multi-disciplinary teamsof social scientistswas found to be very useful and a case for similar training has been strongly put forward for future research. The examples from the studies emphasisehow important it is to harnessthe strong force of sociocultural researchto evolve most policies and programmes, though this may seem like a tedious process,however illustrationshave revealed that it can be addressedthrough adequate training and appropriate resources.Suchendeavours indeed contribute to improving the quality of life in a meaningful and direct manner. 21 Cultures ofPopulations: Introduction REFERENCES Sran (1996): Couplesand reproductive health: a review of couple studies.Studiesin FamilyPlanning 27 (6), 291 - 306. Becker, Marriages without papersin LatinAmerica.In: International Population Conference/CongrQ International de la Population: Beijing, 1997, Volume 2. International Union for the Scientific Studyof Population [IUSSP],Liege, 941 - 960. Castro Martin, Teresa (1997): Chamie, J (1999): Statementto the Commission on Population and Development(Thirty-second session).Presentedat the United Nations Commissionon Population and Development, Thirty-secondsession,New York, New York, March 22-31, 1999. CJeJand, John; Ferry, Benoit (1995): Sexual behaviour and AIDSin the developing world. SocialAspectsof AIDS.Taylorand Francis,New York/London; World Health Organization [WHO],Geneva.243 pages. Goodburn, Elizabeth A; Gazi, Rukhsana; Chowdhury, Mushtaque (1995): Beliefsand practicesregarding delivery and postpartum maternalmorbidity in rural Bangladesh.Studies in FamilyPlanning 26 (1), 22 - 32. l l Demographic,Departementdes Sciences de la Population et du Developpement, Louvain-la-Neuve,Belgium:Academia-Bruylant, Louvain-la-Neuve,Belgium; L’Harmattan,Paris. 257 pages. Nafsiah (1996): Womenand AIDSin Southand South-EastAsia:the challenge and the response.World Health Statistics Quarterly/Rapport Trimestrielde Statistiques SanitairesMondiales49 (2), 94 - 105. Mboi, Ntozi, James PM; Anarfi, John K; Caldwell, John C; Jain, Shah K (1997): Vulnerability to HIV infection and effectsof AIDSin Africa and Asia/India (HealthTransitionReview,Vol. 7, Supplement).AustralianNational University, Health TransitionCentre,Canberra.486 pages. O’Gara, C; Robey, B (1998): Fertility trends and factorsaffecting fertility. In: Womenin the Third World: an encyclopediaof contemporary issues(GarlandReferenceLibrary of Social ScienceVol. 760). (Stromquist,Nelly P,ed.) GarlandPublishing, New York, 176- 184. Orubuloye, JO; Caldwell, John C; Caldwell, Pat; Jain, ShaiJ (1995): The third world AIDS International Development and the Social on the Historyand Sciences (1997): Essays epidemic (HealthTransitionReview,Vol. 5, Suppl.).AustralianNational University,Health TransitionCentre,Canberra.305 pages. Politicsof Knowledge, Edited by Frederick Cooper and RandallPackard,Berkeley: Universityof California Press,Pp. xii +361 Osakue, Grace; Martin-Hilber, Adriane (1998): Women’ssexualityand fertility in Polygamyin Benin: a regional approach to trends and determinants. [Lapolygamie au Benin: une approcheregionale des tendanceset des determinants.]In Fre. UniversiteCatholique de Louvain,Institut de Nigeria: breaking the culture of silence.In: Negotiating reproductive rights: women’s perspectivesacrosscountriesand cultures. (Petchesky,RosalindP;Judd, Karen, eds.) Zed Books,Atlantic Highlands, NJ/London, 180- 216. Klissou, Pierre (1995): 22 Cultures ofPopulations: Introduction Pichk, Victor; Poirfer, lean (1996): Differences and agreementsin the debatesand theories concerning the demographic transition. [Divergenceset convergencesdansles discours et theories de la transition demographique.] Collection de Tiresa Part,No. 380 11l-32 pp. In Fre. (Universitede Montreal, Departement de Demographie:,Canada.:Montreal) l l l l UNESCO(ZOOO]A Cultural Approach to HIV/AIDS Vague& Odetfe (1997): Indian city, Hindu city? Factorsand processesof spatialsegregation. [Ville indienne, ville hindoue? Facteurset processusde segregationspatiale.] In Fre.with sum.in Eng. Espace,Populations, Societes2-3, 21l-223. Watts, Charlotte; Ndlovu, Mavis; Keogh, Erica; Kwaramba, Rudo (1998): Withholding of sex and forced sex: dimensionsof violence againstZimbabweanwomen. In; Sexuality (ReproductiveHealth Matters,Vol. 6, No. 12). (Berer,Marge, ed. 6 camp.; Ravindran,TK Sundari,ed.) 23 --. . ..- “_-.- _._ -.. -.I__ SOCIETY,CULTUREANDPOPULATIONINCAMEROON Paul Nkwi’ INTRODUCTION T he population of Cameroon is estimatedat more than 15 million inhabitants and shows 52% of women and 48% of men. Thisunder-representation of the male population was already evident in 1987and in 1991.According to the estimatesof 1998,45.2% of this population was made up of people of lessthan 15years.In 1987population below 15yearswas estimatedat 46% and 47% in 1991.50.3% of the population is between 15 and 64 years,while people aged above 65 years represent only 4.4%. The population is territorially unequally distributed. At the regional level, the data registered during the population censusshow that the extreme North region is the most populated. It is followed by the East,which counts almost the same number of inhabitants. The South province is the least populated. Density in urban areasis on the rise, the overall distribution following the 1988estimates,indicate that 68% of the people live in rural areasas against 32% in the urban areas. Fertility According to the results of the survey of 1998 on Demography and Health, fertility level remains even, though the number of children per woman has risen from 6.4 in 1978 to 5.2 in 1998.A difference is observed at the level of fertility according to the place of residence. In the rural areasthe number is higher than in the urban areas.At the regional level fertility remains the highest in the Adamaoua, North and extreme North regions. The high level of education of women and the availability of contraceptive methods in urban zones have contributed to low fertility levels.For instance it is indicated that women with secondary school level education or higher (3.6) have an average of 1.3 children lessthan those who have received primary school education (5.3), 3 children lessthan those who have received no education (6.6). life Expectancy Life expectancy has improved considerably over the years. In 1976life expectancy stood at 44.4 it had risen to 54.3 in 1987.Cameroon is likely to witness a fall in life expectancy causedby the AIDSpandemic. 25 Cultures of Potmlations: Africa Migration Two main types of migration are known in Cameroon: internal and external migration. Inrernal migration variesin frequency and structure but is not uncommon. Movementsfrom the High Plateauxof the Western region represent the most important in this category dating back to the beginning of this century. Thisis, in responseto labour demands in the large plantations created by the Germans in the fertile and volcanic regions at the foot of Mount Cameroon. Today the reasonsare mostly associatedwith the high population densities of the Western Province in the face of higher demand for agricultural land and higher population growth in the region. These migrants move to the Littoral, the Centre, and South Western Provinces.They move to towns like Douala, Tiko, and Kumba, to look for work. External Migration: The ethnic map of Cameroon showsthat severalethnic groups are found spanning acrossnational frontiers, indicating, the difficulties of tracking movementsfrom one country to the other with accuracy.But the General Population Censusof 1976numbered some 200.000 foreigners in Cameroon representing 3 per cent of the total population. Of this number, two thirds are made up of Nigerians, Chadians,personsof CentralAfrican origin and French nationals. Among the Nigerians the Ibos are the most populous. They are found in particular in the anglophone provincesand in the metropolitan towns of Yaounde and Douala ( Neba, 1987, Timnou 1996). Urbanisation Severalstudies show that the urbanisation in Cameroon towns is based on the colonial city nucleus.Sincethen new socio-political factorshave given an unprecedented expansion to urbanisation generating severalundesirable consequences:social disorder, uncontrollable growth, poor town planning and severepressureon resources.The big towns are surrounded by nonintegrated, spontaneous settlements, unplanned construction and the non-respect of basic elements of urbanisation. Mots of the urban poor are living in makeshifttents in slums. In the Demographic Census of 1987 (Demo 87), Cameroon’s population was reported as 10,516,229 of which 3,972,599 lived in the urban area and 6,.543,631 in the rural areas showing a urbanisation rate of 37.78 O/o.The population of Douala and Yaounde represented 36,75 O/oof the total urban population. In 1997,there was a remarkable increaseto 6.748.475 of urban dwellers and 7.549.142 people living in the countryside for an estimated population of 14, 297,617. The data indicated an urbanisation rate of 47.2%. Ethnic Composition and distribution Cameroon shows a strong ethnic density with over 200 ethnic groups divided into five distinct culture categories:the Pygmies,Bantu, semi-Bantu,Sudaneseand Fulbe. The dominant ethnic groups south of the Amada mountains are the Bantu, semi-Bantuand Pygmieswhile 26 Cultures of Pomdations: Africa Sudaneseand Fulbe groups occupy the semi-arid regions of Cameroon. Many anthropologists classifyPygmiesinto a different racial category (cf. Mveng, E 1923). The Pygmies: They are generally considered the oldest racial group in Cameroon. They are distinguished from other humans by their small height (1.5m average). There are over 5000 Pygmiesthroughout the rainforest of Cameroon, especially in Ebolowa, Lomie, Mouloundou, Ngambe, Tikar and Messamena.The Babinga constitute the largest Pygmy group and can be found on the borders of Cameroon, Gabon, Congo and the Central African Republic. The Bagelli is the second largest group of Pygmieswho are found in Kribi and around Bipindi and Lolodorf. The Bantus: The Bantusoccupied a greater part of southern and central Cameroon. They can be divided into Coastaland Equatorial rainforestBantus.The coastalBantusinclude the Bakweri, Bassa,Bakundu, Balong, Bamboko, Duala, Mboh who live together with other minority groups. The Equatorial rainforest Bantus comprise the Maka to the east and the Pahouin (Fang, Beti, Bulu). The Duala Bantu ethnic group, occupy the region of the estuary of Mungo, Wouri and Dibamba (Ardener 1956 :17). The city of Douala has a large concentration of Dualas. Their prehistory brings them from variousplacesin Gabon and Congo to their present site. History also has it that they settled with the Bassaand Bakoko before moving to their present site around the 17th and 18th centuries. They were the first ethnic groups in Cameroon to have made contacts with missionaries,traders and colonial administratorsand were largely involved in slavetrade. Intensivecontacts have left remarkable influence in their view of the world. For instance, they have remained predominantly monogamous and their fertility or demographic behaviour has many tracesto European culture. The Bassa and Bakoko have a common ancestry although they prefer to distinguish themselvesin a number of ways (Mveng 1963 :242). Like a majority of Bantu, they are said to have come from the Amada plateau after crossing Central Africa around the 17th or 18th centuries. The Bassaethnic group lack central authority and the villages are largely autonomous units governed by a “council of elders” representing the extended families or lineage. Leadership belongs to “whoever has the skills,and competence to provide it”. The Bassaethnic group was one of the first to fight for the independence of Cameroon. The family is largely controlled by the male head and the woman to whom he is married is considered as “not belonging to his lineage” ( cf. Mveng 1962). The Pahouins (Fang, Beti, Bulu) constitute the Bantusof the equatorial zone, an area which extends from the Sanagariver in Cameroon to the Congo, Gabon and Equatorial Guinea. Their emigration story brings them from north to the south using both peaceful and violent meansto avoid Mboum, Fulbe and Baboute punitive raids. The Pahouinsculture exhibits a high degree 27 Cultures of Populations: Africa of sexual freedom; trial marriages(proof of fertility before marriage) and disregard for virginity in a marriage contract. According to Guyer (1980)the term Beti at first, designated a statusrather than an ethnic group. That is, a people who were born free, among whom are found the Bulu and Fangs.Today,the term Beti designatesa number of inter-related sub-ethnic groups ( Bulu, Ewondo and Eton).The Bulu are said to represent almosta third of the Pahouin group and they are found in the region of Ebolowa, Kribi and Sangmelima. Other ethnic groups within the Bantu group include the Mabea, Batangasand Yassafound on the coastalarea between Kribi and Campo, and the Maka, Bangandou, Badjoue, Kaka, Bobilis, Bekele and Bamvele located in the EastProvinceof Cameroon. Semi-Bantus: There are three major groups of semi-Bantus:Bamileke, Bamoum and Tikars. They share many linguistic, socio-political and cultural similarities. Besides having common history, these semi-Bantustend to have a highly organised political systemwith centralised authority and power concentrated in one person, the chief, foyn, fort, or sulfon. They tend to maintain very high fertility rates.Among these peoples, fatherhood or paternity is considered a high value and marriage and the procreation of many children is considered the enhancement of a person’s immortalisation. The Sudanese Groups: The Sudanesegroups are said to be the first inhabitants of north Cameroon. Two groups can be distinguished : the paleo-Sudaneseand the neo-Sudanese.The Paleo-Sudaneseare the ethnic groups that occupy the Mandara and the Alantika mountains. They are composed of the Mafa ( Matakam), Kapsiki. Guidar, Guiziga, and the Toupouri. The neo-Sudanese live on the flat plains of the Logone region. Among them are the Massa, Mousgoum and Kotoko. Popularly known asthe Kirdi, they have maintained their opposition to Islam and the Fulbe invasion and colonisation. Polygamy is widely practised among these groups and virginity is considered a great value in the future of a bride. Fulbe: The Fulbe who dominate the northern provinces, have a Senegalo-Mauritien origin in WestAfrica. They moved from the FutaJallon heights acrossWestAfrica and took up residence in North Cameroon about two centuries ago. Two groups of Fulbe exist: the urbanised sedentarised Fulbe and the nomad Fulbe who are cattle’herders. Most of them have been islamised and have adopted the Koran as the standard source of authority for sexual behaviour. The Arab-Choa is another Islamicgroup that arrived in Cameroon 300 years ago from the Sudan.Largely from the Hamitic origin, they live on the borders of Cameroon and Chad. It is one of the ethnic groups that practise FemaleGenital Mutilation (FGM). The Present Study In this backdrop of demographic scenario, we now discussthe study conducted in sociocultural factors and demographic behaviour in Cameroon. The main aim of this study was to identify the most important Cameroonian sub-culturesand relevant socio-culturalfactors,which 28 Cultures of Populations: Africa underlie demographic behaviour, the processesof social change and the role of change agents in this relationship. It is hoped that knowledge gained from this study will provide the appropriate information for the formulation of more effective population policies and programs in Cameroon. In order to achieve, these four siteswere selected, representing Cameroon’s four ecological regions: Douala (coastalregion), Yaounde (central rainforest region), Bamenda (grassfields),and Garoua (sudano-sahelianregion). All these sites represent equally the five cultural or ethnic groupings of Cameroon: the pygmies (rainforest);Bantu (coastalregion and central rainforest region), semi-Bantu(high Western plateau), Sudaneseand Fulbe (Sudano-sahelianregion). All four sites,except Bamenda are located in French-speakingpart of Cameroon. The research methodology involved literature review, Focus Group Discussions(FGD)and personal interviews. Data from both literature review and field investigationshave shown that population programmesand policies in Cameroon have often missedthe audience or the target groups for which they are designed. Thus,the study explored various domains of fertility behaviour with a view to using the knowledge developed from the data to design of policies and the implementation of programmes. One goal of population policies is to strive for sustainabledevelopment and match population growth with available resources.The goal generally is to lower fertility ratesor to keep them within manageable proportions. Although the Governmentof Cameroon has enacted a number of policy instruments, the evidence obtained from this study indicates that there is limited awarenessof key socio-culturaldeterminants of fertility in Cameroon. In the context of identifying the important sub-culturesof the Cameroon the researchalso aims to their relevance in affecting demographic behaviour. Furthermore, it seeks to identify agents and processesof socialchange in order to ensure that findings are utilized for the design and implementation of population policies and programmes in Cameroon. Thus, it is argued that while looking for differences in subcultures, it should be recognised that IECprogrammes do contribute substantiallyto changesin demographic behaviour of populations. The underlying assumptionof this study, is that to effect change of behaviour in hard-toreach sub-culturesin the Cameroon society,better understanding of the cultural environment in which they live is necessary.Recognising that sub-cultures may also share common traits, the study seeksto identity converging cultural traits common to otherwise different ethnic or socioeconomic groups in order to integrate this knowledge into population information packages. It is expected that the new knowledge gained from the resultswill assistin improving the design and development of IECprogrammes and their subsequent evaluation would lead to an institutionalisationof cultural variablesinto population programmes to make them responsiveto the needs of local populations. 29 Cultures of Populations: Africa The study areas The following four sites were selected, representing Cameroon’s four different regions: Douala (Coastalregion); Yaounde (Central rainforest region); Bamenda (High Western Plateau) and Garoua (Sudano-Sahelianregion). Theseareasalso represent the four cultural areas:coastal, central, grassfieldand northern cultures.They are also close to provincial (administrative)headquarters. One of them, Yaounde is the nation’s capital. Three sites (Yaounde, Douala and Garoua),are in the French speaking part of the country: while the fourth (Bamenda),is located in the Englishspeaking part of Cameroon. The ethnographic data are drawn from two main sources:the LinguisticAtlasof CentralAfrica (ALAC),and the Ethnic ClassificatoryListing for Cameroon (ECLC).The ALAC, identifies poles of orientation in the field between which all intermediary ethno-linguistic forms exist. ALAC observesthat language and ethnic group do not necessarilycoincide, but often they are coextensive. Basedon these arguments we have been able to locate different ethnic groups native to each site surveyed.Equally included is a brief description of the sourcesof data for each site. Douala is the country’s economic capital, and seaport. Four main ethnic groups (Duala; Lombe; Bassa;and Isu)dominate the Douala area under which the ECLCliststhe following nine sub-groups (or sub-cultures):Abo, Bakole, Bakweri, Bambuko, Bodima, Duala, Malimba, Pongo and Wouri. There is also a dominant migrant population Douala composed mainly of Bamileke and other ethnic groups from other provinces. Yaoundeislocatedin the CentreProvince.Thepopulation of the CentralProvincewas 1,651,600 in 1987; that of Yaounde alone was estimatedat 1 231 314for the sameyear (GCPH,1987).The ethnic map of Cameroon indicates the main ethnic groups in Yaounde are Ewondo; Eton; and Bulu.However,becausethe ethnic compositionof Yaoundeistoday very heterogeneous,grouping virtually all the ethnic groups of the country aswell asthose of other African and even European countries.Yaounde is a political city and seatof two stateuniversitiesand private universitiesand severalother educational institutions. Caroua,is located in the North Provinceand it cutsethnically between the other two northern provinces; Far North and the Amada. The ALAC classifiesall the ethnic groups of the Garoua region as the Benoue groups. Meanwhile, the ethnic classificationof Cameroon lists 15 subgroups within Benoue group: Bata, Dania, Doaya, Dourou, Fali, Gueve, Kangon, Kangou, Koibila, Kole, Koma, Ndoroen, Paka,rape, Voko, Tchamba. The fourth site, Bamenda, probably has the most dense ethnic configuration of all the sites surveyed.Eight linguistic groups are found inside and within the neighbourhood of Bamenda:;. The ECLCclassifiesthese under the Tikar-Bamoun group. Awing, Bambili, Bafut, Babanki , Nkwen, Mankon, Kom and Mungaka. Secondary data for severalsourcesfor the study were obtained in a variety of locations. In 30 Cultures of Populations: Africa Douala, data were obtained from the University of Douala, and to a major extent from several Family Planning Units (FPU)located in the different health Centres and hospitals in the city of Douala. Data Collection and analysis The methodology envisaged for the field operations consistedin a variety of researchtechniques.: The research team started with a training session,which permitted all its members to become familiarwith the theoreticalissuesand , the methodology. Severaltraditionally quantitative and qualitativemethodswere discussedamong team membersand discussions alsofocusedon how to use them in the field. Somekey concepts were defined to enhance their better and identical understanding by all members of the team. Theseconceptswere related to ethnicity and reproductive health. The definition of concepts such as culture within the Cameroon context was necessary.It was important for the team to distinguish the major ethnic groups from the sub-groups and situate them within the context of reproductive health and demographic behaviour. For example, reference is often made to Douala as an ethnic group but upon further analysisit becomes clear that within the Douala ethnic groups there are others sub-groups suchas the Abo, Bakole Bakweri, Bambuko, Bodima, Duala, Malimba, Pongo and Wouri. More importantly, nowadays, the term “Grand SAWA’ is being applied to ethnic units once seen as heterogeneous. Another example is the Fang-Beti ethnic group whose cultural characteristicsexpand beyond Cameroon and has over 26 subcultures. Usually the Beti (Eton, Ewondo and Bulus) are considered as one big ethnic entity because of common cultural characteristicsyet between them there are some fundamental cultural differences which should be taken into account in the design and implementation of IECprogrammes. The methodology proposed for the study is therefore multi-faceted and more participatory than traditional field methods. Hence, its application required specially qualified staff, keen supervisionand institutional commitment at national, regional and local levels.Consequently,a team of professionalsmade up of an anthropologist, a sociologist,four graduate students (3 MA and 1PH D student), and severalresearchassistantsparticipated in the study. Secondly,the team undertook a review of available literature in order to assessthe quality of the existing data at the out set. The analysisof this secondary data constitutesthe bulk of information in chapter one of this report. This exercise permitted the team to familiarise itself with existing information on the topic, especially from the data sourcesper site, as explained earlier. Data from these secondary sourceshas been supplemented with data from field researchand sample surveysin-depth interviews conducted in the four sites. Thirdly,fieldwork was carried in selectedsitesor communities,operationsstartedwith meeting the community leaders. The researchteam focused also on the main characteristicsof each site, 31 Cultures of Ponulations: Africa namely the dominant ethnic group; leadership patterns; religion; associations (youth/ adults/political/gender/ etc, with an impact on reproductive health’; traditional midwifery and main economic activities.The team also identified infrastructure relevant to activities of reproductive health; notably health and educational infrastructure; family planning units, churches, counselling homes, women centres etc. The study made extensiveuse of focus group discussiontechniques (FGD)and individual indepth interviews. Without any fundamental change in the study design with the focuson youth, women; men; and adolescentsand couples, each focusgroup discussiontook account of gender balanceand other important variablesin order to optimisegroup performance.The sizeor number of persons effectively present during the discussionwas recorded in each case.In addition, the characteristicsof participants such as age; sex; ethnic group; length of residency in the neighbourhood, religion, political affiliation, marital statuswere recorded. For the conduct of the FocusGroup Discussions(FGDs)it was necessaryto obtain information on the ethnic origin of the participants for comparative purpose of reproductive behaviour. In order to optimise communication between the researchersand the participants, the local languageswere used. Becauseof the diversityand compositenature of the participants the team gave equal opportunities to every participant to answer each question in a sequence. In this way, the team was able to isolate modest members from those we tended to dominate and monopolise the discussion. The FGDswere followed by selected in-depth interviews of some the participants and/or other membersto verify the responsesrecorded during group discussions.Additional interviews with the purpose of establishing socialbiographies were conducted with older members of the community to learn more about their respectivecultures, especiallyabout changes over time in their customsand norms in connection with demographic behaviour. The use of these researchtechniques was to enrich the qualitative data collected during the study, rather than the collection of mere quantitative data. However, efforts were made not to duplicate existing data or effort. UNDERSTANDINGDEMOGRAPHICBEHAVIOUR. Fertility Fertility is understood in this study as the potential to bear children from normal sex relationships;while virginity, is understood as the non-penetration of the vaginal. In all the four sites,virginity was considered a great value in the establishment of marital unions except for some tribes such as the Beti who do not consider virginity important to 32 Cultures of Populations: Africa marriage. Proof of fertility is far more important than proof of virginity among Beti ethnic groups. The evidence seemsto indicate that youths in urban centresare more exposed to loosing their virginity than young people in the rural or semi-urbanareas.Someinformantsindicated that they were very proud of their wives when they discovered they came to marriage as virgins. Evidencefrom older informantsassertedvery strongly that virginity was a thing of the past. That, given the exposure of young people to western concepts of sex through the massmedia and western culture, there was a high probability of young girls loosing their virginity by age 12 among ethnic groups of the rain-forest region and by age 16 for girls from the Savannahand sahelian regions of Cameroon. From data collected in Mankon, the culture respected virginity and discouraged premarital sex. But marrying a girl without a child was synonymousto virginity. The growing disregard for virginity was confirmed in the Bamendasite by two informants. The first casehad three children out of wedlock but was effectively married, the second casehad two children and said she still had very good chancesof finding a husband. Thus, to have children out of wedlock does not hinder or diminish the chancesof marriage among Mankon women Among members of this cultural growth , virginity was a thing of the past, attributed to the change of perceptions of premarital sex. Sex Education Data collected in all the four sitesindicated that almostall adult malesand female had received some form of sex education before engaging in any sexualactivities.Most informants said they were significantly influenced by taboos passedon to them by their parents. Femaleinformants did not received any form of sex education from their mothers (except one case in Bamenda, who reported her first menstruation to her mother who subsequently gave her some guidelines on how to handle the phenomenon). Although all the young people in the sampleassertedthat sex education is taught in school, it was to a large extent insufficient. However, it was reported that fathers generally restrict their children from attending ceremoniesor weekly dancing with sexual connotation. Such education would not be controlled. For some of the girls such education consistedin advising their friends to try sexor mimic the experience of adults, rather than the dangers (early pregnancy, STDs)associatedwith it. Only one male youth reported having receivedsexeducation from his father, meanwhile the latter laid more emphasison the dangers than on its positive roles. Adult women reported having received sex education from school, or from older sisters. Among the Gambai of North Cameroon, young Gambai girls were prepared for reproductive sex life from the first day of menstrual experience. Thosewho had their first menstrual flows in marriage were initiated or educated by their husbands.In other cases,the female youths asserted that they began to be initiated into sex education from their second year in secondary school 33 Cultures of Powulations: Africa especiallythrough the exchange of ideas through conversationswith their schoolmates. On the other hand, sex education was still generally considered taboo by male informants in all the FocusGroup Discussions,and therefore not to be taught to their children who might get involved blindly. Most married informants in all the casestudiesand in all the FGDswere shy to confront their kids and talk to them on how to handle their sexuality. They find it difficult to discusssuch issueswith their children. That iswhy discussionson sex mattersare very rare in families, becauseparents find it embarrassing.Sinceadults did not havea proper sex education from their own parents, they do not find it proper to discussit with their children. Many were therefore scared at the way the National Televisionwas exposing sex over the screens,and helping children to discoverwhat they, asparents try to avoid. The menstruation of their young daughters were not even reported and many fathers would prefer not to know about it. Unfortunately for some, parents only come to be confronted with a pregnancy at the early stages. Beyond this some parents reported having effectively given sex education to their children. It was observed that, most often the girls were referred to their mothers for advice on sex issues by their father, while boys relied on their fathers. Thus,six of the 15 adult women interviewed in Bamenda said they effectively counselled their children especially the girls on the negative consequences of sex. They observed that the confidence and their relationships with their daughters permitted them to approach sex issuessuch as unwanted pregnancies and possible deaths resulting from crude methods of abortions, as evidenced in some casesin the area. They would advise their daughters against non-clinical abortions without the knowledge of their fathers. Among the Toupouri in North Cameroon it is assertedthat partners in a marriage are educated by elderly persons before the sexualact. Male youths received instructionsfrom their parents not to approach girls as they would contact diseases.The researchteam obtained information that showed that Moslem fathersprepared the young malesfor a future sexuallife within the marital home. In addition, one male Moslem youth was even the president of his School’s” CLUBSANTE” and said he was using the experiences of his faith to have other youths in the school to be acquainted with information on AIDSand other problems related to reproductive health. Bride Price Effortsto improve conditions of reproductive health were acceptable more in marital or semipermanent relationships, consolidated by the payment of bride price. The bride price is a cultural trait, which needs to be understood and integrated into reproductive health efforts and demographic behaviour of families and couples. The amounts of bride price generally vary in amounts and the culture under consideration. In term of cash, data collected in Bamenda suggestthat it ranges between 50.000 and 120.000 frs cfa or between 30.000-200.000 F cfa in 34 Cultures of Populations: Africa some of the culturesin North Cameroon. Bride price could also include the payment of, or reimbursement of school fees paid on the girl and non-monetary items suchaswine, and the labour servicesprovided to the bride’s family. Bride price was generally paid in stages, with total expenditure ranging between one hundred and fifty thousand (150.000 Fcfa),and two hundred thousand (200.000 F cfa)francscfa. In the Bamendaarea, the bride price was distributed either to extended family members at once, or to different members of the bride’s family at different times Among the Toupouri, bride price is composed of the following items: 10 cows paid to the father-in-law (representing the official bride price), 8 to 10 goats, a bed, and some additional cash,all of them paid to the mother-in-law. The marriage was sealedwhen the husband offered a spear to the parents-in-laws.In former times the Toupouri lived on raids and wars, the saidspear for both familiestherefore represented the signing of a pact of brotherhood, non-aggression and mutual assistancein times of attack. Today the spear has been replaced becauseof simple necessityby an iron bar, with the samesymbolismas yesterday. Among the Fulbe, generally bride wealth generally consistsof wrappers, kolanuts, and a certain amount of money of between 30,000 francsand 250.000 F cfa. Thisis paid by the future husband not to the family of the spouse,but to the girl herself to permit her to acquire itemslike clothes (wrappers), plates and dishesand other utensilsfor her future household. Someparents offer their daughters in marriage without requesting the payment of bride wealth, imposing on the future husband not to demand bride wealth on their future daughters. Generallyfor Moslem groups the amount paid as bride wealth are lessthan those paid by their non-Moslem counterparts. One informant of the Bamoum ethnic group said that for the bride price, he provided only some kolanuts, a create of sweet drinks and the sum of 500 F cfa (asrequired by the Imam as bride price). For someother northern groups suchasDowayo, bride price is paid throughout one’s lifetime. Parentsof the bride will continue to receive bride price for every grand-daughter born. Among some groups, the bride price demands may be excessive,sometimesleading the husband to treat the wife with scorn or asan object almostwith the statusof slave.In such ethnic groups the bride is virtually ” purchased ‘I. Someinformants cited this as a reasonwhy they would not want any bride wealth for their own daughters, preferring that their daughters be treated well by her future husbandsas personsand not as sexual objects. Among the Fulbe, bride wealth issuesare discussedduring a ceremony called ” tying the marriage ” to which the following personalitiesare present: friends, the two families,witnesses (two each) of the couple and the marabou charged with ” tying the marriage”‘. Bride wealth for most ethnic groups, is legalised by its acceptance by the family of the future wife, articulated around somespecificceremoniesduring which the bride shylypours a drinkable liquid (brought 35 Cultures of Populations: Africa by the future husband)into the father’scup, asa sign of her acceptanceof the marriage . An open affirmation from the bride is usually considered out of place ; she will be considered too experienced for the future husband. Somereluctancemustbe expressedeven though the future couple love themselves. A majority of the female adult informants considered bride wealth as important and necessary because it is a tradition, the husband’s appreciation of the efforts made by the family of bride in bringing her up. Femaleinformants from the Mankon site said bride price gave some respectability to the woman, creating a favourable relationship with the future husband. The significance of bride price was directly related to the claimsof paternity. Children born in caseswhere no bride price was paid, were theoretically the children of the woman’s father. Bride price gave the husband claims to the paternity of the children born of the woman. Information collected from some health providers (adult females),the non-payment of bride price could result in the girl’s family theoretically ” obstructing their daughter’s womb ” or preventing the woman from bearing any children. All ethnic groups were equally aware of ceremonies conferring paternity, especially in the casewhere the future husband was not the biological father of the child born out of wedlock. However the opinion of the future husband was sought. Among most ethnic groups in the Northwest province any children born of a biological father other than the person who paid the bride wealth, is automatically the child of the person who paid the bride wealth. Bride wealth is therefore a socialand cultural act, which confers sexual rights and social paternity on a man. Paternity is such an important function that men must seek to acquire it before they can feel they are men. Culturally speaking, a man who does not pay bride wealth theoretically loosesclaimson paternity and also on the bride wealth of any daughters born of that relationship. Generally, among certain ethnic groups in North Cameroon, a woman for whom no bride wealth was paid, was considered as have been offered as a gift to her husband but the bride wealth was not obligatorily reimbursed, except on the insistenceof the husband. Bride wealth equally representsor conveysthe messagethat the girl was no longer part of her biological or social family; and now belongs to another family, or to someone else ; her husband. Hence a husband who dies without having paid the bride price for his wife is regarded with some scorn by both the wife and her in-laws. Marital status: All informants in all sites,knew three types of marriage: traditional, court and church. The traditional marriage was virtually the first form of marriage every married person had to contract through elaborate ceremoniesof the exchange of gifts among the two contracting families ( payment of bride wealth that conferred paternity on the man). The court or civil marriage was seenasconferring civil rights and obligations but not valid in many ethnic groups. The church marriage was performed before religious authorities and enhanced the membership 36 Cultures of Populations: Africa of these individuals to the given religious groups. Many Christian informants assertedthat they had undergone the three forms of marriage ; while Moslem informants were more inclined to the Islamiclaw than to civil and traditional marriage forms. The reasonsadvanced for marriage varied with site. Informantsin North Cameroon,observed that one’s wife remained the singular person capable of providing assistanceduring times of temptations in life (illnessesetc). One’swife was thus one’s companion. Marriage is equally considered by many as an act of bravery, the capacity to take responsibility over and care for somebody. Hence non-married adult maleswere regarded as irresponsible. The marital home was equally considered as the ideal frame to conceive and implement projects, procreate and raise children. In fact, for the Moslems, children born out of wedlock have few chances of being good children. Our researchteam had the occasionof listening to the story of two young women from the Kole and Guiziga ethnic groups, 26 and 21 years age respectively.The Kole girl married at age 13to a man of 60, but divorced 7 months later; the second (Guiziga),married at age 15to a man of 57, and divorced him some years later. Both subsequently remarried, and in both casesthis time the women made their respectivechoices.But their bride wealth dropped from 35.000 to 20.000 in the first case:30.000 to 15.000 F cfa in the second case.informants from the Gambti ethnic group, felt that marriage was not a good affair, since once married, one was forced to remain in that relationship. They showed preference for having children with any man who could take care of these children. Polygamy: Some of the informants were effectively polygynists, or were from polygamous homes. The researchteam interviewed 25 married women in Garoua ; six (4 adolescents girls and 2 adult women) were in polygamous marriages,two as first wives. We found out that adult women in all the sitesdid not tolerate polygamy per se, even if one of them in Bamenda thought polygamy good for her son since the competition between the women will be to her son’sadvantage. Many women cited polygamy as the source of conflicts, jealousy, witchcraft, and magic, which could render the other women mad, drive her away or kill her. A few women accepted polygamy only in circumstanceswhere they were unable to bear any children, and on condition that their husbands had enough resourcesto satisfactory take care of themselvesand their children, a fact they doubted, even in circumstanceswhere the next wife could bring in some resources.Somefemale informant accepted polygamy in response to the high proportions of women to men in a population. Somerejected polygamy on the basis that it would diminish the husband’s intimate care of his first wives and draw him nearer the new wife. However one woman in Mankon (married to the chief) and some of Moslem women in Garoua, accepted polygamy because it provided security to the children of all the wives in the event where any of them was absent for one reason or the other. Marrying a chief or becoming 37 Cultures of Populations: Africa a royal wife was already a great honour and offered many occasionsto a woman’s children to be looked after even in her absence. Ofthe 14male Moslems,8 adult malesaswell as6 adolescentsopted for polygamy in respect of Islam (which fundamentally offers the right to 4 wives). However, for reasonsthey associated with problems of inheritance, males born of polygamous homes were opposed to polygamy, These cited casesof polygamy precipitating the death of a man caused by children and their mothers who wanted to inherit his property. None of the serviceproviders, came from a polygamous home. None showed any tolerance to polygamy. One had divorced a polygamous husband becauseshewas accusedof the practice of witchcraft aimed at preventing her husband from having children with his wife. Knowledge of informants’ awareness of the new law on inheritance in a polygamous marriage was not established. Divorce: Irrespective of the conditions under which they were subjected, most married women informants preferred to stay in their marriages than divorce. Adult male informants of severalcultural and sub-cultural backgrounds explained that their respective cultures did not give room for divorce. None of them was divorced. Among the health providers, one woman was divorced because she was considered sterile; another was separated from her husband. Most female informants assertedthat divorce was not frequent because most women do not consider it a proper way of solving marital problems. Birth spacing: For most informants, the periodicity of birth was progressivelyreducing. In most cultures of Cameroon, formerly, just after birth, the nursing mother left her marital home to spend some two (2) years with her mother. During this period, she had no sexual relations with her husband. Birth spacing among many Cameroonian groups was until recently between two and three years.Informantsevaluatedthis length of time long enough to permit the children to be weaned and be healthy before a mother could have another. The husband did not re-establishsexual contactswith the wife until the child was at least two years old. This period has today reduced to an average of four (4) months, equally reducing birth spacing. But generally, preference for birth spacing by participants was for between one and three years Naming rite of a child: All children born out of wedlock among ethnic groups in Bamenda, were named by the girl’s parents, indicating that paternity did not belong to the biological father. In ordinary circumstances,the girl’s family would name the first child. The birth was announced by the husband’s family who will take some firewood to the wife’s father to inform him of the birth of the child, and secondly ask for the name for the new-born. Among the ethnic groups of the Garoua region, with the exception of the Hausa,the father of the child gives the name. In fact among the Guidar, the names are classifiedfor the first 12 children of the family. Among the Hausa,often the husband’sfather provides the name. 38 Cultures of Populations: Africa Hot Water Massage: Care after birth is generally provided by the wife’s mother or motherin-law or any elderly woman from the family. She usually takes care of ” their ” daughter just before and after birth. Such care consistsin the administration of ” hot water massage’ every morning and every evening for a whole month. Apart from the Mankon, the Noni, Bafut, Nkambe and many Tikar groups of the North West Province, all women informants in North Cameroon assertedthe practice as common in North Cameroon aswell. The female adult informantssaid they approved of the practice becauseit expelled all ” bad blood ” left in the womb after birth. On the contrary service providers pointed out the disadvantages of ’ hot water massage” suchas causing excessivebleeding, and therefore discouraged it. One of them maintained that she will apply ” hot water massagingI’ on her own daughters after birth, despite its dissuasionfrom health providers. Care after birth also includes the preparation of special foods for both the new baby and mother. Thus,the Toupouri prepare ” cow foot- pepper soup ” believed to expel ” bad blood “from the new womb of the baby’s mother. Moslem women after birth were expected to drink a lot of cereal pap. Someempirical evidence collected from informants, indicates that the navel of the newborn was treated differently among many tribes. Most tribes interviewed in all the four sitesindicated that the navelwas usuallyburied under a young plantain tree. Sometribes would usethe plantain when it matures 12 months later to feed the child. Subsequentlywhen this plantain grows and produces fruits, it is pulled down and prepared in palm oil and shared among family members and the child who is also fed with it. Sexual Abstinence: Among many ethnic groups in the four sites,sexual abstinence was to be strictly observed after birth and in some caseseven during pregnancy. In the samemanner, the Moslem faith requires that sexual relationships should resume 40 days after birth but some informants said many husbands extend this period to 2 years till the child is properly weaned. The successfulimplementation of this practice therefore requires that the woman goes back to her parents or relativesduring those long months of sexualabstinence. Thispractice also has an impact on birth spacing. Among the Moundang, sexual intercourse is expected to resume as soon as the baby starts walking, although in the urban areas,most couples do not obey these traditional rules as informantsindicated that modern couples now resumetheir sexual life three months after birth. The Toupouri and Guiziga have identical practicesin this matter, but today, the Toupouri couple are said to return to normal sexual life as soon as the menstrual cycle of the nursing mother is reestablished. Meanwhile the Guiziga are said to abstain from sexual intercourse between three and four months. Among the Kole, the period of abstinence is said to be between five and six months, while the Gambai observe a 40-day break. Beyond all of this, many informants said the period of abstinence depends on the level of seduction of the husband by his nursing woman. 39 Cultures of Populations: Afn’ca F+rohibitions during pregnancy Among the Bassasthe consumption of somespecificanimals(” biche “) was prohibited during pregnancy. It is culturally believed that a new-born baby, would have an opening between the lips ( cracked lips) if the pregnant mother ate a deer or could be ugly if the mother ate the tortoise ; or bald if she ate eggs. Among the Dowayo, a pregnant woman was forbidden from eating the chimpanzee and snakesagainst the strong belief that the new child could inherit the characteristicsof thesewild animals.Among the Guidar,should a pregnant woman eat rhinoceros, it was believed the child would be deaf. Among the Bamoum, a pregnant woman was not supposed to stealfor fear her baby would be a thief. Shewas also expected to avoid eating hot couscous,believed to damage the unborn child. Among the Toupouri, each clan has its totem, and a pregnant woman was required to avoid meeting the totem of her clan. It was believed she could attract a curseof infinity, or her child will be born deaf. Among the Hausa,a pregnant woman is also forbidden from eating certain speciesof legumes believed to make the baby fat in the womb likely leading to difficult delivery. Circumcision and Female Genital Mutilation. Among many Cameroon ethnic groups, male circumcisionis widespread but female Genital mutilations(FGM)is restricted to some ethnic groups in the Southwestand Far-North provinces. During field research only one informant, herself a nurse of the Banyang ethnic group (SouthwestProvince),acknowledged the practice of FGMamong the Banyang. FGM is performed generally during an initiation dance called Monikim. The practice is on the decline. Female informants in Garoua acknowledged that FGMwas still being practised among the Arab-choa of the Far North province. On the other hand, many informants knew of male circumcision,saying it took place generally between the ages of one month to nine years and sometimeseven older for some. Most ethnic groups in the Northwest Province performed circumcision on boys during the early months of birth, while most ethnic groups in the forest regions tend to perform circumcision when the child was between 7 and 10 years old. In north Cameroon, circumcision is common practice among Moslems and takes place between the ages of 5 and 16, and is a dicta of Islamto facilitate purity for the observanceand practice of religious ablutions. Some informants observed that circumcision was believed to increasemale sexualperformance and potency. Thus,they stated that a non-circumcisedperson “cannot make sexwith a woman for as many as 2 to 4 times”. The practice of circumcisiondoes not exist among the native Toupouri ; their ” refusal ” to accept circumcisionwas built on their associatingcircumcisionwith the invasionand domination of the Fulbe. Circumcision is therefore associatedwith Islam and anything Islam tends to be rejected by the Toupouri. However, the Toupouri have adopted circumcisionbecause of the impact of migration and urbanisation. 40 Cultures of Populations: Africa Among the Guider and Dowayo, circumcisiontakesplace as from age 16 along with initiation rites, and it was a prerequisite for marriage becauseas soon as a young man was circumcised,it is prohibited to have sex with any other woman than his wife. Thisis believed to lead to sterility on the part of the man. Sterility: the inability’ to bear children without exposure to and the useof contraceptive methods, was associatedwith a ” dead waisr ” among North Westethnic groups. Generally male potency was taken for granted in All ethnic groups and the women bore the blame or accusationswhenever the couple could not have children. Male sterility was recognised only in circumstanceswhere the man could not have children even after a remarriage ; polygamy or overt extra-marital relationshipswas a rerun of the test of fertility. Exceptin those circumstancestherefore, the cure for impotence or sterility was not only provided for or directed towards males.Among the Meta and Nso, sterility was believed to be caused often by witchcraft. One sterile woman informant ( serviceprovider) from Meta revealed that she had sought the help of healersto know the cause of her plight. And sterility was usually attributed to the ” evil-eye ” of some family members, especially when they were opposed to the marriage. In another case,a Nso female informant accusedthe husband’s second wife for being responsible for her infertility. One of the female Moslem informants was sterile and she believed her status was the maltreatment by her husband’s relatives . This led to a divorce, and her current misfortunes. Infertility therefore remainsone of the main reasonsadvanced either for divorce or for polygamy. One of the major causesof sterility (synonymouswith impotence) is attributed to God’s will but most informants attributed sterility to witchcraft, curse or inheritance of a genetic disease.This could well underline the impact of religion in those areas.In Bamenda 12serviceproviders were interviewed, two were effectivelywithout children, but they testified they had (relatively)good relationship with their husband’s family in spite of some minor complaints from some relatives. Informantsassertedthat the sterility of a man could only be ascertained by the wife. In order to maintain male self-esteem,their wives generally kept it asa secret,and could be allowed by the man to ” find breeders ” and bring them into the world to enhance his paternity. Femaleserviceproviders reported casesof hysterectomy(difficulty in the erection of the penis). They observedthat many patients (victims)who came to the clinic had been to traditional healers whose medicinal herbs did not produce the desired effect. But many told them that they had also tried modern medicines but no positive effect was achieved. Those patients who had no children, hoped to explore artificial insemination in the near future. Their husbands (except in one case)did not do any sperm count. It was also particularly interesting to note that wives of such patients said they would choose the sperm-donors rather than leave it to random choice of a donor. 41 Cultures of Populations: Africa The problem of infertility is usually a difficult burden to bear and more painful for married women. Every culture attempts to find a solution to it. Most ethnic groups in the Northwest province conduct special fertility dance for barren women during birth ceremonies. These ceremonial dance consistsin the singing of fertility songs, smearing the barren women present with palm oil and pouring cold water on them. Theserites are performed in the hope of rendering the barren women fertile. Some empirical evidence showed that some women have become pregnant after having participated in such a fertility ritual. Informants in all the siteswere aware of hereditary diseases.Therefore, pre-marital investigations are often conducted in many cultures and sub-culturesto ensure that such diseasesas mental disorder, leprosy, fainting feet or even witchcraft were not observable in the familiesof the bride and bridegroom. Besides,chronic diseases,low moral standing , high frequency of divorce, suicide or murder and observable signsof poor care for wives and children, are reasons advanced for refusal of marriage. Thisexplains why the choice of partners is often the concern of parents or members of the extended family. The consequencesof sterility go even beyond life to affect cultural observancesat death. Thusamong the North Westethnic groups, a man who died without having children was buried with a stone in his fisted hand, and all visible signsof a grave were deliberately eliminated since he died leaving nobody to take care of that grave or remember him. If he had children before his death, these were expected to provide signsof his immortality and maintain a remembrance of him. This notwithstanding, the culture still paid due respect to women who died without children. Suchwomen could have mothered children given to them by a relation asa reward for good characterand in recognition of their capacity to look after such children. Information indicates that ethnic groups in the South of country aswell asamong the Guider have similar practices. Among these groups, if a man or woman died without children, he/she was buried in a manner different from those who had children. At the burial, the grave was filled up with earth; a wooden piston was used to pound it and abandoned on the grave. The dried wooden piston was a sign of sterility.Thispractice was also reported among the Bamilekes, among whom such personswere also buried with a stone in their fisted hands. Knowledge of Sexually Transmitted Diseases : All the informants in all sitesindicated that they knew of the following STDs:Gonorrhoea, Syphilis and AIDS. Only the service providers (informants)added to the list trikonomiasisand Candidiasis. On how such knowledge affected sexual behaviour the following information was collected. All the adult women in the sample said they remained faithful to their partners. On the other hand, they were wary about their husbands’ infidelity but they did not know how to guarantee their resistanceto STDsin such a situation. None of them had proposed the use of condoms to their husbands.Proposing the use of condoms created a feeling of mistrustand loss 42 Cultures of Populations: Africa of confidence. One adult male and two youth informants in Bamenda said they used condoms for preventive purposes, against unwanted pregnancies and STDs. The female serviceproviders who declared that they are faithful to their husbands said they were cautiousand feared the contraction of STDsand unwanted pregnancies. Therefore, in such occasionsof infidelity, they would insistthat their partners use condoms. Thosewho had proposed the use of condoms to their husbandswhen he travelled, met with resistance.One female informant said she had put a packet of condoms in the husband’s travelling bag, but he brought it back unopened either indicating that he was not unfaithful or he used it and simply bought a new one to replace the one he might have used. Discussionswith young people showed that they were aware of the symptoms of various STDs,except that they were not clear about the manifestationsof AIDS.They said syphilisis recognised by the falling of hair. Some said STDsinfection could be recognised three days after a sexualact by a burning sensationor pain in the urinary track. Somewomen informants said for women the sign was an abdominal pain, and/or soresas well as whitish secretionsaround the female genital entrance especiallythey identified these symptomsas signalling the presence of gonorrhoea or syphilis. In all the sites,informants admitted traditional healers also provide a cure for these diseases. Someof them claim they can even cure AIDS. For instance in Mankon, gonorrhoea is believed to be cured with a mixture of elephant stock and some herbs cooked in palm wine. In the Mankon sitesthe youth said they easily turn to traditional healers to cure STDinfections. They also observed that most healers were women of advanced ages and provided the healing service virtually for free. The youth expressedthe desire to see this knowledge handed down from these elders to youths for future improvement and use. However, it appears that the transmission of the knowledge to a young girl might not have the sameeffects.They sayso becausethe older generations believe that young people nowadays are irresponsible. They will not keep the directions and traditional laws and are likely to use the knowledge to exploit clients. Reasons advanced for recourse to traditional medicine included the availability of effective treatment at a cheaper and accessibleprices. The youths simply asserted that modern treatment was so expensiveand therefore inaccessibleand unaffordable. In the caseof AIDSalone, the female youth informants also evoked the problem of the lack of total awarenessof AIDSby the villagers, whom they claimed do not believe in the existence of AIDS. Moreover, the youths argued that these villagers have their own ideas about the disease. AIDS was either real or it was a way of discouraging population growth in Africa. However, all informants were particularly afraid of AIDS since it is incurable. The female adult informants from Garoua knew of syphilis, gonorrhoea, and other STDs.Some said that AIDS really scaresthem. Those (like the Gambai)who had unprotected sex with probable victims of 43 Cultures of Populations: Africa this dreaded diseasesaid they were scared but would not dare test for AIDS.Despite this fear, they had ” no solution to AIDSattacks ‘I. Many adult women informantsdoubted the fidelity of their husbands.One female informant expressedthis in these terms : ’ when he leavesthe house he returns late ” or again “the men of today are dishonest, none of them can tell me that 1am his only love; I accept but I know this is not true I’. However, only those who have traditional healers as husbandswere sure of their fidelity. But, women who still wanted children or who feared being accusedof infidelity by their husbands said they did not use condoms. One married woman said : ” A woman will know very well that her husband is unfaithful but cannot ask him to use condoms.The husband will alwaysrespond that it was the woman who was the unfaithful hooker. Where did she see him involved in a dirty sex deal ? ‘I. Another causefor the non-useof condom, is the desire to have more children. All the female adult informants except the Gambai informants in Garoua, said they were faithful to their husbands.Besides,someof the rural women in Garoua did not even know how to protect themselvesagainst STDs,even though all of them declared that they were faithful to their husbands. One of them asked the question: ’ To look for what outside? ” and none of them admitted having once contracted STDs.Among the Gambai ethnic group, sex appears to be a relatively liberal issue. One woman informant admitted she had virtually two ” husbands “. Married or engaged, shehad a lover,who effectivelyknew her husband, but the reversewas not established. Her love engagements with her lover were based on the fact that her formal husband has a priority. The lover takes secondary position only when the formal husband was out of town. Information obtained from 15 female informants in Yaounde, members of the Beti larger ethnic group ( Etons,Bulu, Ewondo), said infidelity was a common phenomenon and it did not bother them when their husband were involved. They took their husband’sinfidelity for granted but there was nothing one could do about it. After all, they themselveswere involved in such sexualadventures,which they referred to as” couper, coupage, extra ‘I.That is brief stink of lovemaking with an acquaintance or friend even if not on regular basis. Some Gambai female informants in Caroua insisted on submitting their husbands to a test upon return from eachjourney, before they can start sexualrelations again. Someof the women themselvesdo an identical test every 6 months to be aware of the state of their reproductive health. One Gambai woman said she was given a traditional and cultural protection in a pap against STDsand AIDSby her parents. Contact with any male victim of STDswill result in failure of erection in the man ; ” it will drop like okro ‘I,she said, meaning it will render the partner with STDsunable to maintain an erection. The researchgroup also observed that this ethnic group was reputed for its sexual promiscuity. If this knowledge and use of this traditional protection is established and confirmed, it 44 Cultures ofPopulations: Africa could have far reaching consequencesfor other populations. Four female married youth informants said they questioned or doubted the fidelity of their husbands from time to time, and therefore would generally use condoms in moments of doubts. For the adult males,fidelity and infidelity’ are concepts to be banned. They argued that on returning home late, they are accusedby their wives of infidelity, sincewomen claim that a man cannot have only one partner. Theseclaimswere, however, justified with reference to the adult male informants. Of the 20 male informants in Douala, only three had remained faithful to their wives.The three evenadded that ” time will tell “, implying that they too could eventuallybecome unfaithful. The use of condoms was also reported by the men who assertedbeing unfaithful to their wives to protect themselvesagainst STDs.Some of them said they pray to Allah to protect them from contracting STDsduring such ‘I adventures of infidelity “. The men who use condoms prefer to obtain them from pharmacies,where they are sure of the quality of the product. Those who worked in the medical centresprocure them from the stockssold in suchcentres. Referenceto STDsdrove most of the female informants in Garoua to laughter. The laughter was apparently in reference to AIDS (SIDA)as an Imaginary Syndrome to Discourage Lovers (ISDL).However, they quoted AIDSas the first of the STDsthey knew, followed by gonorrhoea, and cancer.They emphasisedAIDSbecauseunlike other diseases,they knew AIDSas incurable. Knowledge of AIDStherefore justified the use of the condom in doubtful casesof sexual intercourse. Someinformants among the Moslem youth group, knew only of one STD,AIDS.Others had more extended knowledge including diseaseslike the burning urine (chaud pisse),syphilis,and gonorrhoea. AIDSdefinitely drove home fear for a majority of informants except for a few who were not convinced of its existence, claiming it is a diseasemounted to discourage numerous births and population growth. Someattributed AIDSto divine punishment for the abominable act of adultery. Mortality Data gathered in the respective sites indicates that there has been relatively low rates of infant, child and maternal mortality. a) Infant mortality: Generally, and in terms of perceptions, children rather than money, represent strength. Culturally, the degree of a man’s death ceremony reflects the number of children he had. For a child to die before the father is a tragic event which most families would like to forget as soon as possible.Among certain cultures in the Northwest province, a baby of lessthan five yearsold, or the first child in a family who dies, is buried in fresh banana leaves.No coffin is used. The grave is done in the formal of a shaft and the child is buried in the shaft. If the samewoman losesher baby for the first time, then gives birth to a baby of the samesex with relative resemblance, it was believed or suspected 45 Cultures of Populations: Africa that the first child who died hascome back. In the event of the death of that second baby, the corpse was mutilated before burial to identify that body if it returned. Somerespondents reported having effectively seen the next child born of the samemother with such mutilations. If it was a still birth, it was considered a woman’s fault since it was attributed to her unkind behaviour towards people. Most often, a pregnant woman was not supposed to shout at night because evil spiritswere said to be angered by such noisesand prevent her from delivery. b) Maternal mortality: Among ethnic groups of the high plateau in the western region in general when a woman gives birth to twins, she is referred to as ” manyi “. At death, she is buried alongside two plantain or banana flowers symbolising the twins (either male or female) she bore while alive. Migration Migration data collected during the researchshows that there is still massrural exodus into the urban areas.All informants assertedthat they had seen people move into their neighbourhood over the last six months. They concluded that the phenomenon of migration was permanent as people continue to move in and out of their respective” quarters I’. In Mankon, informants assertedhaving recorded a progressivemigration especiallyover the last years.Migrants were said to come from Wum, Meta, Nigeria, and from Northern Cameroon (Fulani).Their insertion into the areawas been facilitatedby the hospitalityof the Grassfieldpeople to such an extent that some of them have become members of the Mankon traditional council. Generally such migration, would explain the evolution in the population of the Mankon site, on the one hand and introduce new perceptions in population and demographic issues. The Garoua participants observed the presence of Chadiansamong whom many have been born in Cameroon. Meanwhile the other important alien migrants were the Nigerians, Central Africansand Mauritanians.But they are found mainly in urban centres.Meanwhile the Bamileke, Tikars,Duala and Ewondo are the principal Cameroon ethnic groups are generally found in the urban centres of North Cameroon. EXPEClATlONSAND PREFERENCE FOR SOCIALSERVICES Factorssuch as knowledge and functions of existing social services,would affect peoples expectations and preferences for these servicesin general. What follows is an analysisparticipants’ responsesto expectations and preferences for social services(health, educational infrastructure, churches,women centres, etc.) related to population issues. In our opinion four main related activitiesstand out in which these social servicesintervene 46 Cultures of Populations: Africa in population activities, namely; the curative (sexually transmissiblediseases);sex education; reproductive health; and family planning. The presentation below relates these expectations and preferences to the respectiveindividual interviews and focus groups covered by the study namely : adolescents;youths; women and men; couples; parents: serviceproviders: and information providers. Adolescents Someadolescent boys observed that the knowledge of STDsdid not affect their sexualbehaviour. One male adolescent in Douala said he always uses condoms. Other boys rarely used condoms and one claimed to his female partner is faithful to him, so he does not need condoms. Five informants in Deido claimed they were tested negative AIDS,and that the knowledge of AIDS did not change their sexual behaviour. For some said that the cost of the treatment was estimatedat 750,000 F cfa ( $1,400) monthly, enough reasonto deter them from contracting the disease. Both boys and girls in all sitesknew where they could obtain condoms : in the pharmacy for 40% boys and 60% girls in Deido becauseof the quality of the product; from storesand kiosks for the other informants. Two adolescent said they received a regular supply of condoms from a relative who is a health provider in France. This relative sends them, however, with the warning that they should be cautiouswith their sexual livesand not engage in promiscuoussex simply becausethey have regular accessto free condoms. SEXAND EDUCATION Youth Most female youth informants, knew some main symptomsof various STDs.For instance,that syphilis is recognised by the falling of hair of the victim; and that in the women, gonorrhoea or syphiliswere characterisedby abdominal pains, and/or soreswith whitish secretionsaround the female genital entrance. They also knew that STDswere manifestedin men generally three days after sexualintercourse;thesewould consistin a burning sensationor pain in the male urinary track. However, they did not attribute this knowledge to any specific social serviceas such. In fact they observe that the low impact of specialisedsocial servicesin this matter could explain the low level of awareness of some diseaseslike AIDS especially in the rural areas. Many rural populations did not believe that STDsexist.Thus,in rural Caroua, some informants observed that AIDScame from the white man , from dogs ; and others think it is a way of discouraging free sex. This, notwithstanding, all youth informants in all the siteswere particularly afraid or scared of AIDSsince it is incurable. 47 Cultures OfPopulations: Africa In terms of preference for health services,all adolescent girls interviewed in Garoua,showed preference for the Maison de la Femme (an institution of the Ministry of Women’s Affairs). According to these female youths the staff of this institution are kind, welcoming, receptive and appreciative. During the study, the team observed an impressiveattendance of women at this centre, confirming their preference for this facility. For other social service, many youths felt that the preferences of clients were dictated by their clients’ resources.In their words, ” with more money, one will go to the private clinics,and on the contrary to the general hospital”. Preferencewas alsodictated by whether the servicewas paid for, or inexpensive. Thus,one adolescent male youth in Douala said he obtained a free of charge medicalcertificatein a private clinic;whereashe was charged 500 F cfa for the sameservice in a public hospital. In terms of preference for educational services,for many, the choice of an educational establishment depended on the intelligence of the child, and on the resourcesof the family. Bright children can be sent to any educational establishmentin the country, but dull children requiring more attention and follow up, would have to go sub-standardschools.Beyond this observation, however, some women showed preference for public or Government schools, arguing that government teachers received better professionaltraining and regular salariesthan teachersin the private schools.Hence they may provide better quality education. In Garoua, those who prefer sending their children to private schools(amongstwhom were Gambai women), joined together with some male informants to decry the ills of teaching in public schools,” a child can easilyspend an academic year or at best a school term in the house without homework corrected by his teacher.Worsestill, children are often sitting on the floor in public schoolsbecauseof the lack benches. Parentsare often askedto pay salariesfor additional teachers etc. Government teachers pay less attention to their jobs, and prefer organising mandatory paid private classesin their housesfor the very pupils “. The youths generally preferred private colleges.In particular, somegirls alluded to the sexual harassment by teachers in the public schools to which some of them have been victims. Although the boys accused the girls for provoking or encouraging teachers to harassthem by the way they dressed etc. in order to win favoursfrom the teachers,the girls saw this as something that should not go unpunished in the private schoolsand institutions. Other arguments against the public schoolsand colleges were that teachersin these institutions, though generally well trained and poorly paid, were lured to teach in many private schools,where better supervision, obliged them to offer better quality teaching, resulting in better education in the private schools.Proof of this is that many teachersin the public colleges are part-time teachers in the public schoolswho generally sacrifice the public schoolsto the benefit of these private schoolswhenever the teaching programmes of both schoolsclash.This 48 Cultures of Populations: Africa is why private schools,especially Christianschoolsperform better than public schoolsin public examinations. In terms of family planning in general and on the decision to have children in particular, the female youths in public or private schoolspreferred mutual consent of the couple, rather than counsel from any family planning service.The adolescent girls were generally aware of Family Planning methods. They named pills, diaphragms, IUD, injectables,vaginal douches for women ; condoms for men. They had heard about the female “condoms” ; they even thought these have not reached Africa as yet. They obtained knowledge of these methods from friends, hospitals, Family Planning clinics, media, magazinesand school program (Lectureson human reproduction). In Douala, of 32 female informants interviewed, only 30% of the girls have visited Family Planning units with their boy friends and only 15% of the girls declared to be still virgins, practising abstinence. Again, in Douala a high percentage of the girls had effectively forced their partners to use condoms to prevent unwanted pregnancies. Many of these girls have heard severalrumours about the negative consequencesof contraceptives methods provided in the respective modern clinics. For instance, they heard that all contraceptivesare dangerous, especially the modern methods. That these contraceptives can render a woman sterile; that the condom is not reliable becauseit can break during sexualintercourse;that intra-uterine device (IUD)can causecancer on the walls of the uterus;that pills render some women fat or thin and make them sterile. Others say the pill is not reliable. The youths gave examplesof two girls who have been on pills and who are now pregnant. The impact of the church was evident in FPin Douala. For instance,the Baptistsadvised their Christiansto be faithful to their partners. In the catholic church, Christiansare told that natural methods (Billings, abstinence, calendar, temperature ) are the only canonical acceptable methods. Most often, all the preachers preached the virtues of having more and more children as the bible commands. Even though, the Catholics have revised their vision on marriage making companionship more important that having children, its teaching on population issues is still basically natalistic. We may observe that generally, the merits of family planning as understood by the youths are severalsuch as the reduction in constraintson education, on feeding, health, clothing etc. This is because as the youths want to live a better life than that of their poor parents. As the youths become exposed to and aware of the costsof education, health and nutrition, they desire fewer children than their parents. Thisfact may help explain the favourable responseof youths to family planning rather than the impact of family planning servicesper se. Information providers Family Planning Units are numerous for all the sitessurveyed. In 1990 government initiated officially 10 FPcentres in the Northwest province and today there are over 73 FPcentres in the 49 Cultures of Populations: Africa entire province. In 1995there were 52 centres,and 73 in 1997.The Northwest SpecialFund for Health has been active in the acquisition and distribution of contraceptives.Today,the province hasan overall coverageof 60.3% where the 73 sitesprovide servicesout of 121functional Health Units. The province has an estimate of 424,567 women of reproductive age and the contraceptive prevalence showsa constant increasein the demand for services( Goghomo, 1997).All these centresare supposed to provide information on FPto the populations. Health Units provide general information on FP activities. Relevant information on family planning is given during seminarsorganised by some medical staff,and primary and secondary schools.Severalinformantsalso learn about family planning and FPmethods over the radio, television, magazine and from friends. General male resistanceto Family Planning methods was reported . In all female groups it was said that most of their husbands did not attend FPwith them, even if they were informed before hand. If the level of exposure to FPin some rural areaswas reportedly low, it is likely to be a problem of information flow. Thus, during our discussionsand interviews, one woman in Lainde ( rural Garoua ) remarked that she did not know that FPmethods were less.” After the birth of my child, I will choose a more effective methods. I need some rest “, she promised. SOCIALSERVICES AND SOCIO-CULTURALINFLUENCES Generally, socio-cultural factors have a certain influence on the difference between the availability of social services,the use and satisfactionthat can be derived from them. In health education the cultural dimension occupiesa more important place in the rural than in the urban area. The analysisof people’s responseshave permitted the understanding that there are different options offered to the populations whenever they have health problems. They have the choice between the traditional highly diversified therapeutic network ( marabou, healers, ancestors,diviners....)and the modern health system,clinics,hospitals,health centres, etc. Thus, the population uses the representation they make of the different diseasesand traditional therapeutic means on the one hand, and their perceptions and representation of modern health infrastructure on the other hand. The FocusGroupsDiscussions,establishedthat in the Centre Provinces,especiallyamong the Beti, the causeof infertility of a woman for example, can be attributed to an act of disobedience during the marriage ritual which demands that the newly wedded should run and crossthe first river before looking backwards ( cf. infra). This belief would prevent a sterile woman from consulting a modern gynaecologist. According to tradition, she must undergo a purification ritual to render the woman fertile. 50 Cultures of Populations: Africa Among the Islamic fulbe in the northern part of the country, most patients in rural areas come to health centres generally at a critical and terminal phasesof their illnesses.They would have initially consulted different healers and marabou. The death of the patient in this case is translated asthe will of God. Thisbehaviour could be at the origin of the low rate of visitsto the health institutions in the rural areas. The experience of the patient and his therapeutic knowledge ( representation and perception) have a significant impact on the rate of visits to modern health facilities. Another cultural aspect,which also has influence in the effective demand for modern health institutions is the use of local language as means of communication. Being uneducated, the understanding of English and French in rural areas, the languages frequently used by health providers on the target population, is not common lot to local populations. In the northern region, for example, the knowledge of the local Fulfulde by a health provider is unavoidable. All the focus group discussionsthat the researchteam conducted both in the rural and urban centres, with the exception of Islamic youths, would not have been possible without the assistanceof a local interpreter. In the Northwest province the same problem existssince the language of communication frequently used is Pidgin English.Thus,language is a cultural aspect that needs to be taken into consideration. With regards to education, the part of the country where culture still exertsstrong influences on the rate of schooling, are the northern provinces( Adamawa, North, and FarNorth provinces). The problem is more seriousamong girls where local cultures see the destiny of girls in wives and mothers.. Of the 14 girls ( 15-25 years old) interviewed, only two had gone beyond the primary school. All were married and although four were divorced, three had remarried. Besides,parents for the most part, traditionalists,prefer Koranic schools( which are linked to the Moslem faith ) for their children In a more general way, the socio-culturalimportance of servicesand information coversmany aspects,which for better understanding need to be placed within its social context. POLICYAND PROGRAMME RELEVANCEOF THEFINDINGS In order to addressthe socio-culturalfactorsin population policies and program formulation, the resultsof this study have adequately shown that the effective outcomes depend to a large extent on the implications of socio-cultural variables. The main results of this study can be summarisedto highlight how these results can assistin the designing and implementation of policies and programmes. For population groups Individual interviews and Focus Group Discussionscarried out with men and women of 51 Cultures of Populations: Africa different age groups in the principal study sites(Yaounde,Douala, Bamendaand Garoua)have led the team to conclude that the perception of population issuesand problems is the function of age group and cultures.The ideas and beliefs that people have as socio-culturalfactorsaffect the demographic behaviour of the different ethnic groups and cultures. The perception and treatment of suchissuesas marriage, fertility, bride-price, virginity, age at first sexualintercourse, circumcision,matrimonial regime (polygamy or monogamy),sexualeducation of young children, family planning, the knowledge of contraceptive methods, hot water massage,birth and death rites, varied considerably. Residential pattern also has an effect on the demographic behaviour. When people migrate into the towns, they tend to disregard some of the cultural norms and practicesstill in force in their rural villages. Among the Bantus,there is a fairly liberal attitude to sexual activities. Virginity and other practicesthat take away a woman’s fertility rights are uncommon among most Bantu groups. The proof of fertility is a fundamental condition for a marriage, therefore, concubinnage or trial marriagesare common among the Beti ethnic groups ( Ewondo, Eton, and Bulu). The problem of early marriage which is common among the Sudanesegroups of the northern provinces where adolescent girls are married off even before they reach 15 years of age. Any policy or action against early marriage will definitely affect some sub-cultures of the Sudaneseethnic and linguistic group. Many Bantusand semi-Bantusethnic groups do not generally permit early marriages and they represent more than 50% of Cameroon population. The circumcisionof boys is a common practice among all major cultures of Cameroon. Most cultures circumciseboys while they are still young while the Pahouin -Bantu sub-cultureswait until the boys turn 5 or perform circumcisionbefore the boys get into adolescent years. Some sub-cultures( Banyang) within the Bantu groups practice FemaleGenital Mutilation (FGM)and one sub-groups ( Arab-Choa)within the Fulbe cultural enclavedo not only practice FGMbut also infibulation.. The hot water massagewhich seemsto be common among all Bantu and semiBantu groups, poses serious problems to nursing mothers during the one month following delivery. Informantsprovided information, which showed that many nursing mothers have been brought to hospitalsin a seriousstage of anaemia, or profuse bleeding. Thisvariation in demographic behaviour of Cameroon populations requires that the population programmesand policies be conceived with this in mind in order to achieve the expected resultsor outcomes. On the basisof the results, the study can only suggestthat putting in place of population policies and programmes must take into account customs,beliefs and practicesof the different cultures and sub-culturesof Cameroon populations. 52 Cultures of Populations: Africa For programme managers Service Providers At the level of serviceproviders the findings demonstrate a number of inadequacies : a) the collection and stocking of information ; b) religious conviction asa constraintto family planning ; c) masteryof local languages and culturesin health delivery and d) need for in-servicetraining. In almost all the family planning centresvisited, the serviceproviders complained about the lack of training seminarsfor staff at the local level. Usually,one or two personsare selected and trained in Yaounde. Although, the logic is that they will passon the knowledge to their colleagues, this never happens. The personalisticapproach to knowledge in most Cameroon cultures does not enhance knowledge sharing. Knowledge is power and he who has it usesit for his own prestige and aggrandisement. To presume that knowledge is passed on is an illusion. Knowledge, authority and power are critical concepts that cannot be ignored in the delivery systemof serviceproviders. The recording of information in forms designed by the Ministry of Public Health is not systematicin all Family Planning Units throughout the national territory. There are so much discrepanciesand disorder that only researchershave to figure out things for themselves.While the Ministry is consciousof the necessityto keep statistics,the processlackssupervisionfrom the centre. The units on the periphery ( provincial and district services)can perform their functions effectively if the centreswork closely with them. Although, policy documents make allusion to the necessityto adapt to local cultures and customsof the different regions in the provision health delivery, many health providers continue to function as if their own culture was the centre of the universe. Interviews conducted among health providers, indicated that these tend to judge the local people as ” uneducated, lazy, uncivilised, too traditional “. Such ethnocentric value judgements do not augur well with the open-mindedness that should characterised health providers. Although using trained local people in providing health may seem to be a solution because these would know the local cultures, attitudes and practices, such an action will fit well into the policy of national integration which seeksto foster great feeling of nationhood among people who are ethnically diverse. The teaching of a basic course on culture in our nursing and medical schools is seen as a necessity. Policy makers must be aware that there are thousands of Cameroonians who object to modern family planning for personal or religious reasons.The screening of personnel for Family Planning units is important to render the program effective. Data collected among health providers shows that many provided only those methods that posed no seriousproblems of conscience. In one FamilyPlanning Units, we interviewed three nurseswho work in the unit. All of them were against modern family planning methods. One had resigned because she was 53 Cultures of Potmlations: Africa convinced that prescribing modern contraceptive methods was against her religious convictions. Many Cameroon local culturesare against voluntary abortion and nurseswho come from such cultures have been found to remain faithful to their traditions than to violate it. One informant-nursehad this to say : ” some of us are working here against our religious convictions.We are working here just to earn a living to feed our families...We prefer the natural family planning methods: abstinence, Calendar method, Billings, and prolonged breast-feeding. If we prescribe modern methods may God forgive us ‘I. The main obstacle to family planning may be the service providers themselveswho carry out religious crusadeswithin the units against the goals and objectives of a defined policy. While it is important to include social and cultural factors in the training of health providers, it is equally important to respect their religious and cultural convictions.The whole issueof ethics emergesas critical. Information Providers In all the family planning servicesvisited the level of collection and conservationof statistical information is a weak means.In addition, the sametype of information is not collected in all the family planning centres though it still falls under the direction of Familyand Mental Health of the Ministry of Public Health. It makesone think that each family planning servicehas its way of collecting information on the clients. Certain centres use official registers received from the Ministry while others register information in ordinary registersdrawn up manually. Bad conservation and the absence of a systematiccollection of data have constituted a big handicap to this work. At first we had drawn a list of data to be collected made up of the following: name of client, ethnic origin, age, matrimonial status, level of education, Religion, profession and family planning methods. This information was not collected in some centres becausethey were not available. For Policy Makers The study revealed some traditional harmful practices that deserve the attention of policy makers.Thesefindings showed that the practice of hot water massagewas common among a majority of Cameroon sub-cultures. Also early marriage seemstoo common among Moslem groups in North Cameroon. Also, Female Genital Mutilation was found to be practicesonly in two ethnic groups, namely, among the Banyang in the South Westprovince and Arab-Choa in the Far North province. How can this knowledge lead to policy design or formulation? The hot water of massage: After birth, the mother is expected to undergo one month of daily hot water massage,designed to expel ” bad blood ’ and maintain her form and attractiveness.Although this is widely practised, many mothers have been rushed to clinicsand hospitals for excessivebleeding after the massage.Despitethe creation of awareness seminarsorganised over the last years for community leaders and paramedical personnel on the disadvantagesof 54 Cultures of Populations: Africa massage,this practice is instead being intensified. To this effect policy makers must organise a big national medical and social sensitisationcampaign on the dangers of post-partum massage. Early marriages: Earlymarriage of young girls (often before puberty) is common among the Fulbe of North Cameroon. We interviewed many adolescent girls with an average of 2 children who said they were married before they turned 14. The oldest in the group was 17 years old. Most of these young mothers didn’t present any physical signsof good health. Spacing out and limiting of birth are practicesthat the population acceptswith a lot of difficulty becauseof their religious convictions. Somedata show that the mortality rate is high among adolescent mothers than among adult mothers (1998 DHS : 172). Policy action needs to be taken to prevent early marriage by raising the legal age to marry from 16 years to about 18 years and make it punishable any marriagescontracted traditionally before this legal age. Policy makersmust in accordance with cultural and religious authorities of various cultures take emergency measuresto enforce the respect of these human rights. DATA COLLECTlON,COMPILATION AND ANALYSIS FOR IMPROVlNG THEKNOWLEDGEBASEOF THELOCAL POPULATION DATA COLLECTION The collection of ethnographic data implies working with people over long periods of time. Gaining their confidence and trust enhances the quality and volume of data. The qualitative methods expand from participant observation to extensivenote taking with the choice of informantsare critical methods of data collection. In the courseof this study, it was important getting close to people and making them feel comfortable enough with our presence, thus permitting usto observe and record the information and the findings presented in this study. By establishing rapport with the people, we were able to talk to them about sensitivetopics, suchas choice and mating patterns in different cultures. Thisstudy used Rapid AssessmentProcedures(RAP) which permit researchersto collect relevant information or data within relatively short periods of time instead of prolonged periods in the field. Armed with the interview schedule and guide, the researcherswere able within five weeks to visit eight family planning units in four provinces and interview over 150 informants from 57 ethnic groups representing both urban and rural populations. Using the RAPapproach, the researchhad a checklistof questionsand data to be collected. In order to reduce reactivity, we used a whole network of personswe knew or identified before the field study,who became our entry points into the different communities visited. We spent time getting to know the physical and social layout of the different communitieswe visited, before the actual interviews started.As a golden rule, we had to be honest, brief and consistentwith whatever we were doing. 55 Cultures of Ponulations: Africa It was important to have explicit awarenessof the details of cultural behaviour. The researcherswere therefore trained to build the skillsof observing details of behaviour in all the places (health centres,hospitals, clinics,people, etc) becausethese details were vital in understanding certain behavioural patterns. Thiswas to be exceedingly important in the choice of key informants. Good informants, the researcherswere taught, ” are people who can be talked to easily, who understand the information needed, and who are glad to share it with the researcheror even get the information for the researcher ” (cf. R. Bernard, 1994 :166). This permitted the research group to choose the informants strategically by considering the structure of units visited and the content of the inquiry. Only informants who could talk to us knowledgeably about the reproductive health and who could discussdemographic issuescompetently. The above approach to data collection was also applied to obtaining data from service providers. Not all were willing to provide uswith accessto the information. Somewanted to collect the information and have us pay for it while others were pleased, when their Family Planning Unit was chosen for the study. Being part of the sample was an honour to some of them. For this category of service providers, they wanted to see themselvesreflected in their study as having contributed to its realisation aswell as having a share in the findings. The credibility of data usually depends on the control or masteryof the local language. In each of the site, we used the languages well known to the informant and whenever it was possible, the informant expressed his/herself in the local language and a research assistant recruited on site served as an interpreter. When the researcherknew the local language, the informant was elated. Speaking the local language further strengthened or enhanced the rapport between the researchersand the informants. While it is expected that data is collected under the best of conditions, a number of social, psychological, climatic and political conditions sometimesemerge unexpectedly . In Garoua, the study took place during the hottest month (March) when temperatures are generally between 34-40 C, made it uncomfortable for the researchers. Compilation and Analysis of Data In qualitative analysis,the researchlooks for patterns in the data and ideas that help explain existing behaviour.Thissearchfor patternsoften begin before the actualfield work, and continues through the researchprocess.In the course of the present study, we began on a premise that in many population activities sub-culturesare often not taken into account in policy formulation, design and implementation. The implementation may run into obstacles,which could have been avoided, had suchvariablesbeen taken into account. While it was important not to accept uncritically data collected from informants, the informantswere largely responsiblefor determining the emerging patterns. The searchfor consistenciesand inconsistenciesamong key informants, and finding out why informantsdisagreed, the analysisof the data was largely motivated by the desire for constant validation of the information collected. 56 Cultures of Populations: Africa In the presentation of the data, we haveattempted to make the text come live by using direct quotes of informants. Suchanecdotes and commentsof informants avoid excessiveanalysisand leave the authors (informants)to express themselvesverbally. Such quotes also illustrate ideas and patterns emerging from the data. The importance of quantification of qualitative data is highlighted by the number of informants whose qualitative data forms the core of this study. To a certain extent, the ideas and patterns analysed in this study really belong to the informants who provided the data or information. Thisexplains why many of our informants expressedthe desire to be informed of the final outcome of the study. For them, organising a seminar in the various sitesto share the findings with them will be beneficial. Participatory Research Participatory researchinvolvestwo main categoriesof actors:the researchersand the respondents (participants). The importance of participatory research draws from the willingness of respondents (or participants) to collaborate with the researchersto optimise research as an activity, in terms of scheduling interviews, selecting appropriate respondents, time, place and calendar of activities. This is done to such an extent that the best resultswould be obtained under the worst conditions. Suchresearchidentifies and enhancesthe opportunities offered by each category of actors towards attaining an end. In terms of attitudes of the informants towards the researchteam, the following observations were made: The siteschosen for this study were sitesused by similar studies before. The informantswere curious to know the progressto date. Somesitesmay be considered having reached relative saturation and the researchinquiry processeither bores or excites informants. It bores when previousresearchershad failed to sharetheir findings with the local communities; it excites informantswho were not involved in previous studies.Generally people are happy to be part of a study if they are properly motivated by the objectives and goals of the study. Informants are authors of ideas and concepts analysed by researchers,and the collection of data should consistently record the namesof informants, aswell as the date, place and time of the interview. Such good recording of data from informants could be cited verbatim to illustrate an idea or a concept. The inclusion of the names of all informants involved in the study further strengthens and enhances participatory approach. When informants participate in an action-researchor researchdesigned to provide solutions to problems, their participation should be enhanced by meaningful sharing of the findings. One of the most effective methods of sharing findings is to organise ” local or village seminar I’. The community in which the study was conducted is informed of the date, place and time when researcherswould return to conduct a workshop and discussthe findings of the study.Thisprocess permits researchersto either validate the findings or collect additional information on the subject under study. 57 Cultures of Populations: Africa Observationsof local parficipanfs at sites,as to how they see, or would like to see themselves in statistics,i.e. how participatory research involves the local population. Informants’ perceptions or projections of themselvesin statisticsare composite and loaded with many reactions.A difference is establishedbetween the informant asan individual, and the sameinformant as located within the structure and hierarchy of decision making in his group of reference. In order to carry out FCD,we effectively proceeded by a head count and differentiation of informants by ethnic group. Thisprinciple conveyed the idea of statisticsto the population whose knowledge of strict quantitative data to an extent, is well established.Thus,the FG conveysthe idea of sampling to the informants, and therefore of the informant as a statistical value. But the conceptualisation of the trends like the majority and minority equally integrates both statisticaland sociological implications and components for the informants; and these will affect informants’ understanding of researchfindings. We observedthat for many,their participationwassynonymouswith representingthe individual directly contributing to policy and decision-making. A feeling that is strengthened from the choice of one’s residential quarter to the choice of the informant asa participant etc. Within this logic, the inability of some traditional rulers to organise FocusGroup Discussionsin their areasof jurisdiction, could well be interpreted as resulting from the difficulty of perceiving researchas that resourcewhich permits participation in the decision making process,and could therefore be generally inscribed within the chief’s difficulties in the management of rental positions he could otherwise have accessto. The collection of data during the FGdiscussionsper ethnic group equally was understood by many informants as presenting them beyond simple statisticalreferencesto include representatives of a culture, sub-culture or at least a socio-cultural background nation-wide, rather than limited to that site exclusively.Thispermitted us to establishidentities in line with the objectives of the study between individuals of the same ethnic group, yet residing in two distinct and different sitesas well as the influences of cross-cultureson the participants, as we moved from areas of ethnic predominance per group. This idea of the choice of leadership and, or “representativedemocracy”, finds its roots in these perceptions. Thus,a group would be represented by one or severalpersons,whose decisionswill bear on the group asa unit. For instancethe men decide generally on issuesof procreation. Questions covered by our study as already known include issueslike couple fidelity, the decisionsto procreate, etc all which touch on the mechanismsof decision-making amongst the severalcultures and sub cultures we studied. For instance, if a monogamous male respondent admitted in front of his wife (in the same FC)that he has sex a number of times per week less than the number declared by his wife, what do these statisticsrepresent ? error, memory failure, infidelity, or lies ? In the execution of the study therefore, the researcherhimself is a resource. 58 Cultures of Populations: Af’rica The final answer he takesdown representswhat is no longer challenged by the FG,or a landmark that could therefore be quoted as the truth. From another dimension, a single male in a polygynous household is the statisticalminority to his wives and especially wives and children. But he is the person who takes decisions on procreation, education, attendance to FPservices,binding on the family asa whole. His position will determine reaction to population policies at the micro level by his family. For instance, that no parent teachessex education to their children is not synonymouswith ignorance, or with the acceptance of low sex morals from their children as a result. If aswe earlier observed, bride-wealth transfersnot only the woman’s fertility but equally her decision-making role to her husband, then objectively her empowerment and value seen as a statisticalreference for the study, will not matter much in relation to decisions on procreation even in polygynous settings, but devolve onto her husband. Bride-wealth will transfer even her economic empowerment, to the extent that many married male informants generally did not take their wife’s income contribution in the household statisticsinto consideration. What we can call the quotient of “anonymity”, generally will increasefor the woman in direct proportion to the bride price paid for her. For one’s children too, it will increaseas they reach adulthood but do not contribute to the family income. Both categories of persons therefore remain “social minors” their propensity to take decisions, and therefore to be taken as a statisticalreference, falling into the hands of the adult males. For instance, among some groups, children whose motherswere not exchanged for bride price, will be named or given in marriage by their grandfather. Thus, women’s empowerment culminating in her opinion as a statistical reference, appeared to be incompatible with the payment of bride-wealth. Evidencefrom the field indicatesthat wives will talk lessin front of their husbands,or children in front of their parents. Do they therefore have the samestatisticalweight in termsof the answer they provide to our questions?Thiswould explain why we divided the focusgroups into six subgroups to optimise generational participation of the different categoriesand socio-professional backgrounds of informants. The practice of “two-stream-householdheads” is equally surfacing and gaining ground with a visible impact on the decision-making structure and functions of many ethnic groups. Thusthe eldest person in the household (father or uncle) plays the role of the referee on matters of procreation, because he has the authority and experience. However, the real household head will be the person with financial resourcesto cover expenseson the education, health, unwanted pregnancies, STDsetc. of members of the household. If these researchfindings will contribute to policy, but are drawn from the answersof informants,therefore, the informants are effectively those personscontributing to that policy. Hence who should havethe prerogative to answer the question ? The elders, the adult males,or persons 59 Cultures of Populations: Africa who havebeen initiated etc For instance,any answersgiven by the chief will be taken for granted as correct, since the chief is the custodian of tradition. Personswho felt submerged by the focus group participants, effectively thought themselves asbeing anonymous,a fact, which equally contributes to discouraging potential informants,and therefore their statisticalcount in the findings. One concern for qualitative data, remains the identification of persons whose answers are finally listed by the researcher.Thus, subsequent personal in depth interviews established that the answers of some categories of persons did commit the responsibility of the group because of their social statusrather than the empirical numbers of the Focusgroup members.Therefore, position and socialstatuswere valuable references that explained the potential for statisticaland quantitative bias in favour of qualitative analysis.The answer to each question is loaded with severalconsequenceswhich requires some form of responsibility towards the group. Consequently,any person who answersa question that tended to commit group responsibilitywould provide proof of his resourcepotential or capacity required to match that commitment. The researchteam as well as their answersare themselvesa resource. Information obtained from the team could modify the alliance systemsof respectivemembersof the FocusGroup, (like legislation on inheritance in polygynous homes),by either deepening the existing social stratification, or raising conflict between those who will have accessto the resourceas against those the resourcewill marginalise.A clear understanding of all of the above, we believe, would help to provide understanding informant within statistics,and equally help in a better understanding of participatory research. CONCLUSIONSAND RECOMMENDATIONS Throughout this study, the objective hasbeen to bring out the socio-culturalfactorsthat affect the demographic behaviour and their implications on the formulation and implementation of population policies and programmes in Cameroon. The study was realised around a group of about 198 informants representing more than 57 cultural or linguistic groups. The study has identified sub-cultures and the most important socio-cultural factors that provide a better understanding of the different forms of the demographic behaviour and that possibilities of change exist. One objective of population policies strives to march population growth with available resources. The lowering of fertility rates or keeping them within manageable proportions remains the desired goal of policy-makers and programmes managers. The Government of Cameroon has enacted a number of policy instruments. Evidenceobtained from this study indicatesthat there is low awarenessof key socio-culturaldeterminants of fertility by policy-makers. Thesedeterminants can be classifiedin the following broad categories: 1)the value of the child, 60 Cultures of Populations: Africa 2) the maritalsystem,3) riteslinked to births, 4) taboos and finally fertility decision-makingprocess. 1) The value of the child : the child representsthe immortalisation of a couple, a source of social security for the parents at old age, and the re- enforcement of cultural values. Fertility is considered one of the greatestvaluesin all culturesand sub-cultures.The greatest goal of most women is to have a baby. Children add value to the union in many cultures. In all the ethnic groups studied, sterility is a tragedy that can lead to divorce and witchcraft. Since sterility is such a tragic cul de sac, it is even more tragic for a woman whose physical proof is self-evident becausesome cultures provide outlets for fatherhood. 2) The marital system : We observed in the study three forms of marital unions : monogamy, polygyny and free unions. Marriage is recognised asa social institution that confers socially sanctioned paternity to men and maternity for a woman. Bride price exists in all Cameroon cultures and sub-culturesas an essentialand indispensable component of the legitimisation of a marriage contract. But the amount of money desired and associated social demands differ from culture to culture. Aware of the implications of this social contract, most educated women agree to organise either a traditional, civil or church marriage or all three in order to re-affirm the importance of marriage and guarantee a bundle of rights that accrue to legally wedded couples. Polygyny is recognised by the law, which protects the rights of each spousein event of the death of the other. Many women interviewed in the study did not seem to be fully aware of the contents of the laws regulating polygyny. Informantswho grew up in polygamous homes are opposed to the practice and wished it were further regulated. Polygamy,which used to serveas statussymbol, is today progressivelyfading out for severalreasons: a drop in infant and child mortality and increasein the survivalrate of children. Also statussymbolslike cars,good education and modern prestige have replaced the high statushitherto conferred upon a man by many wives even for groups where polygyny is prescribed by religion such as Islam. On the other hand, free unions, with an impact on reproductive health, were also observed. Bride price and the responsibilitiesassociatedwith marriage and the desire to experiment the marriage processwith a willing partner before, largely explain the prevalence of this practice. Theseso-called” trial marriages” are found among the Beti ethnic groups where having children before marriage is the culturally prescribed route into a formal marriage. A majority of adult informants considered divorce as a disruptive element, many women prefer to remain in their marriage homes provided they can accommodate their problems. Therefore, although the principal causesof divorce were ” forced marriages ” and sterility, polygyny was always the preferred solution whenever breaking up an established union was likely. Among the Bulu a woman who failed to have a child in marriage could be replaced by her sisterso that the woman can bear a child for the husband of her sister. 61 Cultures of Populations: Africa 3) The respect of birth rites : The respect of fertility rites indicates pro-natalistic behaviour for many ethnic groups. Proof of virginity was seen to be fairly synonymouswith proof of fertility. Thus, the bride price for a virgin is higher than for a non-virgin. Bride-wealth itselfvariesin amount, value, and the process.Forpartilineal groups, however, it represents the socialtransferof fertility rights from the woman’s lineage to that of the man. Although bride price is relatively insignificant among matrilineal groups, it confers on the woman’s lineage the dignity and pride of having brought up their daughter to be formally taken up as somebody’s wife. Becausethese cultures believe that the main function of the woman is procreation, many practicesare performed on her towards this end. Thus, hot water massage( after birth) is believed to expel all the ’ bad blood “, maintain her stomach flat and in shape, make her more beautiful and attractive, and thus prepare her for the next pregnancy. Equally,although FemaleGenital Mutilation (FGM)may deny the woman the pleasure or enjoyment of sex, it will prepare her for childbirth. 4) Several taboos exist which equally indicated pro-natalistic behaviour. Birth spacing and abstinence,are a function of cultural perceptionsof how they affectbirth. Thusbirth spacing beyond two yearswas practised by many ethnic groups. But longer periods are preferred becausethey prepare women for the next pregnancy, until they reach menopause. Decisions : Family Planning is equally affected by the structure of decision making in the family. Although rational population policies require the couple together should handle fertility problems, the study showed that fertility decisionswith regards to the number of children were largely taken by men. Generally,women in most sub-cultures are considered ” minor “. This attitude negatively affects women empowerment. For instance,they do not havethe right to inheritance and succession.Furthermore,their voices cannot be heard when fertility decisions are made. The empowerment of women at all levels,especiallyin the domain of reproductive health, will certainly influence demographic behaviour. This means that innovative Family Planning policies should target both men and women but in differential ways. Sincefertility decisionsin virtually all ethnic groups are in the hands of men, population programmesand policies must target the men. 5) Fertility The study showsthat age at first sexualintercoursevarieswith gender and residence. On the whole all males interviewed for this study stated that they had their first sexual intercourse between the age of 17 and 20 years while the women reported having had their first sexual experience between 14and 16years.Firstsexualintercourse occurred between 13- 18yearsfor female informants in the Centre province, while for informants in the Northwest and Littoral provinces, it occurred between 16-20. Those from the North declared having their first sexual intercoursebetvveen12-13years.On a gender basis,boys had their first sexualexperience at the age of 16 and between 14 and 18 for the girls. 62 Cultures of Populations: Africa Although, most informants attached high value to virginity in the past, it was still being regarded and rewarded in marriage among the islamisedFulbe and Sudaneseethnic groups. Youthsliving in the urban areaslose their virginity much easierthan those in the rural areas;they are more exposed to risks than their rural counterparts. The study noted the Moslem females reverseof age in the first sexual experience in girls in the North. Many Moslem girls who are educated run more risk of losing their virginity because marriage is delayed while they cannot delay sexual gratification. The frequency of sexual intercourse varies according to age but the highest frequency was registered among Gambai,found both in Chad and Cameroon,where all the informants agreed that coitustwice a day, every day was normal. All culturesfor variousreasons( taboos, witchcraft, health, ) limit sexualintercourseat certain times and periods ( during Ramada,mourning, menstruation). . Sex education is still tabooed by most parents in all ethnic groups. They claim that it is a difficult subject to handle with their children. Most female adult women said they would prefer to talk to their girls to put them on the guard against unwanted pregnancies. Most parents prefer to leave this responsibility to their children themselves,or to the teacher at school. The data obtained shows that Cameroon ‘s relative political stability attracted many people from different countries to visit and live in Cameroon. The majority of them come from Nigeria, Chad and Central African Republic. Among the Cameroonian ethnic groups, the semi-Bantu (Bamilekes,Tikars,Bamoums)havea high propensity for internal migration. The reasonsbeing that the savannahregion from where they originate is densely populated resulting in land scarcities. The distribution of socialservicesis not equitable. Health centresand schoolsare concentrated in urban centres to the detriment of the rural areas. We found three teachers for a classof 60 pupils in Yaounde and two teachersfor a whole school of 300 pupils in Messamenain the East Province. Public social servicesare rated poor by all categories of informants. They decry the plethoric numbers of patients in hospitals and pupils in schools and lack of equipment in schools.Generalisedcorruption has further exasperatedthe situation. Teachersand principals of schools,openly exploit parents and their children. Parentsuse their professional and financial power to gain admissionfor their children into public schoolsand colleges where tuition is free and education expensesmuch lower than in private schools.The poorly paid or motivatedteachers prefer to teach extra hours in private schoolsthan dedicate their time and energies to the public or state schools.The irony is that public institutions have the best-trained personnel with the least motivation. According to statisticsfrom the Ministry of National Education, there are 457 public and private primary schoolsasagainst 423 secondary schoolsin Cameroon in 1997/ 1998.The dominance of boys in both primary and secondaryschoolsshowsthat culture still hasa great influence over schooling. Parentsstill prefer sending boys to schoolsthan girls. In the North many sub- 63 Cultures of Populations: Africa cultures still regard young girls as destined for marriage. So they believe that the education of girls get from Koranic schoolsis good enough. Of the 14young girls (14 -19)interviewed, all had gone to Koranic schoolswhile only two had gone beyond the primary school level in French, yet all of them were married at the time of the study. Although health centresprovide basic health care, virtually all informants in all the four sites had negative opinion about them. Poor reception, corruption, lack of basicdrugs and negligence characterisedthese health institutions. Someinformants said ” patients have become goods and the doctors the buyers “. In these health centres, better serviceswere provided if the health providers was promised financial rewards over and above the authorised fees. Both corruption and professionalstatuswere the currency at such centres. Missionhospitalsand clinicswere preferred to public institutionsbecausehealth carewas better there and medication more affordable. Accessibilityto health servicesin the urban areasis easynot only becausethe centre iswithin walking distance for some people but also because transportation is available. A majority of health centres in the rural area are situated severalkilometres from the majority of users.This limits accessto them. Transportation is difficult and most patients have to trek for kilometres if they have the energy in order to accessto health servicesin rural areas. Familyplanning units located in health centresalsosufferfrom difficult accessdue to distance, transportation difficulties, poor quality of services,and the economic weaknessof women, who, coincidentally, tend to be in the greatest need for health services.This study examined the records of eight FamilyPlanning Units ( 2 per site)and found that 99% of the clientele is female. Thus, male involvement in family planning is almost non-existent but the evidence from this study shows that men make fertility decisionsnot women. Most sub-culturesstill propagate the belief that ” bride price ” gives men full control over a woman’s fertility “, yet Cameroon’spopulation policy statesthat both partners have equal rights in fertility decision making. This is a contradiction or a failure to acknowledge the overriding influence of cultural values in Cameroon’s health system.Although young people argue for open discussionson sexuality, they are frustrated when their parents fail to share similarviews. The study found that for religious and cultural reasonsserviceproviders in all the siteswould not provide modern family planning methods. This situation prevailed as long as they did not believe in it or family planning was considered to be against their religious and cultural beliefs. There is no doubt from this study that ideas and beliefs or socio-cultural factors affect the demographic behaviour of people. Designing policies that take into account ideas and beliefs about marriage, fertility, virginity, the matrimonial regime, effectivenessof modern health system and different STDswill have significant impacts in lowering fertility rates. Ignoring the cultural and religious background of service providers in policy formulation can produce significant negative effectsand prevent policy from achieving the stated goals. 64 Cultures of Populations: Africa RECOMMENDATIONS The foreseen perspectivesand strategiesat the end of this study is written within the framework of global action which takes into account the socio-cultural dimensions of demographic behaviour. Four dominant sectorsmerit to be retained here as the framework of intervention for recommendations. Information and Sensitisation (different population groups and service providers) taking into account attitudes and socio-cultural and regional views a) There is need for the sensitisationof the different populations without ethnic and regional differentiation on the consequencesof traditional therapeutic practices with regards to hot water massagethroughout the whole country b) populations on the traditional discriminatory or harmful practiceswith regards to young pregnant girls and women more especiallyin the northern part of the country. For example traditionsthat confersthe role of wife and mother on the girls, the practiceof female genital mutilation, non-education of girls and food taboos which may have negative consequences on the health of the mother or early marriage. c) population with special emphasis in the rural areas on the principle of family planning and its advantages to reproductive health because this concept is very often reduced to limitation of births ; d) health service providers ( family planning) and other social sectorson the necessityof taking into account the socio-culturaldimensionsof patients or clients ; e) associationof traditional birth attendants and other village leaders in the different sensitisation campaignsafter training ; 2. Re-enforcement of local capacity and the institution of an integrated organisational system ( health information and school establishment) a) Integrate family planning serviceswithin the country’s health structures.Thisincludesspecial emphasison private health institutions especially in the northern provinceswith emphasis on counselling for both men and women) b) associatetraditional birth attendants and other healers in training workshops of health personnel of the Ministry of Public Health ; c) integrate the socio-cultural factors of reproductive health and their implications in the health delivery systeminto the training program of serviceproviders: d) take into account socio-cultural variables by service providers and their place of work (aboveall in the north provinces)in order to avoid the communicationdifficultiesor religious barriers) according to ethnic group and sex. 65 Cultures of Populations: Africa e) work for the integration of traditional educational systems( Koranic schools) into the mainstreamschool system. f) put a public-private co-operation systemin the domain of health into place to the extent where the majority, if not, the totality of private health institutions do not have Family planning units ; 3. Improvement of the Quality of service within social services and their adaptation to the socio-cultural context a) Elaborate health and education policy design to satisfythe needs of the population and clients, during the training or refresher coursesand supervisionvisits.Emphasishas to be placed on the discipline ( moralisation development) of serviceproviders or personnel in order to avoid flagrant casesof corruption in school and health institutions ; b) Enforce the official and standardised fees /consultation (schools,clinics, health centres, official and) and work closelywith the population in its strict application; c) Improve the conditions of counselling in order to preservethe confidentiality of the clients ( especiallythe youths) ; d) Encourage the integration of male personnel into the Family Planning units throughout the national territory in order to encourage the use of such servicesby men ; e) put the best systemof servicesupply of Family Planning into place to avoid the shortage of stocks; 4. The Adaptation of the major juridical. legislative and administrative instruments to the socio-cultural factors which affect demographic behaviour ( marriage, divorce, brideprice, reproductive health, family planning, traditional and discriminatory practices against women, girl-child and pregnant women). This means a political commitment on the part of government in matters of population a) the elaboration of a FamilyCode which will take into account the different ethnic, cultural and regional differences of the country ; b) Regulate and establisha law with regards to early marriages with emphasison the northern provinces, or provide legal instrumentsto fight these customarypractices; c) Regulate the bride-price in order to avoid abuse and excesseswhich often have repercussionson the lives of couples ( especiallyin Centre and South provinces); d) Render more real the spirit of the people ( those of the Northern provinces)the concept of the fundamental right to education ( both boys and girls). In this matter, compulsory education needs to be legislated and enforced to ensure that all Cameroon children obtain at leasta primary school education. Cultures of Populations: Africa BlBllOGRAPHY ACAFEM,1994:The Traditional Practices Affecting the ReproductiveHealth of Womenin Cameroon,Yaounde,ACAFEM,97 l? l Anne-EmmanuelleCalves& Dominique Meekers, 1997: StatutMatrimoniale et Valeur des Enfantsau Cameroun,Coil Dossiersdu CEPED, 223P. l BalepaMartin 6 Al, 1992:EnquCte Demographiqueet de Santedu Cameroun 1991,Columbia,Macro International Inc,. l BANCHAM. W., 1990: Fertility Leveland Differentialsin Cameroon,Legon Ghana, Universityof Ghana, 15p. l BISILLAT Jeanne, 1992: Relationsde Genreet Developpement; Femmeset Societes,ORSTOM, Bondy, 326 p. l l l l l EVINAAkam et ARROGAA-B.A, 1998:Vie Fecondedes Adolescentesen milieu urbain Camerounais,Cahiersde I’ IFORD,No 16, Yaounde,IFORD,117p. l EVlNAAkam, 1990: lnfecondite et Sous-Fecondite; Evaluationet recherchedes facteurs.Le Casdu Cameroun,Cahiersde I’ IFORD,No 01, Yaounde,IFORD,281 p. l +GabyVelghe-Schepereel& PascaleVan De Wouver-Leunda,1996: Profil des Femmeset Developpementau Cameroun, Yaounde, AmbassadeRoyaledes Pays-Bas,183~. l l l CALVES A. A., 1996: Youth and Fertility in Cameroon: Changing Patternsof Family formation, Unpublished Ph.D.Thesis,the PennsylvaniaStateUniversity,UniversityPart. DAVIDN., 1981: SocialCausesof Infertility and Population Decline among the settled Fulani of North Cameroon,ReviewMan, Vol. 16,No 4, pp. 644-664. ELAJeanMarc, 1995: ” Fecondite,Structures Socialeset FonctionsDynamiquesde I’imaginaire en Afrique noire ” in, Hubert G. et Victor P.(sous la direction de) : LaSociologic des Populations, Montreal, AUPELF/UREF, pp. 189-215. EtudesDesConnaissances, Attitudes Et Pratiques DesFillesMeresDe Yaounde,Vis-A-VisDu Planning - Familial, Focap, 1995. l l Gubry Patrick0 AL, Le RetourAu Village, Une Solution A LaCriseEconomiqueAu Cameroun, Paris,I’Harmattan, 1996,206~. KAMDOUMA. et LIBITEP.R., 1995: LesDeterminantsde la Feconditeau Cameroun; analysesapprofondies des don&es de I’EnquPteDemographiquede Santedu Camerounde 1991,(EDSC), DHS,Macro International INC, Calverton,Maryland. KUATEDEFOB. (sousla direction de), 1998: Sexualityand ReproductiveHealth during Adolescencein Africa, (with specialreferenceto Cameroon),Ottawa, Universityof Ottawa Press, 360 p. KUATEDEFOB., 1998: Fertility Responseto lnfant and Child Mortality in Africa, (with special referenceto Cameroon)in : MONTGOMERY M. and COHENB. (Eds),FromDeath to Birth : Mortality Decline and ReproductiveChange, WashingtonDC,National AcademyPress,pp. 254-315. 67 Cultures l l l l l l l l l of Potmlations: Africa KwekemFankam,1993: TendancesEt Facteurs De LaMortalite Aux Ageslnfantiles EtJuveniles Au Cameroun,L’analyseApprofondie Des DonneesDe L’EDSC1991,Calverton,Maryland, DHS,58~. l LANTUMD., 1995: The Sterility Phenomenonof Cameroon,A PluridisciplinaryInvestigation, Yaounde,CUSS. l Latour PradellesDe, 1991: Ethnopsychanalyse En PaysBamileke,Paris,EPEL,1991,262~. MCH/FP: Policyoptions and strategyguidelines in MCH/FPfor Cameroon,Yaounde,MCH/FP, Ilp. Ministere de I’Economieet du Plan, 1983: EnqueteNationale sur la Feconditedu Cameroun 1978.Rapport principal, Vol.1, analysedes principaux resultats,Yaounde.RC. Neba Aaron, GeographieModerne De La Republique Du Cameroun,Camdem,New Jersey,EditionsNeba, 1987,21I p. l l l Minis&e de I’Economieet des Finaces,1997: Annuaire Statistiquedu Cameroun,DNSC,96 p. MINPAT,BUCREP, 1992: Enquete Demographique et de Santedu Cameroun, 1991,DHS,Macro international Inc, Maryland, Calverton,228 p. MINPAT,BUCREP, 1999: Enquete Demographiqueet de Santedu Cameroun, 1998,DHS,Macro international Inc, Maryland, Calverton,328 p. 68 l l NJIKAMSavage0. M., 1998: ” Adolescents Beliefsand Perceptionstowardssexuality ” in KUATEDEFOB. (sousla direction de) , 1998: Sexualityand ReproductiveHealth during Adolescencein Africa, (with specialreferenceto Cameroon),Ottawa, Universityof Ottawa Press, 360 p. POOLLeeB. L. and BongsuiriL., 1986: The Influence of rural-urban Migration on Fertility of Migrants in Developing Countries: an analysis of Cameroondata. (Finalreport for office of multisectorialdevelopment),Washington, Agency for International development. SANTOWG. and BIOUMLAA., 1984: An Evaluationof CameroonFertility Survey 1978,WFSScientificreport No 64, Wooburg, International StatisticalInstitute. TakouoDieudonne, 1997: CriseEconomiqueEt FeconditeEnMilieu RuralAu Cameroun, L’exempleDe Yemessoa,. TARDISC., 1985: ” Aimer, Manger, Danser; Propossur la grande Polygynie ” in, J. C. Barbier (sousla direction de) : Femmesdu Cameroun, ORSTOM/Karthala,Bandy/Paris,pp. 221-300. TCHEGHO J. M., 1991: LaPolitique de la Parent6Responsableau Cameroun: Que peut-on attendre?les annalesde I’IFORD 15 (I), Yaounde,Iford. TEHT., 1992: The Statusof the Cameroonian Womenand ReproductiveHealth in : R.Leke (Eds): Priority needsassessment in Reproductive Health in Cameroon,Yaounde,WHOcentre for researchin human reproduction, pp. 91-103. Cultures l l of Populations: Africa TimnouJosephPierre,Migration , Urbanisation, Et DeveloppementAu Cameroun, in Cahiersde I’lford, Yaounde,Iford,1993, 115~. l UNFPA,1990: Researchon Socio-Culturalfactors affecting FamilyPlanning programmesin developing countries,New York, UNFPA,33~. l YANADavid S., 1993: Fecondite,Familleet Urbanisation: rechercheexploratoire sur deux ethnies Camerounaises,(Rapportde recherche, projet No 89195),programmespecialde recherchede developpement et de formation a la rechercheen reproduction humaine, OMS, Geneve,324 p. YANADavid S., 1995: A la Recherchedes Modeles Culturelsde la Familleet de la Feconditeau Cameroun: une etude exploratoire aupresdes Bamilekeset Beti de la Ville et de la Campagne,Louvain-La-Neuve, L’Harmattan,32 p. 69 Culrures of Populations . ?i e + , <N 4; jc4 DEMOGRAPHICBEHAVIOUR ANDITSSOCIO-CULTURALCONTEXTINMALAWI CharlesD. Chilimampunga * INTRODUCTION T he influence that socio-culturalfactorshave on behaviour isvery important. To fully understand demographic behaviour it is necessarythat such behaviour be studied within its social and cultural context. Therefore a study was conducted on the topic in Malawi with the main objective to gain a more profound understanding of the socio-cultural factors which influence demographic behaviour and to suggesthow best population policies and programmes may be formulated and executed taking into account the different socio-culturalcontextspeople live in. Population Size and Growth The population of Malawi is currently estimated to be about 11 million people of whom about 52 percent are female and 48 percent are male. The age-sex structure of the population in 1987 was similar to that obtained in 1977.In 1987,about 46 percent of the population was aged lessthan 15 years, 50 percent were aged 15-64years and only 4 percent were at least 65 years old. The population of Malawi increased from about 737,153 (de jure) in 1901 to 7,988,507 (de facto) in 1987 (Malawi Government, 199413).During the 1977-87 intercensalperiod, it increased by about 44 percent (by 45 percent for the male population and by 43 percent for the female population). It is projected that by the year 2000, the population will reach about 12 million people. The national population grew at about 2.9 percent per annum during the 1966-77intercensal period and at about 3.7 percent per annum during the 1977-87intercensalperiod. At the growth rate of 3.7 percent per annum, the population of Malawi would double in 19 years (Malawi Government,199413). The growth ratesincreasedfor all three regions of the country. 71 Cultures of Populations: Africa At the regional level, in the 196677 and 1977-87intercensalperiods the annual growth rate increased from 2.4 percent to 3.4 percent in the Northern Region, from 3.4 percent to 3.7 percent in the Central Region, and from 2.6 percent to 3.7 percent in the Southern Region. The acceleration in the growth rate was causedpossibly by the continuation of high fertility and declining mortality (Srivastava,1989) since international migration has had a negligible effect upon the growth of the population of Malawi. The fertility rate was estimatedto be about 7.6 births per woman in the late 1970s.Although it declined in the 1990sto about 6.7 births per woman partly due to increaseduse of family planning methods, the fertility rate is still high. It is expected that the population growth rate will decline to about 2.1 percent per annum by the year 2000 (United Nationsand Malawi Government,1993),mostlyasa resultof the AIDSepidemic, which is causinga substantialincreasein mortality, rather than asa direct consequent of reduced fertility rate. Population Distribution and Density The national population is concentratedin the SouthernRegion, which hostsabout 50 percent of the total population. The Central Region hosts39 percent and the Northern Region supports only 11 percent of the national population. Although it continues to be the most populated region in Malawi, the Southern Region’ssharehas declined since 1966while that for the Central Region hasincreasedwhile that for the Northern Region hasremainedabout the same.The spatial dispersion of the total population over districts since 1966 has been continuously becoming more equitable, and migration from densely to sparselypopulated districts have been noted (Srivastavaand Jager, 1989). The national density of population is one of the highest in Africa. It was 43 personsper square kilometre in 1966and it increasedto 59 and 85 personsper square kilometre in 1977and 1987 respectively. The Southern Region has a density of about 125 persons per square kilometre. Blantyre District,which is in this region, has the highest density of all the districtsin Malawi. The Central Region has a density of 87 persons per kilometre while the Northern Region’sdensity is 34 persons per kilometre. Rumphi district, which is in this region, has the lowest density. Fertility The current fertility rate for Malawi has declined from 7.6 to 6.7 births per woman. But this is still a very high rate. In fact, in someareas,the rate is much higher than this due to Socio-cultural beliefs and practices.For example, early marriage and pregnancy in some rural districtssuch as Machinga have helped to keep the rate high. As Kishindo (1994) observes,in this district and others, girls are advised to enter into marriage soon after their first experience of menstruation, which is regarded as one of the indications of the beginning of adulthood. As increasein the education level of women and the easy availability of contraceptivesespecially in the urban 72 Cultures of Populations: Africa areas have helped to reduce the fertility rate. For example, about 43 percent of girls aged 15- 19yearswho had no formal education had startedchildbearing compared to only 20 percent of those with some secondary education (Malawi Government, 1992). Morbidity Someof the most common causesof morbidity in Malawi are malaria, pneumonia, diarrhoea, tuberculosis, sexually transmitted diseasesincluding HIV/AIDS and anaemia. At both national and regional levels,the percentage of in-patients suffering from malariaand sexuallytransmitted diseasesincreased significantly between 1980 and 1990. One of the factors influencing the increasein the incidence of malaria particularly in urban areas is concentration of population. During the same period, the percentage of in-patients suffering from diseasessuch as measles and diarrhoea declined as causesof morbidity but their incidence is still high. Mortality The crude death rate in Malawi was about 25 deaths per 1,000 persons in 1977.By 1987 it has declined to about 14 deaths. At regional level, the rate decline in all three regions, particularly in the Central Region where it had declined from 29 to 15 deaths and in the Southern Region where it declined from 23 to 13 deaths. life Expectancy Life expectancy in Malawi was estimatedto be 37 yearsin the 1950s.It increasedto about 41 years in the 1970sand to about 48 years in the 1980s.It is estimated that life expectancy in the 1990sis about 45.5 years. In 1992, life expectancy for femaleswas estimatedat 46 years in 1992 (UNDP,1995)compared to about 44 for males.The United Nations has lowered its estimate for average life expectancy in Malawi from 45.5 years to 41 years due mostly to the HIV/AIDS endemic. HIV/AIDS is responsible for partly reversing the improvement in women’s life expectancy in Malawi. Migration and Urbanisation A high proportion of Malawian population is not mobile. For example,the 1987censusshowed that, for migration related to place of birth, over 60 percent of the population in almost each district had not moved. Also, lessthan 10 percent were born outside the country. For migration related to place of residence 12 months before the census,over 90 percent of persons enumerated in each districtwere residentin the samedistrict 12monthsbefore the census.Only 2 percent were resident outside Malawi. Migration outside one’s village but within the same Traditional Authority is common and it is influence in part by marriage. In the patrilineal communities, a higher percentage of the femalesmigrate than in the matrilineal communities. While much of the internal migration was initially towards the south, there has been an 73 Cultures of Populations: Africa increaseof movementtowards the centre sincethe early 1980sdue to both the economic opportunities and availability of fertile land. Blantyre and Lilongwe continue to receive a significant flow of in-migrantswhile the rural areasnear urban centresgenerally experience out-migration to the urban areas.However,the sizeand significanceof migration from rural areasexperiencing land pressureto other rural areaslessland pressurehave increased. With about 11percent of the population of Malawi living in urban areasin 1987,it is projected that by the year 2000, the percentage will have risen to about 30. Much of this increasewill be accounted for by rural to urban migration. In the 199Os,migration outside the country, particularly to South Africa, Zimbabwe and Botswana,has become fashionable again. Thosemigrating are mostly the literate urban dwellers. Migration from rural to urban areasin Malawi is mostly for the purpose of seeking education and job opportunities. Though it is not one of the main factorsinfluencing most rural people to migrate to urban areasor 1nhibiting urban people to migrate to rural areas,witchcraft accusations or fear of being bewitched issometimesmentioned asone of the reasonsfor migrating outside one’s village. The major urban centres of Blantyre and Zomba in the Southern Region, Lilongwe in the Central Region and Mzuzu in the Northern Region contain about 75 percent of the total urban population in Malawi and this share seemsto have stabilised at this level (Srivastavaand Jager, 19 89). The Scope of the Study A lot of population and development activitiesare basedupon mostlyquantitative information at the national level. Thisbasisalone failsto addressimportant demographic issueswithin specific socio-culturalcontexts. Consequently,this study does not endeavour to collect new quantitative information. The study focusesmainly on the need to supplement the quantitative information known about Malawi with qualitative data. This data will help to explain the discrepanciesbetween what people say they feel and do and what they actually do. The study mainly consistsof activitiesat the local community level.It attemptsto identify the socio-culturalfactorsthat motivate people to behave the way they do within their communities. The Sample Areas Fiveareaswere carefully selectedwith the assistanceof National StatisticalOffice (NSO),Banja LaMtsogolo, Demographic Unit of Chancellor College, and the project anthropologist. The sites were selectedpurposively on the basisthat, together, they represent the major ethnic and socioeconomic groups in the country. In general, they are the major sub-culturesin Malawi. 74 Cultures of Populations: Methodologies Africa Utilised Before fieldwork, the team was trained in a 5-day workshop on qualitative data collection methods. The trainerswere from Centre for SocialResearchof the Universityof Malawi, and from the Demographic Unit of Chancellor College. The workshop was also attended by three Mozambican experts who contributed to the training of the team through discussionof their Mozambican experience. The fieldwork began on February 23 1998and ended on 22nd March 1998.The team spent 5 to 6 days at each site. However, prior to the main field work, an anthropologist visited each of the five sitesand spent two days at each site collecting important information useful for the main field work and the study asa whole, about the general socio-economicand cultural make up of the site. To achieve the goals of the study, six main methods of data collection were used as shown in Table below. A synopsis of methods utilised Method 1. Literature review 1 2. Focusgroup discussion 3. In-depth interviews 4. Life histories 5. Interviews with service and information providers 1 6. Participation observation Type of Data Collected I Mostly quantitative Qualitative Qualitative Mostly qualitative 1 Quantitative and Qualitative Qualitative A brief description of each of these methods and how they were used in the field is presented as follows: 1. As part of the project, the project director reviewed 1iterature on socio-cultural factors influencing demographic behaviour in Malawi and other documents relevant to the topic. Thisstarted before field work and continued at all stagesduring the study. 2. Focus group discussionswere held, separately, with adolescent females, adolescent males,adult malesand adult femalesin the 1anguage chosen by the participants. A pretested focus group guide was used. Eachfocus group had a minimum of six and a maximum of 12 participants who were selected randomly with the help of local community leaders. The number of participants per focus group varied because in some areasand for some categories it was difficult to get the participants. For example, in Kachere 75 Cultures 3. 4. 5. 6. of Populations: Africa where most adult malesare in employment only 6 men turned after the initial selection of 12 men. Sincein Kachere male adolescentsand female adolescentswere combined, a total of 19 rather than 20 focus groups were conducted. The group discussionswere facilitatedby one of the researchassistants, and tape-recordedasanother researchassistant took notes. Later in the afternoon or evening, the researchassistantsprepared a report on each of the discussionsheld that day. At leasttwo in-depth interviews with some of the participants and/or other membersof the community were held soon after each focusgroup discussionto verify or to complement the views expressedin the group discussions.Through these in-depth interviews, detailed information on particular cultural beliefs and practiceswas obtained from the perspectivesof the subjects.In Chilooko there were no in-depth interviews with female adolescentsbecausethe focus group with these adolescentshad yielded adequate and reliable information. In each community, at least four interviews were conducted with older members of the community to establishsocial biographies. The purpose of these social biographies was to learn about changesover time in customsand in norms,which have taken place in the community over the years. Among those interviewed were community leaders. Interviews with selected serviceand information providers were conducted to establish the gaps between the expectations and preferencesof the local community on the one hand and the perspectivesof the serviceproviders, and how these gaps can be bridged. Those interviewed included traditional birth attendants, traditional healers, medical professionals,teachers,religious leaders, and video-show operators. The team lived in each communityfor about five daysduring which it attempted to interact with the local population. Thisapproach allowed the team someaccessinto the daily life of the members of the community. Before lea&g each site,the researchassistantsand the ProjectDirector prepared a report for the site. The report summarisedfor that particular site, the prevailing attitudes and motivations towards sexual relations, teen-age pregnancies and marriages, unsafe abortions, unsafe sex, male responsibility in family planning and reproductive health, the statusof women, violation of normsand taboos,constraintsto behaviouralchange, and other socio-culturalfactorsinfluencing demographic behaviour, and the community’s perceptions of messagesrelated to sexual and reproductive health. Concepts and Definitions A number of concepts used in this study mustbe defined in the context of Malawi. Theseare 76 Cultures of Populations: Africa concepts that are used frequently in this study. The concepts were developed initially from literature review and then refined and new concepts developed in the field with the assistance of the participants in the sites. Puberty Puberty is defined in Chichewa as “kutha msinkhu” or “kukula chinamwali” (coming of age). It is generally believed that this 1s the time that a boy or girl begins to have sexual desires.The age-category that most boys and girls reach puberty is 10-15.In some areassuch as Ngokwe, a child who hascome of age and has undergone traditional initiation is often regarded asan adult since he or she is capable of having a child. Adolescence In this study, adolescence is defined as the transitional period between puberty and adulthood. For purposesof this study, adolescentswere those personsin the 12-20year age category who were not married. Personswho are married, irrespective of their age are generally considered adult in Malawi. In the Malawian context’ the physical changes that a boy or girl undergoes during this period are emphasisedmore than the emotional. Adulthood Thisis defined asthe time beginning from the time that a woman or man marries.Sometimes, a adolescentwho has a child is defined asan adult if she hasa child or children. It is in marriage that a person is expected to shoulder a lot of responsibilitiesand to begin procreative duties. Hence the associationof adulthood with marriage. It is common to hear people saythat “mwana sangabale mwana mzache” (a child is not capable of bearing a child). Social System In Malawi there are two main social systemsas far as marriage, descent and inheritance are concerned. Theseare the matrilinealand the patrilineal. In the former system,descentis reckoned through the male line while in the latter it is through the female line. Promiscuity In the context of the five sites,promiscuity is defined as in terms of lack of sexual satisfaction with one man or woman. Words such as “chimaso-maso”or “wothamanga-thamanga” are used to refer to this behaviour. Initiation Traditional initiation is the counselling of boys and girls by an elderly woman (for girls) or man (for boys). This takes place mostly in the bush but sometimesit takes place at home. The initiation ceremony marks the end of childhood and the beginning of adolescence or, in some cases,adulthood. 77 Cultures of Populations: Africa Traditional Birth Attendants Traditional methods of contraception include withdrawal, abstinence, and the use of traditional medicine. In someareaswomen eat cow peasor tie traditional medicine around a woman’s waist to prevent pregnancy. Thesemethods are differentiated from those prescribed at health clinicssuch as the pill and vasectomy. Fertility Fromthe point of view of the people in the communitiesvisited,fertility is definesasthe ability to procreate. The concept is generally used with reference to a personswho has many children since every person is traditionally expected to have children. Having a child or a few of them, therefore, is not an issue.Thisterm is used mostly in relation to a woman rather than to man since it is the woman who bears children. Early Marriage In the traditional Malawian context, early marriage refersto marriage of an individual before he or she is mature. Maturity is in both physiological and psychological senses.One is said to be mature when one capable of taking the responsibilitiesinvolved in marriage suchastaking care of a child. Quality of Data In the light of the feedback from the field experience, a number of points can be made with regard to data quality. There were severalnotable constraintsin the use of some of the data collection methods. Someof the constraintsand alternativestrategiesare presented in Chapter 6. First,it was not alwayseasyto selectparticipantsfor both focusgroups and in-depth interviews randomly. This was because many of those initially selected failed to turn up. Consequently, those community members who were not initially selected but turned up for the focus groups and interviews were included. Second, particularly in the rural areas,in carrying out life historiesof older members of the community, it was necessaryto have a younger member of the household to provide reliable quantitative data, which many of the elderly people could not provide due to lossof memory. Third, one of the major constraintsto participant observation was the lack of knowledge of, and fluency in, the local languages by some of the team members.Community members could tell that these were strangersand it is possible that some of the community members changed their behaviour or language. For instance, it is possiblethat some of the words and phrasesthat they use in their daily life to refer to abortion, sexuallytransmitted diseases,and other concepts were not used in preference for words and phrasesused in Malawi in general. 78 Cultures of Populations: Africa Fourth, a combination of methods of data collection was found to be useful becausewhere one method was not appropriate, another or others yielded reliable information. For example, in Chamba and Ngokwe villages, the focus group method was found to be inadequate in soliciting data on very sensitiveissuessuch as initiation. Only a few participants discussedthe issues openly. However, in the in-depth interviews some of them were more open. Limitations Thisstudydid not do two activities,which would havehelped to enhancethe quality of thisstudy. First,mapsof each of the five sites,namely Kachere,Mtandire, Ngokwe and Chambavillages, Chimaimba village, and Kalonde villages, were not made. Thiswas becauseof time limitations. Suchmapswould have helped to gather data about each community by enabling the members to representtheir community and its issuesthrough drawings. Sinceit was discoveredthat existing mapsof each of the areasare out of date, not very accurate,and do not havemuch of the required data on location of facilities,services,and important physicalfeatures,attemptsmade to construct these maps after the field work were abandoned. Second, a profile focus group participants was not made for all focus groups. In some of the focus groups, especially in Ngokwe and Chilooko, many of adults could not remember their ages, and sometimes,collection of such data delayed the focus group discussions,which were the main method of data collection in this study. Moreover, the anthropologist had already collected adequate information on the profiles of each of the sites. Very valuable information about each of the siteswas collected before, during and after the fieldwork by the researchteam, despite the limitations mentioned above. The Conceptual Framework The socio-culturalfactorswhich influence demographic behaviour are many and the interact with other factors in influencing that behaviour. The relationship is more complex than the conceptual model given below in Figure 1 may suggest. There are other factorssuch as economic and political factors,which influence demographic behaviour. In addition, there may be interaction among some of the socio-culturalfactors (such as initiation affecting education) on the one hand and among the demographic factors (suchas migration affecting fertility) on the other hand. Further, the demographic factors can impact upon socio-cultural factors, such as when child-raising practices change due to rural to urban migration. The model is presented here in a simple fashion to act as a guide in understanding the relationshipsamong the different concepts. 79 Cultures of Populations: Africa Figure 1: The Conceptual Model What this framework suggestsis that fertility is influenced by initiation, religion, education, social system,polygamy and wife-inheritance; Infant, child and maternal mortality are affected by food taboos and education of the mother; and migration is influenced by education and social system.There are severalintervening variablessuch as use or non-use of family planning methods, which have to be taken into account in the analysisof the relationships. UNDERSTANDINGDEMOGRAPHICBEHAVIOUR o gain a deep understanding of the demographic behaviour in the Malawian Context it is imperative that socio-culturalfactors, which influence the demographic behaviour of the different subcultures in the country, be analysed. This chapter is a review of literature on suchfactors,which influence fertility, infant and child mortality,maternaldeath, pregnancy-related death, first delivery care of the pregnancy, migration, and ageing. The discussionis based upon the findings from the five sitesaswell =- on a review of the literature on these topics in Malawi. T Fertility Fertility rate in Malawi is very high. The national fertility rate was estimatedto be about 6.7 births per woman in the 15-49year age-category. However, there are significant regional differences (United Nations and Malawi Government, 1993). Fertility is affected by a number of factors including socio-cultural ones. Different sub-cultureshave their own ways of educating their adolescent malesand femalesin beliefs and practicespertaining to sex and marriage. 80 Cultures of Populations: Africa Initiation One of the purposes of initiation is “to ensure that children are taught obedience and brought up according to the culture of their ancestors”(Kamlongera et al, 1992).Thisis done at different stagesin the development of a girl or boy. Kishindo (1993 and 1995) points out that among some ethnic groups such as the Yao in the Southern Region and the Tonga in the Northern Region, girls are socialisedat a very early age through, for example, initiation ceremonies, into what is perceived to be their role in society,namely that of wives and mothers. As a result, girls marry and start bearing children at early ages. Early marriage contributes to high fertility. Early marriages are encouraged to some extent by what is taught at initiation ceremonies. Indeed, initiation ceremoniesfor boys such as “jando” and for girls such as “msondo” practised mostly in the Ngokwe community may encourage the initiates to engage in pre-marital sex and early marriage. Khaila (1995)observesthat in some parts of the southern Region, both boys and girls are considered unclean soon after initiation. Therefore, they are expected to engage in sex to cleansethemselvesas the final rite. It is believed that failure to do so “would result in having persistentstomachpains.” A man called “fisi” (hyena)comesat night to have sex with the initiate without her consent. The same concept of cleansing applies to the practice, in some areas of Malawi, of “fisi,” whereby a man is invited by a couple to have sexwith the woman whose baby has just died. The “fisi” may also be in the form of a surrogate husband where the husband is impotent or he has gone away from home for a protracted length of time. In all these cases,this may contribute to fertility and spread of sexually transmitted diseases,infertility, and death. In Kachere, Mtandire, Chilooko, and Chikulamayembe,initiation ceremoniestake place but these are done mostly among specific ethnic groups or individually at the girl’s or boy’s home rather than in the bush among severalinitiates. Initiation of boys and girls is also conducted by church leaders but family life education’ rather than sexual education, is emphasised. Kamlongera et al (1992) point out that the girls sent for initiation may be aged 7-11 years. They are sent by their mothers to a “nankungwi” (an instructor) for the initiation. Instructionsare given through song, dance, mime, and direct word. Kamlongera et al note that some of the songs, dances and acts by the instructorsand other participants at an initiation teach the girls sexualintercourseetiquette. Theyare taught how best to bring satisfactionto their sexualpartners, especially husbands. Communication is one way, that is, from the instructor to the initiates and the curriculum is never written down. But the girls are also given a word of caution in other songs, dances and direct instructions againsta loose life. Forexample,they are taught that if they havea looselife, they would be calling for trouble from “men who can bite like a snake.” Once a girl or boy graduates she or he is no longer a girl or boy but a woman or man and is given a new name. He or she is expected to behave like a woman or man, no matter how young or immature. 81 Cultures of Populations: Africa Another important form of initiation for adults is what is called the “kitchen party” which prepares the young woman for a life of submissionto her husband and to men in general, through song, direct messageand gifts. This is related the traditional practice whereby a bride and bridegroom are taught what is expected of them assexualpartners.The two are encouraged to have a child as soon as they can. In Chilooko, iCule wa Mkulu” (traditional masked dance) generally encourages adolescent males to prove masculinity by engaging in early sex and marrying at an early age. Boys are initiated at the age of about 15years and once they graduate they are expected to behave like adult men. It must be noted, however, that the influence of this factor on sexualbehaviour and marriage is little. Religion From this study, it is clear that religion is another important cultural factor influencing fertility. In Chikulamayembe,sex outside marriage and polygamy are strongly discouraged by religious leaders even though tradition allows malesto practice polygamy. On the other hand, polygamy, divorce and re-marriage are generally accepted among the mostlyMuslim villagers of Ngokwe while in Chilooko, paganism allows all this. In this area, boys are sometimesgiven aphrodisiac drugs by their grandfathers, as one participant put it, “which make them look for girls.” Initiation conducted by Christian denominations may help to reduce fertility. Initiates are taught about the dangers of early marriage and engaging in pre-marital sex. On the other hand, as suggestedabove, the traditional initiation tends to encourage fertility. In the squatter areasof Kachere and Mtandire, the role played by religion is undermined by other factorssuch as economic factors.An urban male, for example, cannot easily marry two or more wives given the economic hardship he facesin the town. At the sametime, in these areas, co-habitation is common, in part because of the decline in the influence from kin. &e-marital and extra-marital sex is also encouraged by exposure to pornographic movies,which are more common in the urban areasthan in rural areas. At the sametime, although to a limited extent, the adults and adolescentsin the two squatter areashave more accessto family planning information and servicesthan those in the three rural areas.Where these serviceshave to be paid for, the rural familiesare lessable to afford them. In addition, with limited exposure to massmedia, the rural people are not well informed about family planning services. Education Also, urban women’s labour force participation and income levelsare higher than those for their rural counterparts. Theseare positively correlated with education. As is well known, formal education is strongly associatedwith lower fertility. Education for girls in particular is associated 82 Cultures of Pomlations: Africa with later age at marriage, preference for smaller families, higher use of family planning methodsand participation in decision-making.In Ngokwe as in the other areas,females’low status is perpetuated by the traditional practice of advising the bride on the engagement or wedding day not to refusesexualadvancesfrom her husband. As Khaila (1995)notes, traditionally, a wife is supposed not to accept sexual advancesfrom her husband at all times. Traditional and Modern Methods of Contraception Both traditional and modern methods of contraceptivesare used in both villages and cities (Bisika,1995).Useof traditional and modern methods of contraception can lower fertility among women. Bartlett et al (1995) point out that despite widespread knowledge of family planning, current use of contraception remains low. They note that only 7.4 percent of currently married women were using a modern method and another 6 percent were using a traditional method of family planning. In all the five sitescovered in this study, because the primary function of sex is regarded to be procreation, and children are highly valued, the use of condoms and other methods of contraception are rarely used. In Ngokwe and Chilooko, many adult males use traditional methods becausethese are within reach while the modern ones are said to be expensivewhere they are available In fact; Ngokwe boys feel that contraceptivesare not for boys but for girls so that they (the girls) can prevent pregnancy. In different areas people have their beliefs and practices which in one way or the other influence fertility. For example, in Chikulamayambe and Chilooko, participants reported that women wear stringsand herbs in their waist asa contraceptive method. But sometimesthis does not work and the woman has an unplanned pregnancy, which she may or may not abort. Vasectomyis the only method which is not acceptable to many males (Bisika,1995).Having vasectomydone is going against a strong cultural belief that judges manhood largely by a man’s ability to father children. Polygamy and wife-inheritance In all the areasan impotent man, a barren woman, or a childlesscouple is stigmatised, and the marriage can end in divorce or the man can marry another woman. In these areas, a marriage counsellor, a traditional healer (or in the urban areas,a modern medical practitioner) is consulted to get traditional medicine to reverse the situation. As adult females in Kachere pointed out, an adult male who does not engage in sex “is not a man.” In Malawi’ people in all regions and among all socio-economicgroups practice polygyny but there is variation in its prevalence It was estimated that 21 percent of all currently married women in Malawi have at leasttwo other co-wivesand that 9 percent of currently married men have more than one wife. The practice of polygyny is more prevalent in the Northern Region than in the Central Region and Southern Region (Malawi Government’ 1994a).Thisstudy found 83 Cultures of Populations: Africa that this practice is common in Chikulamayembe, Chilooko, and Ngokwe. Gaynor and Ntata (1992)found that polygynous familiesare very common in Wovwe in Karonga district where 41 percent of a sampleof male heads of household were polygamous. The samepercentage of the samplewere monogamous Men tend to marry additional and younger wives after the first one has reached menopause so that the new wife can bear more children for him. Somemen marry more than one wife since traditionally this is a prestigious thing to do. As an elderly man in Chilloko noted, “people marry more than one wife because of the barrenness of a wife. Sometimesit is because the man is rich. It may also be because the man wants to have many children.” Polygamy can help to increase fertility since women who are not married, divorced and widowed are now brought into marriage in which child-bearing is generally legitimised. Traditionally, malesmarry another wife, who is younger than the first one. Often old men marry women who are in the childbearing age group so that they can bear children for them. Divorced women are common in the Muslim community of Ngokwe. Inheritance of wives (“chokolo”) is another cultural practice that influences fertility. When a man dies with or without children, his brother takes the widow and raisesup children to the dead brother. This is common particularly in patrilineal societiesin the Northern Region. Wife inheritance is a device for ensuring the continuance of the family group and for increasing the size of the lineage. Thispractice is on the decline due in part to the spread of HIV/AIDS. Sexual Behaviour and Marriage In each of the areas, there are some socio-cultural factors, which encourage and others, which discourage sexual intercourse and early marriage, as well as extra-marital sex, divorce, and remarriage. Hellitzer-Allenand Makhambera (1993)observethat although tradition dictates that young femalesabstain from engaging in sexualrelations until being initiated by traditional advisorsfollowing initial onset of menses,many pre-initiation and pre-menstrualgirls break the tradition in order to receive school fees and gifts in exchange for sex. Both boys and girls are sometimesmotivated by the need to be like peers who already have the experience, otherwise, as an adolescent male in Ngokwe put it, “people might think you are impotent” (unagwa mu’tmtengo), to prove masculinity,and as one school girl in Chikulamayembeput it, “we want pocket money to buy our needs at school.” At the sametime, in Chikulamayembe,as one adult male put it, “pre-marital sex is strongly discouraged by telling the boys that women have knives that can cut their penises. Strong pressureis put on Malawian girls to marry shortly after reaching puberty, and to start bearing children. Thisis true especiallyin the rural areas(Malawi Government, 1997).The Onset of childbearing is indeed early. Over 25 percent of Malawian women aged 15-19have already borne at least a child, and about 25 percent of women aged have borne ten or more children 84 Cultures of Populations: Africa (Malawi Government, 1994a). Traditional dances and songs Dance and song are an important expressionof Malawi’s culture. One of their functions is to educate either directly or indirectly. Some traditional dances such as “Manganje” in Ngokwe, and some “Gule wa Mkule” performances, in which songs and the dance have sexual connotations and may encourage both young and old to become promiscuous.In fact, in Chilooko, a boy pointed out that “dances such as ‘Chintali’ and ‘Chitelera’ make us feel like having sex.” As Kamlongera et al (1992)point out, “Gule wa Mkulu” performance gives licenseto the performers and the audience-participants to behave out of the norm. A relaxed and joking atmosphere permits the actors and the audience-participants to gratify their libidos and it also provides an opportunity for making new acquaintances. Like in some other traditional dances, all this can lead to the development of sexualrelationshipsand marriage. At the sametime, sometraditional dances and songs teach about the dangers of promiscuity, early marriage, and polygamy. Morbidity and Mortality Mortality is linked to many factors such as age, sex, and social class.The incidence of death can reveal much about a population’s standard of living and health care. More important is the fact that infant and child mortality tend to be associatedwith high fertility rate and high maternal death. All these are closely associatedwith the mother’s socio-economic status in the society. Somecustomsand cultural practicesrelating to food taboos, abortions, and unsafesex endanger the lives of children, women, and men. Food Taboos. Nutrition deficiency is one of the major determinants of the high rate of infant mortality in the country. Rural populations are especiallyprone to mal-nourishmentand malnutrition because of their poverty. Malnutrition takes its heaviest toll on children, and the health damage can begin before birth. Msukwa (1994, cited in Mvula and Kakhongwe, 1996) saysthat anaemia affects 15-25Percentof pregnant women in Malawi and that maternal nutrition is a factor in the high incidence of low birth weight. Chanje and Kaiya (1995)agree that the nutritional statusof a mother gets reflected in low birth weight, which may lead to infant and maternal morbidity and mortality. In Kachere, the adult femalesreported that pregnant women are not allowed to eat sugar cane for fear of delivering a shivering baby. They are also forbidden to eat pepper and bananas, which are believed to result into the baby contracting “red skin” and the common cold, respectively. In Chikulamayembe, as in some other areas, young children are not fed eggs to avoid “chakumutu” disease.Suchbeliefs can deprive pregnant women of important nutrients. Although extended breast-feeding is common practice in Malawi, traditionally’ infants are 85 Cultures of Populations: Africa given complementary food and drinks before they are four months old (Malawi Government, 1995).The risk of malnutrition and diseaseincreaseswhen weaning begins too early. One of the cultural factors influencing early weaning is the tradition of leaving the care of infants in the hands of grandmothers, daughters or some other relatives. Studieshave shown that cultural practicesin Malawi dictate that women deny their own food and nutritional requirements in favour of male members and young children of the household (United Nations and Malawi Government, 1993).As a result of this practice, many women bear underweight babieswhose chancesof survivalare reduced. In addition, the women’shealth status is lowered. Life Expectancy and Ageing Evenwith only slightly declining fertility levels,continued declinesin mortality levelsincrease the proportion of the elderly. Women generally have a higher life expectancy than males in Malawi as in many other countries.However, the HIV/AIDS epidemic, which is affecting females more than males,is having a negative impact on the females’life expectancy. In the rural areas, particularly in Ngokwe, the elderly women are taking up more responsibilitiesin advising and counselling the youth. From the findings of this study, the socio-cultural concepts used about old people suggest that the old are seen aswise people. Thisis true for both malesand femalesalthough the former are accorded much more respect. As one woman Chikulamayembeput it, “Can old people tell lies?They know what they have gone through. That is why we listen to them.” Since generally females in Malawi have a higher life expectancy, there is a significant percentage of single old women who are widowed. Suchwomen tend to be given the responsibility of looking after their grandchildren, particularly children of their unmarried daughters. This is common in Ngokwe for example. With this arrangement, these women tend to have pregnancies at short intervals. Migration Migration is a very important component of demographic behaviour and population change. Becauseit is usuallyselectivein termsof suchvariablesasage, sex,and socio-economicstatus,it can change quite significantlya community’spopulation sizeand composition,and itsgeneral character. It is important to understand how migration affectsthe migrants’and non-migrantsdemographic behaviour,aswell asthe compositionof the placesof origin and destination. Migration is perceived as a temporary movement from the village in which one was born to another village or town far away from the home village. It is seen astemporary becausethe individual aswell as his or her family continues to see the village of origin as the permanent home. That is why the migrant maintainsties with that village where his or her ancestorswere buried. 86 Cultures of Populations: Afi-ica Education Attainment Over the past 20 or so years, the most significant flow of migration in the five siteshas been rural to urban migration in search for employment opportunities. Of the three rural areas, Chikulamayembehas experienced a higher flow of both out-migration and in-migration especially becauseof the relatively higher education background and prospectsfor employment on tobacco estatesit enjoys. Social System Migration in Malawi is also influenced by socialsystem.Mvula and Kakhongwe (1996)point out that female-headed households, which are common among the matrilineal system of marriage, have fewer males residing in them because men usually migrate to marry in other villages. Family systemsshape demographic processessince it is within the context of family systemthat individual strategicbehavioursare actually moulded. Generally,under the matrilineal systempredominating in the Southern and Central Regions, the husband migrates and lives in the wife’s village. In the patrilineal system common in the Northern Region, in northern Kasungu in the Central Region, and in Nsanje and Chikwawa districtsin the Southern Region, the wife migrates and lives in the husband’svillage. It is in part due to the above reasonsthat the femalesof Ngokwe are lessmobile than those of Chikulamayembe. In addition to influencing migration, the social systemalso influences fertility. As Kishindo (1994)observes,to woman’s eldest brother in a matrilinealsocialsystem,having a large “mbumba” (lineage) is a desirable thing since it constitutesa potential basisof political power. Unlike in this systemwhere a woman produceschildren for her own matrilineage,in the patrilineal socialsystem “lobola” (bride-wealth) effectively transfersa woman’s reproductive capacities from her own lineage to that of her husband’s lineage. Fertility is influenced differentially in that it is the wife whose procreative duty is emphasisedin the patrilineal systemwhile it is that of the husband in the matrilineal system. The impact of Migration on Socio-cultural Practices As a result of continuous in-migration of people from different ethnic and socialbackgrounds into Kachere and Mtandirel these two urban areas have undergone tremendous changes in character over the past two decades. A few examplescan be given here. First,in Kacherel the practice mostly by the original Yao inhabitants, of initiating a group of boys and girls in the bush near the river where they stayed for a period of about two weeks is not being practised much any more. The reason is that the newer residents have more or less imposed on the community the practice whereby parents invite “anankungwi” (initiation counsellors) to initiate their boys and girls in their homes individually. This is also true for Chikulamayembeexcept that this is mostly due to the influence of the church. 87 Cultures of Populations: Africa Kamlongera et al (1992)point out that if township parentswant their daughters initiated into adulthood, they have to send them to the village. They further note that due to destabilisation associatedwith urbanisation, mostparents living in town havegiven up observing suchpractices. As a result, many girls living in the towns go into marriageswithout undergoing initiation which used to be a prerequisite to family life for many ethnic groups. Many boys and girls in the towns end up learning about sex and family life by chance from their peers, video showsnewspapers, magazines,and the radio. In these areas, children and the youth are left to their own devicesas family ties loosen or even break down. As a result, many of them are increasingly exposed to riskssuch as dropping out of school, sexual exploitation, unwanted pregnancies, and sexually transmitted diseases. Mtandire is having similarexperiencesalthough group initiation was not as commonly practised there as in Kachere. As a result of the mixture of people from different backgrounds, some of the old traditional practicesare being eroded or modified in the new environment. Second,it should be pointed out over 30 percent of those migrating into the two urban areas are young men who are either unmarried or have left their young wives at home in the rural area. Most of these have little formal education and end up unemployed or into the informal sector.There is a general oversupply of out of school adolescent malesin these two urban areas especiallyin Kachere.It is common for theseyoung men to engage in promiscuitywith prostitutes and young girls. In the two rural areasof Ngokwe and Chilooko, there is not a significant imbalance in the sex ratio since these areasare relatively economically poor and isolated. As a result they have not experienced much out-migration and in-migration in recent years. At least two reasonsexplain why women have not migrated into the urban areasas much as their male folks have: First, in some areas like Ngokwe, females are culturally confined to their land and home. Becausethe husband usuallystaysin the wife’s village where he gets a piece of land to cultivate for his family from her lineage, it is the wife who must stay to look after the property. However, in this setting, women do not necessarilyenjoy a high statussincethey are under the power and influence of their brothers and uncles. Second, in the urban areas, especially in the high-density areas such as Kachere and Mtandire, there is an acute shortage of housing suitable for a family. Husbandstend to leave their wives behind until proper housing is found. Sometimesthis takesyears. In such cases,the husband may visit the wife once in a while year. Long periods of separation of couples may encourage extramarital sexual affairs. 88 ‘... _.. ...-- Cultures of Populations: Africa CONCLUSIONAND RECOMMENDATIONS T his study was set out to identify the various socio-cultural factors, which influence the demographic behaviour of different groups and sub-groupsof population. It alsoattempted to show the implications of the findings for the formulation of population programmesand policies. This section presents the conclusion and provides a number of recommendations relating to the formulation of population programmes and policy in Malawi. Conclusion It is very important that people who are engaged in population activities and particularly those who are responsible for conceiving and carrying out population programmes are very sensitiveto the existenceof sub-cultures.Thesesub-culturesor social-culturalenvironments play a major role in influencing people’s attitudes towards sexual and reproductive behaviour. They also explain in part the motivation and the value systemsthe people adhere to. Population programmes must take into account these social-culturalfactorsand the different needs of the specific groups within each community. As changeswithin society take place rapidly, different subculturesrespond and adapt to the changes differently. How well or poorly they adapt to the socio-economic, demographic and physical changes depends, to a large extent, on the value systems,the attitudes and the various social control mechanismswhich constrain the behaviour of the people. At times the social control mechanismsfail to prevent some groups from breaking the social norms. Female adolescents may be motivated, for example, to engage in pre-marital sex, which in most communities is not sanctioned, by money with which to buy their needs such as food and clothing. At other times, they may be motivated not to engage in this behaviour in order to avoid getting pregnant and contracting sexually transmitted diseases. In conclusion, it must be emphasised that sub-cultures exist in Malawian society. People’s perceptions of information and services depends very much on the value system of their subcultures,whether or not an adolescent in a remote area in Ngokwe accepts information on a modern family planning method and actually utilisesit is a function of his or her social-cultural environment. Therefore, it is essentialthat a thorough understanding of existing subculturesbe the basisupon which population programmes and policies are formulated. In other Words, the impact of information, education and communication activities can be greatly enhanced if the social-culturalsystemis well known. Recommendations From the resultsof this study, an number of recommendations can be made. These recommendations are presented below under 4 different but related themes: 89 Cultures of Populations: Africa Adolescent Sexual Behaviour i) Sincemany adolescentfemalesand malesin all the five sitescovered in this study engage in unsafe sexual activities which often lead to unplanned pregnancies, abortions, contracting sexually transmitted diseases,early child-bearing and other consequences that have a negative impact on the health of these adolescents,it is recommended: a) that this group be targeted for IECmessagesurgently. Specialfocusshould be on the girls as these are the most vulnerable; ii) The factorsmotivating adolescentsto violate the normsrelating to pre-maritalsex,abortion and early marriage vary between malesand femalesand depend on the cultural setting. There is need to examinethese closelyin designing strategiesand programmesto address their concernsand needs. iii) Discussionof sex and sexuality is perceived astaboo by many adolescentsparticularly in the rural areassuch as Chikulamayembebut not so much in Ngokwe. Many adolescents learn about sexfrom friends and other sourcesdepending on the availabilityof the source the cultural environment. It is therefore recommended that to better servethe needs of the adolescents the specific sourcesof information and the type of information they want must be identified in any socio-cultural area and that the right information be provided to them. iv) Although some factors,such as the HIV/AIDS epidemic, are influencing adolescentsto change their sexualbehaviour, socio-culturalconstraintsto change in the sexual behaviour of boys and girls remain. The constraintsinclude the stigmatisationof virgins and child-lesscouples. It is recommended: a) that such constraintsexisting in any cultural setting be identified and analysed in order to understand why many adolescentsare not changing their sexualbehaviour; b) that such constraintsbe overcome through a gradual processof persuasionthrough the provision of right information to the communities. Gender Issues i) The statusof women in all the five sitesis much lower than that of men. However, in Ngokwe and Chilooko, the statusof women is the lowest. In these two areas, strong socio-culturalfactorsinfluence women’s position in their communities.It is recommended: a) that for any area, these must be identified and analysed if the statusof women and their familiesis to improve; b) that socio-cultural practices which hinder the advancement of women and girls be discouraged while those that foster it be promoted. 90 --... Cultures ii) of Populations: Africa In Ngokwe, the education for girls is not encouraged as much as that of boys. Traditionally, girls are expected to become wives and mothers. This expectation is reinforced at initiation. As a result, the girls drop out of school and marry at an early age. There is need, therefore, for collaboration between initiation counsellors, community leaders and formal education providers to ensure that girls stay in school. a) that women be sensitisedon their rights; b) that to encourage open and candid communication there is need to actively involve men in sexualand reproductive health programmes. iv) In Chilooko, Ngokwe and Chikulamayombe, polygamy is common. Polygamy tends to be commonly practised where the statusof women IS low. It is important to examine the cultural factorsinfluencing this practice before making any intervention. For example, in Chilooko, the men want a large family to help on the family farm. Raising the socioeconomic statusof the family and of the women can help to discouragethis practice. Information, Education, and Communication (IEC) i) Some socio-cultural practices such as wife-inheritance and arranged sexual intercourse of an older man with young female initiates to “cleansethem” or with an impotent or barren man’swife, are not healthy practices. It is recommended that such practices be discouraged in consultation with the community elders and leaders by providing such communitieswith information and education. ii) It is strongly recommended that IEC messagesto a local community be in the local community’slanguage(s).Forexample,in addition to other minor languages,the following main languages would be suitable: Chichewa, Chlyao, Chilomwe, and Chitumbuka in Kachere; Chiyao and Chichewa in Ngokwe; Chichewa, Chitumbuka, and Chiyao in Mtandire; Chichewa in Chilooko; and Chitumbuka, Chichewa, and Chitonga in Chikulamayembe. iii) IECmessagesmustbe communicatedto the membersby well-trained community leaders, elders, peers, religious leaders and other influential members of the community in whom community members have great confidence. Respected community members and initiation groups such act as initiators, mediators, and advisorsand they are traditional and important communication channels.Community participation or socialmobilization, using existing channelsand networks for servicedelivery and communication is important (UNFPA,1992).All important categories of the population can be reached if several communication channels are used. For example, in Ngokwe providing family education in schools must be complemented by out of school messagesto reach the out-of-school youth who account for a large proportion of the youth in the area. 91 Cultures of Populations: Africa iv) It is recommended that information and servicesbe made easilyaccessibleto all appropriate individuals and groups in the communities,and that they must reflect the specific needs of the local communitiesand groups. v) Because people’s general socio-cultural environment and perception and attitudes towards sexualand reproductive health servicesand IECmessagesare always changing, population programmesand policies mustbe constantlyreviewed to meet the changing needs. For example, in the past in Mtandire and Chikulamayembewife-inheritance was common but today it is no longer practised by many community members. vi) Sincethere is low turn up for treatment of sexuallytransmitteddiseasesin health centres, the strategy to addressthis is through IECcampaign and advocacy. vii) Many boys and girls experiment with sex at an early age. It is therefore recommended: a) that family life education in the activitiesof local communitiessuchas initiation ceremonies be introduced and/or strengthened. Both in- and out- of school boys and girls would benefit from such activities. In addition, there is need to train more teachersin population and family life education; b) that leaflets on the negative consequencesof pre-marital sex and unprotected sex be produced and disseminatedto the youth. In addition, it is recommended that the performing arts, especially drama, music, song and dance, should be among the methods used for delivering messagesto the youth since these are most appealing to them; c) that the massmedia be used to raise awarenessand there is need to create more motivational and persuasivemessagesif peoples attitudes and behaviour are to be changed. viii) Sincemale participation in family planning is still low in all the areas,it is recommended that more creativeand postersbe developed to supplement existing ones to encourage malesto participate fully in reproductive health. ix) There is need to identify the key target populations in IECinterventions so that the interventions are tailored to the needs and preferencesof the target. Finally,since this study examined only five of the sub-culturesin Malawi, it is recommended that similar studiesbe conducted to examine the socio-culturalfactorsoperating in other major socio-culturalareasin the country. Theseinclude the Sena,Lomwe,and Tonga,and the emerging rural centresexperiencing high ratesof international and internal in-migration, suchasMwanza, Mchinji, and Karonga. Suchsub-culturesmay display unique demographic behaviour. 92 Cultures of Populations: Africa Future Research This study suggeststhree main areasthat need to be investigated in more detail. It was not possible for this study to cover these areasin detail due to the scope of the study and the time factor. 1. Initiation is one of the most important factors influencing demographic behaviour in Malawi. Sinceinitiation is shrouded in secrecy,discussionswith community members in focus groups and interviews did not yield detailed information related to what exactly is taught and why. There is need for further researchin this area. 2. Thisstudy did not investigatein any detail, the influence of socialand health serviceson culture, that is, whether and how the culture in each of the five sitesis affected by the social and health servicessuch as girls’ education, and provision of modern family planning methods at clinics. Provisionof the servicescan influence cultural beliefs and practicesof the community members negatively or positively,and, as a result, influence demographic behaviour indirectly. 3. Communication is vital between partners whether in family or outside it to reduce the incidence of unwanted pregnancy, unsafe sex, abortion, and the spread of sexually transmitted, There is need for further research to find out in detail how partners communicate,whether verbally or non-verbally by using gesturesor symbols,and why they communicate in that manner. Further investigation into these areaswill deepen our understanding of how socio-cultural factorsinfluence demographic behaviour and also how intervention strategiesmay affect sociocultural practices. 93 Cultures of Populations: Africa REFERENCES AND BIBLIOGRAPHY l l l “Information, Education,and Communication (IEC)Strategyfor the Educationof AIDSand FamilyHealth (STAFH) Project. D. and M. Allen, “Focused EthnographicStudyof SexuallyTransmitted Illnessesin Thyolo, Malawi, ” FamilyHealth International and USAID. 1995 1992 Bartlett, P., Domatob, A. and P. Twea, “BehaviouralComponent of the PreparatoryAIDSVaccineEvaluation(PAVE) Studies,”Centre for SocialResearch,Universityof Malawi, Zomba,in collaboration with John Hopkins University. 1995 Bisikct, T., Chanje D. and P. Kaiya, l l l Kalemba, l Kalemba l l 1992 Kamlongera, C., Nambote,M.,Soko, B. and E. Timpunza-Mvula, “Danceand Theatrein Malawi,” Researchand PublicationsCommittee, Universityof Malawi. A Studyof Knowledge, Aspectof Attitudes and Practicesof SchoolTeenagersin Malawi, about HIV/AIDS. Caynor, C. and P. Ntata, “Surveyof Social concepts,Structuresand Practices:Karonga Agricultural Developmentand Division,” Centre for SocialResearch,Universityof Malawi, Zomba. E, “Anti-poverty Policiesin Malawi: a critique”, Chilowa,W, W. ed., Bwalo, Universityof Malawi, Centrefor SocialResearch, Issue1, PP21-37. 1997 Chirwa B. Z. 1992 E, “The Determinantsof infant and Child Mortality in RuralMalawi: A caseStudyof MagangaArea ,“unpublished M.A. thesis, Universityof Swansea,Centrefor Development Studies. No year l 1996 l D. and M. Makhambera, 1993 “Trapped in the Chinguwo, E., Socio-culturalConstraintsto Women’sUtilization of Maternal Servicesin Zomba and NsanjeDistrict,ChancellorCollege, Universityof Malawi, Zomba,unpublished M.A. thesis. Hellitzer-Allen, “How can we Help Adolescentgirls avoid HIV infection?, “Network, I3 (4) Malnutrition of Food Policies,”paper presented at the Seminaron Womenand the DemocratizationProcessin Malawi, Ryalls Hotel, Blantyre, 28-31,May. 1995 Hellitzer-Allen, 1992 S., The Cultural Determinantsof Violence AgainstWomen:A Basisfor Policy Intervention, Centrefor SocialResearch, Universityof Malawi, Zomba 1995 l Khaila, l Kishindo, P., “The Case for Non-formal Vocational Educationfor Out-of-SchoolYouths in RuralMalawi,” DevelopmentSouthernAfrica, Vol. IO, No. 3, August, pp 393-400. 1993 94 .-, Cultures l l of Populations: Africa Kishindo, P., “FamilyPlanning and the Malawian Male,” Journal of SocialDevelopment in Africa, Vol. 9, No. 2, pp 61 69. 1994 P., “SexualBehaviourin the Faceof Risk:The Caseof Bar-girlsin Malawi’sMajor Cities,”Health TransitionReviewSupplementto Vol. 5, pp 153-160. Malawi Government, Ministry of Women and Children Affairs, Community Developmentand l SocialWelfare,“TheMalawi Platformfor Action: Follow up to the Fourth World Conferenceon Women,”Lilongwe. 1997 Kishindo, F., “Languageasa Reflectionof Gender Biasand Prejudice:SomeExamplesfrom Englishand Malawian Languages,”paper presentedat the workshop on Gender Sensitizationfor Media Personnel,RyallsHotel, Malawi, 30 Nov - 2 Dec. 1995 l Moto, l Mvula, 1995 l Lapukeni, K., P. Rashidi, N. Kumwombe, and J.B. Webster, “AmachingaYaoTraditionsI: One Hundred Interviews,”History Department, Universityof Malawi. 1977 Malawi Government Ministry of Health, “Child SpacingPolicyand Contraceptive Guidelines,”Lilongwe. 1992 Malawi Government/United 1996 Srivastava, l Srivastava, Nations, Malawi Government, Malawi Population and housing Census,1987,National StatisticalOffice, Zomba:GovernmentPrint. 1994b Malawi Malawi Government, Ministry of Economic Planning and Development, National Statistical Office, and Centre for Social Research, “Malawi SocialIndicatorsSurvey, 1995,”Lilongwe. 1996 M.L., DemographicImplicationsof Child-spacingProgrammein Malawi, paper prepared for Orientation Seminarof Decisionmakersunder Child-spacingprogrammeof the Ministry of CommunityServices,Blantyre, Feb 12-16. 1990 l SituationAnalysisof Povertyin Malawi. 1993 Government, Demographicand Health Surveys1992,National StatisticalOffice, Zomba. 1994 a P. and P. Kakhongwe, “Womenin DevelopmentProfile: Malawi,” Universityof Malawi, centre for SocialResearch,Zomba. l l M.L., Towardsa Population Policy: The Caseof Malawi, Professionalinaugural lecture delivered on 13thNovember,Zomba. 1991 Tavrow, P., FamilyPlanning knowledge, Attitudes and Practices,Machinga District 1993, Centre for SocialResearch,Universityof Malawi. 1994 UNICEF-Malawi, The Barriersto Behaviour Change, Universityof Malawi, Centre for Social Research,Zomba. 1994 95 Cultures of Populations: l United Nations, Africa Aids and the Demographyof l United Nations Population Fund (UNFPA), Malawi: ProgrammeReviewand Strategy DevelopmentReport, No 33. Africa. New York. 1994 1992 l Report of the international Conferenceon Population and Development, Cairo, 5-13September,New York. United Nations, 1995 l United Nations Development Programme, HumanDevelopmentReport,1995,New York: Oxford UniversityPress. 1996 96 l World Health Organization and Malawi Government, Report of the HouseholdSurvey: indicatorsfor Monitoring ProgressTowardsthe Achievementof Health for All by the year 2000, Ministry of Health, Lilongwe, August. 1990 Cultures of Populations * ?A t!v + +4 , ‘4; SOCIO-CULTURALFACTORSAFFECTING DEMOGRAPHICBEHAVIOURINMOZAMBIQUE Aida Mohammed l INTRODUCTION T he objective of this research is to study the socio-cultural factors affecting demographic behaviour of the Mozambican population. The scope of this analysisincludes a literature review on the subject and priority is given to materials published from 1990 to present. Despite the fact that few socio-cultural studies were found from these recent years, the work attempts to respond as closely as possible to the issuesrelated to socio-culturalmilieu of demographic behaviour with a view to affect policies and programmes. GENDERAND ITSROLES One characteristicof the political and socialprojects of post-independent Mozambique is the important role accorded to the woman in the processof national reconstruction and political participation. Education would allow her to participate in the political life of the country. In comparativeterms,it can be noted that in the school year prior to independence (1974/75), the number of girls enrolled in primary education represented 27.7% of the national total. Despite the rise in girls’ primary school enrolment figures, not all succeed in finishing lower primary. In the rural schoolsof Nampula, only 5% of Class1 enrolees finished Class5 according to a publication called Educational Opportunities and Disparitiesfor the Girl Child in Mozambique from 1992. Girls’ dropout rates, especially beginning in Class3 in rural areas, is related to the following: - Earlymarriage - Pregnancy during schooling - Age-based increasein domestic tasks ’ Ministry of Edocodon, Moputo, Mozambique 97 Cultures of Populations: Africa - Lack of pressureby parents or responsible adults to keep girls in school - Costsof education which give preference to boys’ education - Familymobility which at times involvesentire communities - Incompatibility between the school calendar and the timing of agricultural seasonsand initiation rites. The following factorsalso influence the preference for boys’ schooling: Fewer guaranteesthat the girl will continue her studies.Girlsin rural areasmarry early. In the study done by the Fundapao para o Desenvolvimento da Comunidade (Foundation for Community Development),it was found that girls in the north marry immediately after their first menstruation, since marrying off a daughter signifies relief to the mother in terms of economic support (FDC,1995). Lessreturn on the investmentin a qirls’ education. Once a girl is married, her husband’sfamily becomes responsible for her. In this way, the investmentin her education does not benefit her own family (in patrilineal societies).Evenso, girls’ enrolment in matrilineal societiesis lower than in patrilineal ones. This may be explained by the fact that the northern part of the country, which corresponds with matrilineal practices, is also less developed than the southern part, which is more rural, and consequently is more in need of agricultural labour. In addition, more than 50% of the north’s primary school network is comprised of incomplete schools,or schools, which only provide two or three levelsof lower primary education. The majority of incomplete schools are found in the provinces of Niassa,Cabo Delgado, Nampula, Zambezia, and Gaza. With the exception of Gaza,all of these areascover matrilineal societies.Where schoolsare quite distant from their homes, parents are reluctant to send girls due to the danger they may meet along the way. In addition, long distancesbetween home and school mean a great deal of time in transit,which does not leavetime for girls to perform their domestictasks(FDC,1995).The fact that Islamhas a greater number of believersin the matrilineal north may also contribute to girls’ lower enrolment rates, though to reach this conclusion we would need a more in-depth study of the influence of religion on school participation. &ck of confidence in schooling. Parentsbelieve that the girl is wasting time in school, and that this time could be utilised in agricultural and domestic activities,as well as in preparation for marriage. Furthermore, schooling permits contact with moralsthat may conflict with those of the family. In one study undertaken in Maputo, Gaza,and lnhambane (patrilineal areas),parents mentioned that their daughters returned from school asking for stylish clothing that parents could not afford or would consider important. On the other hand, parents believe that through schooling girls have accessto easiermeansfor earning money to satisfytheir new needs, suchas going to the cinema, discotheques, and other diversions. Some parents (it is not known how many) associatedschoolswith discothequesand prostitution (Zucula, 1992). 98 Cultures of Populations: Ati-ica The woman in Mozambican society plays an important role at both economic and social levels.In the rural areas,according to Casimiroet al. (1991),the woman is involved in activities relating to the following: - Agricultural production - Food processing - Supply of water and fuel (firewood) for domestic use - Care of children and the aged - Participation in social taskssuch as marriagesand other ceremonies. In agricultural production the woman utilisesrudimentary instrumentssuch as the hoe, and the products of her activity contribute in part to her family’ssubsistence,while the rest is sold. Despite the fact that she is the producer, the money from salesis administrated by the man. In urban areas, 22% of women have salaried work (DNE, 1995), while many others must supplement their family income through work in the informal sector, due to their low levelsof education. (According to the same Demographic and Socio-economicPanorama,the level of illiteracy in urban areasis 43.596.) Along with this work, the woman hascontinuous responsibility for domestic tasksas well as for meeting the social needs of the community. Gender Discrimination in Education, Work, and Nutrition Reproduction occupies a central position in the family of communities. In Mozambique, socialisationof sonsand daughters marksthe different destiny of each gender, and a difference in their relative power. In the family, sons and daughters are each prepared for the role they must play. In Gazaarea, according to Andrade et al. (1997),found all of the elements of subordination in girls’ socialisation.Girlsprocure water, cook, and care for younger siblings,while their brothers undertake more valued taskssuch as hunting and house construction. In the cities,girls’ education appears equitable to boys’; for example, girls’ enrolment in 1997 was 49% according to Estattsticasde Educapdo (EducationalStatistics).However, for economic reasons,when it is necessaryto chosewho will study, the boy is given priority, depending on his ability. Due to the way they are socialised(for aggressionand competitiveness),boys seem“naturally” better prepared for the male-dominated job market. At the national level, girls’ enrolment in lower primary school is 44.19%, versus55.81% of boys (EducationalStatistics,1997). In interviews with suburban parents regarding their choice for school attendance when vacancy is limited, they said they would opt for the boy (Zucula, 1992).Meanwhile, among the upper-middle classin the city of Maputo, there is no suchdifferentiation between boys and girls. In other interviews conducted in Maputo (Andrade et al., 1997), mothers responded that their children were all raisedin the sameway. However,girls were educated to behave differently 99 Cultures of Populations: Africa and to undertake tasks appropriate to their situation, such as caring for younger siblings, cooking, cleaning, and procuring water and firewood. It can be noted that the country is undergoing socialchanges,and that the use of gender as a criteria for school selection is diminishing. For example, when the girl’s school performance is better, the family prefers to keep her rather than the boy in school. Normally mothers are less likely to use gender to determine who will be sent to school, though the final decision is made by the father. In the rural areas,schooling is only considered useful in caseswhere the girl is lucky enough to finish school without disobeying any norms of the traditional rural community. Schooling is a risk that could bring about economic disorganisation of the family, through a marriage outside the traditional scheme,since the girl is exposed to being chosen by or choosing a stranger.This is a sentiment expressedasmuch south of the Zarnbezi River(in Massinga,lnhambane and Guro, Manica) as north of the river (in Lalaua,Nampula). For Moslems,sending a girl to school means losing the dowry if the girl does not remain a virgin (FDC,1995). In rural and even suburban areas, there are many caseswhere students must travel great distancesdaily to get to school (unfortunately, statisticsare not available).Girlsare more affected by this situation due to danger along the route, and to the time taken away from household tasks such as carrying water, cooking, and caring for siblings. In addition, more than 50% of the primary school network is made up of incomplete schools(DC, 1995).Thismeansthat, for many children, the schoolavailableto them only teachestwo or three levels,and if they want to continue their schooling they must transfer to other schoolsoutside their community. Parentsof rural areasdo not reject the need for schooling of their girls or boys (Zucula, 1992). Nevertheless,depending on their priorities, parents must make their decisions based on the following: - What the school offers - The different roles played by boys and girls in their future social context. Gender-Specific Responsibilities In the sexualdivision of labour, domesticwork is done by women. Evenif she works outside the home or practices family agriculture, the woman has the responsibility for domestic tasks including childcare. At present this work is not valued nor remunerated (Casirniroet al., 1991); it is an “invisible” job, one which is never thought about. To procure water, a resource essential to human survival, the woman must travel some kilometres, which takes up time that she could be using for other activities.More than 90% of Mozambican family units lack accessto running water, and must use water from riversor wells, which are not always near their residences (DNE, 1995). Interviews in Xai-Xai and Massinga 100 Cultures of Populations: Africa revealed that women there travel five kilometres in searchof water, which meansin termsof time per day meanssevenhours and three trips to provide the minimum amount of water necessaryto the family. According to a study by Albert0 (1997) in the coastal area of Furvela,Morrumbene district (province of Inhambane), which hasa water network consistingof the Inhanombe, Furvela,and Mucambe riversand receivesrain practicallyyear-round, the population and women in particular have much easier accessto water. This resource is available at any time during the year. This meansthat women do not lose so much time procuring water, and are able to dedicate themselvesto other activities,which allow them a certain degree of financial autonomy. Women in this area, along with carrying out agriculture and fishing, make clay objects, which are later sold or traded for food. When the head of the family unit is a man, as in the caseof patrilineal societies,he manages the income from the selling of products, even though he has not collaborated in the making of these products. It is up to him to make decisionsabout the use of income, and in many casesthe woman never even knows how the money is spent. The woman is left only with her self-esteem and the fact that she has contributed economically to the family well being. On the other hand, when the head of household is the woman, it is up to her to spend her own income. She normally investsin the education of her children, improving the diet of the family, and purchasing other goods that may improve their quality of life or their material or socialwell-being. Thisdoes not in any way mean that when the man administersthe money he does not spend it on food or on the children’s education, but what is known is that he often uses part of the money (there are no data on the exact quantity) on the purchase of cigarettes and alcohol, or spends it on other women. In another area situated in the interior of the Morrubene district about 500 kilometres from the coast,the population is faced with a seriousproblem: lack of water. It is practically impossible to find water in holes or wells, becausethe water table is about 300 metersdeep and the people have no material meansto reach it. Women of this region have to travel great distances,and at times require 24 hours to provide one container of water for the home. There is little time left for these women to engage in other activitiesthat could contribute to their autonomy. In this situation, women depend solely on their husbands, have little possibility to gain selfesteem, and come to accept polygamy as a form of resolving their problems. It is actually the woman who may suggest that ha husband arrange another woman with whom she can share the daily activitiesof the family. While one goes to the family farm, the other can go for water, take care of the children, and so on. In the patriarchal societiesof the country, it is common to find situationslike those described above. According to Machel (1990),in the set of valueswhich regulate communitiesbeginning 101 Cultures of Populations: Africa with the family, traditional education does not have a code of rights for the woman, only a code of requirements. This means that there are a number of obligations (suchas obedience to the husband, and dependency on the husband for decision-making about her and their children), which are governed by theoretical concepts, by socialconduct, and by a pedagogy of daily life which conditions the woman to inferiority and submission.In the samebasic principles there is no clear understanding of the woman’s rights, but only her obligations. Theseare assumedby the woman and by all family members, in particular the men. Gender-Specific Motivations and Behaviour Gender-specificmotivations relate to behaviourssuch asthe forming of a family, ideal sizeof a family, post-partum abstinence, and acceptance of birth control. The decision about the number of children rests with the man. This can be understood through one interview done by Andrade et al. (1997): The woman does not have the right to decide alone about the number of children, because if she did so during her reproductive years she would not be able to live in harmony with a husband who wanted more children. But what 1know is that the woman mustnever stop having children, becauseshe never knows whether or not she is preventing the birth of someonewho will become a president, an engineer, or a doctor. Thisiswhy a woman mustnever decide alone not to have more children. She must have them until she has exhausted the supply of children in her stomach. (Translation of an interview with a 68-year-old man, Gaza, southern Mozambique.) One study by Enoque (1994) in Manyika, central Mozambique among patrilineal groups describesthe value of a human being as being mediated by the number of children, sincethey represent a necessarylabour force. In a 1996 study by the Institufo de Comunica, coo Social (Institute of Social Communication) in Mocuba, Zambezia, 89.6% of the 29 adults interviewed responded that a very poor man could have many children as long as there was sufficient food for them. 65% said that it was good to have many children becausethey were an economic help to the family. Thesepassagesreveal the concept, which a society has about its children, as the providers of future socialwell being. How the man exercisespower over the family is reflected in the following statement: It is he who decides, if he thinks that the woman has had difficulties in giving birth or if the children are always sick. It is he who normally decides not to have more children. You as a woman can not initiate a conversationbecause men are bad and the woman could get herself into serious problems. The husband could ask, You want to stop having children to do what? (Translation of an interview with a 48-year-old woman in Caza, southern Mozambique, in Andrade et a1.,1997). 102 Cultures of Populations: Africa In the urban environment the same occurs, with some modifications. This depends on the level of education, work, and the social position of the woman, but even more on the statusof the man. In these conditions the man feels the need to secure the future of his children with a good education and a good social situation. Having a large number of children could impede such aspirations. In interviews conducted by Bardalez (1997) in Niassa,Nampula, Zambezia, Tete, Caza, and Maputo, with usersof a family planning service, the number of children that a woman should have varied depending on urban or rural environment. 67.4% of the service usersin the rural areassaid that women should have six or more children, as opposed to 62.2% of urban users. In a study carried out in Cabo Delgado, a northern province with matrilineal societies,the average number of children women wanted was seven.Women from the suburb of Pemba,the provincial capital, and from the district of Mueda wanted fewer children (6.4) in relation to those women of the villages of Wavi and Matambalale. This indicates that they still consider their children part of their own familiesand not of the husbands’ families.The men interviewed said they wanted as many children as possible. They explained that if they had ten children, maybe three of them would care for their parents in old age. If they had only two children, they would not feel securebecauseof the greater possibility that neither would care for them. In interviews with 599 young people in Mocuba and Gile, province of Zambezia,regarding the desired number of children, 4.29% wanted four children, 17.4%wanted five children, 14% wanted two children, 13%wanted more than six children, 10.9% wanted six children, 10.7% wanted three children, and 1.84%wanted as many as God willed (KS, 1997). Considering the results obtained by Andrade et al. (1997), adults in both matrilineal and patrilineal groups prefer to have many children. The resultsfrom the Zambezia study indicate that young people want fewer children (the majority wanted five). Whether or not this might be the sentiment of youth in the rest of the country would be a good future topic of study. MARRlAGEAND FAMILY Marriage Marriage is both a consequence and an instrument of an alliance, in which the man and woman are actors playing roles in the family strategieswhich regulate the alliance. Marriage establishesan exchange of servicesbetween familiesin which the lobolo, or bride price, provides the economic and moral basisfor the marriage, making the husband and his family responsible for maintenance of the woman. The lob010 is a common practice in the region south of the Zambezi River, involving certain monetary or material compensation, or both. This practice exercisesan important influence, as much in individual gender relations between a man and a woman, as in relations between families based on customary norms of the patrilineal system, 103 Cultures of Populations: Africa according to a 1992 study called direiro a alimentos e a mu/her em Mozambique: Estudosde cosos no regiao sul (The right to food and the woman in Mozambique: Casestudies in the southern region). The lob010compensatesthe family of the bride for the sociallossthat her departure represents to the community, since marriage implies that the woman will go and live in the husband’s home, and will become part of and owe respectto his family. South of the ZambeziRiver(which coversthe centre and south of the country), marriage is patrilocal and the woman becomes a circulatory element. Power over her is transferred from her family to that of the husband. In the event of the husband’s death, the woman continues to belong to her husband’s family, and is not capable of making decisions about herself, her children, or even the belongings she brought to the marriage. The children who come from a union that has involved a lob010 belong to the family of the husband. In the event of discord in the home, there is intervention from both the family of the woman and that of the man. The woman rarely divorces,whether becausethere are insufficient reasonsto legitimise the request, or becauseif it is accepted the woman must leave the children with the husband’sfamily. To the north of the ZambeziRiver,among matrilineal societies,marriage is uxorilocal. In the rural areasthe man movesto the residence of the woman’s family and must provide servicesto the parents of the woman. Thisprovision of services,known aspetre among the Macua-Llomwe, consistsof agricultural work, the making of straw mats, and the offer of products from hunting or fishing (CEA,1994).The children adopt the last name of the mother, and the one who makes decisions about them is the maternal uncle, not the father. In matrilineal groups, while the marriage is defined and oriented by the woman’s family, the man continues to wield power in his role as uncle or brother. The age at marriage variesdepending on sex. In the study conducted in Manyika by Enoque (1994) the girl’s age at marriage ranged from 16 and 21 years, but there were the casesof one girl who had married at 12 and another after her first menstruation. The boy’s age ranged from 18 to 25 years. In the study by Inroga (1994) in Zambezia,the age of girls at marriage ranged from 14 to 20, and for boys from 16 to 26. The type of marriage which is legally or officially recognised is the civil marriage. Neither traditional nor religious marriages are recognised. For this reason, religious people celebrate two marriages,one civil and one religious. Moslemsin Mozambique, who constitute 19.7%of the population and are concentrated in Nampula, Cabo Delgado, and Niassa,celebrate the Nikah. This is a ceremony directed toward a maulane (father), in which the bride declaresbefore two witnessesthat she is marrying voluntarily. It is up to the groom to offer his bride an amount of money, known asmahari, whose value is fixed by the bride. It should be noted that the value is symbolic, and that it belongs to the 104 Cultures of Populations: Africa bride and is for her use.Thisis something different than the lobolo, which is offered to the family of the bride. People of other religions (Catholic,Protestant,Jewish) celebrate in their respective churchesin ceremoniesconducted by their leaders. In the city of Maputo, though there are no statisticaldata, we can describe what actually occurs among families who practice the lobolo but who also practice some form of religion. Thesefamilieshave a lobolo ceremony,which functions as a proposal of marriage, where along with the engagement ring the man must pay an amount stipulated by the bride’s family, aswell asoffering clothing, shoesfor his future parents-in-law and bride, and other things they request. In addition, they have a civil wedding and a religious one. Among patriarchal societies,a marriage is recognised once the lob010 is completed. This comment testifiesto the importance of the lobolo: “If a girl marrieswithout the lobolo, there will be no harmony in the home. The lob010 has symbolic significance.The ancestorsdo not forgive them for a wedding without the lobolo.” According to the study in Maputo and Boane (a district 30 kilometres from Maputo), registry of civil marriage is practised by less than lO%of rural women and no more than 40% of urban women (CEA,1994). While inequalities are common in both regions, in matrilineal societiesa woman has more options to modify the traditional marriage model. This is because she has a more visible social position, which values her for her destiny as a producer of resourcesand of children. A woman is given respect and has her own material possessionssuch as a house, herd, and farm. The farm products pertain to the whole family (CEA,1994). In all regions, whether countryside or city, a marriage is only considered perfect when there are children, which guarantees the continuity of the family. Children are a resource and an investment,and at the sametime are symbolicof the family as recognisedby society.The absence of descendants can result in the dissolution of the marriage and return of the lobolo in areas where the practice is the principal meansof union of a man and a woman, even in the area south of the Zambezi Riverwhich is mainly patrilineal (Andrade et al., 1997). Family and Customary Rights The concept of family, according to Mozambican law, is defined as a product of relations between people who are tied by bonds of matrimony, parentage, affinity, and adoption. Marriage, then, is understood as a contract celebrated by two people of different sexeswho wish to legitimately form a family and share their lives. In Mozambique there are two types of familiesbased on different lineage: catrilineal. This rule of descent declares that an individual automatically acquires the basic elements of social statusfrom the father. That is, an individual pertains to the sameline of inheritance as the father, and he of his father. Thisrule applies to .the Mozambican population living south of the Zambezi River. 105 Cultures of Populations: Africa Matrilineal. This rule of descent declares that an individual automatically acquires the basic elementsof socialstatusfrom the mother’sfamily.Thismeansthe inclusion of an individual in the family group (clan or lineage) exclusivelyfollows the genealogical ties with the mother. Thisrule applies to the Mozambican population living north of the Zambezi River (De Coloane,l991) In the patrilineal system,the main role of the man is as a father and a husband. In fact, the sexual relationship is institutionalised through marriage, and the lobolo formalisesthe statusof the children born of this union. There are certain rules that apply if the marriage does not result in children. In the caseof female sterility,the woman’s family mustarrange another woman, who may be a sisteror a niece (daughter of a brother) of the wife, so as to assureprocreation; if not, the lobolo must be returned. In the case of male sterility, the woman and her mother-in-law come to someagreement in arranging for a sexualrelationshipwith another man, so asto permit biological reproduction. In the matrilineal system,the main role of the man is as a maternal uncle and a brother. In the caseof successionof political or social duties, the sonsof the sistersucceedtheir uncle and not his own children. In the caseof inheritance of materialgoods, these may be divided between his children and the sonsof his sister(De Coloane, 1991). The study in the districtsof Mueda and Chuiba, Cabo Delgado, leads us to believe there are changestaking place in the organisation of the matrilineal system.When asked with whom the children will stay in case of divorce, all of the women interviewed responded, “It is up to the father.” If the father decides to keep the children, the mother can not offer objections. The men interviewed responded, “Now, fortunately, we keep our children.” The oldest men and women confirmed that years ago women had kept the children, but the norm began to change after independence. Others (it is not specified which) said that the change began during the colonial period, becauseadministrativefunctionaries demanded that men be in charge of their children. In urban centres, due to the influence of colonial society and religious groups (Catholic, Protestant,and Moslem, from patriarchal structures),the organisation of the matrilineal system suffered changessuch as children adopting the family name of the father. At least lnroga (1994) is of the opinion that the village of Rampani, located 20 kilometres from the city of Quelimane, can neither be identified as matrilineal or patrilineal because the two systemscoexist, despite the fact the village pertains to a region considered matrilineal. Family Structure The family can be structured in three different ways: Enlarqed domestic unit constituted by ascendants,descendants,and collateral. Polygamousdomestic unit, made up of the husband and different wives. Nuclear domestic unit, representing the married couple and their children. 106 Cultures of Populations: Africa In a study by Loforte (1996)in the Laulane neighbourhood on the outskirts of Maputo, it was found that the domestic units were all partilineal but differed from each other depending on the social and professional background of its members, who had various origins (57% from Maputo, 13% from Inhambane, and 30% from Gaza).Migration of these people to the city meant that, for 43% of those interviewed, their family units had become nuclear and they had developed relatively autonomous families. For 15% of those interviewed, their migration was motivated by a desire to escapereliance on their relatives. On the other hand, the neuclarisationof some familiesarose through the struggle of women who, using their influence in combination with that of their husbands, sought to escape the authority and control of their parents-in-law. Evenso, neuclarisation is not viable for all. Most of the time widows do not have the means to support themselveswithout help from their family network, which provides insurancein the husband’sabsence. The position of the woman in any type of family is defined by the sexual division of labour and has a reproductive basis,where the family provides the woman with her identity through her function asa woman and a mother. Thisguaranteesthe continuity of rules,which govern the society in which she has been placed. REl’RODCJC7WE HEALTHAND SEXLWTY Initiation Rites Sex education and moral training for life, for the majority of youth who lived in rural areas during the colonial period, was done mainly through initiation rites. In the early yearsfollowing independence, this practice was repressed due to the political force, which considered these rites as validating the supremacy of the man over the woman, who was taught through these rites to do everything to please the man. At the school level, children had been taught moral education asa discipline, which was also taken out of the curriculum following independence. Without the education provided through initiation rites for those who had practised them, and without the school’smoral education for the others, a vacuum developed in the orientation of Mozambican youth for social and sexual life. Thisvacuum was compounded by the war and subsequent disintegration of families. Today, to fill this void, there are some initiatives by the Ministry of Education,religious groups, community leaders,and others to find waysof transmitting moral valuesand behaviours appropriate to a new socio-economiccontext (CIADAJ,1997). In this context, some communities have openly resumed the practice of initiation rites. In a study done in Mocuba and Gile by the Institute of SocialCommunication (KS, 1997),30% of the 107 Cultures of Populations: Africa 597 adolescentsinterviewed had gone through initiation rites. Of these, 51O/ohad gone through initiation at lessthan 13years of age, and 27.7% at age 13 or 14. Initiation rites represent a public announcement that the young boy or girl has passed through childhood and has arrived at the stage of adulthood. Many girls who passthrough initiation ritesfeel ashamedto confirm this publicly, sincethey are concerned they will be rejected by their friends and by the school (ICS,1997).Thisis a result of the repressionof these practices in the period immediately following independence. In interviews in Mocuba (with the Chuabo ethnic group) and Cile (with the Lomwe), in the province of Zambezia(matrilinealarea),young men who passedthrough initiation ritesconfirmed that the riteswere useful.They learned usefulthings suchasto respecttheir parents, not to steal, to help the poor, not to enter their parents’ room, how to have sexualrelations, how babies are born, rules of behaviour at a funeral, and how to bury someone. Once they are married they must respect the wife, and they must not beat her, insult her, or argue in public. They also learn that it is better to have sexualrelations after 20 years of age, and that after relations they should bathe. To avoid sexually transmitted diseases,they should have only one woman. They will become sick if they have sexual relations when the woman is menstruating. It is also taught that immediately after a woman gives birth, the husband must not engage in relations outside the marriage, or the baby will become sick (KS, 1997). In the study mentioned above, all of the young women interviewed who had gone through initiation rites confirmed that they liked the rites becausethey learned to respect older people, to perform domestic tasks,how to behave during menstruation (not to get closeto their parents during this period, to use sanitary napkins, and to take baths three times per day). In case of pregnancy they must inform an older person, but they do not learn how to avoid pregnancy. They learn sensualdances and movementsto perform in bed to sexually satisfythe husband. They must also clean him after the sexual act. They also learn to pull out the outer labia, unlike the practice in Rampani, Zambezia (Inroga, 1994) and in Manyika, where the inner labia are elongated (Enoque, 1994)with a specialoil, since if this is not done the man will not experience pleasure. According to lnroga (1994),in the study undertaken in Rampani,Zambeziawith the Chuabo ethnic group, initiation rites occur in two phases: When the girl experiencesher first menstruation,a palhoro (grasshut) is constructednear the main home. The girl (namuali)staysin this palhoro and is attended by an aunt, who is treated like a godmother. Thiswoman gives her advice such as the following: - Respectolder people - How to greet older people - Do not play with boys - Obligation to hide sanitary pads so that no one will see them 108 Cultures of Populations: Africa - Internalise the proverb “A woman is never a guest,” meaning that she must carry out all domestic tasks (get up early, sweep, clean the house, procure water, light the fire, cook, and go to the farm). According to Blesa(1991),boys in Nampula also stayin cabanas constructed for these rites in the middle of the forest, and they may not receive visitors. This is where they receive all the teachings,where they undergo physicaltests,and where they are circumcised.On the day they return home, the godfather dressesthe youth in new clothing. This represents the new adult phase into which he has graduated. The palhora that was constructed is burned. The study by Blesa (1991)in Nampula, Manica, and lnhambane found that in recent years circumcision is done outside the ritual context, becoming more connected with the idea of preventive health of the man and the woman. In Cabo Delgado, between the Macuas and the Macondes, initiation rites used to last between 4 months and one year: now they take place during the school vacation. Older people now saythat this reduction of time has caused “bad behaviour” and lack of respect of youths for their elders. The study done in Manyika by Enoque (1991)found that sex education is undertaken mainly by the grandmother or aunt, but very rarely by the mother. For the initiation rites this role is carried out by old women chosenby the family.The themescoveredare: menstruation,childbirth, sexual pleasure, and the relationship between men and women. Pre-maritalsex is prohibited. Initiation rites contribute to the education of girls, and to their responsible behaviour in questions of sexuality. Nevertheless,they need to receive the correct orientation on other questions, such as how sexually-transmitted diseasesare contracted, how to prevent them (especiallyAIDS),and the practice of sexual relations during menstruation. Patterns of Sexual Behaviour Socialbehaviour in married life is governed by norms that women and men both learn. The fundamental characteristicof the man-woman relationship in marriage or in another type of union is the sexual power accorded to the husband. This situation limits the woman’s sexuality to inside marriage and avoid an undesired sexual relation. On the other hand, there are caseswhere the man, normally one with a higher level of education, tries to introduce somevariety into the couple’ssexualpracticesand meetswith resistance from the woman. Thesevariations may not fit into the patterns of sexual behaviour transmitted by the mother, aunt, or grandmother, and are considered taboo, something abnormal, or an offence to one’s dignity. In interviews done in one neighbourhood of Maputo by Santoset al. (1993), 23 out of 25 men said they had extramarital relations for one reason or other. In contrast, it is expected that a woman will always remain loyal to her husband. In the caseof adultery, the other man must 109 Cultures of Populations: Africa pay a fine to the offended husband. If the extramarital relation resultsin the birth of a child, the lover paysa fine but the child remainswith the married couple. Thispractice is common in Niassa (among the Ajawas), Nampula, Maputo, and Gaza. As we can see, there are many taboos connected with sexual practices.In addition, there is the belief that the woman must satisfythe man’s demands without concern about herself. Choice of a Partner In the south of Mozambique, marriage is an exchange of servicesand power between families, where the lobolo (compensationgiven the family of the woman) establishesthe connection between the two families. The choice of partners is most often made by the family members in this method of exchange, which permits the circulation of women between families;it may also be made by free choice. The study in Manyika found that when the choosing strategy fails, physicalviolence is inflicted on the women, mother and daughter. As punishment the father may burn the palms of the mother’s hands (Enoque, 1994). In Zambezia, a woman who remains single is considered a “trouble-maker,” and a celibate man is considered as having sexual problems (impotency) or as having bad luck (lnroga, 1994). There are norms which regulate who is considered a possible marriage partner and who is forbidden from marriage; that is, there are preferred marriages,which without being obligatory privilege certain individuals to become mates,and forbidden marriages,which prohibit certain individuals from becoming mates.Theserules depend on the systemof family relations and the ethnic group. Among the (matrilineal) Makonde, a preferred marriage for the man is with the daughter of the maternal uncle, since the man can continue to live in the same village (Santoset al., 1990).Among the (matrilineal)Macua, however, marriageswithin the samenihimo (blood clan, descendantsof a common ancestor)are prohibited (CEA,1994). Among the Ronga in Maputo, marriage to consanguine relatives is forbidden and, since exogamy is a rule of the community, such a marriage is considered incestuous.According to Mozambican law, these marriagesare also forbidden between relativesof the samegeneration. The influence of traditional alliancesis lessstrong in the urban areasthan in the countryside. Marriage within the sameethnic group continues to be preferred, but it is possibleto find marriages between classesor where the emotional dimension is considered. The choice of a mate, while there are no statisticaldata, is frequently made by the couple themselves. Fertility and Behaviour lnfertility can causedivorce, evenwhen it is not known which of the couple is sterile.For many, sterility is a female illness,and men refuseto be clinicallytested.Thisis also reluctanceon the part of the man to consulta physicianand be proved sterile,which can negatively affect his image. 110 Cultures of Populations: Africa It is expected that during her fertile years,the wife will have the maximum number of children possible, only avoiding pregnancy while breast-feeding. To avoid conception, the method is sexual abstinence. The abstinence period may last for 2 years (asin Gazaand Maputo) or for 14 months (asin Manyika). Normally during this time, the man who only has one wife arranges another. In Cabo Delgado, tradition prohibits the married couple to have sexual relations until the child begins to walk, but in actuality many couples (we do not know how many) do not comply with this rule. Even so, all are concerned about the effects of their behaviour on the child’s health, since they believe that sexual relations during the abstinence period can be bad for the child. The child could get diarrhoea, and become weak and pale. To avoid this problem, the couple goes to a curcmdeiro (traditional healer) for a root which is rubbed onto the head and the anus of the baby; only after this can the couple resumetheir sexualactivities.The end of the abstinence period does not mean that the mother ceasesbreast-feeding. Breast-feeding stops when the mother becomes pregnant again, or when she herself decides to stop. In familieswithout children, sterility is almost always attributed to the woman. She is seen as failing to complete the task for which she is designated according to the sexual division of labour in her husband’sfamily. In rural areas, rejection of the woman is considered normal, both by the family and by the woman herself, since the absence of children meansan interruption in the exchange and circulation of descendants.In the cities, the woman is stigmatised subtly, not by expulsion from the home but by having to accept a second wife. In urban families,childlessand without traditional mechanisms,which protect the woman, she is in an unstable situation and filled with anguish. A woman without children is not a complete person. Maternal Mortality Maternal mortality is one of the principal causesof death in women of reproductive age in developing countries. The magnitude of death in childbirth in Mozambique, as in other underdeveloped countries, is a difficult task due to the fact that not all casesenter the hospital, and often reports are ambiguous as to the age and causeof death. In Mozambique, one of every 16 women of reproductive age dies for reasons related to childbirth (pregnancy, delivery, or post-partum complications) (DNE, 1995). In addition, whether due to poor work conditions, being overworked, lack of proper nutrition, or even failure to use a condom, women are subjected to exposure to many types of illness,such as: - Anaemia - Rheumatism(from farming in flooded areaswithout any protection) - Malaria (from washing clothing in stagnant water where mosquitoesproliferate) 111 Cultures of Populations: Africa - Malnutrition during pregnancy and lactation (due to shortage of food or deficient nutrition in poor familiesor familieswithout farms) - Sexuallytransmitted diseases. The most common causesof maternal mortality, however, are peritonitis, post-partum haemorrhaging, uterine rupture, and eclampsia (Casimiroet al., 1991).At present, between 60 and 70% of the Mozambican population livesin conditions of extreme poverty (Casimiroet a1.,1991). Poor familiesare more likely to be subjected to such high-risk situationsas malnutrition and premature death. Though there are no concrete data available on maternal mortality and poor living conditions, we can interpret the above-mentioned data assaying that women in poor socio-economic situationsare more vulnerable given their lack of accessto information about proper prenatal care, the lack of appropriate medical facilities,the distance of medical facilities,and the conditions of overwork during and after pregnancy, as well as malnutrition and anaemia In 1990 in Zambezia, one of the most populated provinces of Mozambique, more than 50% of pregnant women suffered from anaemia Thisdata demonstratesthe gravity of the situation in the country (Women’sForum, 1990). RELIGIOUSAND TRADIONAL DISCRIMINATION Thissection discussesgender-based discrimination based on religious and traditional beliefs, relative to systemsof inheritance. It can be said that in Mozambique there are three co-existing normative systems: - Written law, based on legislation in force and recognised by the State - Customarylaw, with various characteristicsdepending on the locale - Sharialaw, followed by Moslems. Unlike what happens in other southern African countries, Mozambique only recognisesthe law emanating from written law, operating and exercising its power based on this law. Recognising this difficulty, the government has opted to construct a legal system,from the local community courts up to the supreme court, which can reconcile written law with customarylaw as practised by different groups in Mozambique According to formal law, property, family organisation, and society’spolitical organisation constitute the base necessaryto characterisea systemof succession.Law of successionis related to family law and property law. Inheritance of goods and possessionsfalls under customarylaw, depending on the existing structure of the family and- the lineage systempractised by that group. 112 Cultures of Populations: Africa Among the Macuas(matrilineal system),if the husband dies, the heir is the first-born nephew, son of his oldest sister(or cousin).The wife has the right to inherit the house, domestic articles, food, and the farm, which she owned before marriage, which was augmented upon their marriage. However, there are caseswhere the deceased husband’soldest brother is the heir, which seemsto reveal a transition to a patrilineal system.This may be through the influence of Islam, Catholicism,or the colonial system,all of which are or were notably patriarchal in nature (CEA, 1994). In a patriarchal society, when a husband dies, his widow is kept within the nucleus of the family with their children. She may enjoy the inheritance left by the husband after being submitted to rites of purification and other practicesrelated to the leviraro (seeexplanation below). According to customary practice, two types of marriage are prescribed upon the death of one member of the couple: - The liveroro, which is the norm compelling the widow to marry her brother-in-law or another member of her deceased husband’s family. The man chosen inherits the woman, her children, and her material goods. In the casewhere the woman choosesto marry another man who is not part of the deceased husband’s family, the lobolo which was paid at the time of the original marriage must be returned (Santoset al., 1993b). The liveroro type of marriage occursmost often in the southern part of the country in patrilineal zones,and also among the Macondes. - The sorororo, which is the rule prescribing marriage of a widower to the sisterof the deceased wife. Thistype of marriage is practised by the Macuas,and the children continue to fall under the authority of the mother’s side of the family. In Makonde society, the widowed man can demand the youngest sisterof his deceasedwife, or a niece. The situation of widows in matrilineal and patrilineal systemsis actually quite similar. In a matrilineal society, the widow remains within her family group, along with her children and goods. It would seemthat she would be better protected than in a patrilineal society.However, in the study done in (matrilineal) Nampula and (patrilineal) Maputo, the majority of widows in both areasremained alone with their children (CEA,1994). On the other hand, in patrilineal areas the husband’s sistersoften re-take possessionof goods, using the argument that the amount paid for their lobolos was used to pay the lobolo of their brother. In the CEAstudy (1994)in patrilineal Maputo and Boane, according to the women interviewed, widows and women separated from their husbands can only count on the help of their biological parents, and not on the members of the husband’s family. This suggeststhat some traditional family relations and inheritance practicesare undergoing transformation. It should be noted that when the lobolo systemis combined with another type of marriage, the lobolo norm is superseded by principles governing other marriages, especially religious 113 Cultures of Populations: Africa principles. This is confirmed by one widow interviewed in Boane, who said, “I didn’t accept being inherited, becausewhen my husband died l was already praying, so I did everything I should have done according to the rules of the church” (CEA,1994). There is a new tendency for women to be heads of the family. The number of women heads of household in urban areashas been growing. In these familiesit is the woman who arranges the meansfor the family’ssurvival.In the rural areas,women-headed familiespertain to widows and women separated from or abandoned by their husbands. Widows who are heads of household and lost their husbandswhen they were quite young confirm with great conviction that they became heads of household because of the need to educate their children, undertaking taskstraditionally carried out by men in order to support their children and control the family. For thesewomen, a new marriage would have many implications. There would probably be conflicts between the stepfather and the children, and later physicalaggressionin the form of domesticviolence, something that never occurred in the past. The best option for these women is to live alone with their children until they are grown and support their mothers. One surveydone in Maputo found that the percentage of women-headed householdswas considerably higher among poor families:25.9% of indigent familieshad a female head of household, asopposed to 11.8%of familiesconsidered better off (UPP,1993).Thiscan be explained by the fact that 78% of women were war-related refugees to Maputo, whose husbandshad disappeared, been killed, or emigrated. Those running from the war were often illiterate rural women with no material resources,and few possibilitiesfor employment which would permit them and their familiesto make a living. DIFFUSIONOF IDEASTO CHANGEVALUES How can values be changed, especially those related to patterns of education and health,? In interviews done by Enoque (1994), the majority in a group of 30 women was favourable to the introduction of sex education in the schools.Differencesaroseconcerning who should teach it and how it should be taught. Some preferred the teacher, while others wanted a traditional educator. Some wanted gender-separated classes,but with some themes like menstruation, childbirth, and the risksof early pregnancy being taken up with both sexestogether. Themes related to sexual behaviour should be treated in segregated groups. In a total of 73 interviews done in Mocuba and Quelimane, the majority who had used some form of avoiding pregnancy (78.1%) had education higher than Class5 (KS, 1997).It appears that formal education provides young people with accessto information about options for preventing pregnancy. 114 Cultures of Populations: Africa Many women are not very receptive to the use of contraceptivesbecausethey fear that they many lose the possibility of having more children, and their husbandsare not open to accepting it. lnformation on family planning and its implementation have been directed only at the woman (Women’sForum, 1990). It would be important to involve the man more in family planning, so that he could understand and feel that the use of contraceptivesis a way to protect the health of mother and child. In interviews with men married to fertile women in Cabo Delgado, many men said they knew what family planning was, but that they would like to hear more explanation. Nevertheless,they failed to see the advantage of the possibility of having sexual relations during the period of abstinence (during breast-feeding), since they liked to have other women during this time, and they feared the negative effectson the baby’s health if they had relations with their wives. It can be said that to a certain degree there is a change in attitude about the number of children, which can be noted in the interviews done by Bardalez(1997)and KS (1997).Both found that the ideal number of children among the younger generation is lower than among the older. Probably young women aspire to work outside the home, continuing their studies, and providing better education and health to their children to better their quality of life. DIEFUSIONOF 1NFORMATlONAND KNOWLEDGE Diffusion of information and knowledge is the role of the media of social communication. The media carry out an important function in the disseminationof messagesand development of public opinion. Unfortunately our communication media rarely take a deep or open approach to sexuality,reproductive health, or questionsof gender. Instead, people fall back on interpersonal communication, which is subject to distortion of information. Only a small minority of people have accessto the information that is sometimespublished or debated in the newspaper about sexuality, sexually-transmitted diseasesincluding AIDS, abortion, or abandonment of new-borns. Newspapers are not available to the majority of the population due to their cost, to difficulties of transport in the caseof more remote areas, or to the fact that 56.7% of the population over age 15 is illiterate (DNE, 1995).In the KS study carry out in Quelimane and Mocuba (1997), only 10% of a total of 589 young people interviewed read a newspaper such as Noticias,Savana,or others available. AIDS prevention campaigns about condom use are run by radio which, despite the fact it does not cover the entire population, hasthe advantage of transmitting its messagesin the local languages, which greatly facilitatestheir comprehension. The “women’s program” in the afternoons, which comesfrom the Maputo city transmission,takes up questions such as mother and child health, preventative health measures,women’s rights, and domestic violence. 115 Cultures of Populations: Africa With regard to television,which functions in some provinces (Maputo, Beira, and Nampula), programs are limited to AIDSprevention campaigns.There are daily publicity spots on prevention during peak hours. But only very rarely are questionstaken up suchasabortion, adolescent pregnancy, family planning, divorce, or family relations. CONCLUSIONSAND RECOMMENDATIONS Conclusions As we can see that socio-culturalfactorssuch as norms, and valuesabout gender, family and reproduction that affect socio-cultural behaviour in Mozambican society do not provide for equality of rights and responsibilitiesbetween men and women. The woman must raisethe children, undertake all domestic tasksalone, look for water and firewood, and do the farming. In matrilineal societies,the woman is the owner of material goods suchas the farm and the home, unlike in patrilineal societieswhere everything pertains to the husband or his family. The norms which regulate either societyare changing in some parts of the country, for example where the father can now make decisionsabout the children in matrilineal areas,and where the woman can no longer receive help from her deceased husband’sfamily in patrilineal areas. The decision about family size, especially the number of children restsessentiallywith the man. Having a large number of children contributes to his social prestige, so that even where contraceptivesare available and there is understanding of their benefits to maternal and child health, they are rarely used. Nevertheless,there are indicationsof a change of attitude and behaviour, particularly in urban areas. People are becoming more favourable to the idea of contraceptive methods, since controlling the number of children can mean better conditions for educating them, feeding them, and keeping them healthy, aswell as improving the quality of life. Despite the fact that there is a growing number of women seeking family planning services, there remain numerous constraintsguised as traditional and religious taboos and ethical/moral values.Thesemake people seefamily planning asa limitation in the number of children one can have, and as a form of promoting promiscuity and adultery. The current use of media of communication to create awarenessand teach about gender roles and preventive health is of a very tentative nature and limited to the urban areas.This is due to the difficulties of transporting newspapers to different parts of the country, to the high rate of illiteracy, and to the limited radius of accessibilityto radio and television broadcast. Young people, and especiallythose who do not passthrough traditional rites of passage,are extremely lacking in information on sexuality,avoiding pregnancy, abortion and its risks,sexually-transmitted diseasesSTDsand HIV/ADIS prevention. Cultures of Populations: AfFica Recommendations Extensive education program It is necessaryto undertake an extensiveeducation program for young people, for parents, and for the genera1community to promote a change in behaviour. Thiseducation must include themes on sexuallife, gender, and the role of the family in the education of their young people. Education on sexuality in school curriculum It is important and urgent that the Ministry of Education collaborate with the Ministry of Health, the Ministry of Culture and Youth, and the Institute of SocialCommunication to provide information and introduce into the school curriculum such themes as sexuality and gender. This form of education should promote responsiblebehaviour among the youth of tomorrow concerning sexuality and an improved relationship between women and men. Health services improvement The Ministry of Health should promote awarenessamong its health personnel concerning how to deal with young people seeking their family planning services.Counselling centres for young people should be created, or specialhours at health postsshould be set aside for dealing with young people’s questions.They should be sensitiveto the young woman’s need for privacy. Involvement of men Men must be involved more in family planning, so that they could understand and feel that the use of contraceptivesis a way to protect the health of mother and child. Additional Research Becauseof the lack of information on some provinces related to family planning, sexuality, marriage, and abortion, it is suggested that more researchbe conducted in those areas. Thisanalysesleads to the conclusion that it is necessaryto undertake an extensiveeducation programme for young people, for parents, and for the general community to promote a change in behaviour. This education must include themes on gender (with the idea of developing equitable relationship between women men), and the role of the family in the education of children. It is important also for Educationaliststo promote awarenessand skillsamong its serviceand information providers concerning how to deal with young people seeking information and services. In addition, counselling centres for young people should be created, or special hours at health postsshould be set aside for dealing with young people’s questions.They should be sensitive to the young woman’s need for privacy. It is important and urgent that Education, Health, Culture and Youth, Institutes of Social Communication and NGOsto provide information and introduce into the various curricula such themes as sexuality,reproductive health etc 117 Cultures of Populations: Africa Becauseof the lack of information in the country about socio-culturalfactorsand demographic behaviour, it is proposed that qualitative and quantitative researchbe conducted to fill the gaps in information to develop effective policies and programmes. Conclusion The decision about fertility and family planning restsessentiallywith the man. Having a large number of children contributes to his socialprestige, so that even where contraceptivesare available and there is understanding of their benefits to maternal and child health, they are rarely used. Nevertheless,there are indications of a change of attitude and behaviour, particularly in urban areas.People are becoming more favourable to the idea of contraceptive methods, since controlling the number of children can mean better conditions for educating them, feeding them, and keeping them healthy, as well as improving the quality of life. Despite the fact that there is a growing number of women seeking family planning services, there are numerous obstaclesfrom traditional and religious taboos and ethical/moral values. Thesemake people see family planning asa limitation in the number of children one can have, and as a form of promoting promiscuity and adultery. The current use of media of communication to create awarenessand teach about sexuality, fertility and gender is of a very tentative nature and limited to the urban areas.Thisis due to the difficulties of transporting newspapers to different parts of the country, to the high rate of illiteracy, and to the limited radius of accessibilityto radio and television broadcast. Young people, and especiallythose who do not passthrough traditional rites of passage,are extremely lacking in information on sexuality,avoiding pregnancy, abortion and its risks,use of condoms, and sexually-transmitteddiseases. As we can see, there are still many taboos connected with sexual practicesat certain times such asabortion or menstruation. In addition, there is the belief that the woman must satisfythe man, with no concern that the woman should also be satisfied. 118 Cultures of Populations: Africa BlBLIOGRAWY l l Rosita (1997).Resourcemanagement for sustainabledevelopment. Maputo. Methodology: Interviewsof someresidentsand comparativemethod. Alberto, Andrade, Ximena; Loforte, Ana Maria: Oshio, Conceiq-o; Ribeiro, l l Jorge (1997).Estudode intercept-o do consumidorde metodosanticonceptivos (Studyintercepting the consumerof contraceptive methods).Maputo: ProjectoPHCS. Methodology: House-by-housesurveyin 6 provinces of the country (3 districtsand one an area with a total of about 100surveysin each). l l Bardalez, Bless, C.G.(1991).Estudoantropokgico “Asregrasde comportamento”(Anthropological study “Rulesof behaviour”). Maputo: FNUAP/OIT/OMM.Methodology: Interviewsin sex-segregatedgroups in Manica, Nampula,Inhambane,and Maputo in rural and urban areas. Anthio (1995).Perfilepidemiolbgico, complicacdese custodo abort0 clandestine, comparac-ocorn o abort0 hospitalar e parto em Maputo, Mocambique (Epidemiologicalprofile, complications,and costof clandestineabortion, comparisonwith hospital abortion and childbirth in Maputo, Mozambique).Doctoralthesis in ob/gyn medicine. S-o Paulo,Brasil: Universidadede Campinas. Methodology: Quantitative researchand case study accompaniment. Bugalho, Casimiro, Isabel; Loforre, Ana: ETPessoa, Ana (1991).A mulher em Mocambique (The woman in Mozambique).Maputo: CEA/UEM. Methodology: Bibliographic research. Lricia; Temba, Eulcilia (1997).Familiesin a changing environment in Mozambique. Maputo: CEA/UEM.Methodology used: lnterviews done in Maputo and Cazawith groups of religious and traditional leadersand administrators,indirect observation,and family histories. l l CEA(1994).Direito a success-oe a heraga (The right of successionand inheritance). Research project. Maputo: CEA/UEM. Methodology: Interviewswith widows/widowers of Maputo and Nampulato record their life histories. CfADAJ(1997).Planonational de acg-o para o desenvolvimentodo adolescentee jovem (National plan of action for adolescentand youth development). Draft.Maputo: MCDJ. h-a@ Baptista Lundin (1991).The reconstructionof the premisesof socialrelationshipsin the resolution of severeand generalised problems.Maputo: UEMFaculdadede Letras. * De Coloane, l l (1995).Mocambique: Panoramademografico e s6cio-econbmico(Mozambique: Demographicand socio-economicpanorama). Documentnumber 5. Maputo: DNE. Methodology: Questionnairesgiven to a random sampleof families. DNE Dominguez, Marta Isabel (1996).Generae violencia domestica.Analisecomparativanuma zona rural do sul de Mocambique (Genderand domesticviolence. Comparativeanalysisin a rural area in southernMozambique).Maputo: CEA/UEM.Methodology: Individual interviews of 36 participantsand 3 collective interviews, 2 of which were only with the women.Maria Angelina (1994).Mulheres de Manyika contam... Sexualidadee famiia * Enoque, 119 Cultures of Populations: Africa Methodology: Rapid analysisof court sessions for basicand impact studies,also called the “card system”by Elinor K Lafontant.Questions were translatedinto the local languagesof the 2 regions. (Womenof Manyika speak...Sexualityand family). Exploratorymicro-study.Maputo: INDE/FNUAP/UNESCO. Methodology: Interviewsof young women aged 16to 23 and older women over 50. (1995).A escolarizacaoda rapariga (Theformaleducationof girls).Preliminary version.Maputo: Fundacaopara o Desenvolvimentoda Comunidade. Methodology: Bibliographic researchand interviews. l FDC l Ferrari, Katia & Bardalez, Jorge (1996). Conhecimentos,atitudes e pmticasem DTSe planeamento familiar (Knowledge,attitudes and practicesin sexuallytransmitteddiseases and family planning). Maputo: Medecinsdu Monde/AMODEFA. Methodology: Quantitative interviews in 3 neighbourhoods of the city of Maputo, where 239 family aggregateswere selectedall having someonebetween the agesof 16and 44. ICS(1996a).Relat6riode pesquisasobre temas de saudee populacao corn liderancasformaise informaisem Mocuba e Gile (Researchreport on the themesof health and population with formal and informal leadershipin Mocuba and Gile). Maputo: ICS. Methodology: Rapid analysisof court sessions for basicand impact studies,also called the “card system”by Elinor K. Lafontant.Questions were translatedinto the local languagesof the 2 regions. l l ICS(1996b).Relat6riode pesquisasobresaude reprodutiva cornjovens de Mocuba e Gile (Researchreport on the reproductive health of young people in Mocuba and Gile).Maputo: ICS/FNUAP. 120 ICS(1997).EstudoCAPsobre saudereprodutiva de adolescentesem Quelimane (CAPstudy on the reproductive health of adolescentsin Quelimane).Maputo: ICS. Methodology: Interviewsof 601 adolescents and qualitative researchin groups. l (1996a).Condicdess6cio-culturaispara a introducao de educacaosexualnasescolasprimariasem Mocambique (Socio-culturalconditions for the introduction of sex education in primary schoolsin Mozambique).Maputo: INDE/FNUAP/ASDI. Methodology: Questionnairesgiven to 289 adults and 169youths in Nampula,Gaza,and the city of Maputo. l INDE l INDE l (1996b).Relat6riodo seminariode orientacao pedag6gica (Reportof the seminaron pedagogical orientation). Maputo: INDE/FNUAP. Isabel (1994).Mulheres chuabos contam...Sexualidadee familia (Chuabo women speak...Sexualityand family). Exploratorymicro-study.Maputo: DE/FNUAP/UNESCO. Inroga, (1996).Analiseda componentematerna (Analysisof the maternal component).Maputo: MISAU. l MISAU l Netherlands Embassy (1997).A posicaolegal da mulher vis a vis a interrupcao de gravidez e laqueacaodastrompas(Thelegal position of Cultures of Populations: Africa the woman in termsof interruption of pregnancy and tubal ligation). Maputo: Netherlands Embassy.Methodology: Bibliographic research and interviewswith 5 doctors. l Santos, Balbina Dorsan &Arthur, Maria JOG (1990).Programade pesquisasobre o comportamentosexual da popula@o (Researchprogram on the sexual behaviour of the population). Maputo: INS. Methodology: Accountsand interviews done in Niassa,Nampula,Tete,and the city of Maputo. l Santos, Balbina Dorsan Es Arthur, Maria em Mocambique (I, a woman in Mozambique). Maputo: UNESCO/AEMO. Methodology: Bibliographic researchcontaining resultsof a pilot questionnaire on sexual behaviour. l Carmen (1992).Socio-culturalaspects of the attendanceof girls at the primary level. Maputo: INDE/ARPAC. Methodology: Rapid analysisof court proceedings in 6 rural and urban communitiesof Maputo, Gaza,and Inhambane. Zucula, Jo& (1993a).Comportamento,atitudes e pr6ticas entre OSjovens escolares--As DTS,o SIDA,o preservative,e avida sexualafectiva (Behaviour, attitudes, and practicesamong schoolaged youth-- sexually-transmitteddiseases,AIDS, condoms,and the affective sexuallife). Maputo: PNCS/DTS. Methodology: Questionnairegiven to students in two schoolsin Maputo. l Santos, Balbina Dorsan &Arthur, Maria Jo& (1993b).Vida sexual no casamento:Pkiticas sexuaise sexualidadefeminina e masculina (Sexuallife in marriage:Male and femalesexual practicesand sexuality).Maputo: Programa National de Controlo de SIDAe DTS. Methodology: Individual interviews,interviews of women at the health post that day, individual or collective interviews of local authorities. l Santos, Balbina Dorsan &Arthur, Maria Jo& (1994).EnquantoOShomenstiverem o poder sexual... comportamentosexuale a expand0 dasDTSe SIDAem Maputo (While men have the sexualpower... Sexualbehaviour and the expansion of sexually-transmitteddiseasesand AIDSin Maputo). In UNESCO, Eumulher 121 Culrures of Populations SOCIO-CULTURALCHANGEANDDEMOGRAPHYINFIJI Dharma Chandra* S ocial change precipitated by rapid urbanisation and industrialisation, modern and western lifestyles,education and employment, particularly of women, and relentlessglobalisation, has a significant impact on the demographic behaviour of people. Demographic changes such as declining fertility, changing family sizes,the emergence of nuclear families, changing patterns of marriages, increase in the age at marriage, and reproductive and contraceptive behaviour are some of the important outcomesof the social changes experienced by people at local and national levels.Socialand cultural differences between cultural groups and subgroups and acrossethnicity and gender make it important to explore how well these groups respond to these social changes and how they consequently affect demographic behaviour. Socialand cultural norms relating to sexuality,reproduction, gender roles, position of women in the household, marriage norms, knowledge, attitudes and beliefs towards family planning and contraception, views of family size, and the value of children are some of the issueswhich require further exploration. The multicultural nature of Fiji’s population and more specifically the cultural differences between the Fijianand the Indo-Fijiancommunitieswere important considerationsfor the choice of Fiji as a participant in this research.Indigenous Fijiansand lndo-Fijiansform approximately 96 per cent of Fiji’spopulation. Indigenous Fijianscompriseabout 51 per cent of the total population while Indo-Fijians(fifth or sixth generation descendantsof indentured migrant labourers)represent about 44 per cent. Eachethnic group has retained much of its traditional and cultural lifestyles, but both have been significantly influenced by modernisation. Both communities have very strong religious and cultural backgrounds. The indigenous Fijian population is mainly Christian, with the majority being Methodist, while the lndo-Fijian population is mainly Hindu, with small minorities practising Islam,Christianityand Sikhism. Both communitiesare patriarchal.There is a strong senseof authority and hierarchy,especially in Fijiansociety.Men have a dominant role in all the decision-makingprocessesin the household as well as in the larger community. Women’s position is subordinate to that of men. Women in lPmfemr, University ofSouth Pacific, Suva, FVi 123 Cultures of Populations: Asia Pacific both communitiesare expected to fulfil their roles aswives, mothers, caregiversfor young and old, and as homemakers.However, women’s roles and position in the household are changing due to improvement in their education level and participation in paid employment. Respectfor people in authority is of importance in both the societies.Young people in the household are expected to show courtesyand respectto their elders. Adolescentsand young adultsare expected not to question and argue, but obey in silence. Young people learn behavioural norms by listening to their elders, participating in gender differentiated tasksand roles, and by observing the cultural norms prescribed for their behaviour. However, socio-culturalchanges are rapidly eroding these values. Norms relating to sexualityand reproduction are not the subjectsof open discussion.In both societies,sex and sexuality are taboo topics especially in mixed gender and age groups. There are severecontrols relating to overt sexualbehaviour. Sexualexpressionssuchas holding hands, hugging, kissing, touching and fondling in public places are culturally not acceptable. Premaritalsex and childbearing out of marriage are strongly disapproved of among femalesin the Fiji-Indiansocietyand there are severesanctionsthat control suchbehaviour.In the indigenous Fijiansociety,however, it is mildly tolerated (Seniloli, 1992). Women’smajor role is that of homemaking, reproduction and child rearing. Both the reproductive behaviour and position of women in societyare therefore influenced by a mix of factorswhich include the politics of population numbers and ethnicity in a multi-racial society: the socialand gender norms of one’s own ethnic group: cultural factorssuchasthe education of women, marital status,age at first marriage, and the social, economic and psychological values attached to children; and the use of family planning. Thesefactors significantly influence individual and group demographic behaviour, particularly those relating to fertility and family planning, and sexualand reproductive health. Population growth, structure and distribution The ethnic composition of Fiji changed slightly between 1986 and 1996. In 1996, Fijians represented51 per cent of the total population of Fiji,Indo-Fijians44 per cent and the other ethnic groups 5 per cent. The Fijian population increasedby 19.5per cent, while the Indo-Fijian population suffered a decline of 2.8 per cent. The intercensalannual growth rate for lndo-Fijianswas - 0.3 per cent and 1.8 per cent for ethnic Fijians(Bureauof Statistics,1998a: 12). Emigration has severelyaffected the Indo-Fijian age and sex distribution (Bureauof Statistics, 1998a:21). Their population became decidedly older between 1986and 1996.The proportion of those aged under 15yearsdecreasedfrom 38 to 33 per cent: those aged 16-64yearsincreased from 60 to 65 per cent: and the dependency ratio fell from 67 to 55. Theseageing and dependency trends were also evident, but to a far lesserdegree, in the Fijian population. Children still comprised well over one-third of the Fijian population (38%) and two-thirds of the population were dependants. The Fijian population, hardly affected by the 1987 coups and little touched 124 Cultures of Populations: Asia Pacific by declining fertility, was by 1996considerably larger, younger and more ‘dependent’ than that of Indo-Fijians Thus,more Fijian than Indo-Fijian young adults remained never married for a longer period, a situation that has serious implications for the sexual and reproductive behaviour of Fijian youth.’ There is thus a greater likelihood of many Fijian young people engaging in sexual activity before marriage, and a consequential higher risk of exposure to non-marital births and STls. Urban and rural distribution Fiji has a relatively high level of urbanisation with some 46 per cent of the total population living in urban areas, higher than the overall level of 35 per cent for the Pacific islands as a whole. The urban population increased by 2.6 per cent per annum between 1986 and 1996, marginally higher than the rate of 2.4 per cent during 1976-1986(Chandra, 2000:2). The urban population increasewas partly due to changes in some urban boundaries and the declaration of new towns and township areas,and partly due to rural-urban migration and urban fertility. Fertility While both Fijian and Indo-Fijian total fertility rates have been declining over the last three decades (Bureau of Statistics,1998a),the Indo-Fijian decline has been more rapid and greater than that of Fijians.The acceptanceof smallfamilies,the future prospectsof children, use of family planning, and other socialand economic factorshave hastenedthe decline of Indo-Fijianfertility. The most important factor since the 1960shas been older age at marriage. More recently, the emigration of Indo-Fijian women of reproductive age has further contributed to significant fertility decline. Fijianand Indo-Fijian fertility decline may be attributed to many factorssuchasthe rising level of education of women, increasein the age at marriage, employment opportunities, and other socio-cultural changes favouring smaller families. A most significant factor has been the introduction and vigorous promotion of family planning. With increasing emphasison education and employment for women, fertility is expected to decline further in the future. Over 90 per cent of all Fiji’sbirths occur in hospitalswhose records show some10-15per cent of all live births occurring to teenage mothers, about one-third of these involving single women. In 1994,25 per cent (and in 1996 30%) of all teenage births occurred to single mothers (Ministry of Health, 1998). There are important concerns in Fiji about unplanned teenage pregnancies. Hospital data show that while the majority of the births among Indo-Fijian adolescents occurred within marriage, nearly half the births to Fijian adolescents occurred outside marriage. While the adolescent fertility rates are low (discussedearlier), there is concern about unplanned teenage births to single women, contraceptive knowledge and practice among adolescent women. I According to the Fiji Census, rhe category - married included those who were /egofly mam’ed and those who were living rogerher. 125 Cultures of Populations: Asia Pacific Studiesshow that the prevalence of premarital sex and adolescent births outside marriage among Fijiansisin part explained by the perceivedrole of marriage.Marriage isstillvery important for entry into regular sexualexposure and childbearing for both Fijiansand Indo-Fijians,but for Fijians,premarital sex and pregnancy may causethe partners to begin a de facto union which may or may not later result in marriage (Seniloli, 1992:20).Theseare new forms of marriage and procedure “where consummationtakes place before marriage rite is performed” that are becoming acceptable in the Fijian community (Ravuvu,1978, 1987:290). The prevalence of contraception among adolescentwomen is not known, as previousstudies on contraceptive prevalence have focussed on ever-married women and not on adolescent women as a separategroup (Mandoza, 1988; Seniloli, 1992, 1996). However, Gyaneshwarand Roizen (1992:27) in a survey of 306 pregnant women at the Colonial War Memorial Hospital indicate that for the majority of the young, single mothers, pregnancy was unplanned and unwanted. a) Family planning Family planning began in Fiji in 1963 in response to the country’s high birth rate and the annual rate of increase. Rapid population growth was feared. Prolific births and uncontrolled family sizewas seen asa burden on both parents and the economy (FamilyPlanning Association, 1966).There was specialconcern about the very high lndo-Fijian birth rate when compared with the Fijian birth rate. Until 1966, Indo-Fijian birth rateswere much higher than the Fijian birth rates.There was a grave political concern especiallywhen the Indo-Fijian population was larger than that of the Fijian population. Fertility reduction was seen as essentialfor political stability. b) Male participation in family planning The demographic literature on male participation in family planning service indicates that there are severalbarriers to their participation. Theseare: Limited availability of contraceptive methods for males Men’s discomfort and feeling out of place at family planning clinics Lack of information and knowledge among men Religiousand cultural barriers Inability of men to discusssensitiveissues(taboo topics) Childbearing is biologically from women; therefore family planning has been focused on women Provider bias against malesas serviceproviders are mostly females Limited communication between spouses Rumoursand misconceptionsinfluence men’s acceptance of family planning. l l l l l l l l l 126 Cultures of Populations: Asia Pacific Mortality The total number of reported deaths has remained fairly constant over the last 20 years. According to the Ministry of Health (1997:lo), the crude death rate has remained at 5.5 deaths per 1000 deaths per year. Under reporting of deaths is a problem. Thisis most likely to be due to the failure to file a death certificatewith the proper authorities,and inaccurateand incomplete recording of deaths (Bureauof Statistics,1998a:68). The life expectancy at birth for the Fijian and Indo-Fijian populations has not changed in recent years. In fact, both ethnic groups and both sexesappear to have experienced a slight decline in life expectancy at birth according to 1996 Censusdata and Ministry of Health data. “The difference between the male and female average life expectancy at birth remained approximately four years to the advantage of females. This difference is caused by higher mortality of adult males than adult females. In 1996 the difference between male and female mortality was somewhat larger for Indians than for Fijians” (Bureauof Statistics,1998a:71). a) lnfant and child mortality Fiji’sinfant mortality ratesare low compared with those in many other developing countries, and there have only been slight decreasesfor both Fijiansand Indo-Fijians in recent years. Child mortality remained low at 5 for both sexesfor 1986 and 1996. However, it was marginally higher for females of both ethnic groups and for Fijian compared with Indo-Fijian infants. b) Maternal mortality Fiji’s overall maternal mortality rate (MMR)2is low compared with Papua New Guinea, Vanuatu and Solomon Islandsand many other developing countries, and the total number of maternal deaths has declined greatly from the 1970s.The data for 1987 to 1997 show a relatively low but fluctuating maternal mortality rate. Reasonsfor the sharp fluctuations are unclear but they could be due to the relatively smallnumbers involved or record inadequacy. During the ten-year period, the highest maternal mortality rate experienced was 92 per 100,000 in 1989,which decreased,without obvious reason, to 27 in 1991.The averageMMR for the ten yearswas 54 per 100,000. c) Morbidity related to reproductive health - STIs, HIV, AIDS Morbidity relating to reproductive and sexual health is a growing concern in Fiji. The incidence of sexually transmitted diseases(including HIV, AIDS and reproduction-related cancers)requiresurgent attention to createbetter awareness,disseminateaccurateand detailed information, and produce better data for monitoring and analysis.Existing data on STIsare inadequate due largely to the sensitivenature of these problems and consequent underreporting due to shame,embarrassmentand socialstigma. 2 Morernol pregnancy, monaliry from rate refers 10 rhe dearh of a womecm while pregnant or within my muse related to pregnancy or ifs monogemenr (UN, 1994). 42 days of the ferminnlion ofpregnancy irrespective of rhe duration ond the sire of 127 Cultures of Populations: Asia Pacific Hospital data show that STlsare a major concern among male young adults, especially in urban areas.There is also a growing concern among high school students, and young people generally. Government Clinic data indicate that among those people who report to the clinics, mostyoung males(especiallyFijian)sufferfrom STls.Syphilisand gonorrhoea are the mostcommon STlswith genital warts, herpes, pelvic inflammation and chlamydia also of concern (Ministry of Health, 1998).HIV/AIDS casesare rising. In 1998there were 58 casesof AIDSin Fiji, the majority being Fijian males aged 20-29 years. There were a few infants who contracted AIDS through their mothers (Ministry of Health, 1999).3 The multicultural nature of Fiji’s population and more specifically the cultural differences between the Fijianand the lndo-Fijian communitieswere important considerationsfor the choice of Fiji asa participant in this research.Indigenous Fijiansand Indo-Fijiansform approximately 96 per cent of Fiji’spopulation. Indigenous Fijianscompriseabout 51 per cent of the total population while Indo-Fijians(fifth or sixth generation descendantsof indentured migrant labourers)represent about 44 per cent. Eachethnic group has retained much of its traditional and cultural lifestyles, but both have been significantly influenced by modernisation. Both communities have very strong religious and cultural backgrounds. The indigenous Fijian population is mainly Christian, with the majority being Methodist, while the Indo-Fijian population is mainly Hindu, with small minorities practising Islam,Christianityand Sikhism. Both communities are patriarchal. There is a strong senseof authority and hierarchy, especially in Fijian society. Men have a dominant role in all the decision-making processesin the household as well as in the larger community. Women’s position is subordinate to that of men. Women in both communities are expected to fulfil their roles as wives, mothers, caregiversfor young and old, and ashomemakers.However,women’s roles and position in the household are changing due to improvement in their education level and participation in paid employment. Respect for people in authority is of importance in both the societies.Young people in the household are expected to show courtesy and respect to their elders. Adolescentsand young adults are expected not to question and argue, but obey in silence.Young people learn behavioural norms by listening to their elders, participating in gender differentiated tasksand roles, and by observing the cultural norms prescribed for their behaviour. However, socio-cultural changes are rapidly eroding these values. Norms relating to sexualityand reproduction are not the subjectsof open discussion.In both societies,sex and sexuality are taboo topics especiallyin mixed gender and age groups. There are severecontrols relating to overt sexualbehaviour. Sexualexpressionssuchasholding hands, hugging, kissing, touching and fondling in public places are culturally not acceptable. Premaritalsex and childbearing out of marriage are strongly disapproved of among femalesin the Fiji-Indian society and there are severesanctionsthat control such behaviour. In the indigenous Fijian society,however, it is mildly tolerated (Seniloli, 1992). Women’s major role is that of 3 Unpublished 128 data, Minisrry of Health. Cultures of Populations: Asia Pacific homemaking, reproduction and child rearing. Both the reproductive behaviour and position of women in societyare therefore influenced by a mix of factorswhich include the politics of population numbers and ethnicity in a multi-racial society; the socialand gender norms of one’s own ethnic group; cultural factorssuchasthe education of women, marital status,age at first marriage, and the social, economic and psychological values attached to children; and the use of family planning. Thesefactors significantly influence individual and group demographic behaviour, particularly those relating to fertility and family planning, and sexualand reproductive health. The main aims of the current researchstudy were: to assistpolicy makers, population programme executivesand staff to become more aware of, and better respond to, existing subculturesin society,eachwith its own characteristicsaffecting demographic behaviour; to develop a methodology for identifying specific socio-cultural differences among Fiji’s sub-populations, to ensure the feedback of research results into policies and programmes, making these more adequate in addressing specific population groups and categories. Given the complex interrelationships of the many diverse socio-culturalfactorsand different aspectsof demographic behaviour, the researchobjectiveswere focusedon specificdemographic issuesof current interest in Fiji. Theseincluded similaritiesand differences between Fijiansand Indo-Fijianswith respectto: reproductive health needs for never-marriedadolescentsand young adults, premarital sexual relationships,unplanned teenage pregnancies, prevalence of sexually transmitted diseases,ethnicity and fertility change, male participation in family planning, reproductive health concerns such as the fear of HIV/AIDS and reproductive system-relatedcancers. In addition, the education and empowerment of women in relation to their sexual and reproductive rights and decision-making are of major concern. Objectives of the field study The researchproject had the following objectives: to identify socio-culturalfactorsamong sub-culturesthat influence demographic behaviour (fertility,childbearing, fertility control, family planning, male participation in family planning, marriage patterns and norms, and reproductive health); to examine the prevailing cultural norms and customsrelating to sexuality,marriage, and reproduction and the behaviour of adolescents and young people in relation to these norms and customs: to examine the main socio-cultural changes and the change agents that influence demographic behaviour;‘ to determine the reproductive health (family planning) needs of people (adolescents, youth, adult men and women) and to examine how these needs are perceived and met; l l l l 129 Cultures l l l of Populations: Asia Pacific to determine the expectationsand preferencesof people in relation to educational, reproductive health and information services,and to examine socio-culturalfactorsthat promote or inhibit accessto information, education and communicationson reproductive health; to examine the impact of mobility on the demographic behaviour of people; and to examine socialand economic conditions of the ageing populations. The scope of the study This researchhas two-pronged objectives: first, to collect data on socialand cultural factors that affect demographic behaviour and their relevance in the formulation of policies and programmes; and second, to develop and test methodologies for conducting research to understand the cultural and social forces that determine demographic behaviour. The research was essentiallyqualitative in approach. The nature of the researchtopics, which included some very sensitivetopics such as those dealing with sexuality,contraceptive method use and sexual health, rendered the use of multiple qualitative techniques more useful than quantitative techniques. The methods used - in-depth interviews, focus group discussions,social biographies, and key informant interviews - enabled the triangulation of data to examine the quality and the validity of the responses.The multiplicity of these methods greatly contributed to the testing of overall reliability and validity. The fieldwork was conducted on the main island of Fiji, Viti Levu,at six selectedsites,two of which were urban suburbs and four rural sites.Eachof these siteshad one ethnic group as the major component of its population. While the urban suburbs were ethnically more mixed, the Fijian rural villages and Indo-Fijian rural settlementslargely comprised only one major ethnic group. Gathering qualitative data for a smallnumber of researchsiteswith the short time period available was difficult. Further, time and funding constraintsdid not allow more researchsitesto be included in this study. While the use of a small number of sitesin urban and rural areasis not necessarilyrepresentative of Fiji’s urban and rural regions as a whole, the study did provide valuable insights into many of the different underlying factorspertaining to socialand cultural forcesat the local level that influence behaviour related to fertility, reproductive health (especiallyamong adolescents and young adults), migration, gender and ageing. The resultsdemonstrate the effectivenessof qualitative techniques in research that seeks socio-cultural explanations for sensitiveresearch topics. Existing sources of data for the selected sites or regions Both macro-leveland micro level data were used in this study. Findings on fertility, mortality, migration, gender and ageing are from the 1996 and previous Fiji Population Censusdata. Ministry of Educationand Ministry of Health data records provided national level statistics,which were integrated in the macro level findings. 130 Cultures of Populations: Asia Pacific Secondary data at research sites Secondarydata at the researchsiteswere gathered from different sources.In the Fijianvillages, the village head had basicdata on the population, economicactivitiesand the villagesin general. In the rural Indo-Fijian settlements,members of the rural advisory committees, head teachers and principalshad somebasicinformation on their settlements.The schoolsand the health centre provided valuable information on school servicesand students,while hospitalsand health centre records and community nurses provided information on basic reproductive health status and especially on the family planning servicesat the respectiveresearchsites. Methodologies used for data collection and analysis This research used four different qualitative data gathering techniques, viz. focus group discussions,socialbiographies or life-stories,key informant interviews and in-depth interviews to collect data from selected researchsites.Before data collection, preliminary visitswere made to researchsitesin order to inform and seek the approval of village leaders for the research.The researchfacilitators for the villages were identified and trained. Researchfacilitators made the task of organising and conducting the researcheasier at the village and settlement level. Two researchfacilitators,one maleand one female(who included people suchasthe village/settlement leaders,professionals,and other people who were known in the village/settlement)were selected to facilitate the research. The use of facilitators provided people from the village/settlement with commitment to the researchand provided them with opportunities to participate in the research process. The facilitators enabled the researchersto use different methodologies by organising the informants and helped overcome barriers such as languages and local customs. They also helped clarify aspects of local cultures and subcultures. However, the use of local facilitatorsmay haveintroduced someelement of biasin the selectionof informants.The following sectionswill discussin detail each researchmethod used. Data analysis Qualitative data analysisis time consuming and difficult. The interviews recorded from individuals, focus group meetings and socio-biographies were transcribed and typed. These data fileswere then coded with key topicsasidentifiers.Further,the topicsand subtopicswere recorded along specific themes and sub-themes.Thesewere then integrated to provide a broader and a wider perspective on the emerging themes. Data were analysed manually. The qualitative software programme Ethnograph was used for data analysis.Data files were used to identify key concepts,topicsand themes.For each topic, code words were used to identify and mark sectionsof each interview and focus group discussion.Everydata file was coded and marked. This helped greatly in sorting data into a tree diagram according to important topics and subtopics. Notes for each topic were prepared in memo documents. These memos were 131 Cultures of Populations: Asia Pacific then integrated to help compile the report. The software used facilitated the collection and analysisof topics acrossmany different data files. Validity and reliability of data Different researchtechniques were used to determine and ensure the validity and the reliability of the data. Use of multiple methods, translation and re-translation of transcripts,interviews and re-interviewsof someinformants,and consistencychecksduring interviewswere used to examine the quality of data. Referring to participatory research,Narayan (1994:23)argues that “Reliability is achieved by using multiple methods, and validity confirmed through consensus,discussionsand dialogue”. The use of multiple methods is particularly important and useful in situations where there is qualitative data gathering over a short period of time. Different methods allow the researcherto examine different perspectives in studying a problem. Furthermore, the use of multiple methods helps ensure that information gathered is complete and reliable (Narayan, 1994:IO). The validity and reliability of qualitative data are of greater concern when compared with quantitative data. Qualitative data demand a more rigorous attention during data collection. It is essentialto verify and test the consistencyof data to establishits reliability and validity. The open-ended questions,long varied responses,and the examination of underlying conceptsand themes make the recording and analysisof data especiallydifficult. Understanding findings socio-cultural factors affecting demographic behaviour: micro-level “People rarely behave reproductively, rhey rather behave sexually with reproduction as Q by-product of their sexual behaviour. Such behaviour is regulated by social rules in all human societies, rules that govern the trcrnsitionto adulthood...” Pottsand Selman(1979:3). An important finding was that adolescentswho had studied family life education or biology in form five were slightly more knowledgeable about reproductive organs but the proportion of this was very small. In rural Indo-Fijian settlementsMoral Education on family values, family life and religious and cultural valueswas taught once a week. In the rural Fijian villages, there was no focus on family life education. Fijianand Indo-Fijian adolescentsin high school therefore had no or limited instruction on the human reproductive system.4 The brief review of socio-culturalchange and demographic phenomenon provide the background of the study, we shall now move towards analysisof the main findings of this research undertaken in the selected sites Fertility As stated earlier that changing life stylesof population especiallythat of Youth are manifested in their attitudes towards sexuality,contraception, fertility and family formation. 4 This poinr is discussed 132 hnher lorer in rhe repon Cultures of Populations: Asia Pacific Overall, the findings show that premarital sex is far more common today than in the days when today’s parents were young. Changing lifestyles, the weakening of traditional and religious beliefs, the impact of Western culture, greater social interaction among adolescents, liberal attitudes, and education have all contributed to a more sexually active adolescent population Who gets the blame for sexual activity? In both urban and rural areasand among both ethnic groups, initiation into sexual activity was blamed on girls. Elders,religious leaders and even women blamed the adolescent girl for sexualactivity. Girlswere meant to exerciseself-control and motivation not to enter sexualunion becausethe perception among people is that ultimately it is the adolescent girl who suffersthe consequencesand not the young man. Young women who were perceived to be promiscuous were unfavourably looked upon in both Fijian and Indo-Fijian communities.They were labelled as ‘loose and bad women’ and often other women and adolescent girls were discouraged from associatingwith them. Double standards are evident in reprimanding adolescent boys and girls in regard to their sexualbehaviour in both ethnic groups.The adolescentmale often getsaway from any punishment for engaging in premarital sexualactivity 5while the adolescent female is severelydealt with. A Fijianadolescentfemale from a rural area said: “It is the girl who will be always blamed because she is supposed to be more responsible and she should be able to say no to sex. The boy does not get any blame. The parents of the boy will perhaps only tell him not do it. There is no punishment for the boy”. According to young people, girls are meant to exerciseself-control and motivation not to enter sexual union because the perception is that in the end it is the adolescent girl who will suffer most of the consequences. In the Fijian community, the common perception among community elders, mothers, and even young males is that adolescent girls are to be blamed for premarital sexual relationships. Generally, males did not see themselvesas responsible for relationships although they might have coerced or initiated sexualactivity. A rural Fijian woman explained “A girl will always get the blame, she is held responsible because she should be in control of her body. She should be able to say no to sex. The Fijian girls are assumed to be responsible for their body. Any violation of her body is seen as her irresponsibility”. A rural village male informant indicated that “A girl is always blamed if she becomes pregnant. The young girl is supposedly nurtured and moulded by the mother. She is protected and advised by her, but if she gets pregnant then it is her fault as she herself has given herself to the boy and she did not follow the mother’s instructions”. Indo-Fijian girls are also held responsible for their defilement. They should be able to control their feeling and be responsible for their bodies. If sexualviolation occurred then the girl is seen fo rape cases where rhe moner is reponed to the police. Many incidences between consenring odolescenrr. 5 This does nor relate of rape mm may nor be repomed. The research here refers 10 sexual union 133 Cultures of Populations: Asia Pacific to have given way or have invited it. Boyswere not blamed as a rule. The perception is that the adolescent girl displays wanton behaviour that motivates others to see her as promiscuous. However, the blame and shame were not only on the adolescent girl. In the Indo-Fijian community it is on the whole family. The perception is that parents have failed in bringing up a responsible girl, and the resulting social stigma affectsthe marriage prospectsof other females in the immediate and extended families. Attitudes towards contraceptive use There were two divergent views. On the one hand, older people, parents,village priestsand church leaders were against the provision of contraception servicesto single adolescents.IndoFijianparentswould prohibit their unmarried adolescentsfrom obtaining contraceptivesbecause they are not supposed to be sexually active. Parental disapproval was also evident among the Fijian parents, who thought accessibilityof contraceptive serviceswould encourage adolescent promiscuity. On the other hand, many older adolescents,young adults, progressiveteachers, and youth leaders believed that contraceptive information would make young people more informed and also provide them with choicesif and when they were ready to engage in sexual activity. Older adolescentsin schoolsor employment were strongly of this opinion. In the urban area, young people showed positive attitudes towards the use of contraception by sexuallyactive adolescentsand young adults. Urban Fijianadolescent femalespreferred that single young people, both malesand females,should be able to get contraceptive information. They stated that nowadays, teenagers get sexually active at quite an early age and the girls are at a risk of becoming pregnant. Most adolescentsand young adults agreed that young people need information on contraception so that if they do engage in sexualactivities“they con hove safe sex” and also “they can explore with protection”. Others thought, “everyone should get ’ ” ‘You never know when they will the information and the contraceptives if they ask for rt. need it for use.” “It is better to have safer sex than to get Q girl pregnant or get the disease”. In rural areasthe opinions of young people were more mixed. While a few Fijian informants thought that sexually active young people should use contraceptives,Indo-Fijians,and IndoFijian female adolescentsin particular, were opposed to contraceptive information and use by young, single adolescents. Single young people should not be exposed to sexualactivity, and therefore, contraceptive information and use is unnecessarywas the general thinking. In the Indo-Fijian community, a young girl’s future is extremely bleak if she has premarital sex and premarital birth: education, employment and prospects for good marriage are doomed. She losesall respect and support from family members and relatives.There is a feeling that young people will engage in sexualactivitymore if they are given contraceptiveinformationand services. Despitethese views, which are still those of the majority, a significant number of young Fijian and Indo-Fijian young men and women indicated that young people should know about 134 Cultures of Populations: Asia Pacific contraception and be able to accessit when they needed to. Thisview was especially strong in the urban area. Incidence of teenage pregnancies Premaritalbirths among teen mothersin both communitiesare treated differently from marital births. In Indo-Fijian families,there is an outright rejection of both the single teen mothers and the infant born out of wedlock. It is extremely difficult for parents to allow their teen daughters who became mothers to live with them. The stigma and dishonour attached to the single teen mother and parents causesmuch shame to whole family, and the girl loses all prospects of finding a suitable spouseor stable future. The focus group meeting in the rural settlementsfor Indo-Fijian females indicated that the majority of young women take the issueof childbearing outside marriage very seriously.Only rarely did they hear about premarital teenage pregnancy in their areas.The following statements clearly summarisewhat young Indo-Fijian women feel about teenage pregnancy: l l l l l “If a girl is pregnant before marriage then no one will marry her”. “Parents will punish them and accuse them of embarrassment and shame brought on the family”. “Beating them and removing them from the family may lead to her to commit suicide”. Women also know that doctors carry out illegal abortions and may take the teenager to the doctor to save “face’ from the neighbours and family members“. “Sending her away from home to get the baby aborted or get her married to someone far away. The girl has to face the problems of bearing the taunts and gossips passed by others”. In the Fijian family premarital teen birth is also disapproved of and regarded as shamefulfor the teen girl, her parents and relatives. Young unmarried women indicated that they would bring shameand stigma to the parents if they became pregnant. They expressedthe view that they would be treated differently from adolescent girls and they would suffer verbal and emotional abuse. A Fijian informant from a rural area said, “I will bring shame to my family. My parents will be very angry and my friends will be too embarrassed to mix around with me and the villagers will treat me anyhow”. However, Fijian behaviour towards premarital teen pregnancies is more tolerant than in the Indo-Fijiancommunity.Despitetheir disappointment and shame,they accommodatethe teenage mother and provide for the needs of the child. However, the researchindicates that the responsibility of caring for the child restsmainly on the mother’s family and that there were situations where single mothers were not able to meet the all needs of the child. On the question of who looks after the child born out of wedlock by teen mothers, most Fijian female informants in focus 135 Cultures of Populations: Asia Pacific group meetingsagreed that the pregnant teenager and her parentsusuallylook after the welfare of the infant, but they acknowledge the difficulties in these arrangements. There was some concern raised by young people that different relativessometimeslooked after the children of teenage mothers and that they lacked a stable family environment. In addition, children born out the wedlock are often not fully accepted by the people in the village. There is stigma and also shame associatedwith teen births, especially in caseswhere the fathers are not known. “They will be always termed as ‘luve-ni-yali’ (children of the road)“, said a village woman. Factors contributing to sexual activity and teenage pregnancies among adolescents Adolescents,young adults and parents were asked about explanations, that they believed might be contributing to sexualactivity and teenage pregnancies among young people in their areas. The data showed the multitude of factors that might influence single young adults to engage in sexualactivities.Someof thesewere: a lack basicinformation on puberty and sexuality, experimental behaviour, peer pressure,exposure to intimacy and sexualityvia moviesand print media, weakening of customarypractices,greater degree of freedom for young people, changing roles of parents, poor parental supervisionand control, problems of communication, and a lack of easyaccessibilityto contraceptive information. A greater social interaction among males and females and weakening of customary beliefs and values relating to sexuality and marriage In traditional Fijian society, customary practices such as gender-segregated roles did not allow for socialinteractionsamong male and female adolescents.Adolescent femalesassociated more with mothers and older women; similarlymalesassociatedwith older males.Brother, sister and parallel cousin relationships were marked with respect and avoidance. Brothers had protective and corrective roles over their sisters.However, according to village elders and religious leaders, there have been some changes in these familial relationships. There is a lot more social interaction between males and females than in the past. Young people associate more freely with members of the opposite sex. They have more freedom to do things on their own than in the past as these can be seen from the following commentsfrom informants. “Brothers, sistersinteract more freely and the role of being n brother has changed. Before the brother was responsible for the well being of the sister. Nowadays you see them going to places together and having friends from opposite sex” - Village church leader. Young men and women are given too much freedom, especially at night to walk around freely”- A rural youth leader. “Respectfor brother and sister, and cousins and the family members were believed to be not as strict as it was in the past. The boundary of relationships is broken and it is not clear” A village priest. 136 Cultures of Populations: Asia Pacific The western conceptsof having boyfriends or girlfriends are a significant influence, especially in urban areas. Urban secondary school students in focus group meeting agreed that it “was reasonable to have a friend from the opposite sex, with whom they could share their time”. They were positive about dating which included going to movies, playing sports, and sharing each other’s problems. Perhapsmostsignificantwas the viewing of western movieswhere adolescentswatched scenes of sexual intimacy. Both adolescentsand parents agreed that the negative effect of television and cinema on social behaviour. Although the adolescent boys and girls were aware of the traditional and religious views on premarital sex, it was evident that some young unmarried people engaged in sexual relationships. Parents spent less time with their adolescents The weakening of the supervisory roles of parents was seen as an important factor. Many adolescentsthought their parents do not spend much time with their children. This view was more prevalent among the Fijian adolescentsthan Indo-Fijian adolescents.The multiple roles of parents in household duties, work place and church duties often leavesthem with little time to spend with the children. Consequently, adolescents often find themselvesleft alone or with their neighbourhood friends. Thiswas also found in the Fijianvillageswhere parents usuallyhad many other activities to attend to and left the adolescentsvery much on their own. For Fijian adolescent males, their peers were especially important role models because they spent more time with them than with their parents. These findings echo the findings of other researcherssuch as Lasaqa(1984) and Adinkrah (1995). Adinkrah (1995), for instance, points out that urban Fijian parents were to preoccupied with other things such asyaqona sessions,club visits,church servicesand extended family visits and left the young people very much on their own. Most rural Indo-Fijian adolescents said their parents had important supervisory roles over them. The vigilance of supervision was stronger for adolescent girls than boys. Girls who left school early and who were staying home were under the strict control of parents particularly in the rural areas.They were rarely left alone at home. As most mothers stayedhome, they ensured that adolescentsand young adults were home aswell. Male adolescents,especiallyin rural IndoFijian settlements,said they spent most of their time with the parents. However, in some cases concern was expressedabout adolescentswho spent too much time with friends and neighbours whenever they gathered to drink yaqona. Absence of communication on sexual and reproductive and young adults and their parents - cultural constraints topics between adolescents The adolescents were asked in individual as well as focus group meetings whether they 137 Cultures of Populations: Asia Pacific discussedreproductive health issuessuchassex,contraception, and risksof pregnancies and STls with their parents. The majority said their parents did not talk about such issuesdue to taboos. However, some adolescent girls said their mothers occasionallytalked to them about sex indirectly, Often the communication was in the form of directivesor commands,without adequate or complete information on sensitivetopics such as sexuality, childbearing and contraception. The general perception was that neither they nor their parents broach these topics. Thus,youth in Fiji enter the stage of sexualexperimentation with little to no knowledge of the human reproduction system,sexuality,contraception, or the possible consequencesof sexualactivity. Changing marriage norms influence sexual and reproductive behaviour In the study of population when adolescents and young adults were asked about their attitudes towards marriage, and their views on arranged and love marriages.Most adolescents in the focus group meeting indicated that arranged marriages were out of fashion and not acceptable in both rural and urban areas,except among some adolescent Indo-Fijian girls who stayed home and had limited chancesof finding suitable spouses.Urban adolescentsof both sexesbelieved in knowing and socialisingwith the partner before marriage. In the Indo-Fijian community, there is a major social change where the educated and employed adolescentsseek their own spouses.The families in the rural and urban areas have accepted this arrangement. They were indeed quite relieved and happy that their educated son or daughter would find their own suitable match. However, it was different for those who did not complete school and were staying home: for them marriageswere arranged. In rural areas, some Indo-Fijian adolescent girls indicated an arranged marriage was better because parents attempt to provide for the best for their children. Young women felt they had a higher chance of a better social and economic life when marriage occurred to an overseasspouse. This also affected the age at marriage of young adults. Elopement was severelydisapproved of in the Indo-Fijian community. Adolescent girls who eloped were not welcomed back in the house.Thisdishonoursand showsdisrespectto the entire family. Relationshipswith relativesand family memberswere affected as a result of elopement. The young woman who elopes is subjectedto severecriticismand is often isolatedand neglected. In such situations parents make all efforts to arrange the marriage of the eloped couple. Attitudes towards elopements are different among the Fijian adolescents. Family size and value of children The value of children in termsof wealth generation, socialsecurity,psychologicaland cultural satisfaction,the education of couples and their ability to control fertility are important determinants of the number of children in a family. Young adults (20-24 years)and adults (over 25 years of age) were asked specific questions to determine their views on large or small families. The 138 Cultures of Ponulations: Asia Pacific resultsof the focus group discussionsand individual interviews indicate that the perceptions of smalland large familiesvaried according to ethnic groups and gender in both urban and rural settings. Indo-Fijian families Among Indo-Fijians,there was no gender difference in the perception of what constituted a smallor large family. Most Indo-Fijian malesand femalesconsidered lessthan three children in a family as small and more than three as large. However, young couples’ perception of a small family is where there are no more than two children and large family was that with more than three children. “Most of the Indo-Fijian couples want two or three and not more than three,” stresseda health sisterat a rural health clinic. Thisattitude was consistentamong both urban and rural Indo-Fijian families.This is consistentwith the Indo-Fijian total fertility rate of 2.54 in 1996 (Bureauof Statistics,1998a:90). Fijian families In contrast, Fijian informants expressed different views on what constituted large and small families.Generally older men and women indicated that a family with an average of four or five children was considered a smallfamily and more than four or five large. Thisperception was not consistent,however, with some young couples in urban as well rural areas.Young urban Fijian adolescentsconsidered 2-3 children in a family as smalland more than three as large. A young urban Fijian male informant said “today it is better to have a small family. Before couples preferred respected important especially a large family because the children could work on the farm. These couples were and regarded highly as they had many ‘helping hands’. Today, money is most and the problem now is money ... so it is difficult to financially support a large family in the ciry”. Economic costsof raising children and lack of paid employment were important factorsindicated by young people for the support of small families. Older Fijian informants said large familieswith five or more children were important in rural settings. The rural community nursesindicated that in their respectivevillages there were some couples with as many as 8 to 10 children and that large familiesof more than four children were the norm. There were religious, socio-culturaland economic explanations for the preference for large familiesamong Fijian adults. Older men in the villages had indicated explicitly that large families were important, as there was much land for their people to live and work. Children were seen as old age support and wealth for the households. Religion also influenced some informants’ attitudes towards family size. For some it was the God’s wish for them to have as many children as they did and to not limit childbearing. Thiswas the view of older men and the religious leaders. Village women, however, did not always share these views. According to women, men desired large families and most women did not have 139 - Cultures of Populations: Asia Pacific much say in it. Women generally agreed that ” husbands wanted to have more children because they were assets(liga ni cakacakoj, who would be there to ‘lend a hand’ in domestic duties, corn money for the family, participate in village obligntions, church and counrry therefore women should not be short-sighted but they should see things in the long run.” The fear of being ridiculed and labelled as infertile was another reason for women having more than two or three children. Low statusof women in the households, the stigma of being labelled asinfertile, and the fear of embarrassmentwere given asreasonsfor women continuing to have children in the later years of their reproductive lives. While there were contrasting views on the size of the family, especially among older Fijian and Indo-Fijian informants, there was a convergence of attitude towards family size among young Fijiansand Indo-Fijiansin the urban area. Urban living is seenas costlybecausesocialand economic needs and large family sizemake it difficult to meet the everyday needs of the family. The belief among young people is that both parents in the urban area have to work in order to support the children and with less ‘family’ time a large family would result in even lesstime being available for each child. Son preference Son preference has been a cultural feature of both traditional Fijian and Indo-Fijian communities. Sonshave special roles in cultural and religious ceremonies.The eldest son is generally seen as the father figure in the absenceof the father. Sonsgenerally inherit the family property, look after the ageing parents and continue with the family name in male-dominated societies. There were some changes in the attitudes towards son preference especially in the Indo-Fijian community. In the Fijian community son preference continues to be important as sonscarry on the family name and have traditional responsibilitiesin the context of their socialstructure. In the Indo-Fijian Hindu society sonshave a specialrole in other religious ceremoniessuchas funeral rites. Preferencefor sonswas very strong in the traditional and early Fiji Indian families. Many parents of the older generation wished the first born to a son and they expected the same for their children. This study has shown that son preference is no longer dominant, especially among young married people. It is seen as desirable by the younger generation parents but no longer essential.If a young couple had a son and daughter, they would see their family sizeas complete. If there were two sonsor two daughters only, then a couple’s intention would be to have another child of the preferred gender. However, in many casescoupleswere satisfiedwith either two or three girls or two or three boys. Gender preference was not strong among young couples. The birth of a girl child was as equally welcomed as the birth of a boy child. The belief according to the Hindu religion was that the girl child resembled a form of “Lakshmi” (Indian goddess of wealth). Parentsin both rural and urban areasare also aware that girls provide more care and socialand economic support for their parents than boys. 140 Cultures of Populations: Asia Pacific Women - the focus of family planning In both rural and urban areas,women, who have been the target group for family planning sinceits beginning in 1962,were the main recipients of family planing services.It is believed that the traditional and customaryrole of women is to bear and raise children. Women themselves perceive this as their role. Theseviews are, however, reinforced by the family planning services that direct contraceptive information mainly to women. Women visited pre-natal and post-natal clinicsand they were given advice on family planning services.They obtained information from health clinicsand hospitalsand other women in the village. Men have been generally excluded from family planning servicesbecause it was mainly directed to women. However, today there is a growing interest in men’s involvement in family planning servicesin Fiji. Communication between spouses on family planning Both married men and women were asked whether they and their spousestalked about the contraceptive methods. The degree of participation differed between ethnic groups. Most IndoFijian men and women discussedcontraception in private together, but the choice of method was usually left to the wife following advice from the health service. Among Fijians,however, the situation was different. In the focus group meetings of men in a rural area most agreed that contraceptive and family planning topics are not for discussion becausetalking about suchmattersare taboo. The following excerptsfrom a focusgroup meeting show the attitudes about discussionson contraception. l u Talking about contraception and family planning is embarrassing because it is part of our private lives and it is talking about our private parts.” l u There are information available but we are just too ashamed to get it or ask about it”. l u They (men) turn it into a joke and have a good laugh.” l u Wejust do not talk about it at home. It is regarded as a taboo.” Why most men do not access family planning services: women’s perceptions Men’s social position and their role in the family and wider community are significant influences on their family planning behaviour. Both Fijian and Indo-Fijian societies are male dominated. Men’s attitudes and behaviour towards family planning method use, and birth limitation and spacing exert considerable influence on the sexual and reproductive behaviour of women. According to most women from both ethnic groups men generally do not obtain contraceptive information and servicesbecauseit is not considered astheir domain. In situationswhere there is support for family planning, it is left to femalesbecauseit is perceived to be their responsibility. In the rural villages health nursesresponsible for their areasindicated that men rarely (or Cultures of Populations: Asia Pacific never) visit family planning clinics to obtain family planning services.A key informant in an urban area stated: “The wives visit us all the time in relation to family planning. Their husbands hardly come ro the hospital. 1suppose they are too shy to talk about such topics in a public place or with an outsider, so the wife comes ro find out about contraceptives”. The family planning messagesare given to women directly when they visit the health centre for postnatal checks.The wife is the communication link between the family planning nurseand the husband. Sociallyand culturally it is not considered appropriate for men to accompanytheir spousesor partners to seek contraceptive service.Thisis not perceived as his role and hence is considered unmanly. This view existed among both Fijian and Indo-Fijian men. Men who minded the children and visited family planning clinicswere ‘seen asliving under the control of their wives’. Ridicule and derision of such behaviour also prevented men from participating in family planning services.Men’s statusand attitudes did not permit them to be concerned about family planning matters.Thesewere considered unimportant in the wider perspective, as there were other important things for men to do. However, the serviceproviders in the urban area and some rural areassaw a positive change in some young men’s behaviour. A few of them visited the clinics to obtain contraceptivesand especially condoms. In the urban area, young men from both ethnic groups visited the clinic to obtain family planning information. Most of these were Indo-Fijiansbut this is still a significant changewhen compared to older men, who rarelyvisitedhealth clinicsfor familyplanning services. The differential participation of Fijian and Indo-Fijian men stemsfrom a number of factors. The support of large family size as social and economic security and old age support is seen as desirable. In some rural areas,Fijianmalesexpressedthe view that there is enough land for their own people to use and they should have more people to work on the farms.Thiswas a contrast to the views expressed by Indo-Fijiansin rural settlements,who indicated that they could not afford to have many children (more than three), as there will be limited opportunities for them in the future. Socio-political insecuritiesare tied to the concern about having large families in Fiji. Parentswere concerned about their children’s future education and employment prospects in Fiji. Indo-Fijian parents in both rural and urban areaswanted a smallfamily and better quality of life for their children. In addition, the strong efforts of family planning services,especially among Indo-Fijians,are a significant factor that promotes smallfamiliesamong Indo-Fijians. Another important factor inhibiting contraceptive use, as discussedby the serviceproviders and the Fijian women informants, was the lack of approval from spousesand partners. Several explanations are possible.Thesewould include fear of infidelity, concern about the side effects, attitudestowards family size,and religious and pronatalistviews.A Fijianwoman leader indicated that “some women mode the decision to use the methods on their own without consulting their spouses, and there were some spouses who stopped them as they feared that their spouses 142 Cultures of Populations: Asia Pacific would ‘sleep around”. According to a rural community nurse, “there were many situations where women sought contraceptives without the knowledge of their spouses ... because the male partners did not approve of family planning”. Awareness of STIs, HIV, AIDS Both Fijian and lndo-Fijian malesand femaleshad heard of STlsand HIV/AIDS. More urban than rural adolescentsand young adults were aware of STIsand HIV/AIDS. Fijianand Indo-Fijian adolescents had similar responses.Women were generally less aware of sexually transmitted infectionsthen men. Young people were more aware of STIsthan older people. People indicated that they had heard about STIsbut did not understand much about them. When asked to name STIs,more informants in focusgroup meetings and in-depth interviews, particularly adolescents, named AIDSthan any other STI.However, some informants indicated syphilis and gonorrhoea. The sourcesof information about STIsvaried. While married women and somerural informants had heard about STIsfrom the family planning clinicsand health centres,most adolescentsand young people had heard about them from schools,over the radio or through the print media. Medical sourceswere not important sourcesof information for adolescentsand young people in either both urban or rural areas. Most people lacked detailed information about symptomsor the physicalsignsof the diseases. The service providers indicated that from their experience at the health centres and family planning clinics generally most young people do not know that they have contracted STIs because they do not know about them. Further, according to health service providers, “most women do not know about the illnesses of private parts in the community. However, they do come forward when they see something wrong with them“. It is only after medical teststhat they learn that they had contracted STI.A family planning nurse indicated that “Women suffer from sexually transmitted diseases. In most cases they contract them from spouses/partners who may have multiple partners. In a health centre, 6 per cent of pregnant teenage women (n=584) had symptoms of STDs.About 5-6 per cent of women who reported for Pup smear test every Thursday had symptoms of STls”(Personalcommunication). Expectations and preferences for reproductive among specific groups health education and information “Sex among adolescents and young adults are secret acts and they need secret contraceptive services (condoms)“- An urban youth. The expectations and preferences of service providers-teachers, family planning nurses, community nurses,socialworkers and membersof NGOs-and the target groups as recipients of the reproductive health education and information, differ greatly due to socio-cultural factors. The ability to accessreproductive health servicesfrom different sourcesdepends on people’s 143 Cultures of Populations: Asia Pacific awarenessof them and their accessibility.Thisis further dependent on the quality of the service and the serviceproviders. Other factorssuchas gender relations, age, and religious and cultural beliefs influence the relationshipsbetween the serviceproviders and their clients. Thischapter will examinethe different serviceprovidersand their target populations and it will broadly discuss expectations and preferences of each in relation to their reproductive health education and information and their socio-culturaldeterminants. The roles of schools and teachers in the dissemination of reproductive health Information to adolescents in urban and rural areas In Fiji, over 95 per cent of lo-14 year olds and 64 per cent of 15-19year olds were attending schoolsin 1996. Gender parity and school enrolment are extremely high in Fiji in both urban and rural areas.The 1996 Censusdata show 100 per cent gender parity at the end of primary and at the end of secondary enrolment, although adolescent girls out-numbered boys at the end of upper secondary schools(Bureauof Statistics,1998). Adolescents (13-19years old) spend most daylight hours at school, and teachers and their peers greatly influence their social and emotional development. Most adolescentslearn a lot about puberty during their high schoolyears. Most adolescentsand someparentsacknowledged the role of the school in the disseminationof information and education on sexual and reproductive health. They stressedthe need to be informed about sexuality,reproduction and family planning services and other related needs. Most expressed concerns about never-married adolescentsfacing challengesof premarital sexand the risk of contracting STIsand of unplanned pregnancies. What are the schools doing? The FamilyLife Education(FLE)programme co-ordinated by the Ministry of Educationis offered in many schools.The main objectives of the FLEare to create awarenessabout human reproduction and sexuality,family life and relationships,the role of parents in the sexual and moral development of children, and problems facing youths suchasteenage pregnancy and STIs.Basic Scienceand Biology lessonsalso provide adolescentswith information on human reproduction and sexually transmitted diseases,and the Moral (religious) education programme is expected to provide basic information on family life, morals and values,and on the important aspectsof sexual and reproductive health. FamilyLife Education(FLE)was introduced into Fiji’seducation systemin July 1985.The project lapsed in 1991.However, in 1996, the programme was re-introduced and interest in teaching family life education grew. According to the Ministry of Education, 110out of 148 high schools (58 urban and 52 rural) were teaching family life education in 1999.* Enquiriesin Suvasuggested that 62 per cent of the secondary schoolswere teaching FLEin 6 Ministry of Education -unpublished sourer 144 .lll---_-l. __.. -_. _I __ Cultures of Populations: Asia Pacific 1999. FLEwas offered as a non-examinable subject in the urban researchsites,where emphasis was also placed on moral education. Most rural schools visited taught Moral Education but FamilyLife Educationwas offered by none. The study showed that moral and religious education was organised very much on an ad hoc basis. There was no syllabus, and the frequency of instruction depended on the availability of teachersand time perceived to be lost to activities that are considered more important, suchaspreparation for external examinations. It is evident that rural children have little to no instruction on any aspect of sex education. Findings on perceptions and preferences of teachers and students in relation to reproductive health education and information ’ Although most teacherssurveyedwere concerned about reproductive health matters -such asrelationshipsbetween adolescent malesand females(girl friend and boy friend relationships), perceptions and knowledge about sex and sexuality,gender bias, unplanned pregnancies and other aspects of adolescent behaviour - they commented on numerous obstacles to the disseminationof reproductive and sexual health information to adolescentsin schools. Teachers’ perceptions and concerns about FLE Teacherssurveyedthought that FLEand Moral Education received insufficient attention and recognition in the school timetable, and reach far too few students. Typically, they are taught only once a week to selectedstreamsof classes.The majority of studentsreceive no FLEor Moral Education. The limited emphasison FLEis mainly due to the heavy bias towards examination subjects,which are considered more important for future career and employment options than family life education. FLEteachersthought that FLE,with its emphasison sexualityand boy-girl relationships,needs to be first offered about the age of puberty when adolescentsundergo many socio-psychological changes. Thiswould mean introducing FLEin upper primary school classes,and not, as is now the case,in secondary, and even upper secondary classes.While some schoolsintroduce FLEin Forms3 or 4 (student average age 14-15years),others do not commence FLEuntil Forms5 or 6 and even 7 (16-19year olds). In-depth interviews with teachersindicated many concerns that need to be addressed if FLE is to be more effective and useful. Theseincluded: Non-examinable core or optional subject which is not taken seriouslyby staff or students. Sex education and boy-girl relations often receive less attention than moral education, religious teaching, careersinformation, study sessions,and free time to catch up with other work. Untrained teachers -- teachers are not specifically trained in family life education and availabletraining is extremely limited. According to the Ministry of Education,mostteachers l l 7 Results of (1 rub- survey on fomiiy life educanon. 145 Cultures of Populations: Asia Pacific who receive training are women, and older teachersare generally preferred to teach this subject. While such preference undoubtedly reflects cultural sensitivity,it also excludes teacherswho may be the most influential in conveying sexually sensitiveinformation to teenagers, such as younger teachers. l Limited resourcesfor teaching - charts, booklets, resource materials and other teaching guides are not easilyavailable. l A lack of overall support. Too much depends on the influence and goodwill of individual schooladministratorsand community members.Lackof parental support isa major problem. Most parents believe that if students know about sexuality and contraception they will become promiscuous. l Religiousand traditional taboos which inhibit teachersfrom talking openly on these issues. Schoolsrun by religious organisations(and in Fiji this representsthe majority of the schools) are unlikely to encourage teaching and discussionon sensitiveand taboo topics such as sexuality,reproduction, family life, boy-girl relationships,and contraception. The findings of the focusgroup meetings of adolescentsindicated that they had limited information and education on topics such as sexuality,premarital relationships,sexually transmitted diseases,contraception, risksof exposure to pregnancy, and other related topics.The adolescents wished to be made aware of basic and accurate factson these issues.Studentstaking FLEwere, on average,somewhat better informed about sexuality,reproduction, and current issuesrelating to teen pregnancies than those who were not. The Role of Health Service F+roviders The Ministry of Health provides a comprehensivereproductive health serviceand about 90 per cent of all people in Fiji are within easy reach of health services (Ministry of Health, unpublished). The health infrastructure is organised in a hierarchical system,the base of which comprisesmobile health workers, suchascommunity nurses,who visit homes in their designated zones. The next level is that of rural health centre with nursesand doctors at some sites.These are linked to the district and regional hospitals. Maternal and child health care, family planning, and safe motherhood are some of the important reproductive health issuesaddressedby most health care providers in rural and urban areas.The Ministry of Health through itsMaternal and Child Health clinics,family planning clinics, and rural health centres is providing basic family planning servicesto its clients. The clients are mainly married women. The focus is on the provision of prenatal and postnatal care, contraceptive services,aspectsof safemotherhood and breast-feeding and immunisation.Adolescents and young adults have some accessto reproductive and sexual health information, but only in Suva where the adolescent health centre, based at the main hospital, aims to cater to their 146 Culrures ofPopu/c~tions: Ada Pacific needs. The next section discussesthe perceptions, expectations and preferences of the health servicesproviders and their clients. Health service providers: their expectations and preferences Adolescents and young adulis as perceived by service providers Serviceproviders in both rural and urban areasindicated that despite a general awarenessof the current issuesof sexual and reproductive health problems -such as sexual activity among adolescentsas evidenced by unplanned pregnancies and sexuallytransmitted infections-nevermarried adolescentsand young adults face problems of limited accessto sexualand reproductive health information. Other problems, such as the lack of privacy, social implications of providing contraception to young teens and a lack of priority in the provision of servicesparticularly to rural areas,further hinder the extension of sexual and reproductive health services. Family planning and community nursessaid that never-married young people were free to accesscontraceptive information and servicesand there were no restrictionson these services. Nevertheless,they usually did not seek them: “There is no ban on gerting contraceprive information for youth from the village health centre. It is just the traditional idea that sex and anything fo do wirh sexuality is taboo” (a community nurse).They acknowledged that traditional beliefs and customs,cultural norms, gender norms and taboos about sex and sexuality make it difficult for adolescentsand young adults to freely communicate and to accesscontraceptive services.For instance,young men feel uncomfortable asking older women serviceproviders for condoms, or talking openly about sexand contraception. Generally,single men and women do not visit family planning clinics simply because it is not normative behaviour. However, urban health officials indicated that very small groups of never-married adolescent males did access health clinicsto obtain condoms.Adolescentsingle girls alsovisitedthe centre to obtain injections. The nursesperceived these occurrencesto be positive signs of change. The lack of privacy in accessingcontraceptive serviceis an important problem identified by service providers. Fear of being seen by others and a lack of trust in service providers are hindrancesto reaching out to young people. Referring to the problem of lack of privacy,a family planning nurse at an urban clinic, which also servesa large rural area, explained “The clinic is housed in one small room, which is divided by a curtain. The waiting room section has less than ten chairs. Clienrs often find themselves waiting ourside the clinic, Often mosr married women clients and their infanrs are present to seek assistance.Theirpresence makes ir extremely difficult for single sexually active adolescent girls and men ro seek family planning assistance from rhe clinic” ‘. Another important obstaclefacing serviceproviders is uncertainty about providing contraceptive servicesto single adolescent girls. Even though they are allowed to provide contraceptive servicesto single men and women who asked for them, the serversare concerned about the 8 Personal communicorion with family planning nurse of an urban clinic.. 147 Cultures of Populations: Asia Pacific reactions of parents if they discoveredthey are providing contraception to their teenagers. The implications of administering contraceptive services,such as pills and injections, to 15-19year olds without the knowledge of their parents are considered severe.Thisconstrainstheir roles in dispensing contraceptive services. Health service providers are acutely aware of the gap between what needs to be done (“Adolescents have a lot to learn about sexuality and contraception, especially at a time when fears are growing of early sexual activity, teenage pregnancies and the spread of STDs‘Jand what is actually being done to provide servicesto sexually active single adolescents and young adults, particularly in rural areas(“There is a lack of priority as far as reproductive health of adolescents is concerned”and “There is a lack of funds and resources to really make health issues”). young people aware of FepFOdUCtiVe Most men do not respond to concerns of FepFOdUCtiVe health issues -- concerns of SeFViCe PFOVideFS A man’s supportive role in family planning may be seen in different ways: the direct use of contraception, such as vasectomy and condoms; awareness of women’s reproductive rights; support for birth spacing and limitation; and visitsto health centresfor contraceptiveinformation and child care. Men’s support and involvement in family planning is limited, and is not assisted by family planning serviceswhich have been geared since inception for mothers and infants. Despitethe more recent interestof clinicsto involve both partners in family planning services, few men accompany their wives to the clinic although, on some occasions,an Indo-Fijian man may accompany his wife to the clinic but remain outside. Fijian men very rarely accompanied their wives to a clinic. Perceptions of the family planning and community nurses by their women clients Women in both rural and urban researchsiteshave relatively easy accessto health centres and hospitalsbecausethe areasare well servedby a daily bus service,mini-buses,taxisand carriers. The majority are within a reasonable distance of serviceproviders. Most of the family planning and community nursesare Fijian women. In addition, community nursesare expected to visit rural areas on a regular basis.Rural villages are usually visited once a month and rural settlements once every three months.’ The physical infrastructure for the provision and delivery of serviceare well in place. Women in the settlements and villages visited during fieldwork were asked whether community nurses visited their area to provide reproductive health information. There were varying responses.Indo-Fijianwomen said that community nursesseldom or never visited them. These women visited health centres or hospitals whenever there was a need for them. Fijian women said community nursesdid visit them but the visitswere irregular. The visitswere mainly 148 Cultures of Populations: Asia Pacific to see infants and their mothers. Other reproductive health issuessuch as those relating to STIs including HIV/AIDS and reproduction-related cancerswere not addressed.Theseresponsesdiffer from those given by the health serviceproviders. Provision of information on STls by the service providers Communication about sexual health issuesis difficult. According to health centre nurses, women do not feel free to talk about contraception or sexually transmitted diseases.Theseare taboo topics and they are shy about asking questions and worried about how the nurseswill perceive them. These barriers therefore make it difficult for both service providers and the clients to talk comfortably on sexual health issues.However, from women’s perspectivesthere was very little information on sexual and reproductive health related diseasesand they do not know or understand about them, as discussedearlier. Almost all informants in focus group discussionsand one-to-one interviews said that the health officialsprovided inadequate information on STlsand HIV/AIDS. Most people who suffer from any problem relating to their private parts will visit a clinic for treatment, but most women agreed that people got information “only when they suffered from a problem in [heir private parts. Sometimes when the nurses were busy, rhey brushed the topics aside and did not talk about it” and “DOUOFS do not explain these things unless one asks them. Information is not provided freely”. Most women said doctors and nursesspent too little time with their patients. The women also felt that explanations by doctors and nursesshould be in vernacular. Women cited severalcultural and other obstaclesthey faced when discussingtheir private parts with doctors and nurses.They were embarrassedabout telling the serviceproviders about their problems and feared how the serviceproviders would perceive them. One married Fijian in the urban area said: “Sometimes even if rhese services are provided and people do not visit because others will think rhat they have the problems therefore, Such messages spread fast and people talk about it.” they were seeking information. Adolescents and young adults and their expectations and perceptions Both urban and rural adolescents (13-19years) and young adults (20-24 years) knew there were many different sourcesof information on reproductive health. Parents,family members, teachers, medical personnel at health centres, hospitals and family planning clinics, and nongovernment organisationswere mentioned by almost everyone but all agreed that basic sexual and reproductive health information did not reach mostadolescentsand young adults. In addition to problems of accessibility,communication and delivery of services,shame, embarrassment, and the perceived fear of promiscuity among young people by older and conservativegroups of people interfered with the disseminationof sexualand reproductive health information. 149 Cultures of Popularions: Asia Pacific A lack of reproductive health focus on adolescents and young adults especially in rural areas: people’s lack of basic information Most single sexuallyactive people do not visit health centresor family planning clinicsbecause they are seen as the domain of married women and infants. The provision of sexual and reproductive health servicesto adolescentsand young adults in rural areasis poor. There is no regular awarenessprogramme by family planning clinics,NGOsor the media. While some rural health service providers and teachers indicated they had limited information for reproductive health awareness,this is not easily available to adolescents.Adolescents interviewed in rural areas said that service providers such as community nurses rarely addressed issuesaffecting adolescents,either in schoolsor in the villages and settlements. Embarrassment and shame Never-marriedyoung people, especiallythosewho are sexuallyactive,do not feel comfortable accessingcontraceptive information and methods. They are embarrassedand ashamed to seek information on contraception and to seek contraceptive methods. Most young men and women feel that other people will come to know and, more importantly, they are worried about how serviceproviderswill perceivethem. lack of confidence in accessinginformation isanother factor. One urban Fijian female interviewed said: “A lot of my friends had children when they were young. Most knew about contraceptives bur they were ashamed of using them because they know rhar they are young. They have never stopped engaging in sexual activities but they were ashamed fo obtain them from whichever places they were available at. They were concerned about the people’s perception of them”. A rural adolescent said: “I know of condoms and rhat was through listening fo the rodio dut I have never seen one so 1don’t really know about it. I believe that people are ashamed to talk about it because it’s an embarrassing subject.” In sum, the findings show that although young people are aware of contraception, especially condoms, lack of easyaccessand shynessgenerally prevent their use. Contraceptive information might lead to promiscuous behaviour Adolescentsthink that parents and elders oppose contraceptive information being available to young people because they believe this would make young people promiscuous.As one twenty-year-old urban male said, “Parents do nor wanr adolescents ro know about it because they are saying that if they know about it then they will try and experience it”. Thisview can also be seen from the following quotation from a health official: “Most young people are not informed about family planning because the messages are not given to them. The belief among the older people is that if you provide young people with contraceptive services then they will become sexually active. Nevertheless, young people do get sexually active without contraception. And most of those who are sexually active practise unsafe sex”. Thiscomment 150 Cultures of Powulations: Asia Pacific from a rural health nurse reinforces the above: ‘Young people are engaging into risky sexual behaviour. They do not practise safe sex. They do not access contraceptives from the health centres. They are too embarrassed to ask for it OF being seen around health centres. Also there is a fear that everybody in the village will come to know about them accessing condoms”. Other serviceproviders both in rural and urban areasechoed similarviews. The critical situation facing reproductive health education in Fiji is the contradictory views held by most adults and young people. Adult attitudes stem from a pressure to conform to traditional and religious beliefs and values,disapproval of sexual activity among never married adolescentsfor the fear of promiscuity, and the perceived fear of sexual initiation at early ages among adolescents.Theseviews result in contraceptive information being withheld from young people. Most never-marriedadolescentsand young adults hold the contrary view: they wish to acquire basic and accurate information on sexual and reproductive health as an important contribution to their growing up to be responsible adults. The role of NGOs in the pro&on of sexual and reproductive health information The following non-government organisationsprovide information and education on certain aspectsof reproductive and sexual health issues:AIDS TaskForce of Fiji, Fiji Council of Social services(FCOSS), The Reproductive and FamilyHealth Associationof Fiji (RFHAF),Fiji Red Cross, Fiji Community Education Association,religious groups, Fiji Women’s CrisisCentre (FWCC)and other women’s organisations such as Soqosoqo Vakamarama(Fijianwomen’s organisation), Fiji Women’s Rights Movement, Youth Groups, and regional organisations such as the Pacific Community (SK). Exceptfor some NCOssuchas FWCCand RFHAF,which direct their servicesto both urban and rural dwellers, most NC0 activitiesare focused on the urban area. NGOsprovide a range of servicesto out of school youth, women and other target groups such as commercial sex workers, and informal youthful workers such as shoeshine boys. The Fiji AIDSTaskForce,for example, is involved in addressing sexual health issuessuch asawarenessof HIV/AIDS and the promotion of condom use by sexually active adolescents.Its focus is mainly Suva,the largest urban area of Fiji. RFHAF,on the other hand, provides a broader range of sexual and reproductive health services.In addition to sexual health information, they provide contraceptiveinformation and servicesto youth, peer education at schoolsand training of family life teachers.The FWCCaddressesgender, sexualabuse and domesticviolence in both rural and urban areas. Despite their good work, NGOsare very much constrained by their own goals and strategies and limited funds. Their activities do not reach many adolescents,and rural areas,in particular, are very much neglected. The rural areas visited during the research had no places where adolescentsand young adults could accesssexual and reproductive health information. 151 Cultures of Populations: Asia Pacific Mass - Media Fiji has a dynamic mass-communicationsindustry. Media coverage of population related issuesare good. There are three daily Englishnewspapers,and two papers in vernacular - Fijian and Hindi. There are two main radio stationsand one televisionstation:that haslimited coverage. Radio is most popular and the only medium that reachesalmost every household in Fiji. The coverage of population related issuesis widespread, most especially reproductive and sexual health problems. Teenage pregnancies, the increase in STlsand HIV/AIDS, sexual abuse, unwanted infants and domestic violence are all current and topical issueswhich frequently attract media attention. The media also provides relatively good coverageof eventssuchWorld Population day, HIV/AIDS AwarenessWeek, and Women’s Day. As television and newspapers are not easily accessedby many rural dwellers, radio is more effectivein the disseminationof reproductive health information. Radio messageson populationrelated issuessuchasfamilyplanning, reproductivehealth related diseasesand familydevelopment issuescould reach out to a large population in a short time. The media’s role in reproductive health education is very important but it is not yet sufficiently and effectivelyrealised in Fiji.The study showsthat adolescentsand young adults are very much aware of the role of media in providing them with information on reproductive and sexual health. Most had become aware (or more aware) in a general way of the dangers of HIV/AIDS, teenage births and abandoned babies becauseof media exposure. Nevertheless,the truly educative role of the media in providing basic information on reproductive health, HIV/AIDS and other STIssuch as syphilisand gonorrhoea, has not really been developed. Most young people interviewed had listened to radio programmes which mentioned STls, AlDSand sexualissuesconcerning young people but at the focusgroup meetingsand in interviews adolescentscomplained that radio coverage lacked detail on sexuality and contraception, and rarely provided information they needed. Many said programmes and messageson family planning and related issueswere too short and infrequent. As one adolescent said: “1 have heard of the messagerelating to STIsand HN/AIDS on the radio. I remember one, which says ‘Be wise and condomise’. Although people have heard rhe message, 1do not think the information ir provided is adequate.” Youth felt radio messageson reproductive health would be improved if they were scheduled at times when most youth listen to the radio and if they were integrated with their favourite programmes. This chapter has highlighted some important aspectsof service provider -- client relations. Attention has been given to the education and health sector,the work of NGOsand the role of the media. It is evident from the differing perceptions of married women and serviceproviders, and of adults and adolescentsthat serious gaps exist which hinder the effective delivery and utilisation of sexualand reproductive health information by those who most need it. 152 -. ..- .I . Cultures of Populations: Asia Pacific The social and cultural factors, which in large part explain these gaps, need to be acknowledged and incorporated into reproductive health education. The next chapter examines bridging the gaps by utilising the social, cultural and demographic factors. Socio-cultural relevance for bridging information and service gaps between availability and utilisation of information and services The perceptions and expectations of never-married adolescentsand young adults, married women and men about knowledge and accessibilityof reproductive health servicesand their utilisation is very much influenced by the socialand cultural environments in which they live. ln addition, the social and cultural background and the attitudes of the service providers also determine the extent to which the clients accessthe available reproductive health services. Therefore, the gaps in the expectations and preferences of service providers and their clients represent the interplay of socio-cultural and other factors at both ends. The research findings indicated that there were numerous socialand cultural factorsthat create the gaps between the service providers and their clients. Some of these are religious and cultural practices, ethnicity, age, gender norms, the position of women in the family, taboo associatedwith specific topics and communication, confidence in service providers and education of both men and women. Thesewill be discussedin the sectionsbelow. Gender norms and roles of women Reproductive health and gender roles and norms are linked in complex ways. In both Fijian and Indo-Fijian communities women’s position is subservientto men. Generally they occupy a lower social statusand are dependent on men for meeting most of their social and economic needs.Women’ssexualityis to a great extent controlled by men. Men’s dominance and women’s submissiveacceptance guide the sexual relationship. Women have limited opportunities for negotiating sexual relationships in the unequal power relationship between men and women in patriarchal societies,such as Fiji. In both Indo-Fijian and Fijian families,family planning and the use of contraceptive methods need the approval and consent of men. The reproductive behaviour of women in relation to the number of children they desire, and the spacing of births also needs men’s co-operation. Therefore, men’s role and participation in family planning servicesis crucial. While some men do support the useof contraception to spaceand limit births, there are others who form a barrier in getting their spousesto use family planning services.Fear of women’s sexual freedom and infidelity partly influences the attitudes of men towards their spouses/partnersaccessingfamily planning services.The study showsthat there are women in both urban areasand rural villages who are keen to limit births but are not allowed to use family planning methods and that there are others who usecontraceptivemethods without the knowledge of their spousesand partners. 153 Cultures of Populations: Asia Pacific Gender norms also restrict men from accessingsexual and reproductive health information. The researchfindings indicated that men generally do not visit health centres to obtain contraceptive information and services.Family planning matters are left to the wives because it is perceived to be their responsibility but the approval and consent of spousesare critical. In the rural villages health nursesresponsible for their areas indicated that men rarely (or never) visit family planning clinicsto obtain family planning services.Thiswas not perceived astheir domain and was considered unmanly and unacceptable. Similarviews existed among lndo-Fijian men even though support of the use of methods was more positive among Indo-Fijian than Fijian men. Men who minded the children and visited family planning clinics were ‘seen as living under the control of their wives’. Derision of such behaviour also prevented men from participating in family planning services.Men are the household heads and their statusand roles do not permit them to be concerned about family planning mattersthat were women’s responsibility and were considered unimportant. Evenwhen maleswished to accessfamily planning methods, they felt restricted. For instance, Adolescent males in the urban area indicated that they were not aware of any restrictionson young people accessingcondoms from the health centres, but they were not confident to ask nursesabout them. They indicated being too shy to approach the serviceproviders becauseof what they would perceiveabout their behaviour.Socialand culturalconditioning makesit awkward for young people (especiallymales)to ask female nursesabout condoms. Someyoung people indicated that “they prefer that contraceprion such as condoms should be placed in special baskets in chemistsand health centres where they can pick up themselvesand do nor have to ask for it”.” Gender norms and the positions of women in the societyinhibit women from becoming fully informed and open in discussionson topics of sexuality and contraception. Tabooson sensitive topics limit the extent to which they can be fully conversant.However,the education of women not only empowers them to be informed and knowledgeable but it also prepares them to communicate effectively in relation to their sexual needs and the demands of their partners. More specifically,information about sexuality,reproduction, and contraception enables them to communicateeffectivelyabout sexualand reproductive behaviourwith their spousesand partners. Thusone of the main ways of bridging someof the gaps identified in this study isto encourage the education of women. Age sensitivity Age differential, an important demographic characteristicand cultural concept, influences the behaviour of people seeking reproductive health information. In both Fijianand Indo-Fijian families,older people are given respect due to their age. Accessingreproductive health information from older people, often of the opposite sex, conflicts with the cultural norms. IOMen 154 have fo ark forcondomr c~f rhe heolrh cenlercenfres and also condoms are not kept on open shelves in most pharmacies. Cultures of Populations: Asia Pacific Therefore, the adolescentsand young adults do not find it comfortable to obtain servicesfrom older women serviceproviders. To bridge this gap, service providers should aim to employ young people and use peer groups. Communication barrier as a factor in transmitting of adequate information In both ethnic groups, sex and contraception are taboo topics among certain categories of people. Elderscannot talk freely about this to young people. Males do not discussthese things freely with females. Parentsgenerally do not talk about these with their children. In the IndoFijian society, it amounts to talking about ‘bad’ or ‘dirty’ things. lndo-Fijian mothers may talk about family planning and contraception in indirect waysto their daughters.There is no discussion and open talk because it is considered inappropriate, as it does not show any respect for the couple’s private life. In the Fijian community, adolescents indicated that anything to do or discussabout sex is considered inappropriate and people just do not talk about these. However, adolescentsmay jokingly talk about this in kinship relationshipswhere there is no cultural constraint; this may be also permitted in the cross-cousinrelationshipsand in the samesex and age group in the Fijian society (Roth, 1973; Nayacakalou, 1955;Torrens, 1990:51).In lndo-Fijian society,brothers-in-law and daughters-in-lawcanjoke about sexualtopicsindirectly. Becauseof taboos and the perceived attitudes of adolescents, men and women about sexuality and sexual relationships, there are problems in the discussionof such matters relating to sexual and reproductive health with the serviceproviders. Women indicated that they are too embarrassedto discusssexualhealth issues such as STlswith serviceproviders. Similarlyadolescentshave difficulty in talking about sexuality and reproduction with parents,teachersand elders.The culture of silenceand shameis associated with discussingsexuality,reproduction and contraception with older people and acrossgender. According to the service providers the advice and messagesabout family planning and contraceptive methods are given to women in the vernacular, but Englishwas also used when communicating with people who could speak English. There are problems of communication especially when the service providers are not proficient in either Hindi or Fijian. In both rural Fijian villages and lndo-Fijian settlementsvisited during the study, Fijian female nursesprovided contraceptive and family planning information. Useof appropriate words in vernacular or even in Englishand appropriate communication skillsto disseminatesexual and reproductive health information is a problem experienced by serviceproviders. In addition, women also felt that they were not able to discusssensitiveissuessuchas diseases and problems about sexual health with the service providers and especially male doctors. According to them, communication on sexual health such as STlsis difficult. 155 Cultures of Populations: Asia Pacific On the delivery of family planning information, mostwomen indicated that often little verbal explanation was given on the contraceptive methods. Women lacked brochures written either in Fijian or Hindi and even in English to read themselvesin the privacy of their homes. In both urban and rural health centres not much in the way of printed information sheetsor brochures on contraceptivemethodswas availableto be given out. The extent to which women understood about contraceptive information given to them orally remainsan issuefor further research. It is important that more female doctors are recruited for reproductive health services,and better proficiency in the vernacular languages should be striven for. lack of confidence and attitudes of the service provider Lack of confidence in the serviceproviders and their attitudes to their clients formed a significant barrier in the accessibilityof reproductive health information by adolescents.The fear that the community nurse or health nurse may divulge information to their parents and relatives,and fear of gossip and jokes among service providers, are important deterrents for sexually active young people. Adolescentsalso indicated that a village nurse knows the people in the village, who therefore do not feel comfortable visiting and obtaining contraceptive information from her. The attitudesof the serviceprovidersare termed asjudgmental and moralistic,the adolescents fearing interrogation because it not a norm for them to accesscontraception information. (Whether there is good reason for these subjective responsesof the young people is another question). In some villages and rural settlementsthe nurseshave been stationed there for a very long time. As such, they develop cordial relationshipswith the rural people, and most people come to know them personally. Thiscould be seen as an important drawback. Another influence on young people accessingcontraceptive serviceswas the collection of data on the contraceptiveusers.”The fear that nameswould be recorded for condom usedeterred people from accessingit. In a rural settlement a young man stated “Young people do not go to centres because the nurses ask too many questions, and they ask about the age and record their names. We believe that married people are supposed to get contraception and not single people”. Sexualactivity among the youth is discreet and very secretaccording to the findings of this research.Thosesingle adolescentswho are sexually active do not wish others to know about it and therefore accessingand using contraceptive methods is difficult 12.Record keeping on adolescentsand young adults for method use has a negative effect on their accessof contraceptive services,rather than on their sexual behaviour. In order to bridge the gap between the service providers and their clients appropriate measuresshould be taken to ensure that serviceproviders adhere to their confidentiality oaths, II This is very useful from the perspectives ah 156 in order see if as on infringement conrrocepriw prevalence raw. Bur that inhibits rhem. Some would of their (human) right 10 privacy. m measure of yourh rhe this was a facror 1.7 Penonol adolescents. communication with service providers and in-depth inrewiewr with Cultures of Populations: Asia Pacific They must refrain from moralistictalks and judgmental views. Retraining and rotation of service providers, especially in rural areas, should improve the accessibility,utilisation and quality of services. Attitudes of service providers Familyplanning and communitynurseshavea very significantrole in providing family planning information to the clients.Their attitudes towards clientsare important in order for them to assist women in understanding and making the right choicesabout methods. Women from traditional cultural backgrounds,rural settingsand alsowith low levelsof education find it extremely difficult to talk about sensitivetopics, therefore the nature and attitudes of serviceproviders are critically important. Indo-Fijian women in the rural areasindicated that serviceproviders were influential in their decisions to use family planning services.They provided direct and positive messagesabout family planning and even encouraged them to use contraceptive methods to space and limit births. Some women expressed concern at the judgmental attitudes of service providers. In some instances,nurses rebuked them for having more than two or three children, and often advised them not to have too many children. The approach and the attitudes displayed towards the Fijianmothers differed in the sensethat they were approached in indirect and more sensitive ways. Thisperhaps could be due to cultural insensitivities. The unfriendly and unapproachable nature of some of the service providers was another negative factor. Women feared being treated badly in the presence of other women and this made it difficult for some of the women to feel confident to ask more questions regarding contraception, their side effects, STlsand reproduction related cancers. Women did not feel confident to talk to the serviceprovider unlessthey had developed trust and faith. Someof the negative attitudes towards clients identified above need to be changed through the retraining of the sameproviders, especially in provider-client interface. lack of knowledge The gap in awarenessof reproductive health related cancersand utilisation of servicesis of urgent concern in both rural and urban areas.Women lacked awarenessand basic information on reproduction related cancersand STIs.Most women indicated hearing about the cancer of the cervix (commonly known asthe cancer of the baby bag) and breast cancer.They had limited information on these diseases.Limited knowledge and ignorance is a barrier to accessinghealth servicesavailable. Examiningthe socialand cultural factorsand their influence on perceptions and expectations of the service providers and clients on specific demographic issuessuch as sexual and reproductive health behaviour and fertility and family planning is imperative in providing relevant 157 Cultures of Populations: Asia Pacific and appropriate programmes.The next chapter examinesthe policy and programme relevance of findings for different groups of people at national, local and household levels Policy and programme relevance for findings In order for a policy to be effective it has to be accepted voluntarily and widely by those affected by it (Jain, 1998:14). The earlier discussionindicatesthat there are micro-leveldifferencesin the perception of the serviceproviders and the expectations and preferencesof the clients and vice versa.The siqnificant underlying social and cultural factors deserve further consideration in the formulation of population policies, programmes and activitiesto make them more effective in bringing about the desired change in the demographic behaviour of people. The relevant government service providers, non-government organisationsand interested parties need to consider diverse social and cultural factors at both local and national levels in order to determine policies and programmesthat are meaningful, relevant and meet the userneeds. In the following discussion,we shall focus upon the relevanceof the findings for the different stakeholdersin the field of population and development in Fiji. A For policy makers at the national level A number of key personnel are involved in population and development policy and programmes at the national level. Theseinclude those responsible for population statisticsand surveydata, and government planners and programmers at the various ministriesdealing with population, health and education sectors.Their accessto population data and more general inputs from both the local and national levelsis very important, as is the involvement of local leaders. Only by using this multi-faceted approach of utilising hard data and taking into account the knowledge and attitudes of local level leaders and the community at large will population and reproductive health policies have a good chance of success. l Community participation In order to induce behavioural changesthat relate to fertility, family planning and reproductive and sexualhealth, it is imperative that policy makersencourage community participation in the formulation of programmes and activities that are meaningful and workable at the local level in the community. Community participation will encourage the inclusion of different views of subgroups and subculturesthat exist in the community. Hence it is important for policy makers to understand the socio-cultural backgrounds in which different social groups and subgroups exist and interact and also to assesswhether the programmes and activitiesare designed take into consideration differences in demographic behaviour. 158 Cultures l of Populations: Asia Pacific Use of demographic and other data The importance of the availability and use of demographic data in policies and programmes cannot be overestimated.The trends and differentials of the sub-populations and subcultures demonstrated by the demographic data in the urban and rural settings are important for the formulation of the population policies and programmes. However, this study showsthat there is a lack of relevant and good quality data on many different aspectsof family planning, reproductive health issuesand gender. The absence of data at local level clinics and health centres according to gender, age and reproductive health concerns,and the timelinessof relevant data were of much concern. Therefore,the effectiveintegration of data in the population programmes remainsan issue.In the absence of relevant and timely data, the use of demographic and social surveysfor determining trends in fertility, reproductive health and other aspectsof demographic behaviour and their correlates is vital. And it is useful to identify the specific programmes and activities that incorporate the social and cultural perspectives essential in addressing the concerns of different sub-populations. The lack of data is only one aspect of the problem; it is also important to change the mindset of planners and programme developers so that they actually value data and seek to use these data. l The involvement of men Another important area of concern for policy makersis the importance of men’s participation or involvementin family planning and reproductive health issues.The study highlights the limited participation of men. Information and education for men is imperative for their positive role and participation in all aspectsof reproductive health. Men’s role in joint decision-making about reproductive health concernswith their spousesand men as usersand providers of servicesare to be encouraged. The participation of men in policy-making, programme design and implementation and more importantly as service providers in reproductive health issueswill help remove socio-culturalbarriers and encourage other men to become involved as well. . Human resource development For policy makers, the problems of lack of resourcesand of human resource development particularly in relation to reproductive health information and education and the provision of sexualand reproductive health servicesthrough health and education servicesare very relevant. The study indicated that in rural health centres,there were concernsabout limited resourcesand personnel for the delivery of effectivefamily planning programmesand sexualand reproductive health information. In addition, the roles of teachersand school administratorsin the promotion and implementation of effective family life education in rural and urban schoolsare of concern. There is urgent need for training and re-training of serviceproviders so that they are aware of 159 Cultures of Populations: Asia Pacific the current developmentsin sexualand reproductive health. Training needsto include upgrading of the skills and knowledge base, addressing the issuesof gender in reproductive health and education and information on sexual and reproductive health, reproductive rights and the empowerment of women, gender roles and language and communication skills in order to provide effective education and information. B For health and education service providers at the community level Doctors, family planning nurses, community nurses, teachers and peer educators provide information and education on sexual and reproductive health to different target groups. The kind and quality of information provided by the serviceproviders may vary in urban and rural areas.The rural areasindicated gaps in limited information sourcesand difficulties in accessing reproductive health education and information in schoolsas well from the health centres and district hospitals. There are a few specific areasof major concern for the policy and programme relevancefor health and education serviceproviders for both family life education and reproductive health projects. The serviceproviders need to consider the local cultures and subcultures,gender and age sensitivestrategies,the need for monitoring and evaluation of programmes, language and communication aspectsand the extent to which reproductive health information is disseminated in rural villages and settlementsand in the urban areas, . Understanding of cultures and subcultures Reproductive and sexualhealth behavioural changescall for a general understanding of the local cultures and subculturesin order to provide relevant knowledge and information, particularly in a rapidly changing multiethnic community suchas Fiji. Fijianand Indo-Fijian populations havecertain socio-culturalaspectswhich are similarand which draw both the communitiestogether in terms of their social,and reproductive health needs. For instance,strong religious beliefs and ideals about premarital sex, attitudes towards sexuality and the associatedtaboos, and reproduction, gender norms and the position of women in the family show much convergence in the socio-culturalfactors.In addition, the intergenerational gaps in the changing attitudes and lifestylesmore specificallytowards western lifestylesalso bring the young people together. Despite the emergence of more liberal attitudes towards sexual behaviour and accessibilityto contraceptive information among many of the progressiveand educated young people in the urban areas, there were distinct differences about perceptions of these among certain groups in the rural areas. Understanding of the cultural similarities and differences is relevant for service providers in the effective provision of sexual reproductive health information. l Gender and age in sexual and reproductive health services In education and health, mostserviceprovidersare women. In all the researchsites,the family 160 Cultures of Populations: Asia Pacific planning nurses and community nurses were women. Most family life education or moral education teacherswere also women. Most of them were older women. Older women in both Fijian and lndo-Fijian cultures have special places in their families. It is expected of adolescents and young adults to show respect to older people. They respect older women nurses and teachers because of their age: they resemble a mother figure or role model. Age barrier is an important cultural inhibition for adolescentsand young adults in accessingsexual and reproductive health service. Gender roles also prevent men from easily accessingfamily planning and other sexual and reproductive health services.The service providers acknowledged the limited participation of men during prenatal and postnatal visits.Men’s accessto sexual and reproductive health information from women is difficult due to cultural norms and sensitivities.In addition, single young people feel ashamedand shy to seek information and servicefrom older women nurses.Women also find it difficult to discusssexual and reproductive health issueswith male doctors. Gender roles are significant aspects for consideration as far as policies and programmes for service providers are concerned. l Confidentiality in relation to sexual and reproductive health service provision The health serviceproviderssuchascounsellorsand especiallynursesand doctorsare expected to maintain a strict sense of confidentiality when they deal with their patients. Despite the providers’ assuranceof maintaining confidentiality, adolescentsand never-marriedyoung adults expressseriousconcerns in this area. They lack trust in the service providers. There is fear that the serviceproviders may divulge information to their parents, friends and relatives.Thisis seen asa strong deterrent in accessingreproductive and sexualhealth information. A high degree of sensitivityiswarranted especiallyamong the serviceproviders when there isa strong perception among the adolescentsthat they lack trust and confidence in the health serviceproviders. l Improving communication skills Most married women obtain information about family planning and contraceptive methods from the service providers at the health centres, family planning clinics, private doctors or at hospitals.Their degree of successin seeking correct information depends their own social and cultural characteristicsand also those of the service providers. Some of these include their knowledge about family planning and contraceptive methods, education level, cultural constraints, and attitudes of the service providers as well as language and communication skills. Unlike the school system,where English language is used for communication, language and communicationskillsare of major considerationfor health serviceproviders.The researchfindings show that in rural areaslanguage and communication skillsare important concerns particularly when disseminatingfamily planning information. Both Fijian and lndo-Fijian clients are in many 161 Cultures of Populations: Asia Pacific ways disadvantaged by problems of communication especiallywhen seeking sexualand reproductive health information. Inability to speak both Fijian and Hindi as effectively as possible is a major drawback for serviceproviders especiallyin areaswhere clientsare not of the sameethnic and language background. While cross-culturalapproaches may be useful in situationswhere some women may feel at ease to discusssensitiveissueswith women from another cultural group, at other timesit can be a disadvantage.The useof reproductive health terms,where they do not have the vernacular substitute,is a problem. The use of specificforeign termsthat are not in the usualvocabulary of the clients further complicatesthe messagethat is to be provided to women. Theseare further compounded by their problems of understanding of the information given to them. C For information providers The gap in the availability of appropriate information and education on reproductive health and its delivery to the target population is an important issuethat deservesthe attention of the information providers. The inability to accessrelevant and correct information particularly on reproduction, sexuality, contraception and childbearing by never married sexually active adolescentsand young adults indicates that these young people are ignorant and unaware of basic information and its sources.It is a major socialresponsibilityof the information providers (teachers, health serviceproviders and other servicegroups) to ensurethat there is adequate public awarenessand education about reproductive health issues.Effectiveand innovative use of media such as television,radio and print materialis essentialin ensuring that messagesreach out to the target population at large. Often young people, especiallyin the rural areas,do not have appropriate and approachable sourcesto accesscorrect information. D For population groups - become involved and be proactive The perceptions and needs of the target groups such as adult men and women, couples, never-marriedyoung adults, and adolescentsdiffer according to their socialand cultural groups. For effective disseminationof reproductive health information and the utilisation of services,a more proactive participation is needed. A progressiveapproach in reaching out for information and taking initiativesto become involved in accessingreproductive health serviceis vital for target groups. Adolescents and young adults are active members of cultural, religious, sports and entertainment groups. Thesegroups could become important vehiclesfor education and information on all aspectsof life -- including sexualand reproductive health, family relationships,and moral values.Similarly,informal men’s groups and women’s groups suchas mothers’ clubs, parent and teacher associations,women’s interestsgroups and other NGOsin both urban and rural sitescan be useful in highlighting important population, education, and health issuesthat are of concern 162 Cultures of Populations: Asia Pacific to the local people. The involvementof people at the local level is extremely important to ensure that basicinformation on reproductive health, family life, PlannedParenthoodand other important issuesis filtered to the people. To conclude this chapter,we can reiterate that this researchisvery relevant for all stakeholders in the field of population and reproductive health education and servicing as it indicates how these policies can be made more effective in better serving the clients and in inducing desired demographic and reproductive behaviour. Data collection, compilation and analysis for improving the knowledge base for local populations U The abilities, intelligence and knowledge of local sraff and community members are relied upon in rhe research process. People -- including children-are usually knowledgeable about their environment, their interests, preferences and knowledge these should be respected and utilised“ (Narayan, 1994: 10). Local people at the community and village levelsare paramount sourcesof information on important aspectsof social, cultural, religious and demographic aspectsof society.They are also the record keepers in oral and written forms of eventsand socio-culturalchanges that occur in their localities. Their participation in research ensuresthat complete and reliable information from varied sourcesis gathered and utilised.In addition, they also help determine the knowledge and service gaps relevant to their demographic, socio-economicand cultural needs. Involving local people in data collection is a positive step towards encouraging them to be part of the researchprocessand empowers them to participate in the programmesand activitiesin order to improve their demographic and socio-economicservices. This also allows them to be aware of the different views and concerns relating to specific demographic and socio-culturalissuesthat exist at sub-group and sub-cultural levelswithin their own community. This chapter highlights issuesin data collection and analysis for the improvement of the knowledge base for local populations. Researchsuch as this exerciseencouraging community participation createsawarenessamong the leaders and respective groups of the need for and the importance of socio-economic and demographic data for their local areas. Second, it demonstratesthe usefulnessof up-to-date data to examine the past and current demographic trends. Third, the useof local record keepersand local facilitatorsdemonstratestheir participation at both household and community levels. In addition, the facilitators also participated in the National workshop for this study and assistedin defining the reproductive health needs of the local people and also in the formulation of the policies and programmes that are expected to bring the desired changes in their areas. In this study, the local participants -- in both Fijian villages and Indo-Fijian settlements -were vital sourcesof important information on demographic and social characteristicsof their 163 Cultures of Populations: Asia Pacific communities. In the Fijian villages, the village headman (turaga-ni koro),13the church Minister (talarala), and the head teacher of the school had data on the different aspectsof village life. The demographic record for the village was well maintained and regularly updated. The researcher’s first sourceof data about the village was the village head. The useof data for this research demonstratedthese men’s important role in record keeping for the village. Further,it established the parametersfor additional data collection particularly on current reproductive health issues, which is little understood and about which limited information is available. While the Fijian village heads had reasonable data records on their villages, Indo-Fijian settlementslacked such organised record keeping. However, they had oral information about the demographicsof their settlements.The priests’record is alsoimportant, particularly in relation to data on marriagesand births. In the Indo-Fijian settlementsdata from schoolswere equally useful. While village records are useful, village data keeping and analysiscan be strengthened through workshops and training, which should also include Indo-Fijian settlements. Nursesat health centres in both urban and rural siteswere very important sourcesof data on the reproductive health and family planning and other health issuesof the local population. Eachhealth centre had data on family planning services,contraceptive use,mothers and infants, mortality and general morbidity relating to sexual and reproductive health. These data were most useful for the study. However, there were concerns about data quality, the number of demographic and reproductive health variablesand about the updates of records. Given the effort already expended on these health records, and their importance, a major effort should be made to audit theserecordswith a view to remedying the shortcomingsidentified above. The participation of family planning and community nursesin this researchwas extremely important not only as data sourcesat local sites,but in the monitoring and evaluation of their activities. In addition, there was an awarenessof the usefulnessof up-to-date and reliable data for demonstrating the trends in demographic and reproductive health issues,and for improving the quality of serviceprovision in the local areas. The participation of serviceproviderswas also helpful beyond the function of data collection. Service providers became aware of current information about demographic and especially reproductive health concerns and other trends. Most importantly, service providers became aware of the perceptions of their clients about themselvesand the problems of the usersabout their services-something they are not ordinarily aware of becauseof the absence of systematic feedback processes.It is also possible that due to discussionsof the current inadequacies in record keeping at the health centres, some improvementswill be made. researcher obtained Fijian Affairs Minimy. 13 The 164 mosf of the demographic and social and economic data from rhe village head. This, according 10 rhe researcher, ~(1s a requiremenr ofthe Cultures of Ponulations: Asia Pacific At a national level, the participation of the serviceproviders suchas those responsible for the policy framework on fertility and sexualand reproductive health at the ministerial level was an essentialfeature of this survey.The national workshop organised by this project on socio-cultural factorsand their impact on fertility and reproductive health behaviour involved many national stakeholdersin discussingthe researchfindings and the policy and programme recommendations. The Ministry of Health, family planning services,community nurses,private medical practitioners, women’s organisations,the Bureau of Statistics,the co-ordinators for plans and programmes for information and education suchas family life teachers,donor agencies, suchas UNFPA,regional organisations such as the SK, church ministers,and representativesof local non-government organisationsparticipated in the workshop and outlined the policiesand programmeson population health issuesat the national and local levels.The village facilitators made important contributions in discussingthe findings and assessingthe implications of programmes and activities suitable for implementation at local levels. This processhas highlighted their roles in actively pursuing population issuesand problems affecting their areas. The perception of local people about their participation in the researchprocesswas positive. They acknowledged that unlessthe people at the community level and especiallythose in rural areaswere involved in identifying and determining the socio-cultural,demographic, and reproductive health needs, effective programmes could not be developed. People at the local level are very much aware of their needs and requirements and involving them is a positive step in meeting their developmental needs. It also empowers them to be in control of their population problems and issues,and at the sametime, it gives them the opportunity to be resourceful and active in policy-making and programmes specific to their local needs. It is important to avoid a one-way movement of data. While data from the local level is used for policy at the local and national levels,there is much national data that these localities should be able to access.In particular, the national censuscontains comprehensivedata on villages and settlementsand these data should be made available to these local communities. The participation of the ordinary members of the community in this researchproject helped them in a number of ways. They received correct information on aspectsof their reproductive and sexual health. The researchalso dispelled some incorrect perceptions held by them. The researchproject also encouraged many of them to talk a little more openly about sensitiveissues, thus opening up the possibilityof them seeking information and assistanceif needed. In general, this researchproject added to the empowerment of the ordinary members of the community, particularly girls and women. The generation of their interest in mattersrelating to reproductive and sexual health could mean that discussionon these topics, and population activities might become more sustainable. 165 Cultures of Populations: Asia Pacific Despite certain drawbacks, suchas the quality of record keeping, at the local level, and funding and resource constraints, data gathered from different primary and secondary sources were most useful. The participation of local people in gathering data and alsoas sourcesof data shows that they were directly involved in highlighting some of the important areasparticularly in reproductive health, family planning and other socialand cultural concernsabout their local areas.In addition, the involvementof other stakeholdersduring the disseminationof the findings and discussionof recommendationsand programmeshighlights their importance from local and national perspectives. The next chapter summarisesthe main findings of this research project and makes recommendations. Theserecommendationsare based on researchas well as on discussionswith the chief stakeholdersat the national workshop. Furthermore, these recommendations emanated from the participants at the National Workshop and reflect their consensus. CONCLUSIONSAND RECOMMENDATIONS Understanding Adolescent, Youth sexuality and reproductive health Education, liberal values, Western lifestyles,increasingly diverse media presenting international programmes, and urbanisation are some of the important influences on the traditional way of life. In addition, the erosion of cultural values,weakening of traditions and change in family systemshave also contributed to rapid social and cultural changes in both the Fijian and the Indo-Fijian communities.Adolescentsand young adults are experiencing lifestyle changes that are very different from those experienced by their parents. Increasein age at marriage due to the education of children, the closer and greater number of interactions between malesand females,changing marriage norms, and attitudes towards childbearing and family relationships are some major demographic changes experienced by young people. The survey data show that adolescentsare uninformed about sexuality, risk of exposure to pregnancy and sexuallytransmitteddiseases,and that they lack sufficientinformation on contraception. Ruraladolescentsare even more poorly informed than urban adolescents.Young people do not get accurate and basic information on these topics, as the researchfindings show that friends, peers and the media are important sourcesof information. The serviceproviders and parents do not communicate basic factson sexual and reproductive health to adolescentsand young adults due to socio-culturalfactors. However, Family Life Education and specific science subjects such as Biology and BasicScience do provide some information to a relatively small number of adolescentswho take these subjectsas part of their school curriculum. The general belief and perception among the adolescentsis that premarital sex is taboo and is disapproved by parents, elders and community members. In the Fijian as well Indo-Fijian 166 Cultures of Populations: Asia Pacific communitiessuch strong beliefs exist. However, most young people felt that there is a need for them to understand more about sexualand reproductive health so that they are informed about it and can take responsible stepswhen pressured into having sexual relationships. This might encourage them to delay entry into sexual union at early ages. A significant proportion adolescentsand young adults are sexually active, as evidenced by non-marital teenage pregnancies and prevalence of STls among the young population. Moreover, there is a strong perception among the adolescents and young adults that young people are sexually active. Sexualactivity is believed to be more prevalent among males than femalesand also more in urban than rural areas. Most sexually active adolescentsand young adults are unable to accesssexualand reproductive health information, asthere are many sociocultural barriers that prevent them from seeking methods and information. Socio-culturalbarriers, age and gender norms and communication problems (language issues)inhibit adolescentsand young adults from seeking and utilising information. Changing values in fertility and family planning There are significant ethnic differences in preferred family size and fertility preferences among Fijiansand lndo-Fijians.While a large family is still desired and much value is attached to them in the Fijian community, a significant contrast was noted in the lndo-Fijian community. Most Indo-Fijians, irrespective of gender and age, prefer a small family. The concept of small family is strongly associatedwith the provision for ‘quality children’ among them. Now there is an even greater need for smallfamilieswith a securefuture.14However,intergenerational change in attitudes to family sizesespecially among some young Fijian adults show that family size of 2-3 is preferred. Therewas a convergenceof attitudesamong young Indo-Fijianand Fijiancouples in urban areas towards small family size. This latter point emphasisesthe critical role of urbanisation in reducing fertility levelsand perhaps in cutting acrossethnic lines in Fiji. Familyplanning iswidely known in both rural and urban areasin Fiji.Thisresearchfound that most men and women are aware of family planning. Most people know about health centresand hospitalsas sourcesof information on family planning. However, despite nearly four decades of family planning services,most women indicate that they do not fully understand different methods and their side effects. This is a seriousindictment of the family planning programme that startedsowell. Men are lesswell-informed about contraceptivemethodsand alsolessinvolved with contraception and family planning. The use of condoms and vasectomyis limited. There is limited promotion of condoms and vasectomyis least known and accepted as a method. Gender roles were found to have a very significant influence on the use of family planning servicesamong men and women. Women, by virtue of their gender, are bearers and caretakers of children. Family planning serviceshave been targeted to women mainly because women bear children. Men, therefore, havenot had the attention of the family planning serviceproviders. 14 The polirtcol crispssraning on the 19th of May 2000 has led 10 e.x?reme insecunry otoor the IPZUS andamong residence ofIndo-Fijians in Fiji.. 167 Cultures of Populations: Asia Pacific However, men have important control over the sexualityof women in traditional and patriarchal societies.Low statusand gender roles prevent women from exercisingtheir rights fully in the use of contraceptive methods. The useof family planning servicesamong women depends upon the support and consent of their husbandsand partners. The absence of this support might lead to conflicts in the marital dyad. Women have to inform and in some casestake permissionto use contraceptivemethods.Thisismostclearlyevident among both Fijianand Indo-Fijiancommunities. A woman who does not seek permission from her spouse or partner is deemed irresponsible, wanton, and loose. However, there was a difference in male responseto and support for contraceptive methods between the ethnic groups. While among Indo-Fijiansthere isan explicit aswell an implicit support for the use of family planning servicesto control fertility, most Fijian males indicated mixed responsesto the use of family planning services.Some Fijian men support their spouseswhile others do not. Large families were still desirable among the adults and family planning and contraception are certainly not important concerns for some of them. The findings also show evidence of limited family planning and reproductive health information, problems, of clients as they highlight poor services,a lack information and inadequate treatment by health servicesproviders. Similarly,the family planning serviceproviders highlight problems, such as inadequate resources,lack of seriouscommitment by the government, time and transport factor and overwork in addition to other socialconstraints.Theseare new areasof concern and these need further research. RECOMMENDATIONS AND PROGRAMMES 1. For the school system and teachers l l l l 168 Make FLEcompulsory and examinable in all urban and rural schoolsand teach it at two levels:a lower form (2 or 3) and higher level (4, 5). FLEshould be given important status like all other subjects. Update FLEto include all aspectsof puberty, sexuality,and sexualrelationships,reproduction, pregnancy risk factors, teenage pregnancy, family planning, contraceptive methods and STlsincluding HIV/AIDS. There should be trained and specialisedfamily life education teachersin the schools,who teach at all levels. Age and gender are important considerations in choosing family life education teachers. Groups of school peers should be trained and educated in reproductive health. Peer educators should be used to spread reproductive health information. A peer information Cultures l l l l l l of Populations: Asia Pacific servicenetwork at different levelsin schoolsand out of schoolswill be useful in spreading basic information on reproductive and sexual health services. Sufficient, appropriate and relevant resource materials should be made available to schools.The Ministry of Education, Ministry of Health and NGOs working in information and education programmes should deliver resource materials -- pamphlets, brochures, information sheets-- to school libraries and FLEteachers. Gender sensitivityshould be observedwhen disseminatingsensitiveand relevantinformation to adolescent boys and girls in schools. A closer link should be establishedbetween the Ministriesof Education and Health, where health servicesproviders are actively involved in regular information sessionscovering sexual and reproductive health information for high school students. In addition, close co-operation should be established between FLEteachersand the curriculum unit and the other NGOsworking in the areasassociatedwith sexualand reproductive health issues.Exchangeand sharing of resourcesare essential. FLEshould use innovative techniques to addresssexualand reproductive health issuesthat havethe support of parents,community membersand religious leaders.Parents,community membersand religious leaders should be involved via information sharing and workshops about the current concernsand issuesaffecting adolescentsand young adults. There should be regular evaluation and monitoring of the FLEprogramme in order to determine its effectivenessand progress. 2. For doctors, family planning and community nurses l l l l Reproductive and sexual health information delivery should take into consideration age and gender aspects.Information seekersmust not be constrained by age and gender roles. It is culturally inappropriate for young males to seek contraception from older female clients. Basicfactson reproductive and sexual health should be prepared in vernacular (Fijianand Hindi) and simple English for target populations and should be widely distributed for in and out of school youth. Youth-friendly information sheetsfor relationships,sexuality,and contraception and other reproductive health issuesshould be disseminatedwidely. Accurateand detailed information on contraceptive methods should be available to clients so that they can make informed decisionsabout methods. Training in communicationand language skillsin relation to sensitivetopicssuchassexuality, reproductive health-related diseases,contraceptionand family planning should be provided so that service providers can be effective when disseminating reproductive health information. 169 Cultures l l l l of Populations: Asia Pacific Serviceproviders (from the health ministry and NGOs)should be trained and educated about the non-judgmental and confidential nature of the provider -- client relationships and all efforts should be made to ensure that no breach of confidentiality between client and serviceprovider occurs. Service providers should talk with frankness and accuracy. There is a need to remove taboos when passing basic accurate factsabout sexuality and reproductive health related diseasessuch HIV/AIDS. Service providers should make contraception and especially condoms available within easy reach of sexually active adolescentsin urban and rural locations that are discreetly accessibleby most people. HIV/AIDS and STlsawarenessprogrammesshould be conducted at schoolsand workplaces to inform and educate people more about these diseases. 3. Gender considerations l l l l l l l l 170 There should be increasedemphasison gender and reproductive rights awarenesstraining for men and women. Their awarenessof sexualand reproductive rights should be increased. Both men and women should be involved in the delivery of reproductive health information. Gender equality in all facetsof society should be strived for including equality in decision making. Male participation should be significantly increasedby using innovative meansto reach to men so that they are involved in reproductive health decision-making, family planning and family responsibilities.Information and education programmesshould be implemented for men via workshops, health clinics,and information packages. Train male health serviceproviders to work with male clients. Reachout to male clients at alternative locations. Train more female doctors to provide sexual and reproductive health servicesto women clients. Improve the socialmarketing of condoms. Condom promotion and marketing are essential in order to develop positive attitudes towards condom use. Introduce condom vending machinesat strategic sites. Ensurethat health service providers work with women and their partners especially for prenatal, postnatal and home visits.Include men as partners when providing sexual and reproductive health information. Introduce couples visiting hour service to encourage their attendance. Ensurethat health service providers provide more specific information on STls,HIV/AIDS Cultures l l of Pomdations: Asia Pacific and reproductive systemrelated cancersto women in both rural and urban areasand more specifically in rural villages and settlements. Make basic information on reproduction-related cancers and the procedures for their screening available to people at all health centres and hospitals. Create an awarenessof these servicesvia radio and newspapers. More effectiveuseof media by the Ministriesof Educationand Health should be encouraged to disseminatesexual and reproductive health information. Radio spots and newspaper advertisementson reproductive and other health issuesshould be made a regular feature. 4. Others l l l Improve the quality of data on population and reproductive behaviour. It isvital to monitor the progress of programmes, and good quality data are essentialto this. Data collection should also remedy current gaps, and information technology should be utilised fully. Population data should be made more accessible,especially by using new facilitiessuch as Web pages. Enhancethe capacityof the local communityin data collection, recording, storage,utilisation and dissemination. 171 Cultures of Populations: Asia Pacific REFERENCES Chetty,K. and Prasad,S., 1993.Fiji’s Emigration: An Examination of Contemporary Trendsand Issues, Population Studies Programme,Universityof the SouthPacificand UNFPA,Suva. Adinkrah, M., 1995.Crime, Deviance and in Fiji. Suva:Fiji Council of Social Servicesin associationwith AsiaCrime PreventionFoundation, Departmentof Sociology,the Universityof the SouthPacific and Fiji PrisonsService. Delinquency Laquian,A. and Naroba,V.L., 1990.Family Planning in Fiji. In Chandra,R. and Bryant,J. Eds.Population of Fiji, Noumea:SouthPacific Commission. Aubel, J., 1994.GuidelinesFor StudiesUsing The FocusGroup Technique,Training Papersin Population and FamilyWelfareEducation,Paper No. 2, International LabourOffice, Geneva. Ministry of Health, 1997.Health StatusReport, 1996,GovernmentPrinter,Suva. Bureauof Statistics,1998b.The 1996Fiji Census of the Population and Housing, General Tables,Bureauof Statistics,ParliamentaryPaper, No. 43 of 1998,Suva. Ministry of Health, 1997.National Centrefor Health Promotion Implementation Plan 1997-1998,GovernmentPrinter,Suva. Bureauof Statistics,1998a.7he 1996Fiji Census of rhe Popularion and Housing, Analytical Report, Part 1 Demographic Characterisrics, Bureauof Statistics,ParliamentaryPaper,No. 49 of 1998,Suva. Ministry of Health, f998. Recommendationsfor Policyto Support Health Promotion:A Report to the Minister of Health, Health Promotion Policy Advisory Committeeand National Centrefor Health Promotion, Chandra,R., 2000. Contemporaryurbanisation in Fiji: level, ratesand issues.Unpublished panel presentationto the RegionalWorkshopon PacificEconomicOutlook, ResearchInstitute for Asiaand the Pacific,Universityof Sydney,2 November2000. Ministry of National Planning, 1997. Development Strategyfor Fiji: Policiesand Programmesfor SustainableGrowth, ParliamentaryPaperNo. 58 of 1997,Suva. Narayan,D. 1994.Toword Participatory World BankTechnicalPaperNo. 307, The World Bank,Washington,D.C. Chandra,R. and Bryant,J., Eds,1990. Population of Fiji, Population Monograph No. 1, SouthPacificCommission,Noumea. l Chandra,R. and Mason,K., Eds,1998.An Atlas of Fiji, Departmentof Geography,Schoolof Socialand EconomicDevelopment,Universityof the SouthPacific,Suva. 172 Suva. Research, l Nathanson,C.A., 1991.Dangerous Passage: The Social Control of Sexuality in Women’s Adolescence, TempleUniversityPress, Philadelphia. Cultures l l l l l of Populations: Asia Pacific Plange,N., 1993.Manual for BasicTraining in NeedsAssessment Methodology. Preparedfor training on prevention of substanceabusein SmallIsland states,Departmentof Sociology: USI? Smith,M.L., 1994.Biological Methods. In Denzin. N.K., and Lincoln Y.S., Eds,Handbook of Qualitative Research, Sage,ThousandOaks, California. Population Information Programme,1998. Population Reports,JohnsHopkins University, Baltimore. SouthPacificCommission,1995. Pacific Islands Popularion Updare, South PacificCommission, Noumea. Population Information Programme,1995. Population Reports,JohnsHopkins University, Baltimore. Torrens,C., 1990. Making Sense of Hierarchy: Cognition as Social Process in Fiji. London: Athlone Press. Reproductiveand FamilyHealth Association, 1996.Annual Reporr, Reproductiveand Family Health Associationof Fiji, Suva. United Narions, 1994. Reviewand Appraisalof the World Population Planof Action: the 1994 Report, United Nations, New York. Roizen,J., Gyaneshwar,R., and Roizen,Z., 1992.Where is the Planning in Family United Nations Fund for Population (UNFPA), 1996. Regional FocusGroup Meeting on Youth Population and EmergingChallengesFiji: A Country Report, UNFPA, Suva. Planning? Fiji after Three Decades of Family Planning Programmes, Population Studies Programme,Universityof the South Pacific, Suva. l l Seniloli, K., 1992.The Socio-economicand Cultural Dimensionsof EthnicFertility Differentialsin Fiji: The Caseof Two Villages in S.E.Viti Levu,PhDThesis,Canberra:Australian National University. UNFPA,1997. The Stare of World Popularion, United NationsPopulation Fund, New York. Seniloli, K., 1996. The Report of the Fertilify *United NationsDevelopmentProgramme (UNDP),1999. Pacific Human Developmenr Report 1999: Crearing Opportunities, UNDP, Suva. and Reproductive Health Survey, Fiji 19941995, Population StudiesProgramme,University l of the SouthPacific,Suva. l Activities Sharma,N., 1996.Demographic dafa on clienfs requesting medical termination of pregnancy in general practice in Fiji, 1996, unpublished paper presentedat the Fiji Medical Association Conference,1997,Suva. l World Health Organisation(WHO),1995a. AdolescentHealth and Development:The Key to the Future, paper prepared for the Global Commissionon Women’sHealth, Geneva. A ReproductiveHealth Profile of the WesternPacific,Vol. I, WHO, Manila. WHO, J995b. 173 Cultures of Populations DEMOGRAPHY,CULTURE,ANDSOCIETYINMALAYSIA Khairul Bashar* INTRODUCTION D emographic behaviour is not a constant. It differs according to an individual’s attitude, beliefs and perceptions, which are in turn directly or indirectly influenced by the prevailing socio - cultural environment. In this study, an attempt has been made to discussand analysethe demographic behaviour of four major communitiesin Malaysia,in order to aid the formulation of policies and programmes with regard to factors such as marriage, fertility, family health, reproductive health, gender equality, education, migration, traditions and beliefs and sexual behaviour. This was a qualitative study, where male and female respondents (including adolescents) from four main communitiesi.e. Malay, Chinese,Indians and Orang Asli (indigenous tribes)were interviewed using a pre - determined set of questions.The fieldwork was conducted at four sites, of which three were rural and one urban. Respondentswere interviewed first as a group: one person from each group was then selected for an in - depth interview. Further details are given in the section on Scope of the Study, Objectivesand Methodology. Religion, education and economic statuswere found to be the most important socialfactors, which influence how an individual reactsand thinks. In a country where the majority population are Muslims, and the official religion is Islam, the importance of this factor cannot be under estimated. For instance, it affectsthe extent of socialintegration with other communities,family sizeand sexualbehaviour. Traditionssuchasthose in the Indian (Hindu) community also give rise to a fairly rigid social structure which affects gender equality, family size, reproductive health and sexual behaviour. Education hasbrought about a great socialchange. In a spaceof about two generations, literacy rateshave shot up. The change hasbeen particularly marked for femalesliving in urban and suburban areas;they haveequal accessto quality education. Thishasdelayed marriage,decreased fertility levelsand encouraged the use of family planning methods. However, the study has also shown that in the rural areas, the chancesfor female children to study up to tertiary level are 175 - Cultures of Populations: Asia Pacific lower. This was found to be due to the attitudes of the parents, lack of good schools,lack of money, and the need to contribute to the family’s income. Many parents in these areaswere more concerned about their daughters marrying before they (the daughters) became “too old.” Thisattitude was lessnoticeable in the caseof the Chinesecommunity. The economic statusof an individual also hasa bearing on the level of education, family size and accessto health care. While many respondents agreed that they would like more than two or three children, they realised that too many would put a financial burden on them. Exceptions were noted for the Malay community where for some of the respondents, the attitude was that “God will provide.” Accessto health care was generally said to be satisfactory,with the rural areas being served by government and private clinics. However, for more specialised care, respondents would go to the nearest big town or city. Living together before marriage is still considered immoral and a sin in Islam.Generally,legalised marriage is the prerequisite for sexual intercourse and family formation. Polygamy,which is allowed in Islam,happens in the Malay community. In casesof divorce or death of a spouse, the remaining partner, if Malay, is encouraged to marry again. The reverseis true for the Indian (Hindu) community, particularly if the remaining partner is a woman. Some believe that a woman is the source of bad luck. For the Chinesecommunity, remarriage is fairly common. The criteria in the selectionof a marriage partner were common to all communities:maturity, financial stability, education and good family background. However, in the caseof the Malays and Muslims from the other communities, religion (Islam)was the prime factor. Non - Muslim parents were not receptive to the idea of their children marrying a Muslim because it would mean a major change in lifestylesand attitudes. The exception was in the caseof the Orang Asli of Pontian who do not mind their children marrying Muslims,as many of them are also born Muslimsor converts.Marriage with Chinese partners is also common in the Orang Asli community. Muslim parents also preferred their children to marry other Muslims, whatever race the potential spouseis.Mixed marriageswhere one partner is a Muslim are therefore not ascommon as those between two non- Muslims. In the Malay, Orang Asli and Indian communities, children are expected very soon after marriage. Many of the Chineserespondents also felt the sameway, but there is a trend, particularly among the younger ones, to put off having children for severalyearsafter gaining working experience. The Chinesemale adults said that they would begin discussingfamily planning with their wives after the second or third child due to the financial costsinvolved in raising children. In the Indian community studied, male adults said that in casesof arranged marriages,children will usually follow quickly, whereas in caseswhere the marriage is based on love, there is a tendency to wait 2-3 years to “enjoy life.” Knowledge on family planning methods was lacking in some aspects;whilst adults from all communities knew of the various methods, many were 176 Cultures of Populations: Asia Pacific vague about the efficacy and safety of pills, for instance. The Orang Asli community in Pontian was the only one which said that traditional methods are no longer used. Adult femalesfrom the other three communities,particularly the Malaysand Indians, used either modern or traditional methods, or a combination of the two to avoid what they perceived to be undesirable side effects. Of the four communities, the Chinesewere the most tolerant of unplanned pregnancy and abortion. Adult femalesfelt that if a girl becomes pregnant, she should be allowed to keep the child if she is financially able to. Abortion, although illegal, is described as “very common”, through traditional or modern means. Chinese Buddhists took a more conservative stance towards the issue;they said it was a sin. Adolescentswere found to have significant gaps in knowledge particularly for the “taboo” subjectsof sexualand reproductive health and diseases.None of the young people interviewed said that they approached their parents for information. Instead they went to friends and the massmedia. Adolescentsfrom all the communitiesthought that age at first marriage should range between 18-25 (for women) and 25-30 (for men), depending on maturity and financial stability. Compared to their parents, the young were more accepting of the fact that more women want to study to a higher level and thus may marry later. However, severalOrang Asli youth did not agree with late marriagesfor women. With regard to fertility, Malay adolescentswere aware of the costof raising children; neverthelessmalesthought that 3-4 children were a good number while femaleswanted 4 or lesschildren. Adolescentsfrom the Indian and Chinesecommunitiesmaintainedthat 2-3 children were sufficient. The Orang Asli adolescents interviewed wanted the most: between 5-8 children. In terms of gender, the Malay young had no fixed preferenceswhile there was a slight bias towards boys in the other three communities. Religion and cultural traditions strongly influenced the social and sexual behaviour of adolescentsfrom the Malay, Indian and Orang Asli communities, but were lessrigid in the caseof the Chineseyoung. Nevertheless,all communities can still be considered to be conservative. Gapshave been identified between the availability of servicesand their utilisation, aswell as their effect on demographic behaviour. However, these gaps were more evident in the areas outside of big towns or cities where there is greater reliance on health/mother & child clinics, midwives and traditional medicine. Educational levelsalso tended to be lower in those areas, which influenced demographic behaviour, especially pertaining to gender equality. The study underscoresthe fact that planners of programmes must be sensitiveto the socio cultural environment of communities (and sub groups within each community). Other recommendations are made in the section on Main Issuesand Recommendations. 177 Cultures of Populations: Asia Pacific Malaysia, as formed in September 1963, consistsof fourteen states namely the Federal Territory, Selangor, Negeri Sembilan, Johore, Pahang, Terengganu, Kelantan, Perlis, Kedah, Penang, Perak,Melaka all of which are in Peninsular(West)Malaysia,while Sabahand Sarawak are in EastMalaysia.It hasan area of 330,000 square kilometres,with a population density of 56 persons per square kilometre. Peninsularor WestMalaysiais more densely populated than East Malaysia,which is made up of Sabahand Sarawak. In 1998the population of Malaysiawas 22 million people and this is projected to increaseto 33 million in the year 2020. However, out of the 22 million people about 1.5 million are nonMalaysian citizens or migrants from other countries. Internal migration occurs between states, rural to urban and rural to rural areas.The pull factorsare mainly work, marriage and education. The average annual growth rate for 1998 is 2.3 percent, which has declined from 2.8 percent per annum in 1995 (Department of Statistics,Malaysia). Malaysia’spopulation is still considered young becausethe proportion of aged is still below 7 percent, the level at which the United Nations defines a country’s population to be ageing. In 1998, the proportion of Malaysia’spopulation aged 60 yearsand over was 6.8 percent and 4.5 percent for those aged 65 yearsand over.The proportion of the aged isalso gradually increasing asa result of declining fertility and longer life expectancy at birth and at older ages. Life expectancy at birth for malesis 70 yearsand for females,74 years.Women make up almost half of the total population. Both fertility and mortality have declined and this has brought about changes in the age structureand family size,which is now getting smallerwith an averageof five people per family. The crude birth rate has declined from 28 in 1995to 25 per 1000 population in 1998.Mortality stabilised at 4.5 per 1000 population in 1995 and 1998. Infant mortality declined from 10.5 in 1995to 8.3 per 1000population in 1998.Maternal mortality hasremained at 0.2 per 1000births since 1995. The mean age at first marriage for males has risen from 26.6 years in 1980 to 28.2 years in 1991.For females,the mean age at first marriage increased from 23.5 years in 1980 to 24.7 yearsin 1991.Thishasan implication on the fertility of Malaysianwomen, who now already have low fertility. Furthermore, asa result of migratory mobility, the majority of familiesare now nuclear families. Malaysia’s population consists of diverse ethnic groups and cultures including Malays, Chinese and Indians, who reside mainly in PeninsularMalaysia, whilst the remaining ethnic groups namely lban, Dayak Darat, Melanau, Kenyah, Kayan, Kedayan, Murut, Kelabit, Bisaya, Punan, Penan, Kadazan, Bajau, Dusun, Loh Dayuh, Kadayun, Orang Sungei, and Suang Latut reside in EastMalaysia.Eachof these ethnic groups has its own socio-culturalnorms and values, which influence the behaviour of the community. 178 Cultures of Populations: Asia Pacific Up to the 19th century, Malaya (asit was known before 1957)was populated mainly by the Malays and the indigenous tribes or Orang Asli, literally meaning “the original people”. The earliestancestorsof the Malayswere believed to have come from South WesternChina and intermarried with the Orang Ash. By 2000 A. D, sea trading among the Asians started to spread. A Malay Government in Melaka emerged by the 15th century along the coastof the Straitsof Melaka, which developed into a successfulentreport seaport linking Chinese, Arab and European traders. Since then, PeninsularMalaysiaand a few other areasin Sabahand Sarawakbecame a centre for trade with outsiders.When the EastIndia Company, owned by the British, established itself in India in the 18th century, the Straitsof Melaka became more important. British traders, firstly as individuals and later as companies, were encouraged to trade with countries east of India. Thus, the 19th century could be seenasthe turning point for some countries in Asia,when the Britishcolonised these countries and controlled their economic and political structures.PeninsularMalaysia, then called Malaya, was no exception and fell under their control. The Britishand other Europeansneeded raw materialsfor their industries.In order to support their economic activities,the Britishadministration encouraged the entry of migrants from China and India to work in the tin minesand rubber estatesand this processcontinued until World War Two. Thusemerged the roots of the multi-ethnic composition of the Malaysiansociety. ETHNICCOMPOSlTfON The Malay Community According to reliable historical sources,the Malays lived in this country since 2500 A. D. Together with the other Bumiputera groups they form the biggest proportion of the population. The Orang Asli communicatein their own languages or dialectsand Malay when communicating with other ethnic groups. The Malay language, traditions, Islamand the monarchy form the principal determinants of the political-social structure in Malaysia. The Malays in PeninsularMalaysia have broadly one identity and socio-cultural tradition, which shapes their social behaviour. Religion is a very important influence, playing a significant role in the inculcation of good moral values,aswell as being a form of social control. Islamand ‘adar’traditional customsand values),which are being practised hand in hand, demand that the Malays show refined character,restraint, humility in speech and manner and modesty in dressand behaviour. The Malays,who formed the majority of the rural population before the country’s independence in 1957,now form quite a large proportion of the urban population. The government’s policy on the restructuring of society has contributed significantly towards the transformation of 179 Cultures of Populations: Asia Pacific the urban population structure, largely as a result of the rural urban migration of the Malays, especiallyamong the youths. One implication of this rural urban migration is the ageing of the rural population and the emergence of a tradition whereby the new urban Malaysreturn to the rural areasor kampongs during long public holidays to visit their parents and relativesas part of their obligations, aswell as to enjoy the rural environment. Traditionally, the Malay kinship structure was based on the extended family system,where three or even four generations live under the same roof or within the same compound. In modern days,however,this kinship structurehaschanged, with the emergenceof nuclearfamilies. Nuclear familiesin rural areasemerge asa result of migration, especiallyto urban areas,in search of jobs, education and marriage. In urban areas,Malay nuclear familiesare due to the younger generation migrating to towns while leaving their parents behind in the villages. Most Malay households are patriarchal, except in the state of Negeri Sembilan, where a matriarchal kinship systemstill exists. Generally, the father is the head of the household. In modern Malay families,however, there is increasinglythe sharing of responsibilitiesand decision - making. When a decision needs to be made on an emotive subject, such as divorce, abuse, inheritance, etc., there will be a great deal of group consultation between couples, their kin, and religious and other community figures. The educational level of women plays an important role in determining the extent of their involvement in decision making in all areasof life. Any national programme aimed at influencing the family structure, such as the number of children in the family, education, diet, health and others, has a greater chance of successif the woman of the family is convinced of the benefits of the programme. Most young Malays today find their own partners. Studiesdone by the National Population and Family Development Board (LPPKN),have shown that choice of partners is based on love, religion, financial stability, good behaviour, compatible educational level and good family background. The minimum age at first marriage is now legally fixed at fifteen years but early marriagesare rare, as both boys and girls attend school to the highest level possible.The mean age at first marriage for the Malays is 19.5 years (MalaysianPopulation ETFamilySurveys- MPFS, 1994). Arranged marriages can still be observed but on a smaller scale.The bride and groom are likely to have professedagreement to the match. Suchmarriagesare common when the son or daughter has reached the age of about thirty years, with no visible sign of a long-term relationship. With some exceptions, the unmarried person is quite content to leave the matter of finding a suitable spouseto the parents or matchmaker.(A distinction must be made between a marriage arranged at leisure and that arranged because of an unexpected pregnancy). Marriages within kin groups, especiallyin the more rural areasare fairly common, including that between first cousins.The reasonsfor marriageswithin kin groups are mainly to strengthen family 180 Cultures of Populations: Asia Pacific ties or to keep wealth and assetswithin the family.Marriages outside the ethnic group are acceptable, so long as the partner convertsto Islam. Divorceis not encouraged by Islambut it is allowed if the marriage no longer brings happiness to the couple. The rate of divorce is quite high in the Malay community, especially in the states of Kelantan and Terengganu. Remarriagesamong divorced women are also quite common in the Malay community and is encouraged by the religion to protect the welfare of the woman and her children. Polygamy is allowed in Islamprovided that the husband has a valid reason to take more than one wife, such as the inability of the wife to bear children, sickness,insanity or unwillingness to have sexual relations with the husband. The husband must, however, ensure that he is able to provide the needs of his wives fairly and adequately. Familyplanning, which in principle is only made available to married couples, is allowed by the Islamic religion but abortion is considered a big sin. In reality, however, family planning devices,suchasthe condom, can be obtained easilyfrom drug stores.Premaritaland extramarital sex are forbidden by the Islamicreligion. To avoid experimentation with premarital sex, sexual exploitation or abuse, there are attemptsat sexualseclusionbefore marriage (WazirJahan Karim 1990).Young courting couples know that their behaviour (at least in public) should not give rise to gossip, thereby bringing dishonour to the family. In reality, however, casesof single motherhood and abandoned babies are reported to occur frequently in the Malay community, especially among adolescents. There are still certain rites and taboos observed by the modern Malay community, suchasthe practice of traditional family planning methods by taking certain herbs to prevent pregnancy, and avoiding the consumption of certain foods during pregnancy and after birth. Ritual massage after birth is still a common practice. The breastfeeding rate is highest among Malay women but the duration varies because more women are now working. The Malays have no particular preference for sons,welcoming children of both sexes.Often, one reason for having more than two children is as a form of old age security.Although the number of children born to a Malay woman is decreasing, it is still higher than in the Chineseand Indian communities.The decline has taken place because of the difficulties in childcare, especially for working women, and the high cost of child rearing. The Chinese Community During the Melaka Sultanate,there were many Chinese traders who came to trade but the number who stayed and settled in Melaka was quite small. Those who decided to stay in the country assimilatedthemselvesinto the local culture and way of life. They adopted many Malay customs, dress and food but did not convert to Islam. They became known as Babas or ‘Straits’Chinese,and mainly lived in the statesof Melaka and Penang. The big wave of Chinese immigrants to Malaysia began in the mid-nineteenth century when the British encouraged immigrants to work in the tin mines belonging to Malay aristocrats. 181 Cultures of Populations: Asia Pacific Most of these immigrants came from the Kwangtung and Fukien regions. There were many factorsthat pushed the Chineseto emigrate: chief among them was the desire for a better life. By the twentieth century, immigrants had already moved to the various statesin Peninsular Malaysia,especially in statesalong the WestCoast.Their immigration to Sarawakbegan only in the second quarter of the nineteenth century. Chineseimmigrantswho came during the exodus did not attempt to integrate into the local population, professingties to family, associationsand to the government in China. Due to their dominance in the businesssector,their averageincome exceeded that of other groups by a substantialmargin. Since independence in 1957,a new generation of Chinese have grown to adulthood and loyalties have shifted from China to Malaysia.The majority are urban dwellers. The Chineseuse BahasaMalaysiato communicate not only with other races,but sometimeswith other Chinese who may not speak a particular dialect. There are about nine different dialects spoken by the Chinese and these dialects reflect their ancestral origin. Nowadays, most Chinese are able to speak an average of two dialectssuchas Cantoneseand Hokkien. Englishis also commonly used by the different ethnic groups to communicate. There is no threat whatsoever to the survival of Chinese dialects, culture and arts, as the Constitution of the country provides for the freedom for all communitiesto speak their ‘mother tongue’ In schools,classesare conducted in BahasaMalaysia,but Chinesechildren also have the option of attending primary and secondary schools conducted in Mandarin. Their teaching syllabus,however,musthavethe prior approval of the EducationMinistry,and pupils are required to passBahasaMalaysiaexaminations. Where three or even four generations living together in the samehousehold used to be the norm for the Chinese, this extended family structure has now dwindled and is being replaced by a nuclear family structure created by the effect of modernisation. Like the Malays,Chineseare also moving out of their original family householdsto look for better avenues.Nevertheless,the Chinesecommunity regards obligation to family, particularly the patrilineal family, asimportant. The head of the family is usually the father, eldest son or the most successfulson. Chinesephilosophers emphasisefilial piety and respect for the elders, because of the belief that only those who show filial piety can respect rule and order. Only when such individuals know how to respect their elders and family memberscan they know how to hold high positionsand become respectablepersonsin the mandarin (WangGungwu 1979:21).The family obligation is followed by maintaining ties with co-operative associationsand friends. Associationsare normally set up according to the traditional belief that all persons with the same surname are related patrilineally. It is this organisational strength that has been responsible for the community economic successof the Chinese. 182 Cultures of Populations: Asia Pacific Ancestor worship is an important component of the Chinese belief that the actions of the living affect the well being of the spirits of the dead. Conversely,the dead can also affect the lives of their descendants.Good or bad luck may be seen as the influence of the ancestors.This ancestorworship was brought along by the first generation of Chineseimmigrants,who practised it with more zeal as a reflection of their isolation from their homeland. In modern days, it is practised more as an extension of filial piety and for good luck. The women of the household are more conscientiousin practising this ancestor worship than the men. Worshipping is done daily and on special occasionssuch as Chinese New Year, Cheng Beng (equivalent to all Souls Day), etc. Belief in child survival is also practised but not on a very large scale. Some Chinese believe in tying a string blessed by the temple around the wrist to deflect evil spirits. Most Chinese profess mostly Buddhism, Taoism,Confucianismand increasingly Christianity. A small proportion is Muslim. Belief in the first three religions is often combined in varying degrees to form an eclectic form of belief. Like the other communities,Chinesefamiliestoo stressthe need to be legally married before the formation of a family. Although marriage partners are based on free choice, arranged marriages agreed upon by the potential couples still occur even in the Chinese community. In 1994, age at first marriage among Chinesewomen between 15 to 59 years old was 20.6 years. This is an increasefrom 20.2 years in 1984 (MPFS1994 and 1984, LPPKN).It needs to be noted that age at first marriage among the Chineseespeciallyamong the women is the highest among all the other ethnic groups. The Chinese community accepts inter- ethnic marriages but have some reservationswhen it occurs with Muslims because they would have to convert to Islam. Criteria for choosing a partner are similar to the Malays except that for the Chinese, financial stability isthe mostimportant whereasfor the former, the Islamicreligion cannot be compromised. Education level of the couples is preferably of the same statusbut the husband can be more educated than the wife in order to ensure harmony and respect. Chinese community tends to discouragemarriageswithin kin groups or even between personswith the samesurnamebecause of the belief that these people could be related patrilineally in a distant past. Divorceamong the Chineseisascommon as in the Malay community. Although polygamy does occur in the Chinese community, it is not highly regarded by the professionalclass(Duzaand Baldwin, 1977). A major area of concern is related to the fact that the fertility of the Chinese community is declining much fasterthan the other two ethnic communities.Total fertility of a Chinesewoman in 1997was 2.5 children per woman, which is the lowest among the three major ethnic groups. Thislow fertility could be due to the high rate of family planning practices(including traditional herbs) among Chinese women. Studies have shown that the higher the education level, the lower the fertility. The number and spacing of children are normally decided upon between husband and wife. The preference for producing sons is common among traditional Chinese 183 Cultures of Populations: Asia Pacific becausethe sonsare the ones that inherit and carry on the family name. Till today, this preference is still evident, although to a lesserextent. Abortion is illegal but it does occur in all the communities.The practice of breastfeeding is low among Chinesemothers ascompared to Malay and Indian mothers. For the Chinesetoo, old age securityis one of the reasonsfor having children. Sonsare duty bound to look after their old parents although in reality daughters play as important a role in looking after old parents. Patternsof socialisationfor very young children are the same regardless of gender, as in the other communities. Fostering takes place on a small scale in the Chinese community. If ever a Chinesefamily adopts or fostersa child, the preference is usually for a healthy boy. The Indian Community The earliest relationship between India and Peninsular Malaysia began around the first century. During the Melaka Sultanate, Indian traders were common. Although they were Hindus, they assimilatedinto the Malay culture and were popularly known as‘Chitti’ The bigger wave of Indian immigrantshappened in the 1840s.In the beginning, Indian labour was imported by the British planters to work in the sugarcane and coffee plantations in Seberang Perai, Penang. Demand for cheap Indian labour increasedin the early 20th century when the planting of rubber by the European companiesstarted on a big scalein the statesof Perak,Selangorand Negeri Sembilan. However Indian labourers were not brought into Sabahand Sarawak.Labour needs there were mainly met by Javanesefrom Indonesia. The history of this migration explains the distribution of the Indian population in modern Malaysiatoday but this situation is gradually changing. Although the numbers fluctuated according to the situation of the rubber industries, 908,000 was estimated to have entered the country between 1911until 1920. Many came to escapepoverty in their homeland. Somehad been arrested for crimesin India; they were put to work building roads, railway tracts, bridges and government buildings. Others were contract labourers needed for the sugarcane,coffee and rubber plantations. Most of these immigrants came from the southern region of India. About ninety percent were Tamilsfrom Madras and the rest were from Telegu, Kerala, Punjab, Bengal and the island of Ceylon (now Sri Lanka). Malayalis, Ceylonese and Bengalis who could speak English were encouraged to migrate to PeninsularMalaysiaby the Britishto work in government and private offices.Punjabi migrantswere usuallyex - soldiers;they later joined the police and somebecame security personnel or ‘jagas’ Becausethe majority of the estateworkers were of Tamil origin, Tamil schools,housing and clinicswere made available by the estateadministrators,although the quality of the serviceswas often poor. However, over the last decades more young people have begun leaving the estates to look for better jobs and education. Tamilschools,like the Chineseschools,do receive government grants but unlike Chinese schoolsthey do not have a strong businesssector for funding. 184 Cultures of Populations: Asia Pacific Urban Indians like the Punjabis,Malayalis,Bengalisand Ceyloneseare much better off than the Tamilsbecause they had a better base from the start when they came either as traders or as government employees. Interaction between the urban Indians and those from the estatesis limited and very often absent.Although the castesystemis not openly practisedby MalaysianIndians,marriage between the urban (richer) Indians and the estate Indians seldom occurs. Indian society is divided not so much along castelines, as it would be in India but more along socio-economicstandards.Urban Indians are mainly traders, professionalsand clerical office workers. Eachdialect group tends to maintain their own way of life and promote their own culture. Like the Malays and Chinese, lndians too begin family formation with legally recognised marriages. Although marriages nowadays are based on free choice, arranged marriages still occur. However, even if it is an arranged marriage, the agreement of both parties is normally sought. Age at first marriage among Indians increased from 18.5 years in 1984 to 19.5 years in 1994 among the 25-49 years old and this is the lowest among the three ethnic groups (MPFS, 1984 and 1994, LPPKN).Although Indian brides traditionally lived with their husband’s family, in modern Malaysia,nuclear familiesare becoming more common, asis the caseamong all ethnic groups. Marriages within kin groups are allowed such as between first cousinsand maternal uncle and niece. Working classbrides are expected to adjust to the needs of the family and not to demand too strong a bond with their husband. Thisis required in order to prevent the creation of disloyalty within the family (Oorjitham, 1984). Dowry is still demanded in Indian marriages.An Indian woman’s family is expected to provide her new husband with a dowry, the amount of which is usuallyset according to the eligibility of the groom. Theoretically,the money is supposed to be held by the husband but nowadays the money is normally used jointly by the couples to pay for wedding expenses. Inter-ethnic marriages are not objected to but not really encouraged where it involves changing religion. Divorce is not a common feature of Indian marriages but it does occur on a smaller scale compared to the Malays.The taboo against marrying a widow is strong in the Indian community, as these women are considered to bring bad luck. Studies done by LPPKNshow that the p roportion of first marriages remaining among Indian couples in 1994 was 90 percent (MPFS, 1984and 1994, LPPKN). As in other ethnic groups, the Indian family systemis patrilineal where a male is the head of the household and makes the final decisions on family matters. As more and more women participate in the labour force, decision making in the household is gradually being shared and this also applies to decisionsregarding family size.The population and family surveyconducted by LPPKNin 1994 shows that awarenessof family planning among Malaysian Indian women is 99 percent. Studieshave also shown that the higher the level of education, the lower the fertility. 185 Cultures of Populations: Asia Pacific The total fertility rate among Indian women is 2.6 per woman and this hasdeclined from 3.4 per woman in 1980. Familyplanning is acceptable and in 1994the rate of family planning practised among Indian women was 33 percent. Abortion as a form of family planning is illegal and considered wrong in the Hindu religion. Although abortion occurs in all communities, these incidencesare normally hidden for fear of socialostracisation,especiallyin the Indian and Malay communities. Gender bias infanticide hasnot been proven, and thus it is not known whether suchincidences do occur in any of the three ethnic groups including the Indian community. Like the Malays, Indians teach girls to behave differently from boys. Fosteringof children occursin all communitiesbut how common this practice is in the Indian community and whether it has gender bias is not known. Indian familiesplace great importance on socialand sexualrestraint.Thisnorm is particularly rigid for those living in a closed community like the estates,where the social control is so strict that any girl who mixes freely with a male may risk not receiving offers of marriage. Like the Malay community, malesare allowed more freedom than femalesin this type of behaviour. Extra marital relations are also forbidden in the Indian community. The Orang Asli Community The Orang Asli (“original people”) have been residentsin the Malay Peninsulafor millennia, much longer than the other groups. In 1996, their number was over 90,000 people (A. Baer, 1999).The Orang Asli groups come from many smallindigenous communitiessuchasthe Temiar in the Ulu Plusarea of PerakState,the northern Orang Asli, which include Kensiu,Kintak, Jehai, Batek, Medrek and Lanoh, and others. Eachcommunity has its own unique culture and way of life. Most of their languages are unrelated to Malay, the official language of the country. However, they use BahasaMalaysiain their dealings with other tribes and communities. The Orang Asli have their own religions, which emphasiseways to ensurehealth and survival. Their traditional economiesare simple and they are mainly engaged in fishing and horticulture. In the 195Os,the Orang Asli groups were politically autonomous until the British colonial rulers placed them under the jurisdiction of a government department with the intention of winning them away from the influence of communistguerrillasoperating from forestbases.Thisdepartment still existstoday under the Ministry of National Unity and SocialDevelopment and it monitors all Orang Asli affairs. Since independence in 1957,the government has been trying to integrate the Orang Asli groups into the mainstream of Malaysian society. Two of the main issuesof concern to the government are the health statusand education. Various programmes have been implemented to help enhance the quality of life of the Orang Asli according to modern standards. Cultural 186 Cultures of Populations: Asia Pacific differencesare important becauseany failure to understand them will hamper efforts to improve their health status.The Orang Asli have strong kinship ties, reflected both in work strategiesand residence patterns. The mutual concern and obligations of kin provide the Orang Asli strength to fight againstillness,food shortagesand other crises.As the Orang Asli live mainly in the natural environment of either the deep jungle or its fringes,they are more prone to sufferingfrom malaria and dengue fever because of mosquito bites. Polunin’s surveysin the 1950sshowed that the Orang Asli also suffer from tuberculosis,malnutrition and leprosy. Traditionally, the Orang Asli believe that the first human was a female and this explains why femalesare more powerful mystically.In religious rituals, the priest is normally a woman who may be young or old. Age is not the determinant in these rituals. In terms of childbirth, the Orang Asli Jakun tribe believesthat it is the male who conceiveschildren but after a period of nine days,the foetus is mysticallytransferred to his wife. In sucha cultural setting, women appear to have a respected statusand there is little gender segregation. However, as more and more Orang Asli work outside their communityfor wages, they too are gradually changing their lifestyle where the husband works and the wife looks after the home and children. Orang Asli children attend public schoolsprovided by the government. School hostelsare provided so that they do not have to travel far. The medium of instruction is BahasaMalaysiaand the curriculum is similar to that of any other public school, except that it has to be adapted to the needs and standardsof the Orang Asli children. There are not many studies done on Orang Asli socio-cultural norms on marriage, divorce, gender preference, sexual taboos and practices and the incidences of HIV/AIDS and STDs. Familyplanning is available to the Orang Asli through the health servicesspecially provided for them but the rate of practice is not clearly known. As Orang Asli groups live asa community and kinship ismore important than individual family,determining familysizethrough fertility regulation may not be a priority. Nevertheless,family planning is encouraged for health reasons. Orang Asli in PeninsularMalaysiaare either Muslimsor Christiansbut regardlessof their religion, they still practisetheir traditional beliefs suchasthe spiritsof the dead having the power to affect the living. These spirits can either be evil or benevolent and thus the living have to perform rituals to ward off disasters. SCOPEOF STUDY,OBJECTNESAND METHODOLOGY The study aims to identify the different social and cultural factors that affect demographic behaviour in the various racial, cultural and sub - cultural groups in Malaysia.On the basisof the findings, suggestionsand recommendations are to be made for the benefit of policy planners to formulate and implement population policies in the country. The study is limited to the 187 Cultures of Populations: Asia Pacific collection and analysisof qualitative data at selected siteson demographic behaviour in order to fill gaps in knowledge and supplement existing quantitative demographic studies. Scope of the Study Demographic behaviour, as defined above, includes variables such as fertility, mortality, morbidity, migration, reproductive health, family planning, ageing and gender implications. Eachof these variableswill be looked at in terms of trends and their relationship with the sociocultural norms of the four communities, namely Malay, Chinese, Indian and Orang Asli, in the selectedsites.Implicationsof socio-politicaland economicchangeson the demographic behaviour of these familiesand communitieswill also be analysed.The selectedsitesare Bota, Perak(Malay - rural) PasirPinji, lpoh (Chinese- urban), Siliau,Port Dickson (Indian - rural) and Pontian, Johor (Orang Asli - rural). All the selected rural areasare easilyaccessibleby road to the nearesttowns. Bota (Perak) Mukim Bota is one of the eleven mukims (counties)in the Districtof PerakTengah. At 179.94 square kilometres, it is the second biggest mukim in the District. “Bota” got its name from the belief that a giant once frightened the villagers. It consistsof thirty eight small villages and is administered by fourteen village headman and a Penghulu or District Headman. There are adequate facilities such aswater and electric power supply aswell as good roads in the village. There are nine primary schools,three secondary schools, 17 public religious schools, 15 kindergartens, a community hall, playing field, mosque, and sports club. Three higher institutions are located about 10 kilometres from Bota and they are branch campuses of Universiti Sains Malaysia,PetronasTechnology Universityand MARA Technology Institute. Parentsare aware of the importance of education for their children and thus encourage them to pursue the highest level of education possible. Generally,the health statusof the village population is good. In Bota, there are two government clinicsand one private clinic, also a hospital about fifteen kilometres away. The people in Bota are quite satisfiedwith the health facilitiesavailable. Old people in the village do not like to go to hospitalsfor medical examinationsunlessthey have seriousillness.Usually,they will look for alternativeslike herbs or seekadvice from the traditional medicine practitionerswho are called bomoh. Beliefsin traditional medicine and bomohs is still quite common even among the young who may consult both modern and traditional practitioners. Islamis the only religion professedby the Malayswho are quite committed in performing all the teachingsof the Islamicfaith. The Malaysin this village, however,are still practisingtraditional customaryriteslike giving offeringsto the dead soulsof ancestorsfor a certain request. Thispractice is actually contradictory to the teachings of Islamwhich forbid such activities. 188 Cultures of Populations: Asia Pacific The village’s main source of employment is in the agricultural sector planting rice, tapping rubber, harvestingand selling fruits and harvestingoil palm. About 80 percent of the population are involved in this agricultural sector, 17 percent wage earnersand businessmenand 3 percent unemployed (which include old people). Besidesagriculture, there is one rubber processing factory near Bota. Someof the villagers travel daily to work in nearby towns like Ipoh, Manjung, Air Tawar and others. As the agricultural sector does not interest the young men, they look for jobs in big cities. They will, however, return to the village once a while particularly during Hari Raya(firstday celebration after the fasting month of Ramadhan).Immigration into the village is minimal comprisingmainly Indonesianlabourerswho work in the oil palm and rubber plantations. PasirPinii, Ipoh (Perak) PasirPinji New Village was establishedabout 55 yearsago during the communistinsurgency in the then - Malaya. The village was formally a tin mining area situated to the south of the city of lpoh in the Kinta District of Perak State.A small streamwhich runs through the centre of the village joins the Pinji Riverwhich servesas a south-eastboundary. During the economic boom, the village had about 15,000 people but in recent years, there are only about 12,000 people from 1600 households. This meanson average, each household has 7 people but it is not clear whether these householdsare extended or nuclear families.PasirPinji New Village comprises98 percent Chinese, a few Malay families (mainly located at the village police station), and some Indians (working at the barber shop and nearby factories). Marriage, especially among the older generation, occurs mainly between partners living in the samevillage. Educationand socialbackground are no longer the prime conditions in choosing partners. Young people choose their partners freely without any introduction by middlemen. Marriage age rangesbetween 25 to 45 yearsfor men and 20 to 35 yearsfor women. The number remaining single is about 5 to 10 percent of the men aged 30 to 55 years old. Women who remain single range between 3 to 8 percent. The village community does not look down upon those who remain unmarried. There are about ten casesof mixed marriagesin the village, mostly between Chinese men and Indian women. Thesemixed marriages occur only among the low income group. Divorce rate is negligible. The fieldwork was limited to one site for each ethnic group becauseof constraintson human resource,finance and time. Thusthis study is limited to either an urban or a rural perspective for each ethnic group and community. Rural/urban comparisonsof each community is therefore not possible. For example, the study is not able to compare between a rural Malay and an urban Malay community or Chinese urban and rural community and so forth. There were 24 focus groups and 24 in-depth discussions. The majority of couples prefer to have between l-3 children as they find it difficult to bring up and educate them. Single parents are well respected as members of the village community, 189 Cultures of Populations: Asia Pacific regardlessof gender. There are about 10 male single parents below 55 yearsold and 15 female single parents also below 55 yearsold. Familiesdo not regard taking care of the old asa burden in this village. Many of the younger generation have migrated to bigger towns or other countries for better job prospectsor after marriage. They return to the village for short visitsduring the ChineseNew Year celebrations or religious functions. People who come into the village are normally factory workers and businessmenwho come only during the day. Thus population movement is characterisedmainly by out migration. The number of old people in the village is estimated to be 15 percent of 12 000 people, around 1800 old people, which is quite high. Ageing is not of great concern to the villagers because those who are healthy still contribute to the family and community economically and socially.Someof the older men work as guards, petrol kiosk attendants, factory supervisorsand factory handymen. The women look after their grandchildren while their children go out to work. Othersjoin recreation clubsand associations,which often organiseactivitiesand excursions. There are about 13 to I8 clubs and associationsin the village. Mortality in this village is about 10 to 30 yearly and most of the deaths are old people who die of heart failure, respiratory failure, stroke and cancer.In the past three years,only two young people died one becauseof an accident and the other due to high fever. The dead are either buried in the nearby graveyardor crematedat the temples.The Chinesecommunity in this village organise simple rites or ceremoniesfor one or two days before the dead are buried or cremated. Common illnessesare cough and cold, chicken pox, skin diseasesand occasionally,conjunctivitis. There has been no incidence of maternal and infant mortality in the village in recent years. The villagers generally look after their health, going for regular medical examinationseither at the private or government clinics.They are quite prepared to spend money on buying food supplementsfrom direct selling agents or they prepare supplementsthemselvesfrom traditional herbs. There is a health clinic, clinic for mothers and children, and a dental clinic in PasirPinji Village. There have been no reports of teenage pregnancies or childbirth out of wedlock in the village. Women deliver in government or private hospitalsbut visit the mother and child clinic for regular examinationsand consultation. Delivery at home is virtually unknown. The older generation in the village have lower educational levelscompared with the younger memberswho have accessto higher education. Young children are sent to local kindergartens. In terms of infrastructure, there are two Chinese primary schools and two secondary schools (JalanPasirPutih Secondary Schooland the PerakGirls’ Secondary School).Almost all complete their primary school education but about 20 percent will drop out from secondary schools. Cantoneseis the most common dialect spoken by the Chinesecommunity in the village and other dialectsspoken are Khek and Mandarin. BahasaMalaysia,which is the national language, 190 Cultures of Populations: Asia Pacific isspokento communicatewith the other ethnic groups. Other infrastructureinclude a police station and main roads linking the village with the city of Ipoh and the North South Highway. Sincethe village is located at the periphery of lpoh which is accessibleby cars,taxis or buses,the villagers can get the needed facilities from the city and the surrounding areas. Almost 80 percent of the people in this village are Buddhistswho practise Taoism.Besides Buddhism, the people also practise customary rites like burning paper money, paper vehicles, etc. so that the spiritsof the deceasedcan have a comfortable after - life. Older groups of people consultmediumsto cure illnessesand seekblessingsfor good luck. Thereare about twelve temples in the village and half are run privately. Christianity is professedby about 10 percent of people while about 10 percent are freethinkers. Family members may practise different religions but they can still live together happily because it is not the religion that unites them but their Chinesetraditions and customs Siliau,PortDickson (Negeri Sembm Siliau, a tiny town, has existed since the Second World War. “Siliau” is a combination of Si meaning “die” and Liau meaning “no more” in Chinese;the name invokespainful memoriesof the ethnic cleansing of the Chinesecommunity of Siliauby the invading JapaneseArmy during 1941-1945. Thistown was once noted for notorious gangsterismbut by 1989was declared a “white area” or a danger - free area. Siliau is approximately 15 kilometres from Port Dickson, a well known and popular coastaltourist destination; 20 kilometres from Seremban,the capital of the state of Negeri Sembilan;and about 100 kilometres from Kuala Lumpur. It is located between the towns of Lukut and Rantau. Siliau is accessibleby road from the Kuala Lumpur Highway and the SerembanPort Dickson Highway. Half of the community are illiterate, especiallyamong the older generation. About 90 percent of children attend primary schools but only 50 percent complete secondary education. Languages spoken are Tamil, Malayalam, Telegu, Malay and Chinese dialects. There are four Tamiland three Chineseprimary schools.Secondary schoolsare found in nearby Lukut, Rantau and Port Dickson. Eachestatehas a community hall, and there are recreational facilitiesand five Temples,a police station and post office in the town. Other infrastructuresinclude health clinics belonging to the estatesand a private clinic, which is about 2 kilometres away. The nearest hospital isabout 15kilometresaway. Basicfacilitieslike tap water and electricity are alsoavailable. The general health of the community is good but some of the old people do complain of being sickly.Generally,Indians in these estatesfeel that one is already old at age 40 becauseat that age a person is considered physically weak. It is not known what the exact number of old people are in Siliau.Someof the common illnessesare high blood pressure,diabetes and heart problems. Both the elderly and pregnant mothers do not go for regular examinations at the 191 Cultures of Populations: Asia Pacific clinics.In the lastthree years,three children were reported to have died. A family has 4 children on average. Religion practised among the Indians in the estates is mainly Hinduism. Food consumed is mainly curry which uses coconut milk and mutton. However, skimmed milk is increasinglybeing used to replace coconut milk, which is assumedto contain a lot of cholesterol. Pontian (Johor) Pontian got its name from the word Perhentianwhich literally means“stopover”. Strategically situated along the busy Straitsof Melaka, Pontian is considered a port of call for shipsplying east and west and from the Northwest of the Peninsularto the south. Local legend has it that Pontian used to be a popular transit for Indonesian pirates of Balimini, Sulu, Siantan, Kesang, Siakand Bugis in the 19th century. The population has accessto a hospital and about 40 clinics and health centres; also more than 10 secondary schools,80 primary schools,over 50 religious schoolsand places of worship. There is electricity supply for the whole of Pontian and freshwater supply to 90 percent of the population. Telephonesare availableto about 80 percent of the population. All areasin Pontian are easilyaccessibleby road. In general, the basicinfrastructureprovided by the government for the population of Pontian is adequate. Agriculture is the main sourceof occupation for population in Pontian.Most of the Orang Asli are hired as fishermen by Chinesebusinessmen.The proportion of Orang Asli owning their own fishing operation is below 10 percent. Outsidersare welcomed by the Orang Asli who believe in the philosophy of sharing. Most Malaysare engaged in the agricultural sector (89.6 percent), 95 percent Chinese in businessand trade including tourism and light industries and Indians work mainly as labourers in the oil palm/rubber plantations owned by the Chinese. There is rapid development of the industrial sector and the electronic industry is the employer in the area. Islamis the main religion among the Orang Asli but other religions are also being practised. However, the community leader, not religion, has the greatest influence on the Orang Ash. Rationale of the Study Demographicbehaviour can be defined asthe trends and patternsof variablessuchasfertility, mortality, morbidity, reproductive health, migration, ageing and others in a given situation and environment such as when influenced by socio-cultural factors. It cannot solely be explained from quantitative data becausethe nature of the questionsdo not provide the freedom to probe and discussfreely. It is hoped, therefore, that the researchfindings from this qualitative study will facilitate the formulation and execution of improved population policies, particularly those responsible for conceiving and carrying out population programmes. Specifically,the purpose of this researchis twofold: 192 Cultures of Populations: Asia Pacific 1. To identify the most important sub-cultural attitudes that affect demographic behaviour including reproductive health in the selected sites. 2. To identify the relevant socio-culturalfactorsthat affect demographic behaviour including reproductive health of the four diverse cultural groups selected. Methodology Thisstudy utilisesthree methods: observation, focus group discussions(FGDs)and in - depth interviews (IDIs).Observationson the environment, interactions, reactions, etc. were made by the facilitatorswhile at the sitesand during the focusgroup discussionsand in - depth interviews. Focusgroup discussionswere guided by certain key questions designed for male/female adults and male/female youth of each community group. In-depth interviews were conducted. Facilitatorswere trained on the techniques of conducting focus group discussionsand in - depth interviews. Lectureson reproductive health, contraceptive methods, demographic variablesand demographic behaviour were given by staffsfrom the SpecialistClinic, NPFDBto provide them with some knowledge on these topics. The fieldwork began immediately after the training. Key informants for the actual study were identified again with the help of local community leaders.The groups consistof professionalsand non-professionalparticipants like doctors, nurses, teachers,police personnel, civil servants,petty traders, industrial workers, manual labourers and plantation workers. During the FGDs,a respondent was identified for an in - depth interview. UNDERSTANDINGDEMOGRAPHICBEHAVIOUR In this section,the findings on prevailingattitudesof the variouscommunitiestowards courtship, marriage, sexualrelations, teenage pregnancies, abortions, sexualdiseases,family planning, the statusof women, male responsibility, and other issuesare outlined. Fertility, Reproductive Health and Family Planning In Malaysia,family formation is based on legally recognised marriagesand this applies to all communitiesincluding the study sitesnamely Bota (Perak),PasirPinji (Perak),Siliau(PortDickson) and Pontian (Johor). Severalfactorsaffect the fertility, reproductive health and family planning norms of a community; these include: age at first marriage, childbirth patterns, educational level and use of contraception. Aqe at first marriaqe In Malaysia,generally, legalised marriage is the accepted socialnorm and prelude to sexual intercourse and family formation. In the Malay community, the adult male respondents felt that the most suitable age for men to get married is above the age of 25 yearsand for a woman, from 193 Cultures of Populations: Asia Pacific 23 to 25 years.Women respondents agreed that the age of 25 yearsis suitable for men to marry but that girls could marry as young as 19 to 20 years old, unlessstill studying, on the basisthat marrying late could lead to difficulty in finding marriage partners. Male Malay adolescentsput the ideal ages at 27-30 years for malesand 24-28 years for females.Young Malay girls were of the opinion that “men should be at least 29 and women can be as young as 18 years old at first marriage, unless the women are studying further. Men should be older than rhe women because when rhe latter are in their 4Os,rhey will look much older than the men of the same age.” Chineseadult respondents said that the ideal age for men to marry is 25 to 27 yearsand not later than 35 years of age. A woman should get married earlier and not later than 32 years of age. One male participant saidthat the ideal minimumage at firstmarriagefor a femaleiseighteen years of age because at that time the person already understands the responsibility of being a housewife. The male youth felt that a man can marry at any age above 25 years but a girl can get married earlier than 25 years of age. Young Chinesegirls said that the most suitable age at first marriage for women is from 24 to 25 years and 29 years for men. One girl said that before marrying, she would like to have more friends, complete her studiesand enjoy life. A man, as perceived by the lndian adult respondents, should marry above the age of 25. There are times however, when a man is forced to marry young by parents or wants to marry owing to love. One of the male respondents said “the age of 25 years is ideal to get married because by the time a man reaches the age of 55 years, he would have achieved many rhings. The children would have completed their studies and loan repayments would have been settled. Women should get married before the age of 25 years.” The women admitted that normally it is the parents who want their daughters to marry young. The Indian adolescents’ views were similar to those of the adults. However, one respondent said that in reality, in the estates,men marry below the age of 25 years. Orang Asli adult respondents were in agreement that the age at first marriage should be at least 20 years for femalesand 25 years for males.Somesaid that their children should work for a few years to help out the family before getting married. The youth groups preferred the age of 25 for men and 18 for women. Adolescentsthought that malesshould marry at about the age of 25 yearswhile a girl could be as young as 18. However the malesshould be able to support a family before marriage. The number of children that they would like to have is between 5 and 8, although they are aware of the financialcostsof raisingchildren. Femaleswanted fewer children, between four and five. Childbirth patterns Family,according to the Malay adults, begins with marriage. A year after marriage is the most suitable time to have children. If there is any delay in having children, they may seek modern or traditional help to have children. The number of children is normally not planned becausethe 194 Cultures of Populations: Asia Pacific belief is that God will provide for every child born in this world if one works hard enough to provide for them. If a couple want to plan, it should be after having the first child. The suggested ideal family sizefor the male participants is 6-7 children. One of the participants had 12 children. Most of the female participants wanted fewer children: between 4-6. They are aware of the need to space out childbirth and they felt that a three-year spacing is reasonable. If possible, they would not want to give birth after the age of 35 yearsbecauseof the risk of having disabled children. They would like to have at leastone son becausehe will play a greater role in the family in the future. Old age security is the main reason for having many children. The young Malay respondentsof both sexessaid that between 4-6 children are ideal on the basisthat if the family is small, children will get better care and love from their parents. They felt that 1 to 2 yearsafter marriage would be the ideal time to have children because this will allow the couple to get to know each other. For the adult Chineserespondents,financial securityand the wife’s health and age are factors that influence the decision to start a family. Younger couples normally prefer to enjoy their first few yearsof marriage before deciding on a family. Male adults felt that big families(at least two boys and two girls) have advantages such as the ability to help one another. Somefelt that it is much easier to handle small families (two children). As mentioned in earlier, the Chinese community’s fertility rate is declining more rapidly than the other communities,which can be attributed to greater concern over child rearing costsand education. The young male respondents prefer to be part of a big family becauseit is fun but they realisewhy most people would like to have only 2 to 3 children of both sexes.The best age to be a father, according to the males, is when a man is 30 years old because of financial stability and the ability to care for the family. The young femalesalso prefer big families because it is merrier; and they can share the housework. It is customaryfor the eldest girl child to take responsibility in the house such as helping the mother to do housework. Half of the respondents are from big familiesand the other half from small families. Indian adults respondents said that those who married for love normally would wait 2 to 3 yearsbefore having children but those in arranged marriageswould have children immediately. Before a couple become parents, they must be financially stable and prepared to provide good food and education for the child. The ideal family size is 2 to 3 children; rich families can have more. They said it is difficult to bring up children nowadays becauseof the high costof childcare servicesand education especially in the urban areas. One woman observed that “poor people have many children and to me, this is not good. The reason for these poor people having many children is for old age security where they hope the children will look after them when they are old. These people do not think very much about [he children’s future.” The young Indian malesstated that a man is ready to be a father when he is aged between 25 to 28 years and can support the family. Theseyouths believe that if they have children at an early age, the 195 Cultures of Populations: Asia Pacific children can look after them when they are old. They felt that 2-3 children are ideal, with some preferring boys to girls. Thosewho preferred male children believed that boys can look after the family whilst those who wished to have female children felt that they are better behaved and will look after the parents. For the Orang Ash, most adult male respondents said that they preferred big families, of between 5 and 8 children but femalespreferred having lesschildren, about five. Educational level As more femalesobtain accessto higher education, the trend in all the communitiesis increasingly one of delayed marriage. While most parents supported the idea of higher education for their daughters (due to the perceived ability of the young women to get better paying jobs, thus being able to help their families),many worried about the effect it will have on marriage and fertility. For instance,Malay women felt that when their highly educated daughters are “ready” to get married, they would be in their late 20s or early 3Os,by which time it will be more difficult to find a marriage partner. Additionally, the women fear that their daughters may become too career oriented and thus may not wish to get married. Men are not ready to marry women who are older, better educated and have more money than themselves.If a woman is already 30 years old, her parents will not mind her husband being younger or earning lessso long as she remains married. The Chinesecommunity hastraditionally placed great value on education for both sexesand this is reflected in the trend for young Chinese to delay marriage. The high educational levels have resulted in lower fertility. Young Chineseare also more knowledgeable about reproductive health. Many adult respondents from the Indian community said that higher education is not an important criterion, given that their parents were not educated and still managed to bring up their children. However, it is still thought necessaryfor their children to be educated at least up to SPMlevel (“0” levels)to enable them to earn money to easethe family’sfinancial burden and perhaps help to savemoney to pay for the costof their dowries and marriages.According to one respondent, girls from high-income familiescan marry young becausethe parents can afford to pay for the marriages. Educational levels in the Orang Asli community still lag behind the other groups. Couples tend to marry earlier, have more children, seek less medical attention and thus have poorer reproductive health. Use of contraception Adult Malay women believed that family planning programmesin their community have not met with complete successbecause of insufficient information and men’s attitudes (ego). Talks 196 Cultures of Populations: Asia Pacific by government nursesand doctors are attended by very few men, particularly on the subject of contraception. For instance,a talk on vasectomydid not attract any male participant. Most of the women usecontraceptivepills provided by the clinicsasthey are aware that traditional medicines may not be so effective. However, severalwomen said they believed that the pills made them fatter and more lethargic. Women older than about forty are encouraged to use IUDs(which are given as a free service)but some said that the lUDswere “uncomfortable. The male adolescents knew about methods such as pills and condoms from friends and the media. Severaladmitted to using condoms while their girlfriends obtain pills from the black market. The female adolescents have a more limited knowledge of family planning, gathered from friends and the media. Adult Chinese respondents had a fairly comprehensive knowledge about family planning and reproductive health. Condoms,pills, IUDsand traditional herbs were the common methods. Whilst the women said that pills were reliable, severalsaid they resulted in side - effectssuch as weight gain. Young Chinese respondents were aware of the various family planning methods available. Indian adult respondents said that the estate management and government clinics organise seminarson family planning, aswell as provide information on contraceptive services.However according to the male respondents, many men still do not want to usemethods suchascondoms because they cannot achieve “pure satisfaction.” The women use IUDs, pills and traditional herbs. Most of the adolescentsdo not have an adequate understanding of contraceptives.The malesadmit that when in peer groups, the subject frequently turns to sex, which is when they pick up information from each other. They want sex education to be taught in schoolsso that they are aware of high-risk behaviour,etc. The girls were very reticent when discussingthe subject but they acknowledged that it was important for them to know. For the Orang Asli, family planning is generally not practised until at leastthree children have been born, as most believe that the main reason for marriage is to have children. Some of the male adults said that family planning is a “waste”; others said that condoms are uncomfortable. They prefer their wives to take pills because“pills are more reliable than condoms.” Rillsare easily available from government clinics and this seemsto be the contraceptive of choice for the women. However the women believed that taking pills too early in married life would make them infertile later on. For this reason, newly married couples are discouraged from taking the pills. Traditional contraceptive methods are rarely used these days. The adolescentshad a basic idea of the contraceptivemethods in usethrough the media, schoolsand family planning nurses. They felt that reproductive health should be taught in schoolsso that “pregnancy and diseases can be avoided. m Sexualbehaviour Reproductive health suffers in casesof extramarital sex and premarital sex, particularly if 197 Cultures of Populations: Asia Pacific pregnancy is involved. All communities exhibited an aversion to such behaviour, though the Chineseadolescent groups seemed to hold a more tolerant view. Babies of unwed mothers and illegitimate babies are more likely to be aborted secretly, either by traditional medicine or by doctors involved in the officially illegal practice. Secretabortions may also occur in poor families where the mother eats certain fruits or herbs, perhaps without the knowledge of their husbands.There have been caseswhere the mother carriesthe baby secretlytill full term, gives birth alone and then abandons the baby. The mother thus does not avail herself of health care. Although considered a sin in the Malay community, a significant proportion of abortions involvesunwed Malay mothers due to the community’s greater social stigma attached to unplanned pregnancies. The adolescent Chinesefemale group said that as premarital sex in their community is “common”, unplanned pregnancies do occur. Somesaid if it happened to them, they would continue with the pregnancy but in a different town or city. Others said that they would go to a gynaecologist to “wash out” the baby. The Indian adult groups said that abortion does not occur in their area because it is considered a big sin. However, one man admitted that he had heard of caseswhere a certain “leaf” is used to abort babies secretly.The Orang Asli groups were also aware of modern and traditional techniques to abort foetusesalthough they said that they personally did not agree with abortion. Adolescentswho indulge in premarital sex also run the risk of contracting sexual diseases, including AIDS, due to ignorance about safe sex and the symptomsof a STD.In a health risk behaviour study done in 1996 by the Health Ministry, out of 30 000 school going adolescents, 1.8% had had sexual experience. Of this percentage, 19.9% were either homosexuals or lesbians, and 9.4% had had sex with prostitutes. From the interviews done for all the four communities,adolescent respondents consistentlyshowed a lack of knowledge about STDsand other features of reproductive health. Knowledge on AIDS was more comprehensive, mostly obtained through official information campaigns.Eventhen, it was mostly limited to how a person can be infected with the HIV virus. For example, severalmale Orang Asli adolescentsadmitted that they do indulge in some form of sexual behaviour either with their girlfriends or prostitutes.Alarmingly, some of the respondents believed that they could tell if a prostitute has a STDsimply by “pushing” her navel. If it hurts, then the prostitute has a disease. Other factors Respondentsfrom all the communitieswere aware of the onset of menopausein women and how it affectsfertility and reproductive health. Generally,this was regarded asa “female issue”. Menopausal women either seek hormone replacement therapy (HRT)or use traditional herbs to improve reproductive health aswell as to maintain sexual relations with their husbands.Several of the adult Malay femalessaid that they sought medical help at the government clinicsbut most preferred traditional medicines. The adult Chinesewomen who reported using herbs such as 198 Cultures of Populations: Asia Pacific Pao Sim said that they did so becausethey had heard that HRTcan causecancer.Few had heard of the term “andropause”; however its symptoms(suchasdecreasein sexualdesire)were described by many men. The death of a spouse, or divorce and separation may bring about a halt in childbearing patterns. In the caseof the Malay community, remarriage is encouraged by religion as well as culture. For the Chinese, remarriage is acceptable especially if they are still young: however women participants said that single parents may find it harder to remarry becausemany men still wanted their wives to be virgins. Unwed mothers are looked down upon becausethey are perceived to attract “problem men”. They may get married after they have given birth but the child is often given away for adoption. Remarriagefor Indian women divorceesis acceptable so that children can be taken care of. However, remarriage for widows is lesscommon as they are still perceived to bring bad luck. In a multicultural country such asMalaysia,intermarriage between communitiesis becoming more common. However, parental resistanceto such marriages is still evident, which may delay marriage age. Mixed marriagesbetween non- - Muslimsare more acceptable to all the communities because the requirement of conversion to Islam does not arise. In the Malay community, mixed marriagesare accepted only if the non-Muslim partner convertsto Islam.The Indian community interviewed also felt strongly about intermarriage; most felt that if born Hindu, one should die a Hindu. When it happens, it is usuallybetween Indians and Chinese,and rarely with Malays (Muslims)because of the great religious differences. One of the Chinese respondents admitted that she “would not mind intermarriage excepr with Malays because of the differences in religion, culture, customs, and food.” The Orang Asli community is more tolerant of intermarriage with Muslims because a large proportion is either born Muslims or are Muslim converts. Infant, Child, and Maternal Mortality A few respondents said that although medical servicesare adequate, many Malay parents delay seeking help either through the lack of a senseof urgency or over - reliance on traditional medicines.The adult Chineserespondentssaid that they had not heard of incidencesof maternal or infant mortality,which was attributed to the attention paid to health and the fact that the village is closeto the city of Ipoh. One child was reported to have died in a drowning incident lastyear. In the Indian community, one infant and two toddlers died due to sicknessand accidental death. Apparently the deaths were caused by the lack of proper medical attention as well as the lack of funds to seek help. Respondentssaid there were no casesof maternal mortality as almost all the women gave birth in hospitals. The Orang Asli respondents said that as far as they knew, there were no maternal, infant or child deaths in the past year. 199 Cultures of Populations: Morbidity Asia Pacific Related to Reproductive Health With regard to STDs,most respondents knew the basic facts of transmissionand treatment (pills and injections). People with STDsare quietly accepted in communitiesbut those with AIDS very often are not welcomed back into their families. Those who contracted AIDS through homosexual behaviour are treated worse becauseof what is perceived to be “abnormal behaviour.” In the Malay community,many of the AIDSpatientswere reported to have been infected through drug abuse and severaldeaths were reported last year. None of the Chinese respondents knew of villagers who had contracted HIV/AIDS or venereal diseases.The Indian respondents said that they did not know of anyone in their community who suffered from AIDSor STDs, but in private some admitted that they had. One man said that he could tell jf a person had a venereal diseasebecause there is a smell of pus from that person. Somesaid that the HIV virus could be spread through mosquito bites. In the lastthree years,there have been no information campaigns on AIDSand STDsin the Orang Asli community. Infertility is a sourceof psychiatricmorbidity with regard to reproductive health as in all communities, a woman is expected to give birth and failure to do so may be grounds for divorce. Infertile women often come under pressurefrom their own familiesas well as in - laws to seek medical help. In some Chinesefamilies,the presenceof a son is considered very important; thus failure to give birth can causedepression.When the infertile person in a marriage is the husband, in most casesmedical help is sought quietly or not at all. Severalrespondents attributed this to “male ego.” Thistrend is especially prevalent in the Malay, Indian and Orang Asli communities. Ageing and Gender Implications Data on the proportion of the elderly in the Malay community was not available. However one respondent (who worked in the Welfare Department) said that she knew of at least 30 cases where old people were reported as neglected by their adult children. Somewere sent to homes for the aged. Other respondents said that they did not know of any such cases.Of the total of about 15 000 people in the Chinesecommunity in PasirPinji, some 10%are aged 55 yearsand over. A man is considered old when he is above the age of 55, while for a woman, it is 50 years. There are more old women than men in the village. Activitiesinclude looking after grandchildren and joining suitable clubs or associationsfor recreation and exercise;thus for the able - bodied, lonelinessis not an issue.However,in the pastyear, at leastone death was thought to be a suicide in which an old man, who was living alone, died. Increasingly,more elderly people from the community are sent to homes, although this is still regarded as “ungrateful behaviour.” For the Indian community, people above the age of 50 are considered old. Respondentssaid that about half of this age group suffer from various illnesses(diabetes,heart disease,high blood pressure, cancer).They seek medical attention in clinicsand hospitalssomedistanceaway from the estates. However, some do not go to the clinics regularly becauseof lack of funds. Most of the elderly 200 Cultures of Populations: Asia Pacific live with the spousesor with their adult children. Very few are sent to live in homes for the aged. Retireesoften look for jobs outside the estatesto avoid having to depend on their children. The Orang Asli regard people over the age of 40 as old. Some40% of the community are thus considered old. Approximately half sufferfrom high blood pressure,heart disease,cancerand asthma while someattributed their illnessesto evil spirits.Most of the older people live with their spouses or with adult children. The elderly are not sent to homes. Migration The levelsof migration in all the communitiesinterviewed were at low levels,being restricted to mainly the young leaving in searchof better jobs or education and the influx of smallnumbers of immigrants (Indonesiansand Bangladeshis)to work in plantations and estates.The Chinese groups reported that some of the young leave for foreign countries for a temporary period, which benefits the family financially, but may causedomestic problems such as the neglect of aged parents, wives and children. The Orang Asli respondents said that those who leave are the young in searchof better jobs in big towns or Singapore. Migrants into the community mainly comprise Orang Asli from other villages. The immigrants have greater interaction with (and may even intermarry into) the Malay and Indian communities because of similaritiesin religion and culture. EXPECTATIONS AND PREFERENCES FOR SOCIALSERVICES, ESPECIALLY IN EDUCATION (FORGIRLS),AND REPRODUCTlVEHEALTH Thissection discussesthe expectationsand preferencesof specificpopulation groups for education and reproductive health services.The differences (or otherwise) in the expectations of each group are outlined to enable plannersand policy makersto draw the necessaryimplications. Malay Community There are 2 government clinicsand one private clinic in Bota, with the nearesthospital being some 15 km away. According to the respondents, the clinics provide adequate health care for non - critical illnessesand traditional medicine is easily available. They go to the hospital only when they think it is necessary;consequently by the time they do see doctors at the hospital, many are already very ill. This is attributed to distance, cost and familiarity. Severalfemale respondents said that they did not know the doctors in the hospital, and were uncomfortable when the doctors were male. Therefore for what they termed “women’s problems”, pregnancy and childbirth, they preferred being attended to by the Klinik Kesihatan (Health Clinic) staff comprising severaldoctors (usuallymale), nursesand a midwife. 201 Cultures of Populations: Asia Pacific “Women’s problems” include menopause, menstrual irregularity, bladder infections and cancer.The menopausalwomen were given HRTby the clinicsbut as many of the women were not convinced of the safetyof the drug, they usuallyreverted back to traditional medicine. Some said that they used both traditional medicinesaswell asmedicine from the clinics.Severalwould use traditional medicine first: if that did not work, they would then go to the clinics. Respondentsknew of women who suffered from seriousdiseaseslike cancer of the breastsand reproductive organs.Generally,by the time thesewomen sought medicalattention, it was already too late. This can be attributed to the lack of information on the disease,the reliance on traditional medicine, the lack of accessto cancer treatment and cost. Respondentswanted better information dissemination,equipment to detect cancerousgrowths, and more women doctors so that they did not feel embarrassedtalking about their problems. They would also like to have more counsellorsto help women undergoing depressiondue to maritalproblems,infertility, illness, unplanned pregnancy, etc. The clinics, particularly the government clinics, are also the source of family planning information and techniques. In Bota, family planning is considered a “women’s issue”, where the women may obtain contraception for themselvesaswell as condoms for their husbands.Most of the women use contraceptive pills provided by the clinics as they are aware that traditional medicines may not be as effective. However, severalwomen said they believed that the pills made them fatter and more lethargic. Women above the age of forty years are encouraged to use IUDs(which are given as a free service)but some said that the IUDswere “uncomfortable.” Contraception is never dispensed to unmarried people. The female respondents said that the disseminationof information on family planning is adequate; this is done by the government clinics in Bota, visiting health officials from lpoh as well as personnel from the Family Planning Board.The common complaint isthat men do not want to attend seminarsand talkson the subject. A recent talk on vasectomyattracted only one male participant. They wished that more could be done to increasemale participation. Adult male respondents generally expressedsatisfactionwith the medical servicesavailable in Bota. Many visited the clinicsfor coughs, colds, asthma,high blood pressure,and kidney and heart problems. They would travel to the hospital if the clinic staff were unable to treat the illnesses.Traditional medicines are also commonly used; in fact, many of the older men went to the hospital only as a last resort. A few of the respondents said they obtained condoms from the clinics,while others said that they preferred their wives to take the responsibility for pregnancy. They would not want to undergo vasectomies’for fear of possible sexual problems. Severalalso said that the use of contraception is a sin. None admitted to obtaining medical help for sexual dysfunction. They said that if they did suffer from the latter, there are many traditional medicine men who could help in terms of providing herbs or through a special massaging technique. The most well 202 Cultures of Populations: Asia Pacific known of the herbs is Tongkat Ali, which has a reputation as an aphrodisiac. The respondents said that treatment for STDsis available at the clinics but they thought that some men may feel ashamed to see the staff there. The infected men would probably choose to go to the hospital or to clinicsin Ipoh. When asked whether the health servicescould be improved, the respondents said they would like to have a hospital closerto the area, and more male nursesat the government clinics, which would makeit easierfor them to talk about what they perceivedto be embarrassingsubjects. One of the women respondents had said that there should be a counselling servicefor malesat the government clinicsso that they could talk about an issuelike male infertility, but none of the male respondents thought this was necessary. Many of the women respondents thought that the teaching of sex and reproductive health education (pregnancy, menstruation, STDs,etc) would be beneficial. They would also like to have trained counsellors in schools for students to obtain accurate information about their bodies. However,adult malesdid not agree on the basisthat teenagerswill be tempted to experiment. Severalsaid it would be better to incorporate this topic into the pre - marriage courses that all Muslim couples must undergo before marriage. It should be dealt with from both the medical and religious points of view. One serviceboth men and women felt was vital was religious guidance and counselling for adults and adolescents.They said that many of the problems in society are causedby people not adhering to the teachings of Islam.They agreed that the present facilitiesand services(mosques, religious schools,and the IslamicAffairs Department) were adequate. However, some said that more should be done to guide the young so that they do not indulge in sinful or self - destructive behaviour. Others (women) said that the Religious Department should organise more counselling sessionsand talks on the responsibility of a man and woman in a marriage, absent fathers, polygamy, etc. All agreed that the government should tackle the growth of deviant Islamic groups such asArqam, Tarikatand Shi’a so that the Malay (Muslim)community is not divided. Other servicesand infrastructure available in Bota include water, electricity, a public hall, playing fields, schools,mosques,other places of worship and transport. Youth There are 15 kindergartens, 9 primary schools,3 secondary schoolsand 17 Islamicreligious schools in Bota. Residential campusesof three institutes of tertiary education (Universiti Sains Malaysia,UniversitiTeknologi Petronasand lnstitut Teknologi MARA) are located within a 10 km diameter of the town. Children and adolescents, regardless of sex, have equal accessto the schools. Most of the Islamicreligious schoolsare not co - educational; even when they are, the sexes are segregated into different buildings or classes.Theseschoolsare popular with Malay parents 203 Cultures of Populations: Asia Pacific because the students are perceived to be religious, well behaved, modestly dressed, have an appreciation of traditions and customs,and seriousabout their studies.The fact that the students are segregatedby sexis alsoone factorwhich the parentssay,contributesto seriousness of purpose. Children who attend the non - religious schoolsare still sent for religious instruction either before or after school hours. This reflects the importance of Islamin the upbringing of a child. All the respondents (adult and adolescents)agreed that the number of Islamic schools in Bota was sufficient and that facilitieswere adequate. Parentswho chose to send their children to the non - religious schoolsdid so because they thought the schoolsoffered a better standard of education. They liked the fact that their children are forced to “compete”, since these schoolsare also attended by non - Malay children who usuallyhave a better command of English,Mathematicsand Science.Eventuallythey hoped that their children would be better prepared to studyand work in the cities,and perhapsevenoverseas. As mentioned before, both sexeshave equal accessto education and almost all children complete six years of primary education as well as at least three years in secondary school. Subjectto the family’s financial situation and the interest of the child to study, mostwill continue to complete secondary school. A generation ago, it was common practice for girls to drop out of school by the age of about 15years to prepare for marriage as at that time it was considered a waste to educate a girl to higher levels.In contrast,the female adolescentsinterviewed in Bota fully expected to continue studying at least up to SPMlevel (FormFive).Most also wanted to go beyond that level. However, severalsaid they felt that their parents did not expect as much of them academically in comparison to their brothers. They attributed this to society’sperception that it is the responsibility of the male to eventually support the family. According to their parents, girls can always marry and be supported by their husbands. When askedwhat they thought should be done to encourage the higher education for girls, the respondents said that more girls should be encouraged to study sciencesubjects,rather than the arts. Career talks and seminarsalso tended to focus too much on fields in which there are significantly lower numbers of interested females than males, such as engineering. Career guidance should give equal emphasisto what are still traditionally regarded as “women’s areas” such as nursing and social sciences,as well as “newer” fields such as medicine, dentistry and information technology. The obligation to help familiesfinancially is one of the main reasonsfor young people to look for jobs after passing the SPM(“0” levels)examination at the age of about 17.There are some exceptionsto the rule, suchasif a student obtains good results,he/she may be offered a government or private company scholarshipor study loan to continue their studies.There is no gender bias as to the selection of students for the scholarshipsand study loans; the only requirement is good results. Students who do not score well generally leave in search of jobs in big cities. 204 Cultures of Populations: Asia Pacific Thereafter,prospectsdiffer. The femalesusuallywork as long as they can in supermarkets,beauty salons,and stores,send money back to their familiesand eventually marry someone they meet. Alternatively, their parents may start looking around for suitable spousesafter a few years. The pressureto get married is not as great on males,who are expected to help their families for a longer time. Respondentsof both sexessaid that they could not talk to their parents about sex and other aspects of reproductive health. The only exception was in the case of menstruation, where young girls would ask their mothers for advice. Whateverthey knew about reproductive health, contraception, STDs,AIDS,etc, was gathered from older friends and the media. They thought it was necessaryto know so that they could understand what was happening to their bodies as well as prevent pregnancy and disease. Although premarital sex is considered a sin in the community, several male adolescents admitted to using condoms while their girlfriends obtained pills from the black market. The female adolescents have a more limited knowledge of family planning, again not from their elders but from other sources.They feel that sex education should be taught in schoolsand that at least one counsellor should be present in every school for them to confide in without fear of being judged or scolded. Somesaid that their parents should take on the role, but they acknowledged that this was not likely to happen due to feelings of embarrassmenton both sides. Someof the adolescentssaid that counselling servicesare needed because many could not talk to their parents (especiallytheir fathers),teachersor religious leaders about a wide range of issues.Some appeared to be depressed and had low self - images because of problems in the family, schools,romance, etc. Religiousinstruction was acknowledged asbeing important in guiding a person’s actions.All respondents had had religious education, mostlythrough after/before - school classes.Somefelt that religious leaders should organise courses and seminars for young people (without the presence of their parents) so that their belief could be strengthened and they would keep away from undesirable activities. Chinese Community The village can actually be considered asone of Ipoh’s suburban areas.Thus,unlike the other three sites(Bota,Siliauand Pontian), health, educational and other servicesin PasirPinji are easily available. The village hasa health clinic, a mother 6 child clinic and a dental clinic. Theseare government facilitiesbut there are also some private clinics.All the respondentssaid that health servicesin the village were sufficientand there was no real need for a hospitalsinceIpoh isso close. Cultures of Populations: Asia Pacific Respondentsvisit the government clinicsfor minor illnessesaswell asfamily planning services. Although most of the doctors are male, the Chinese females interviewed did not expressany discomfort about talking to the doctors about “women’s problems” and pregnancy as well as having their babies delivered by them. To the females,the doctors are there to do a job. The clinic staffaswell asvisiting FamilyPlanning Board staffdisseminateinformation on family planning and reproductive health, including STDsand AIDS. The respondents said that they were satisfiedwith the servicesavailable. Consequently, they appeared to have fairly comprehensive knowledge about family planning and reproductive health. Condoms, pills and IUDs were the common methods of contraception. Whilst the women said that pills were reliable, severalsaid they resulted in side - effectssuchasweight gain. Severalmen have had vasectomies with no apparent lossof self - esteem,which was one reason put forward by men from other communitiesto shun vasectomy.Abortions (which are frowned upon by the villagers)are done in the private clinicsand maternity homes, either in the village or in Ipoh. Sinsehs(medicine men) occupy an important niche in PasirPinji, as they do in all Chinese communities.They dispense traditional herbs and medicine which are widely used for general well - being, to increasefertility, and easemenopausalsymptoms.The herbs may be used alone or in conjunction with medicine from the clinics.Women who are infertile or who want to give birth to boys will try both methods together. After a period of time, if a woman remainsinfertile, she may see a specialistin Ipoh. Respondentsdid not think it necessaryto have such specialists in the village, nor to have counsellorsfor infertile couples.They said that societyno longer looked down on what they termed “barren women or sterile men”. Besidesin caseslike this, adoptions are acceptable. All the adults said that they would agree to sex education being taught in secondary schools because they would not feel comfortable discussingthe topic with their children. Somewere afraid that by talking to their children, they (the children) might think that it is all right to have sex. Youth Becauseof the village’s proximity to Ipoh, accessto a good standard of education presents no problems.In the village, there are two Chineselanguage primary schoolswith a total enrolment of 650 students.Attendance at primary level is loo%, dropping to 80% at upper secondary level as some students (mostly male) drop out in search of jobs or vocational training. About 10% eventually move on to universitylevel. Many children from the village also attend the Jalan Pasir Putih Secondary School and the Perak Girl’s School, which are in Ipoh. There are no religious schoolshere. Chinese parents traditionally expect much of their children of both sexesto attain as high a level as education as possible.As most people fall within the lower - upper middle classbracket 206 Cultures of Populations: Asia Pacific (RM 500 - 2000 per month), financing of education is seldom a hindrance to further education, at least till SPM level. Consequently, Chinese adolescents tend to be fairly well educated. Respondentsappeared to be satisfiedwith the educational facilities available to them. In this community, gender bias in education is not evident. What the adolescentsknow about family planning camefrom friends, books, videos, etc. The girls had a wider knowledge of the subject. All felt that they should have lessonson anatomy, sexualrelationships,pregnancy,and diseasesin secondaryschoolsso that they are better prepared to deal with issuesof that nature. Severalsaidthat secondaryschoolsshould havetheir own student counsellorsbecausethey found it difficult to talk to parents, religious leaders and teachers,and sometimeseven friends, about personal matters. Indian Community The town of Siliauis small,with 4 Tamil- language schools,3 Chineseschools,one post office, a police station, 5 Hindu temples, football fields and playgrounds. There are no health facilities except for 3 dispensaries.The nearest hospital is some 15 km away in the town of Port Dickson. Siliau is easily accessibleby road from the state capital of Seremban,20 km away. The dispensariesare where residents can get treatment and medicine for minor ailments. They do not provide any kind of surgical servicesor midwifery. In an emergency, patients have to be rushed to the nearest hospital in Port Dickson or Seremban. The estate management and government clinics (FamilyPlanning Board) organise seminars on family planning, as well as provide contraceptive servicesand information. However, the respondents, especially the men, did not seem to have a sufficient grasp of the contraceptive methods available, their efficiency and usage. Most men apparently do not want to use contraceptive methods such as condoms becausethey cannot achieve “pure satisfaction.”The women have to take more responsibility in the area and many use IUDs,pills and traditional herbs. Knowledge about sexually transmitted diseaseswas limited to certain symptoms;only one man was able to name some STDs.They knew more about AIDS through television and radio programmes, as well as the information campaigns carried out by government personnel. However, even then, one man said that AIDScould be spread through the bites of mosquitoes. When asked if one could be infected by the HIV virus simply by being around a person suffering from AIDS,some male respondents said no, while the others smiled and refused to answer. When a couple is childless,suspicion falls on the woman first. Thesewomen will go to the nearest clinic to determine if she is able to conceive. If not, she is likely to feel ashamed and depressed and will usually seek medical attention and/or traditional medicine. She may also seek blessingsfrom priestsat the temple. If her efforts turn out to be futile, her husband will be 207 Cultures of Populations: Asia Pacific encouraged (by his family) to remarry. However, if the problem seemsto be with the husband, he will probably refuse to see a doctor “due to male pride.” Due to the lack of proper health care in the area, expectant mothers travel to the nearest hospital or maternity home to deliver their babies. Respondentswere aware that some babies are aborted, although it is considered a “bad” thing to do. Again, the women travel out of the area to have the abortions done - married women tend to go to the hospital while unwed mothers go to private clinics. The majority (80%)of the male respondents had not heard of menopauseand did not know if their wives were undergoing it. Somesaid that they had noticed certain changesin their wives but did not know the cause.Femalerespondents who were undergoing menopause asked for vitamin pills from the dispensariesin the area. Somehad heard of HRTwhich they obtained from hospitalsand clinicsoutside the area. Respondents agreed that their community was badly lacking in health service facilities. Women in particular, wished that there were mother and child clinicsin the area. Somesaid that mothers with ill children found it very difficult and costly to go to the nearest hospital by taxi, which they felt had contributed to the death of a child a few years ago. The clinics should preferably be staffed by at least one woman doctor, but respondents realised that few, if any, women doctors or nurseswould want to be stationed in the estatearea on a long term basis.For this reason, they would welcome a male doctor, although for highly personal matters, they would still seek female doctors outside the area. Familyplanning and counselling servicesalso needed to be upgraded, with more thought being given as to the best method to impart the necessaryknowledge. Severalrespondents also suggested that young lndians who want to get married should be required to attend seminarson family planning, religion, responsibilities, reproductive health and child care. These kinds of seminarsare already being organised for young Muslim couples with some degree of success. Despite the average monthly income of RM 800 per family of about 6 children, and a low adult literacy rate (50%), 90% of the children in the area attend school. However, the schoolsin Siliauare not aswell equipped asthose in Port Dickson.In addition, teaching staff may not have the same qualifications as those in other schools. Children of both sexesare sent to primary school, but at secondary school level, somegirls may be forced to drop out to help in household duties, particularly if there are younger siblings and the mother is absent or sick. Boysmay also drop out but for a different reason - to gain employment in order to help the family financially. Respondentsagreed that if there had to be a choice, many would still pick boys to stayat school for as long as possible so that they would be able to get better paying jobs in the future. Educationfor girls therefore depends on many factors:money, child care services,and the cultural outlook of the parents. If estateworkers had accessto reliable yet cheap child care centres,they 208 Cultures of Populations: Asia Pacific could leave young children in the centres instead of having to depend on the older female children to look after them. With regard to their children being exposed to sex education, most said that they did not mind, provided it was done at tertiary level (college, etc). If it is taught in schools,they said it should be at a basic level only, so that adolescentsknow what they should or should not do. Femalerespondentsfelt that the schoolscould do more to inculcate “proper “behaviour in children, especially girls. They thought that one way to do this is to make it compulsory for Hindu children to learn about their religion in schools.Parentsshould also make it a habit to bring their children along when they go to the temple. Youth As mentioned above, there are 4 Tamil schools and 3 Chinese schools in the area. Most parentswant their children to attend the Tamilschoolssothat they can learn their “mother tongue” aswell as receive reinforcement in the culture. However, increasing numbers preferred sending their children to the Chineseschoolsbecausethey recognise that these schoolshave higher scholastic records, especially in the sciencesand mathematics.Severalrespondents also expressed the wish for a national public school in the area so that their children can learn BahasaMalaysia. They understand that in order for their children to progress in the country, they (the children) must be proficient in the national language. Religiousschoolswere not thought to be necessary. As mentioned previously,education for girls depends on the family’s financial situation, and the outlook of the parents. Evenif the girls complete their secondary education, they often have only a vague idea of a possiblecareer.Sometimescareer counsellorsmake it worse by encouraging the girls to enter the “traditional” areas such as nursing, although they (the girls) may not have the aptitude for this kind of job. Parentsalso tend to hold the sameview, believing that once the girl marries,her education will be wasted so there is no need for girls to study for longer periods than necessary.One young female respondent said that it might be better for girls to leave the estate area after completing primary school, and enter a secondary school elsewhere to avail themselvesof better opportunities. However, the parents may not agree to this because of the cost, and the fact that the girl is needed to help run the household. Most of the respondents do not have an adequate understanding of contraceptives. The malesadmit that when in peer groups, the subject frequently turns to sex, which is when they pick up information from each other. They want sex education to be taught in schoolsso that they are aware of high risk behaviour, etc. The girls were very reticent when discussingthe subject but they acknowledged that it was important for them to know. Someof the girls related cases where men forced their wives to prostitute themselvesdue to financial troubles. 209 Cultures of Populations: Asia Pacific Orang Asli The Orang Asli community has accessto a wide range of servicesin the district of Pontian, among them: I hospital, 40 clinics, 80 primary schools, 12 secondary schoolsand 51 lslamic religious schools. Respondentssaid that health care facilitiesin the area are sufficient. Expectantmothers go to the government clinics for regular check - ups as well as post - natal care. They will be seen to by doctors, who are usually male. Expectant mothers or those suffering from “women’s problems” who are uncomfortable with this, will travel to other clinics in the big towns nearby where the proportion of women doctors is higher. Generally,the gender of the doctor was not considered a major issueas the women have enough clinicsto choose from. Someof the men feel that family planning is a “waste”; others saythat condoms are uncomfortable. They prefer their wives to take pills because “pills are more reliable than condoms.” Pillsare easilyavailable from government clinicsand this seemsto be the contraceptiveof choice for the women. However it is believed that taking pills too early in married life will make the woman infertile later on. For this reason,newly married couplesare discouraged from taking the pill. They may try other methods, or use traditional herbs. Abortions are regarded as acts which are forbidden in Islam. However, they do occur. According to one male respondent, he knew of two midwives in the area who would do the abortions, even when the foetus is over three months old. The cost per abortion is RM 400-600. Abortions can also be done at private clinicsin the big towns nearby. For pregnancies lessthan three months, the women may eat “sharp” foods such as pineapple. There is a perceived need for a female counsellor who would be able to talk to women and unwed mothers who wished to abort their babies. Many female respondentswere againstthe idea of abortions being carried out on pregnancies of more than three months, from the religious and personal safetypoints of view. The fact that it is happening indicatesa need for choicesto be offered to the women, such as giving babies up for adoption. The male Orang Asli adults were divided in their opinions as to whether adolescentsshould be taught sex education. Someabsolutely disagreed that it should be done at any educational level. Others said that it would teach the young responsible behaviour. Women were more agreeable to the idea with somesuggestingthat basicsexeducation could begin even in primary school when girls begin to menstruate. Respondentsfelt that the schoolsshould work towards incorporating this subject into the syllabus. Most of the Orang Asli are Muslims,with some 10-l5% being of other religions. Respondents complain that there are not enough facilities for religious education. The teachers are either 210 Cultures of Populations: Asia Pacific elderly, or are non - Malaysians,whose interpretation of Islamdiffers. Therefore the Orang Asli respondents still tend to order their livesaccording to what the penghulu (headman) says.They would prefer more input from the StateReligious Department. Youth Information on the number of schoolchildren and the gender ratio was not available but according to the respondents, all the younger children and most adolescentsin the area attend a variety of schools,including religious schools.Somedifferentiation by gender appears by the time the adolescentsenter upper secondary school, which is the sametrend seen for the Malay and Indian communities: the number of girls studying the science subjects drops. Female respondents could not explain why this was so, other than that “science is harder.” They thought that the percentage of girls in the science stream may be improved if girls were given more encouragement. They also felt that they would benefit from career counselling by the time they enter the upper secondary level. Nationwide, only in recent yearshas the Orang Asli community begun to produce graduates with tertiary education. All the adolescentsinterviewed had a basicidea of the contraceptive methods in usethrough the media, schoolsand family planning nurses,but again, misconceptionsabound. They agreed that reproductive health should be taught in schoolsso that “pregnancy and diseases can be avoided.” Talk on the subject among the girls is rare, while the boys admitted to “always discussingthe subject of sex.” SOCIO-CULTURALRELEVANCEOF SERVICES AND 1NFORMATlON The objective of this section is to analysethe gaps between the availability and utilisation of servicesand information, with regards to education and reproductive health. Education is not as pressing an issueas knowledge on reproductive health because, as will be described below, both boys and girls generally have accessto equal education. All communities also have easy accessto health servicessuchas clinicsand hospitals.Reproductive health issueswill be discussed in greater detail asfindings have indicated that there are alarming knowledge gaps, even in the urban areas. Understanding the socio-cultural background of the various ethnic groups in Malaysiais of crucial importance to provide guidelines for effective implementation of national family development programmes. Education Parents from all communities realise that education is essential for both boys and girls, although those in the rural areas are not as concerned about their children entering colleges and universitiesas those in urban areas. Some felt that even PM (“0” levels)is sufficient for a 211 Cultures of Populations: Asia Pacific child to gain employment and contribute to the financesof the family. One reasonfor this could be the fact that the “better”, more well - equipped schoolsare located in bigger towns and cities, thus rural students are denied top level education. The exceptions are in caseswhere these studentsget a place in boarding schools,although there are more schoolsof this type for the Malay community. Undeniably there is greater emphasison a boy’s education in poor, rural families,regardless of race. The thinking is that boys will be able to get a better job to help out the family,whereas a girl alwayshasthe option of entering into marriage.With time, this kind of thinking will continue to decreaseasmore young people leaverural areasin searchof a better life. Thistrend can already be seen in the rural lndian (estate)community where poverty and illiteracy remained entrenched for decades. Availability of Family Planning Services Currently, Malaysiahas a wide network of family planning servicesthrough a multi-sectoral and multi-disciplinary integrated approach, with special emphasison family development and family welfare. However, the availability and the accessibilityof these servicesdiffer by areas, districtsand states.Citiesand large towns tend to have better contraceptive choice and facilities compared with smallertowns, rural and remote areas.Thusin this study,of the four sitesselected, the city of lpoh is expected to have better availability and accessibilityof servicescompared with rural Siliau in Negeri Sembilan,rural Bota in Perakand rural Pontian in Johor. The resultsof this study show that a significant proportion of the respondents accept family planning. This is very encouraging from the reproductive health point of view. However, the Chinesecommunity showsgreater acceptanceof modern methods and also tends to have better variations in the choice of methods. Some of the Malay women in Bota and the Orang Asli in Pontian are usersof pills from government clinics. Similarly,the lndians who are pill usersget their supplies from estateclinics. The above findings indicate that those living in urban areashave a better choice of contraceptive methods and better accessibilityto reproductive health services.Traditional methods are used widely in rural areas,with somewomen combining traditional and modern methods. Knowledge on Family Planning Family planning is an integral part of reproductive health. This study has shown that all communities, whether urban or rural, are aware of the availability of contraceptive methods. However, the level of awarenessdiffers from group to group. For example, the Chinese groups in Pasir Pinji have indicated that they have better knowledge of family planning methods than the other communities.(However it is important to remember that in the other communities, open discussions on sexual matters are often 212 Cultures of Populations: Asia Pacific difficult to elicit, giving the impression that knowledge is more limited.) The Chinesemale adults mentioned condoms, IUD, safe period, ligation, pills and withdrawal method, while the Chinese female adults mentioned additional methods to the above like injections, and breastfeeding. The Malays, lndians and Orang Asli interviewed reported that they know of pills, condoms, IUD and injections. Besidesthe modern methods, each community is very aware of traditional methods. Adequacy of Family Planning lnformation Although the study shows that the level of family planning awarenessis moderately high among the different cultural groups, the adequacy of the information that these community groups receive is still questionable. There are indications that some groups lack the full understanding of the use and reliability of the methods they talked about. For example the Chinese adults feel that many modern methods are not safeor simply “not good.“. Someof the Chinese women in the lpoh group believe that the use of the pill can cause infertility and weight gain and the use of injections can causevomiting. One woman usesmodern and traditional methods simultaneouslyto ensure safety. The Indian male adults in Siliaubelieve that most of the estatecommunity do not use contraception because “satisfactionis not complete.” Many of their wives still use traditional methods (herbs and certain fruits). The Malay female adult group in Bota spoke strongly against the perceived side - effectsfrom modern methods such as pills and the IUD. Thus many still use traditional methods like herbal drinks, herbal paste and heating of the womb with stones(bertungku). Women who use traditional methods however, realise that they are not so effective and consequently their husbands may resort to the use of condoms. Although some of the male Orang Asli in Pontian report that pills and condoms are used, a few believe that contraception should not be used at all. They consider it a “waste”. The women feel that modern methods can causeinfertility and strongly discourage newly married couples to practice family planning. This situation demonstratesthat there is a need for more effective information disseminationamong this community. The resultsfrom the above findings indicate that there is a gap between awarenessand the quality of awarenessin all communities. In other words, awarenessjust by knowing the contraceptive methods alone is not adequate, if the intention is to change reproductive behaviour. This also indicates that the information, education and communication (IEC)programmes for family planning need to be reviewed and improved to be effective. Attitudes on Sex Education Sexeducation for young people is still a relativelytaboo issuefor interpersonalcommunication 213 Cultures of Populations: Asia Pacific between parents and children, even for the urban Chinese.Adults avoid talking about the issue with their children, fearing that they (the children) may not “respect” them. Responsesfrom the Chineseyouth groups are also consistentin that they do not learn anything relating to sex education from their parents. The Indian community in Siliauwhich, is considered as rural, feels that it is not necessaryto talk about sexwith children. Consequentlyyoung Indians do not learn anything about sexfrom their parents. Thispattern is also observed to occur in the Malay and Orang Asli communities. All the four ethnic groups feel that sex education should be taught briefly in primary school and in more detail in secondary school. Someof the male lndian and Orang Asli participants felt that it should be taught at an even higher level, such as at college or university level. They fear that if taught at school, the children may want to experiment with sex. Basedon the above findings there is a lot more to be done concerning reproductive health, particularly with regard to the information and education aspects.Adults are not willing to communicate with adolescents regarding sex because they perceive it as extremely private. They (the parents) prefer their children to learn sex education in school. The relevant authorities may need to formulate information campaignsto alert the parents (who are the closestpeople to the adolescents)to help young people understand basic reproductive health issues.It is extremely important that thesecampaignstake a form suitedto the local culture and sub -cultureof the target groups for whom they are intended. Sources and Accessibility of lnformation on Sex Education The youth groups in this study confirmed that they get information on sex through sources other than their parents. Thesesourcesinclude schools(through their lessons),friends, books, magazines,television,video, the internet and pornographic films. For example the male Orang Asli youth group admits that most learn about sex through “blue” films. Evidently,there is a gap between the accessibilityof sourcesof information and the intended messagesbeing transferred. An extensive evaluation should be carried out to determine the extent of knowledge of the youths and general population on reproductive health issues. Findings Education is accessibleto all communities;the only difference is in the quality of education offered. In the urban areas,schoolsat all levelsare better equipped and have the best facilities. Awarenessof educational benefits is also greater in these areas.Consequently,malesand females (both youth and adults) in urban areas generally study up to at least tertiary level. In the rural areas,the emphasison higher education is less,particularly for girls from poorer families.In fact, many rural parents still hold the view that it is uselessto educate a girl beyond secondary level becauseshe will marry (or be married off) young anyway. Rural men are also reluctant to marry 214 Cultures of Populations: Asia Pacific girls who have the same level or higher level of education than they. Some said it was bad for the ego. One objective of this chapter is to analysethe gaps between the availability and utilisation of servicesand information with regard to reproductive health, specifically family planning and sex education. Thesegaps have been identified between: Awarenessand quality of awarenesson modern contraception methods Knowledge of family planning and the use of contraception l l l l Availability of information on family planning and the desired messagereceived by the couples Accessibilityof information on reproductive health and the desired messageto adolescents. POLICYAND PROGRAMME RELEVANCEOF THEFINDINGS Thischapter discussesthe relevanceof the findings in severalareas(familyhealth and marriage, unplanned pregnancy, fertility, menopause/andropause, sexual behaviour and STDs)to the formulation and implementation of policies and programmes for adults and adolescents. Current Population Policy and Programmes Current Population and Family Development Programmesfocus on promoting awareness and skillson parenting and family life aswell as disseminationof information to increaseknowledge, and modify attitudes and practicesto produce healthy and resilient families,which are the foundation of a quality population. Variousmodules covering pre- and post-marriagecourses, parenting, and child and adolescent development have been prepared by the National Family Planning Board, the main co-ordinating body for population and family development programmes. Theseactivities are carried out in co-operation with other government, non-government and private agencies. Adults With regard to family health and marriage, the study findings indicate that adults from all the communities believe that certain criteria must be met before a man or woman decides to get married. Thesecriteria are good health, maturity in termsof age, financial security,samereligion and good family background. Early marriage, such as marrying at age below 25 years for men and 20 years for women, is not encouraged due to immaturity, which could result in marriage instability. The Indian and Orang Asli groups also feel that girls should try to help the family financially prior to marriage. 215 Cultures of Populations: Asia Pacific All four groups agree that arranged marriage is no more acceptable for the younger generation and they as parents will not object to their children’s choice so long as their children ask for their blessings.Chineseand Indian adultsaccept mixed marriagesif the child’s partner practices the samereligion. Malay and Orang Asli groups accept mixed marriagesif the partner converts to Islam. However, the Malay community does not encourage mixed marriages in caseswhere the woman is Malay becausethey feel that women are not capable of guiding their husbandsin the practice of Islam.Education is an important factor asa marriage prerequisite for Chineseand Malay male adults but not so important for Indian male adults. For the Chinese,the reason given is to maintain self-esteemand for the Malaysit is for socio-economicreasons. Thesesocio-culturalmarriage factorsidentified by the study findings are relevant to current population policy and programmessuchas pre - marriage courses.However it appears that adolescentsin upper secondaryand higher institutionsmay also benefit from these courses.The findings on different socio-culturalnorms and valuesregarding marriage and the criteria on choice for marriage partners are useful additional inputs to the content of the programmes. The study findings also show that Chineseand Malay adult groups prefer big familiesbecause more help and support will be available. But in practice for the Chineseadult group, a smallfamily is easier to handle. The Malays believe that a big family is God - given. Thusin formulating information programmes on family size,socio - economic norms and religious valuesmust be considered. Filial piety and respect for elders are still the norm in all communities. For example, young people are free to choose their partners so long as parental blessingsare requested. Population policies could enlarge the role of the elders as advisersand sourcesof information. Working wives are not preferred, especially by the lndian adult group because family problems might arise, leading to divorce. The Malay adult group does not mind wives working becausethey feel that wives should help their husbands.Thesefindings are again relevant to the population programmesbecausethey indicate family normsand valueswhich are not in tandem with current socio-economic development and needs. Therefore, population programmes are relevant in educating specific sub-groups on shared family responsibilities between husband and wife and other family members. With regard to planned and unplanned pregnancy, mostof the male and female adults from the four target groups in this study feel that couples should give birth as soon as possible after marriage. Family planning should begin later in marriage. For example, one of the Chinese adults said he did not plan his family in the beginning and another said he started discussing family planning with his wife only after the third child. Someof the female respondents stated that they do not see the need for family planning at the onset of marriage while others think that women should bear children at a more mature age. Many felt that it is good to have many children but the high cost of living today forceshusbandsand wives to discussfamily planning. 216 Cultures of Populations: Asia Pacific Thus economy is the determining factor for decisions on the number of children these adult groups would have. The Chinesepreference for sonsto carry on the family name has resulted in one respondent having sevendaughters before she finally gave up. Thisshowsthat information, education and communication activities on family planning has either not reached certain population groups or that socio-culturalfactors have a stronger influence on them. Population programmes should therefore help promote awarenesson the need to find a balance between family planning needs and socio-culturalpractices. All adults from the four population subgroups are aware of abortions taking place in their communities although it is against the religious principles of most, and is illegal in Malaysia. However, some felt that abortion should be allowed for medical reasons.Generally, the incidence of abortion for married couples is very low in contrast to the proportion of unwed young girls. In recent years there have been callsfrom various NGOsand sectorsof the public to introduce sex education in schools,as most of the pregnancies were reported to have occurred as a result of ignorance with regard to the proper use of contraception and family planning methods. However, this suggestion has met with considerable resistancefrom other sectorsof the population who fear that it may lead to sexual experimentation instead. There also needs to be more support and counselling given to unwed mothers, particularly for those who prefer to go through with the pregnancy and/or intend to put their babies up for adoption. Presently, many unwed mothers abort or abandon their babies becauseof shameand the lack of options. Knowledge on the subject of infertility among male and female adults in the four sub-population groups appears to be vague. Theywere more knowledgeable about menopausebut even then, more needs to be done to boost awarenesslevels.Their knowledge on andropause is even more limited. Awarenesson availability of serviceson infertility, menopause and andropause needs to be enhanced not only among these sub-population groups but also among the general population. Extramaritalsexisnot acceptableto all the population subgroupsin the study.Fromthe religious point of view, both lslamand Christianityexpresslyforbid suchactivities.However,all the groups are aware that extramarital activitiesdo occur and that many men, married or not, do seek commercial sex services.The groups also know that homosexualism,lesbianismand incest occur and some are aware of friends engaged in these sort of activities. An unstable husband - wife relationship is said to be a contributory factor to extramarital sex. For instance, some male and female respondents put the blame on wives for their husbands going astray. Government organisations,such as the FamilyDevelopment Board, organise seminarson happy and healthy family life; participants attend on a voluntary basis.The findings indicate a continued need for similar courses. 217 Cultures of Populations: Asia Pacific The majority of the participants from all the communitiesinterviewed know about AIDSbut very little about m. They know how AIDSis transmittedfrom talks organised by the community and electronic media. Thesefindings indicate that knowledge on the implicationsof extramarital and premarital sex do not seem to be sufficient in stopping people from indulging in such sexualactivities. Youth Big families are preferred by all youth groups regardlessof gender because they feel that emotional and physicalsupport for family membersis more readily available. Chineseand Malay youth groups, however, realise that small familiesare more manageable economically, emotionally and space - wise. As the female Chineseyouth group puts it, small familiesare conducive for studying. The Malay male youth group stated that small families would enable parents to give more attention to their children. All youth groups indicate the need for emotional support from their parents. Mothers are closer to their children and more understanding while fathers are strict. These youths prefer to confide in their friends than parents on personal problems. Thesefindings indicate that big familiesremain a socio-culturalfamily value for all youth groups in the study, but they are aware of the practicality of small families.It is also noted that there is a need to make more parentsaware of the adolescents’need for attention. Training on parenting skillscould be incorporated into future family development programmes. The views expressedon the criteria for choice of marriage partners reflect that of the adults’ socio-culturalvalues.There is, however, no particular pattern in the findings on the age at which youths may start dating. With regard to sex and sexually transmitted diseases(including AIDS),the adolescentsinterviewed showed alarming gaps in their knowledge. None referred such mattersto their parents, preferring friends, the massmedia and the internet. Someof the youths in the groups admitted having experienced premarital sex although they know it is unacceptable in society.Perhapsas discussedin chapter five, sex education needs to be given serious consideration to prevent youths from obtaining information on sexualbehaviour from unreliable sources.Currently,there are no specific programmesavailable on sexualeducation except in parts of the school biology curriculum. Relevance of Current Programmes The findings of the study have shown the importance of socio-culturalfactorsin influencing demographic behaviour, specifically, reproductive behaviour. It is also evident that current population policy and programmeshave not reached all sectorsof the population. Nevertheless, the content of current programmesisstillbasicallyrelevantto meet the needsof the sub-population groups identified in the study and the general population. However,certain areasin the policies 218 Cultures of Populations: Asia Pacific and programmes could be boosted in order to fulfil the needs of all sectorsof the population with due regard to the socio - cultural factors. DATA COLLECTION,COMPILATION, AND ANALYSISFOR IMPROVING KNOWLEDGEBASE FOR LOCAL POPI/LATlON Qualitativeresearchfacilitatesthe understanding of the socio - cultural realitiesof communities and the sub - groups within them. When used in conjunction with quantitative data, they provide a more complete picture of demographic behaviour, for instance, so that planners may be able to formulate more effective policies and programmes. In this study, discussionswere conducted in Malay (Bota and Pontian), Chinese (PasirPinji) and Tamil (Siliau)to enable fluent expressionof ideas by the respondents. Apart from what was said, visual and aural clueswere also noted down. Thisis important in the Asian context because of the cultural tendency to allude to issuesrather than forthright speech. The facilitators of each sessionwere themselvesfrom the sameethnic and cultural background and thus they were able to grasp the meanings behind the words. The respondents were divided by gender and age group to ensure less inhibitions when giving opinions on culturally sensitiveissuessuch as marital relations, reproductive health and sexual behaviour. Eventhen, the facilitators had to be vigilant in soliciting information, taking into account the sensitivities.In one particular instance at the Pontian site, an elderly father happened to be in the same group as the adult son, and took offence at a question on sexual behaviour. It was not so much the question, asthe fact that his son was presentwhen the question was asked, that led to the old man’s indignation. The in - depth interviewswere particularly usefulbecausein the absenceof others,respondents felt that they could speak more freely. More information could therefore be elicited particularly on the subjectsof family planning, sexual behaviour and STDs. Thusfar, the studiesdone on demographic behaviour in the variouscommunitiesin Malaysia, have been quantitative. Policiesand programmes have been planned and implemented on the basisof factsand figures. However, not all of these have been successfulperhaps because they may have failed to take into account human behaviour, which can be difficult to predict. Qualitative data provides the explanation for human behaviour patterns. It may be more complex than quantitative data, but is neverthelessvital if planners hope to formulate effective policiesand programmes. 219 Cultures of Populations: Asia Pacific CONCLUSIONAND RECOMMENDATlONS Rapid structural transformation in the Malaysian economy and social change have brought about major shifts in the demographic dynamics and structures.With mortality hovering at a relatively low level and continuing decline in the level of fertility, Malaysia is on its way to completing the demographic transition. Rural-urban migration has accelerated the pace of urbanisation, with consequential weakening of the extended family systemand community cohesiveness.However, the demographic responsesto socio-economic development are far from uniform acrossthe various ethnic and socialgroups in the country. Religion, education and economic statusare found to be the most important social factors,which influence the demographic behaviour. The educational effect on demographic behaviour has been particularly marked for femalesliving in urban and sub-urban areas-through delayed marriage, greater use of contraception and changing norms towards smaller families.Further improvement in educational level will continue to exert significant influence on the future course of population growth, as more and more educated women enter the modern labour market where maternal roles and work have become incompatible. The Malays are the largest ethnic group, making up 56 percent of the total population of PeninsularMalaysia,followed by the Chinese (34 percent) and the lndians (10 percent). Other communities include the Orang Asli (original or indigenous people) and Eurasians.Since independence, the government has been trying to integrate the Orang Asli into the mainstreamof the Malaysiansociety,and to improve their quality of life. Eachethnic group still retains its socialand cultural traits, which determine attitudes towards issuessuch as gender, reproductive health, marriage, fertility, family planning and sexualbehaviour. It is also important to note that within each group are severalsub-groupswhich, although belonging to the same community and professing the same religion and language, will have markedly different attitudes. This may have been caused by differing educational and/or economic levels.Traditionally the Malayswere engaged in agriculture. However, Government policies which seek to eliminate the identification of racewith vocation and location, along with socio-economicdevelopment haveled to the rural-urbanexodusand the consequenturbanisation and modernisationof the Malays.Policyplannersintending to design programmesmusttherefore take cognisance of the sensitivitiesof each sub-group, even of the same ethnic background, living in various socio-economicand cultural environments. Islamhasbeen designatedthe official religion in Malaysiaalthough adherentsof other religions have full freedom to practise their beliefs, traditions and culture. It functions as a social check and balance systemfor the majority Malay population, aswell as large numbers of other racial groups in the country. Becauseit issucha potent socialand political force, the tenetsof the religion determine government policies to a large extent with regard to population issues.Other major influencesinclude the Chinesetraditionsand beliefs,Hinduism(Indians),and animism(OrangAsli). 220 Cultures of Populations: Asia Pacific Main Issues and Recommendations Marriaqe Marriage, asa prerequisite to building a family, is considered extremely important in all communities. None of the adults interviewed were comfortable with the idea of giving birth out of wedlock. Despite the social norms for males to be married by age 25-30, and for females to marry earlier, age at marriage and non-marriage rate have been rising steadily.According to the 1991Population Census,the singulate mean age at first marriage for the country as a whole has increased to about 28 years for men and 25 years for women, and about 10 percent among those aged 35-39 have remained single. As marriage postponement and non-marriage is strongly positivelycorrelatedwith higher education, it appearsthat the marriage institution may seefurther erosion with educational advancement. The common criteria for the selection of a marriage partner are maturity, financial stability education and good family background. However, in the caseof the Malays and Muslims(from other communities), Islam is the prime factor. The exceptions are in caseswhere the potential bride or groom is a Muslim and the non-Muslim partner would have to convert to Islambefore they can get married. All non-Muslim adult respondents said that they would be unhappy if their children had to convert on the grounds that the marriage might run into problems. Consequently, mixed marriages are generally received with caution. Population policies must take into account these socialrealities. Divorceis not encouraged by Islambut it is allowed if the marriage no longer brings happiness to the couple. The divorce rate is quite high among the Malays,especiallyin the more rural states of Kelantan and Terengganu. The rate of divorce is also quite high among the Chinese. To mitigate the “flight” from marriage, particularly among the highly educated segment of the population, family life education should be incorporated in the school curriculum. Training courseson marriage and parenting such as those conducted by the National Population and FamilyDevelopment Board and ReligiousDepartment should be extended to cover wider target groups from different socio-cultural background. Marriage counselling servicesshould also be made more readily available to reduce the divorce rate. Non-governmental organisations should also be encouraged to play a bigger role in promoting harmonious marriage and family. Thereisalsoa need to implement specialprogrammesto assistsingle parent families.By improving family stability,these programmeswill help alleviatethe socialills, particularly among the youths. Fertility, Reproductive Health and FamilyPlanning The fertility level has been declining steadily over the years. However, as each ethnic group has undergone different pace of fertility decline, wide variations in the current level of fertility can be observed. While the Chinesefertility level is reaching replacement level, with the Indians 221 Cultures of Populations: Asia Pacific fastcatching up, the Malay fertility is still relatively high. However,with increasededucation and the socialchange, Malay fertility is alsoexpected to continue its downward trend. Fertility decline has taken place because of the difficulties in child-care especially for working women and the high cost of child rearing consequent upon the breakdown of the extended family system.The prevailing fertility trends and patterns would have significant implications on the population structure, which must be taken into account in social planning Mindful of the financial burden of raising a large family, most respondents reported wanting two to three children. Younger couples are more likely to postpone childbearing. Exceptions were noted among the Malays,some of whom mentioned that “God will provide” and this may partly explain the larger family sizeamong the Malays.Apart from the Malayswho have no fixed preferencesfor son, there is a slight bias toward having a male offspring in the other three communities. Contraceptiveservicesare available through a wide network of serviceoutlets of the Ministry of Health, the National Population and Family Development Board, the Family Planning Associationsand private doctors. Familyplanning devices,suchascondom, can also be obtained easily from drug stores.Nevertheless,the gap between contraceptive knowledge and practice remainswide. The contraceptive prevalence rate is lowest among the Malays(especiallythose in the rural areas)and they are also more likely than other socialgroups to usetraditional methods such as taking certain herbs. Previousstudies have also revealed considerable unmet need for contraception for spacing and limiting childbirths. While basicknowledge of reproductive health and family planning is rather universalamong adult respondents in this study, many are sceptical about the efficacy and safety of modern contraceptive methods. Many respondents also expressedfear of side effectsof these methods, and are resorting to using traditional methods. Appropriate information, education and motivation programmes should be drawn up and implemented to provide couples from different socio-cultural background with adequate knowledge to enable them to decide on the timing and frequency of childbirths. A profound understanding of the perceptions and value systems of the various sub-groups is essentialin enhancing the effectivenessof the population policies and programmes in promoting reproductive health and family wellbeing. Bio-medical research should be conducted to assessthe efficacy and safety of traditional methods such as herbs and jamu which, are rather widely used among rural couples, particularly the Malays. According to respondentsin this study, decision on birth spacing and the number of children were made jointly between husband and wife. However, analysis of the female and male respondents’ answersindicate that the malesgenerally want more children, particularly if there are no sonsin the family. Women were more consciousof the need to spaceout children for the 222 Cultures of Populations: Asia Pacific sakeof their health. Menopause is understood by most of the women and some of the men but few have heard of andropause. It appears that there is a need to educate men on reproductive health and motivate them to play a more active role in Planned Parenthood. Attitudes toward unplanned pregnancy and abortion vary acrossthe socio-cultural groups. Abortion through traditional and modern means, although illegal, is perceived to be rather common.TheMuslimsand ChineseBuddhiststake a more conservativestanceon abortion, viewing it as a sin to do so. Thesexualbehaviourof adolescentsisstillstronglyinfluenced by religion and culturaltraditions, although it is lessrigid in the caseof the Chineseyoung. The adolescentsinterviewed showed significant gaps in knowledge in matters of reproductive health, diseasesand sex education. Friends,books, videos and the internet are their main sourcesof information. None of the young respondents in this study have approached their parents for information on these topics, but instead went to their friends, massmedia and phonographic materials. Special programmes should be drawn up to educate the adolescentson the “taboo” subjectsof sexual and reproductive health and diseases.There is also a need to educate and change the mind-set of the parents in discussingsuch important issueswith their adolescent children. Respondents are generally agreeable that sexand reproductive health education could be introduced in secondary schoolsand in institutions of higher learning. Concomitant with social change, problems such as to drug abuse, sexual crimes, domestic violence, HIV and AIDSand STDhave grown. According to a surveyconducted by the Ministry of Health in 1996,some 1.8%of adolescentsreported having sexualexperience - about 20% of these are homosexual and 9.4% had sex with prostitutes. From the interviews done for all the four communitiesin this study, adolescent respondentsconsistentlyshowed a lack of knowledge about STDsand other featuresof reproductive health. Thus,those who indulge in pre-marital sex run the risksof contracting sexual diseases.For both adult and adolescent groups, knowledge on AIDS is more in-depth than that on sexually transmitted diseases.This reflects the official campaigns that have been conducted on AIDS - causes,symptomsand treatment. Knowledge on STDswas vague, even for the adults. The findings of this study have indicated the pressing need for the formulation of information programmes geared to adults and in particular, adolescents,which would give them a more comprehensiveunderstanding of the issuesinvolved. The approach would have to differ according to the target group. One way may be to work with parents to find out the best way to impart information to their children since in all communities, respect for elders is still an ingrained cultural trait. Apart from MalaysianAIDS Council and the Federation of Family Planning Associations,more NGOscould be drawn in to provide reproductive and family life education, to augment the efforts of government agencies. 223 Cultures of Populations: Asia Pacific Education Although both malesand femaleshave accessto education and health services,some gender bias is noticed particularly in the rural (poorer) areaswhere very often sonsare expected to work for the family’s benefit. The attitude there is that daughters can always be married off, thereby reducing the burden to the family.In the more suburbanand urban areas,both sonsand daughters are educated to ashigh a level aspossiblebecauseof the recognition of the benefitsof education. Policy programmes designed to uplift the statusof femalesin poorer families must convey the benefitsthat may be obtained from an education. Thisdoes not include merely economicbenefits but also to instil the opinion that an educated mother hasa better chance of raising family health standards. The Changing FamilySystem The processof modernisation and urbanisation is clearly bound up with other complex issues related to family structureand lifestyleimplications.Traditional family support systemsare placed under considerablestrainwith rural-urban migration. Consequentlythere is now a trend emerging where the older personsare left behind in villages. As more and more women are entering the labour market, their roles astraditional caregiversfor the young and the old have been eroded. Without the family support system,it is necessaryto have adequate child-care arrangement to prevent the social problems of the youth that may arise due to lack of proper guidance. Rolesand statusof women In all communities,as more and more women attain higher education and participate in the labour force, decision-making in the household is gradually being shared and this also applies to decision regarding family size. In the socio-culturalsetting of the Orang Asli, women have a respected statusand there is little gender segregation. The Governmenthasplaced great emphasison the integration of women in national development. A Women’sAffairs Department is set up within the PrimeMinister Department to monitor and facilitate the integration of women’s concerns in national development planning. Various NGOsare also actively pursuing the interest of women. Health status The country hasan excellent network of hospitalsand clinicsin providing medical and health care servicesto serve the population. However, utilisation of health servicescan be further improved with proper health education and campaigns, The crude death rate is stabilisingat about 4.5 per thousand population. Infant mortality rate declined form 10.5 per thousand births in 1995to 8.3 in 1998.Maternal mortality has remained at 0.2 per 1000births since 1995.Promotive,preventive,curativeand rehabilitative programmes 224 Cultures of Populations: Asia Pacific can be strengthened to further improve the health statusof the population. With the influx of foreign labour and their dependent, the health situation should be closely monitored. As the Orang Asli live mainly in the natural environment of either the deep jungle or its fringes, they are more prone to suffering from malaria and dengue because of mosquito bites. Special health programmessuchasMalaria EradicationProgrammeshould be implemented to safeguard their health. 225 Cultures of Populations: Asia Pacific BIBliOGRAPtlY 226 l Departmentof Statistics,Malaysia l Duzaand Baldwin, 1977 l Isaacs,S1, 1984 l LPPKN l MPFS,1984and 1994 l Oorjitham, 1984 l Population Census,1991. l StatisticDepartment,Malaysia l Studiesby LPPKN,1994 l Wang Cungwu, 1979 Cultures of Populations SOCIO-CULTURALFACTORS ANDDEMOGRAPHICTRENDSINPAKISTAN RashidAhmad Khan* INTRODUCTION A ccording to the latest census (March 1998), the total population of Pakistan is 130.6 million. Thus, Pakistanstands as the seventh most populous country in the world and fourth in the Asiaand Pacificregion. The historicaltrends indicate a continuouslyincreasing growth in population. The population of Pakistanis unevenly distributed among its four ethnic and linguistic units (provinces).Punjab has the largest population (72.585 million), constituting 55.6 percent of the total population of the country. Sindh follows Punjab with 29.991 million or 23.0 percent of the country’s total population. North-Western Frontier Province (NWFP)has 17.555million people, constituting 13.4 percent of the total population of Pakistan.The least populated province is Balochistanwith a population of 6.511 million or 5.0 percent of the total population of the country. The population density i.e., persons per sq. kilometre has increased from 105.8 in 1981 to 164.0 in 1998. Punjab has the highest population density, with 353.5 personsper sq. kilometre, followed by NWFP(235.6) and Sindh 212.8 Balochistanhas the least population density where only 18.8 persons live in one sq. kilometre. One of the most prominent featuresof Pakistan’sdemography is that the majority of its population still lives in rural areas.According to the 1998 Census,the urban and rural population of Pakistantotals 42.5 and 88.2 million respectively.In 1981,the urban population was about 24 million whereas the rural population was about 61 million. The shareof urban population in the total population increased from 18 percent in 1951to, 33 percent in 1998.The growth of urban population, due to natural increase, rural to urban migration, and to some extent illegal immigration, is expected to remain higher than the growth of rural population. The processof urbanisation is, therefore, expected to escalatefurther in the near future. * Chairman, Deponmenr ofPoli~ml Science, University of Punjab, Lohore, Pakisran 227 Cultures of Populations: Asia Pacific The process of urbanisation in Pakistanhas also increased due to pressure on agricultural land, which created unemployment in the rural areasand a consequent rural-urban migration. Thistransformation is evident from the absolute change in the urban population from 6 million in 1951to 10 million in 1961; 17million in 1972; 24 million in 1981and about 43 million in 1998. In other words the 1951reported urban population of 6 million increased by almost four times by 1981and over seventimes in 1998.Thischange has exerted heavy pressureon urban centres, which led to increased congestion and demanded more resourcesfor urban development and provision of services. Furthermore, the high rate of growth of urban population did not register any decrease in the absolute population of rural areas,which also kept on increasing.Thiswas mainly due to the continuation of high levelsof natural growth in both urban and rural areas.In addition, there is a tendency among Pakistanivillagers returning from the oil producing countries and among immigrantsfrom neighbouring countries, to settle in towns and cities.Thisphenomenon hasled to severalunplanned big cities in the country. According to 1998 population census,there are 23 cities, each with population of 0.2 million and above. Sevencities with populations of over one million each have almost half of the total urban population of Pakistan. Fertility and mortality are the two crucial components of national population growth. Although the findings of different sourcesof vital statisticsin Pakistanare occasionallyat variance, they generally point to a crude birth rate of around 32 per thousand and crude death rate of around 810 per thousand as of 1998.Though mortality ratesin general are expected to continue declining for infants, children, and mothers. However,at present the infant, child, and maternal mortality ratesare still high. Compared to fertility and mortality, migration hasreceivedlessscholarlyattention or academic studiesin Pakistan.During the lastthree decades, hardly half a dozen studiescould be added to the field of urbanisation. These studies are primarily based on censusdata. After the 1979 Population Labour Force and Migration Survey (PLFMS),no nationally representative survey addressing the issueof urbanisation and internal migration could be carried out. Evenregional studies could not be conducted during the last two decades. The age structure that has evolved asa result of sustainedhigh fertility and sharply declining mortality will resultin continuing high ratesof growth even if family normsare substantiallyaltered in the coming years. About 41 percent of the population is below 15, and about 22 percent of the population consistsof women of reproductive age, which will lead to continuing high proportions of women of reproductive age for some time. In fact, there are indications that the proportion of population aged 15-34 years has slightly increased in the PakistanFertility and FamilyPlanning Survey(PFFPS) 1996-97compared with previous surveys.Thisindicates that the persons entering the prime productive age span will be increasing in the coming years. This 228 Cultures of Populations: Asia Pacific trend implies an increased need for reproductive health and family planning services.Similarly, likelihood of lower birth rate in the future will resultfor a time in a higher proportion of adolescents and young adults,which will require more investmentin education, skills,health and employment creation. In return well-educated and well-trained manpower can boost productivity and rapid economic development. Pakistanis a multi-cultural and multi-ethnic society. Within a cultural and sub-cultural group there exist different socialsystems,set of values,and traditions which greatly affect the images, perceptions and attitudes of the members of these groups towards social problems. Although Pakistanhas witnessed a rapid processof social and cultural change, it still retains its major ethnic, social and cultural traits, which vary from region to region and from area to area. There are four major ethnic and language groups in Pakistan.Punjabis,who inhabit the (largest)province of Punjab, the Sindhiswho live in the province of Sindh, Pathanswho are the inhabitants of NWFP and some areas of Balochistan and Baloch whose homeland is called Balochistan.Each of these ethnic groups has different language, traditions, customs,practices and socialsystems.In other words, varioussub-culturesexisting in Pakistanisocietymust be recognised as realities, despite the fact that Islamis the common religion of more than 90 percent of its citizens.Tribalism,SardariSystem,bradrism Caste,and joint family systemexist in Pakistanas different versionsof socialsystem.Although the processof socialand political change has led to some erosion of the influence of these socialforces,they still constitute an important component of socio-culturalenvironment. Thispaper discussesthe findings of a researchstudy carried out in selected siteswhich cover the four regions (provinces)of Pakistan,with distinctivesocialand cultural characteristics,namely Punjab, Sindh, North-WesternFrontier Province (NWFPand Balochistan.The underlying theme of the study is that the behaviour of the individuals in any cultural or sub-culturalgroup is greatly influenced by the prevalent traditions, values,beliefs and practicesthat have accumulated over a period of many centuries as a collective experience of a cammunity. The socio-cultural environment of a community hasa direct or indirect impact on the demographic behaviour i.e., level of fertility, rate of mortality, and pattern of migration of its members. Objectives of the Study The principal aim of the study is to identify and obtain a better understanding of the various socialand cultural factorsthat affect demographic behaviour i.e. fertility, mortality and migration, at national, regional and sub-regional levelsin Pakistan.It is expected that on the basisof these findings it would be possible to make recommendations for policy-makers and programme managersto formulate and execute population policies and programmes. 229 Cultures of Populations: Asia Pacific Other objectives of the study are: 1. To highlight the divergence in perceptions, images, attitudes of different population groups on health/reproductive health and education, and present a set of proposals for the planners and managersof population programmes. 2. To identify the gaps between the availabilityand utilisationof servicesin health/reproductive health, family planning and prepare a set of proposalshow best to bridge these gaps. 3. Toidentify the areasin which there isgreater need for integration of population programmes with the overall national development strategy. 4. To stressthe need for better awarenessamong policy-makersand programme managers to be sensitiveto differences in social systemsand cultural values in various regions and sub-regions of Pakistan while conceiving, designing and executing the Population Programmesand Policies. 5. To explore the ways and means for the promotion of qualitative research in Pakistan, through expanding interaction with the facultiesof Universities/researchinstitutions. 6. To assessthe role of serviceproviders and other change-agentsin the processof socialand cultural change in different regions and at different levelsof society. 7. To improve the databasefor socio-culturalresearchthrough the combination of qualitative and quantitative researchmethodologies. Scope of the Study This study is limited to collecting and analysing for specific purpose the qualitative data on demographic behaviour in different socio-cultural environments. There are a large number of studieswhich contain the quantitative data on demographic behaviour, however the quantitative information alone may not be able to explain the qualitativevariationsin demographic behaviour in the country’s different socio-culturalmilieu. The study is based on field research activities carried out in different regions at the local community level with an attempt to identify various social and cultural factors that influence demographic behaviour in that particular community. Methodologies Utilised for Data Collection and Analysis Training for the researchteam was provided on the following methods and techniques: Arranging FocusGroupsand holding FocusGroup Discussions In-depth Interview/case study SocialMapping Life histories Site preparation l l l l l 230 Cultures of Populations: Asia Pacific The field researchactivity was conducted in two stages:site-preparation and field work. Two dayswere allocated for sitepreparation while field work was completed in four daysat every site. During the two days of site preparation, information about general socio-culturalcharacteristics of the community, quantitative data about the servicesand facilities, population and physical infrastructurewas collected. Following methods were used to collect data during the four days of field work at every site. 1. FocusGroup Discussions 2. In-depth Interviews/Case-study 3. SocialMapping 4. Participant Observation At each site following FGDswere held: 1. Adolescents(Male-Female) 2. Youth (Male-Female) 3. Married (Men EsWomen) Parents 5. Newly Married Couples 6. Service/Information Providers The fieldwork was conducted in eleven (11)sampleareas(sites).Fiveof those sites(three rural and two urban) were located in Punjab; while two (one rural and one urban) were allocated for the remaining three regions/provinces of Pakistani.e. Sindh, NWFPand Balochistan.Following is the description of regions/sample areas(sites).Thisstudy has not covered all the sub-cultures. Following methods were used to collect data during the four days of fieldwork at every site: focusgroup discussions,in-depth interviews/case-study,socialmapping, participant observation. During focusgroup discussionsthe issues/topicsfor discussionwere introduced by the moderator and the membersof each focusgroup were requested to expresstheir views on them one by one in a frank and candid way. The responsesof the participants were recorded by the notetaker against the serial numbers allotted to them. At the end of each focus group discussion,the moderator and the note taker would review data in order to ensure that there were left no gaps for information on important issues.Thisexercisewas done with the help of local facilitatorsand community leaders. There was no uniform pattern for holding in-depth interviews or compiling social biographies. At some sitesonly one in-depth interview/social biography was completed. In other sites in-depth information on the customs,traditions, evolution of social life, and other cultural traits of the community was obtained. No in-depth interview was conducted at a site where the participants of FocusGroupshad provided sufficient information on the issuesand questionsraised. 231 Cultures of Populations: Asia Pacific Key-informantinterviewswere held at eachsiteto obtain informationon the ethnic composition, social organisation, and cultural characteristicsof the community. Through interviews with the Key-Informantsthe information regarding the services/facilities,operation by Community Based Organisations(CBOs)and Non-GovernmentalOrganisations(NGOs).Quantitative data about the community was also obtained. Difficultieswere faced in collecting data from adolescents(female)and youth (female),especially on sexual behaviour. Mothers would insist on sitting with their young daughters during focus group discussions.In such casesit was difficult to obtain data on sexualmatters.Whenever an attempt was made to initiate discussionon such issues,the mothers would object and say: “Do not ask suchquestionsfrom our daughters.” However, during the in-depth interviews it was possible to get some relevant data. Preliminaryanalysisof the qualitative data was undertaken immediately upon the completion of each focus group discussion.The next step of data analysiswas to prepare the report on the basisof analysesof focus group discussions,in-depth interviews, and casestudies. Thisanalysis of qualitative data obtained through focus group discussions,casestudies/in-depth interviews, social biographies and social mapping was checked against the information received through participant observation and informal talks with community leaders. The contents of analysis included, a) main issuesraisedby the membersof the focusgroup during discussion,b) the main concerns expressed by the persons/members of community interviewed, c) and the major points contained in the information secured from key-informants.The analysisof data obtained from every sitewas discussedwith a selectnumber of community membersin order to elicit their comments,thereby making it a participatory process.Thisexerciseestablisheda better equation of the team memberswith the community. It helped create a link and an environment of confidence between the two, which is a valuable assetfor the building of a basisfor future Cupertino and participation of the community. In analysing the data particular emphasiswas placed on clearly identifying the major sociocultural factorsaffecting the demographic behaviour of the membersof the community. Most of the analysiswas done manually.In certain caseswhere it was necessaryto emphasisethe response of a participant on a particularissue,direct quotesof the participantseither in his/her major tongue was given with its Englishtranslationor in other casesthe quoteswere given in Englishtranslation. Perceptions of the Community During the focus group discussions,the main issueswere (a) how to conduct an orderly and meaningful discussion;(b) how to obtain frank and candid views of the participants and (c)how to record the relevant parts of the discussion.In efforts to resolvethese issues,the researchteams were hampered by three problems. One, in certain cases,the elderly people especiallyparents would insistto sit along with their children, especially adolescents.In caseof focus groups for 232 Cultures of Populations: Asia Pacific female adolescents,they would strongly insist on sitting along with their children during the focus group discussion.Secondly,it was very difficult to introduce sensitivetopics for discussion like sexual matters, STDs,and other “socially disapproved” topics. Thirdly, during fieldwork it was found that the moderators and note-takerswere not sufficiently trained and professionally competent to get the real information or gauge the perception of participants.Although a five-day Training Workshop was organised for moderators and note-takers, it was observed during the field researchwork that there was need for more competent, professionallytrained and experienced moderators.Thisis the major drawback of the study. With professionallytrained, competent and experienced moderators and note-takers, better resultscould have been obtained. SOCIO-CULTURALRELlWWCE OF EDUCATION In every site there are separate primary and middle schools for boys and girls. As regards female education, the commonly held belief is that girls should not get more education, because more education gives rise to promiscuity. (Larkion ko ziada naheen parhana chahyee kionke us se behayaee phailti hai). This is a factor explaining why female enrolment at secondary levelsin many sitesis low. Another factor for the under-utilisation of available servicesin education is the problem of accessibility,especiallyfor girls. Many parents do not send their daughters to high schoolssimply for the reason that high schoolsfor girls are situated at forbidding distances.In NWFP(rural) this problem is more acute, because Pashtoontradition does not favour unaccompanied movement of the young girls. In rural Sindh, the problem existsin the form of differing outlook between Sindhisand Baloch-Sindhis.The Baloch - Sindhi culture is relatively more oppressiveof women. Thisiswhy female literacy rate is very low among them. The Baloch-Sindhisare more strict about parcfah. Theydo not favourfemale education. The Balochtradition of opposing female education is stronger where the Sardari Systemis prevalent. Where the Sardari Systemis weak (Shahpak, Balochistan-rural),Baloch tribes encourage female education, In urban sites,the communitieswere of the view that schools(high) for girls and boys should be located at a considerable distance from each other. The parents particularly resent if their daughters have to passthrough bazaar and market placeswhile going to and coming from the schools. Regarding the cultural relevanceof formal and informal education for malesand females,the commonly held view in the communitiesis that systemfailsto provide information necessaryfor the growth of healthy moral and ethical values in society.The textbooks introduced at primary and secondary levelsdo not contain information on life skillsand other issues,which are relevant to studentsin their daily lives. 233 Cultures of Populations: Asia Pacific In Sikandarabad(one site)there was a schoolbuilding for girls,which was completelydeserted due to the fact that there was not a single teacher in the school. The question of the enrolment of the students, therefore, could not arise. The Government, with a view to raising the literacy rate in the country, has introduced the schemeof Masjid schools,where a teacher is appointed with a fixed salary.However, most of the schoolsare without students and the teacher (mostly imam Masjid) gets his salary regularly without doing any work. In a number of areasthere are only school buildings without either studentsor teachers.The community memberscomplain that educational institutions (schoolsand colleges)have failed to provide required services,chiefly on accountof staffshortageand inadequate facilitieslike drinking water and electricity in the schools.The community in Shahpakcomplained that for a period of about four months, the whole area had been without electricity as the power generating plant located at Pasin(216 km) was out of order. The worst affected in such a situation, are schools, hospitalsand dispensaries. The parents in Lawa,Mokhal Sindhwa, Sikandarabadand Shahpak(all rural sites)were of the view that their school-going children do not receiveadequate education from these institutions. They exhibit a feeling that their children were just wasting their time by going to schools.The teachers and other service-providersin Sialkot (urban) said that there was under-utilisation of these services,as the parents did not care to ensure that their children were attending schools regularly. Furthermore, the parents were of the view that they could not find time to monitor the activitiesof adolescents.In Sialkot(urban) an adolescent informed the researchteam that the outer wall of a school had collapsed, and the building had been converted into a gambling den with the connivance of the Chowkidar (watchman).It implies misuseof educational institutions. The problem of socio-cultural relevance of servicein education is more acute and complex in rural areas.In Mehrabwala (Punjab-rural)the parents complained that education was leading towards the erosion of their traditional - cultural valuesand disintegration of their socialsystem. Educated youth prefer to marry the girl of their own choice and are increasingly opposing the arranged marriages. In Shahpak (Balochistan-rural),parents generally determine the marriages of their daughters;honour killing, common in Pashtoonareas,isnot necessarilypractised,however, on girls who marry against the wishes of their parents. In Sikandarabad, the community believed that education and information serviceswere undermining the traditional bra&i and hrcfari systemand joint family system. 234 Cultures of Populations: Asia Pacific REPRODUCTIVEHEALTHSERVKES In health services,and particularly in reproductive health and services,the gap between availability and utilisationwas large. In Sikandarabadwhere two LHWsare working, the community had the complaint that the LHWsfailed to deliver family planning servicesat the ‘doorstep’ of the population. Therewere alsocomplaintsthat the LHWswere charging money for contraceptives, which they are supposed to provide free of cost. In FGDfor ServiceProvidersin Sikandarabad, an LHWdenied these charges.On the contrary, she claimed that the acceptance level of FPwas on the rise because of increasing male involvement. Shewas, however, unable to explain why her records showed a higher population growth rate in her community as compared to the national average. One answer was provided by an interviewee, who said that in the community (particularly among the old Sindhis),polygamy was common. We could not assessthe number but there were quite a large number of men with more than one wife in Sikandarabad. One person, Khan Muhammad, a 60 year old Sindhi in Sikandarabad, reported to have 16 children (6 daughters and ten sons). He is a daily wage earner. Only two of his sons could receive education up to middle level, and the rest of his children are illiterate. He said that he or his wife had never been informed about the methods of family planning. After producing I6 children, Khan Muhammad thought that it was good to have fewer children becausethe larger family had created many problems for him. The community members in Sikandarabad and Mehrabwala reported that family planning programmes could achieve greater successif: (1) FP supplies were regular; (2) post-operation care was assured and (3) Family Planning Clinic and hospital staff adopted a more humane, sympathetic and friendly attitude. The majority of the women, especially elderly, in rural areas are illiterate; whereas family planning clinic and hospital staffare educated and have an urban background. The illiterate and socially backward women of the rural areashesitatetalking to them about (reproductive) health problems because the staff at the family planning clinics and hospital does not communicate with them in local languages. Lack of communication is one of the most serious causesin the under-utilisation of (reproductive) health services.The rural women feel much more comfortable in talking to or seeking advice from older women on the problems relating to reproductive health. For example, in Cheena (NWFP-rural)where most deliveries take place at home instead of hospitals, the presence of an elderly woman is thought essentialat the birth of child. The women in this community have more confidence in the wisdom of elderly women than in the knowledge of Trained Birth Attendants (TBAs),LHWsor even lady doctors. The community in Cheena prefers the birth of a child in the presence of an elderly woman. In Lawa (Punjab-rural) and Mokhal Sindhwa (Punjab-rural) there are Rural Health Centres (RHC)and BasicHealth Centres(BHU)respectively.In both these places,the servicesof male and 235 Cultures of Populations: Asia Pacific female doctors, dispensers(medicaltechnicians),and LHWsare available, but they are not being fully utilised. In FGDsfor married men and women, it was stated that there were a number of reasonsfor under-utilisation of these services.Firstly,there was shortage of medicines. “There are no medicines in the hospitals, so what is the use of going to these places” said one male participant in FGDfor married-men (Mokhal Sindhwa). Secondly,the male doctor either runs his own private clinic in the community or, if he does not, remains generally absent (Mokhal Sindhwa). The caseof the female doctor is similar,asare those of medical techniciansand LHWs. Thirdly; there is a shortage of medical equipment like X-ray machines,ultra-sonicmachinesand even medical instrumentsneeded for carrying out surgical operations. MORTALITYAND MORBIDITY As regards infant and child mortality, the rate is highest in rural and other under-developed areas.It becomesclear that apart from the risein income levelsand better accessto health facilities, education is an important factor which hasa considerable affect on mortality rate. The study has, however, helped identify other factorsfor high rate of infant, child and maternal mortality, especially in rural areas.In our traditional family set up of joint family,pregnant women haveto largely depend upon their mothers-in-lawfor care.The advice by doctor on diet and other precautionary measuresis ignored. The main reason for maternal mortality is that a very smallpercentage of women give birth to their babies in hospitals. As indicated in Ministry of Population Welfare Report, most of the women deliver babies at home without the assistanceof trained attendants. Regular antenatal check-upsduring pregnancy are important to reduce the risksof illnessand death for mother and child during pregnancy and at the time of delivery. One third of the health facilitiesdo not have any female attendant. STDS,HW/AlDS In spite of that Pakistaninitiated a national AIDSprogramme and started testing for AIDSas early as 1986. According to the report the present estimated number of HIV positive case in Pakistan,using WHO computer models may be anywhere from 5000 to 8000. During the field work, the topic of awarenessabout AIDS,how doesit spreadand what are the preventivemeasures, was discussedin the FCfor youth (maleand female)and parents.Almost all the participantswere found to be aware of the disease,the causesof its spread and the preventive measures.During an FGD(youth-male) some participants admitted they did not take any precautionary measure while having sexualintercoursewith women. In the cultural context of Pakistanit is very difficult 236 Cultures of Populations: Asia Pacific to secureadmissionfrom a male or female of having extra-marital relations. However, from the focus group discussionit was gathered that in such casesthere are high probabilities of STDs. Information, Education, and Communication ([EC) Communitiesin both urban and rural sitesare exposed to multiple sourcesof information like print and electronic media, radio, dish (satellitecommunications)in Shahpak (Balochistan-rural) where literacy rate is very low, most of the households have T.V sets, dish antenna and other electric gadgets. The reasonsbeing that a large number of people have been working in the neighbouring Gulfcountries.Most of thosepeople havecome back but they retain their preference for receiving and utilising information on health and education from the most modern and latest sources.However, such information remainsgenerally unutilised, as the necessaryinfrastructure and servicesfor the utilisation of such information are not available. Information on reproductive health and family planning is provided by the government and NGOsthrough advertisementson T.V and in the print media. Booklets, leaflets and brochures are also available to disseminatethis information. The problem with this information is that the vast majority of targeted population who mostly belong to the lower income classes,especially in rural areascannot utilise this information for two simple reasons. Firstly,the government sponsored advertisements(information) tends to create perception in the community that the government (s)is interested only in controlling the birth rate and limiting the size of the family through various devices (contraceptives);whereas some communities, as the study has found, may favour large families due to specific social, cultural and even political factors. During our fieldwork no indication was found that the communities have any other perception of government sponsoredpublicity programme on family planning and reproductive health. Suchis the resistanceagainst government sponsored family planning programmes, that the adolescents(male and female) in Mokhal Sindhwa (Punjab-rural)refused to take cold (soft) drinks arranged for them during discussionby the team due to a rumour which spreadlike wild-fire in the village that some sterilising substancemight have been mixed in the drinks. In most rural sitesthe team had to clarify its position that they did not belong to Population Welfare (FamilyPlanning) Department and their objective was not to motivate the people for family planning. Secondly,the information makesthe poor people believe that only rich people can have the luxury of smallfamilies.As a male member of FCDfor married men in Mokhal Sindhwa said: “m Krore pati logon kay do buchay hotay huh” (Only multi-millionaire familieshave two children). This clearly means that IEC is inadequate and information providers do not fully understand/assessthe needs of information receivers.Hence there is a wide gap between availability of relevant information and utilisation of this information by the receivers. 237 Cultures of Populations: Asia Pacific In contrast to massmedia and printed material, the inter-personal channels used to provide information as in the caseof LHWswas indicated to be more acceptable. It is so because LHWs belong to the samelocality.Theyhavea better understandingof the needsof informationreceivers. They operate in the samesocio-culturalenvironment. They are available for any clarification or further information on health and family planning matters.The systembecomesmore interactive, and there is no communication gap between the information provider and the information receiver. MIGRATION In termsof international migration, Pakistanwitnessedtwo crossborder population mobility in the last fifty years: influx of Muslim refugees from east Punjab and United Province (UP)of India as a result of partition of the sub-continent, and Afghan refugeeswho took shelter in the neighbouring provinces of Pakistanas a result of Sovietinvasion of their country in 1979. As regards internal migration, there has been a high rate of migration to urban areas.The growth of urban population, becauseof natural increase,rural to urban migration, and to some extent, illegal immigration, is expected to remain higher, at least for the first decade of 21st century, than the growth of national as well as rural population. The level of urbanisation is generally attributed to unemployment, under-employment, shortage of housing, transport and others infrastructure like water supply and sewerage. Push factors The migration trend among the low caste groups is higher because if their children get education they refuseto accept the feudal dominated traditional and conservativeenvironment in the villages. In urban Punjab, a number of familieshave left the community to settle in foreign lands on account of religious persecution. However,in Shahpakthe participants in a focusgroup discussionfor youth revealed that the trends of migration to Sindh have considerably abated recently. The main reason has been the deteriorating law and order situation in Karachi and other major urban centres of Sindh. Social oppression, ethnic conflict, deteriorating law and order situation and casteprejudices, education and conservativeoutlook of the rural people are some of the socialand cultural factorsaffecting rural to urban mobility (migration in Pakistan). Pull factors Furthermore, there are a number of temptations for educated youth (male and female) to move from rural areas to urban areas. Chief among them, of course, are facilities and services i.e., educational, health facilities, electricity, piped water, movie house, large markets, jobs opportunities; but such characteristicsof urban life as freedom of expression, liberalism and absence of social oppression and prejudices also function as significant pull factors. 238 Cultures of Powulations: Asia Pacific POLICYAND PROGRAMMERELEVANCEIN THEFlNDlNGS Thissection discussesthe relevanceof the findings of the study in the areasof fertility, family planning, reproductive health, mortality, morbidity, STDs,AIDS,drug abuse and migration. The relevant findings can be useful in the formulation of appropriate population policies and programmes. The discussionfocuseson the perceptions and attitudes of specific population groups i.e., adolescents(male and female), youth (male and female), parents, service-providers and information providers in both urban and rural areasof four regions (provinces)of Pakistan. Adolescents/Youth - Male (Rural-urban) The resultsof 1998 Population Censusin Pakistanshow that population of young under 15 years of age group both for malesand femalesis quite large, though it has slightly declined in 1998 as compared to 1981. The middle age groups are showing proportional increase. According to the findings of the study adolescents(males)in both rural and urban areas,are fully aware of the family planning methods, STDs,AIDS and risks of pregnancies. However, in the cultural context of Pakistan,it was very difficult to secure information from them whether they indulged in pre-marital sexual relations. In Peshawar (urban) through FGD it was found that quite a large number of maleswere using narcotics,viewing blue films on VCRand visiting prostitutes.From the discussionit was possible to infer that they did not bother to take any measure for safe sex. Similar inferences were secured in Quetta (Balochistan-urban).The urban site of Quetta was in fact a labour colony. But as stated earlier, most of the original allottees had either sold the residential quarters or rented them to migrant labour from other provinces, including Afghan refugees. Sincethere was no problem of access,the use of narcoticswas quite common among the adolescentsand youth. They were reluctant to discussthe issuesrelating to sexuality but the team was able to infer that many of them indulged in unsafe sex. In Shahpak (Balochistan-rural),Sikandarabad (Sindh-rural) and Sukkur-Rohri (Sindh-urban) the adolescentsand youth relied on close friends for information and consultation about sexual problems. Neither the teachers nor the parents provided any counselling or advice on these issues.One reason may be that the adolescentsshow hesitation in talking to or discussingsuch problems with their parents and elders. Becauseof the prevailing socio-culturalenvironment, the adolescentsfeel themselvescompletely alienated, isolated and depressed on issuesrelating to their reproductive health. There is, therefore, an urgent need for adolescent and youth’ centred programmes to provide them information or guidance to overcome problems relating to sexuality. The adolescents and youth (male) spend most of their time in the company of their close friends, visiting and enjoying at local hotels/restaurants/tea stalls.Thispractice exposesthem to developing the habits of smoking, drug addiction and even crime. The adolescentswho start by 239 ___-_, --__..--___ __------..- ~-- Cultures of Powulations: Asia Pacific smoking very soon land in drug addiction and end in committing seriouscrimes. Community membersin HajinaShah,SukkurRohri (Sindh-urban)saidthat mostof the crimeslike theft, robbery and even murders, were being committed by drug addicts, and such crimeswere on the rise. Community members in Sialkot (Punjab-urban)told that drug addicts were mainly responsible for the removal of water/gas pipes or fittings from the streets. In rural areas,the joint family systemis still intact to a great extent, but in urban areas,it is fast disintegrating. The newly-married couples are therefore, deprived of traditional sourcesof information and consultationson the problems of reproductive health. The newly married couples are more inclined towards adopting methods of family planning but availability of servicesis not satisfactory. In urban areasmaleyouth are in favourof femaleeducation but in rural areasfemaleeducation isdiscouraged.Thereisa cleargender biasin education, employment,food, freedom of movement and choice of life-partners. Although the role of religion as a factor in determining the rate of fertility has declined yet parents prefer female marriage at the earliest stage possible even if it means discontinuation of education. In rural areas large families are still favoured due to high infant/mortality rate and deteriorating security environment. Security could, therefore, also be considered as an important factor affecting demographic behaviour. Parentsgo for marriage of their daughters at an early stage due to, many others, also security considerations.People migrate from rural to urban or vice-versaon grounds of security. The policy makers and programme managerswould, therefore, have to take into account the factor of securityin the formulation and implementation of population policiesand programmes, and recommend to the authorities to improve law and order in order to ensure a safe, secure and congenial environment for socialand cultural activities. The processof socialand cultural change causedby education, especiallyfemale education, accessto information sources,communication explosion, increased level of national and international migration (like rural-urban mobility and emigrant labour/workforce in the Gulf and the Middle East,countries) has widened the generational gap, resulting in social tension/conflict which some times takes a violent form. Marriage against the consent, of parents is still socially unacceptable in tribal and traditional/rural societies. Parents/married Men/Women (Rural-urban) Although joint family systemhas not remained as strong as it used to be in the past, parents still exerciseconsiderable influence over the adolescentsand youth in the mattersof education, marriage and family planning. In urban as well as in rural areas parents take the decision on female education, and generally this decision is influenced by traditions at sub-culturallevel. For example, in Sikandarabad (Sindh-rural) Baloch-Sindhis do not favour female education. Similarly,in Cheena (NWFP-rural)parents do not favour higher education for femalesbecause 240 Cultures of Powulations: Asia Pacific Pashtoontradition does not allow freedom of movementfor girls. In all the sites,parent’s attitude towards female education is shaped by the belief that, daughters are, after all, praya maal (somebody else’sproperty). If the programmes for female literacy are to succeed,seriousefforts must be made to change this attitude of the parents. Femalesare generally subjected to discrimination in rural as well as in urban area in education, food, facilities and freedom of movement. Many adolescents/young females complained in Lahore, Mokhal Sindhwa, Mehrabwala and Lawa that parents paid more attention to the males and neglected the female members of family regarding health, education and nutrition. In rural areasthe women had to over work even during pregnancies. In Sikandarabad (RuralSindh),for example, the women had to work from 4-5 AM to 10PM. The bad working conditions for women in rural areasare seriouslyaffecting their health. Thishas led in a number of casesto miscarriage,still birth and birth of under-weight babies. In Shahpak, it was stated that almost every child born suffered from jaundice. In Mokhal Sindhwa newly married women said that they had to do a lot of work evenwhile pregnant and in-lawsdid not allow extra-food prescribed by the doctor. Theseconditionsare largely the resultof lack of education, absenceof country-wide movement for the protection of the rights of women. Due to poverty and unemployment, especially in the rural areas,the women had to perform all the rigorous duties. Programme Managers Pakistanis a multi-cultural, multi-ethnic and multi-linguistic society.The attitudes its members towards and perceptions, of population programmesand policiesare shaped by socialconditions and cultural values prevalent at various levels of society. The Programme Managers would have to take all these facts into consideration while conceiving and implementing population programmes. At present the processof policy/programme formulation is highly centralised. Due to this, certain imperativesexisting at regional and sub regional levelsare ignored. This is one reason that most of the population programmes initiated and launched during the last 40 years have failed to achieve their stated objectives. As already stated, though religion has declined as a factor and economic compulsions are increasingly influencing the fertility rate, religion is still a strong social force, especially in rural areas. No programme, therefore, can be effectively and productively pursued unlessreligious leaders at various levelsare associatedwith the implementation of the programmes. In urban as well as in rural areas, religious leaders still enjoy considerable influence. They are members of Zakat and Khidmat Committees,which gives them an added leverage to exerciseinfluence. 241 Cultures of Powulations: Asia Pacific As the resultsof 1998 Censusindicate the adolescentsand middle-age groups constitute the largest component of country’s population. There is, therefore, a need for programmes,which target these population groups. In almostall the sites,adolescentsand youth (male)are dangerouslyexposedto drug addiction. There is, therefore, an urgent need for launching programmes for the creation of awareness about the misuseof drugs and narcotics.The local community, particularly the studentsmust be involved in the designing, planning and implementation of programmes. The example of Shahpakwhere studentshave done a lot of usefulwork in creating anti-narcoticsawarenesscan be emulated. Through FGDin Sukkur-Rohri,it was discoveredthat the first stage of drug addiction among adolescentsand youth was smoking. Anti-smoking drives,therefore, should be streamlinedand more vigorously pursued. According to an estimate,there are about 4 million drug addicts in Pakistan,2 million being heroin addicts. The COPhas initiated a number of rehabilitation programmes for these addicts. But, firstly, these programmes have limited reach; and, secondly, rehabilitation programmes cannot succeedwithout a change in the attitude of community towards an addict. Generally,the community reacts by resorting to social boycott of an addict. But addicts need sympathy and support of the community. It is good that community reactsby socially disapproving the drug addiction but drug addicts should not be taunted by calling them nashaee,jehaz etc No programme can succeed unless it enjoys credibility and is consistently pursued. In Pakistanpopulation policies and programmes have not been consistentdue to political factors, and as a result, these programmes suffered from credibility crisis. During the field work we found that there was lot of uncertainty about the future of PM programme for FamilyPlanning and PrimaryHealth Care.A number of LHWscomplained about delayed payment of salariesand irregular supply of medicinesand family planning aids. There are many countries, developing and developed where cosmopolitan medical system and indigenous medical systemco-exit. In Pakistan,the indigenous medicine has its roots in the social,cultural and religious layersof the society. ’ Thisstudy has found that in a number of sites, especiallyin rural sites,traditional methods and medicinesare still in useto ensure prenatal and post-natal health of mother and child. Programmesfor reproductive health should not aim at replacing these indigenous methods; rather they should be based on the integration of two systems. A large number of Pakistaniskilled and semi-skilledworkers went to the Gulf and Middle Easterncountriesasexpatriates.Sincethe end of oil boom and, especiallyafter the 1991Gulf War, majority of them has returned. Thosewho have returned are in the dire need of rehabilitation. Northern, Central Punjab and Mekran are the most affected. Programmesfor the rehabilitation 242 Cultures of Populations: Asia Pacific of these young men should be launched, otherwise, as the team was told in Shahpak,there is a real possibility of turning many of these young men as drug addicts, drug pushersand criminals. Programmesfor the empowerment of women should be based on an improved and better mechanism of information, education and communication; otherwise such programmes may backfire. In our society, men enjoy dominance over women in all walks of life. This is accepted as part of religious beliefs and cultural values.As a wife, a woman is subservientto her husband: if she is a widow she must obey her eldest son; as a sistershe must be subservientto her brother and as a daughter she must obey her father. This tradition finds almost universalacceptance in the social-culturalcontext of Pakistan’ssociety.Any programme, therefore, aimed at the empowerment of women cannot succeed in our society without the co-operation and, of course, involvement of men. Service Providers There are a number of findings in this study that bear relevanceto service-providers.In good old days, the head of an educational institution in rural areas(head-master)used to take rounds of village and motivate the community for the enrolment of their children. This old practice should be revived not only for the purpose of enhanced enrolment but alsoto curtail the number of student absentees,and thus prevent rising level of school drop-outs. The BasicHealth Units (BHU)and Rural Health Centres (RHC)are situated at such a distance from the communities that woman do not feel inclined, unlessforced by some highly pressing need, to visit thesefacilitiesfor re-productivehealth advice.Fora better utilisationof theseservices, the service providers should visit the communities and provide the serviceat the doorsteps of the receivers.Under PM Programme for Family Planning and Primary Health Care, the serviceproviders are required to visit the community for this purpose. But they seldom do it. There is, therefore, a need for monitoring mechanismto make the serviceproviders conform to the duties fixed under the programmes. Banksand other financial institutionsshould chalk out specialprogrammes for the promotion of savingsamong rural and urban women and extend credits to the female entrepreneurs. Serviceshould conform to the objectivesof the programmes. In most of the sites,this was not being followed by the service-providersin the reproductive health sector. For example, LHWs are not meant to act as ‘lady doctors’ or TBAs;their function is to provide family planning aids and promote primary health by mobilising community for cleanlinessand hygienic environment. But in many communities, the LHWshave replaced TBAsand act as ‘lady doctors’. Women in many sitescomplained that Population WelfareCentresdo not provide family planning aids and LHWscharge money for contraceptives,due to which a large number of women are unable to adopt family planning methods. 243 Cultures of Populations: Asia Pacific Information Providers Non-availability of safe drinking water is one of the most seriousand wide-spread problem in urban as well as in rural areas. But there is no programme for the provision of information under which the affected people could be informed of the risks of drinking unsafe water. Information, educational communication strategiesshould be group specificand they should be based on the findings of this study. Thisstudy holds that __bradrism still retains its influence as a strong socialforce. Male is the head of family and is sole decision-makerin all important matters, women are considered inferior to men, religion has a strong appeal, family ties are still valued, elderly people are still respected and inter-personal channelsof communication preferred. Any IECstrategy,therefore, mustbe based on the mobilisation of these forcesand take into consideration the gender and cultural sensitivitiesof the targeted groups. An effective IERstrategy may also include public representativesi.e., MNAs, MPAsand Local Bodies Members (Councillors)for inter-personal channels of communications.The MNAs, MPAs and Councillorsrepresent quite a large number of people in their respectiveconstituenciesand exerciseconsiderable influence over them. They can be very effectiveas inter-personal channels of communication. Programmesshould be designed to brief the public representativeson the aims and objectives of population programmes and they should be requested to facilitate the implementation of these programmes in their respectiveconstituenciesespeciallyin making IEC mechanismmore effective. Policy Makers In many respectsthe findings of the study are relevant to policy makersat national, provincial and local levels. For those who may be engaged in the formulation of population policies at national level, the study points to a strong imperative of integrating the population policieswith an overallnational development strategy.The study hasfound that lack of education environmental degradation, unemployment, particularly among the educated youth, deteriorating law and order situation,poverty particularly,in the rural areasare alsoaffecting demographic behaviour. In Shahpak (Balochistan-rural)for example, the biggest problem was unemployment. In Sukkur-Rohri(Sindh-urban) the most urgent need was the provision of safe-drinking water. In Quetta (Balochistan-urban)the most pressing issuewas the easy accessto narcotics caused by free movement on borders with Afghanistan. In Peshawar(NWFP-urban)the greatest concern was the environmental degradation caused by the presence of (still) large number of Afghan refugees. All these problems are relevant to population policies. The policy-makers,therefore, should take a broader view of population problems and frame the policies accordingly. As this study found, in a number of sites,various NGOsare operating in the areasof family planning, reproductive health, women empowerment, rural credit facilities,and education. In the policy formulation processinput from these organisationsmustbe included. LocalBodiesare 244 Cultures of Populations: Asia Pacific an important component of our political system.Theseinstitutions must be involved not only in the implementation but also in the formulation of population policies and programmes. DATA COLLECTION,COMPILATION AND ANALYSISFOR IMPROVING KNOWLEDGE BASEFOR LOCAL POPULATION The contents of this section are based on experience gained through field researchactivity, interaction with community members, and general observations during the field work. The, chapteralsocontainssuggestionsasto how, in the light of field researchexperience,the techniques of data collection, and analysiscan be improved. Data Collection In this study both qualitative and quantitative methods were used for the purpose of data collection. However most of the findings are based on field researchconducted through participatory research (PRA)approach and qualitative researchmethodologies and techniques like FocusGroup Discussion(FGD),In-depth Interview/Case Study (IDI/CS)and socialMapping (SP) Quantitative data sourcesincluded the results of 1998 Population and Housing Censusof Pakistan, and data collected by National Institute of Population Studies (NIPS)in Lahore, Peshawar,Quetta (urban) and Mokhal Sindhwa and Lawa (rural) sites.The quantitative data and community profile prepared by NIPS,in respect of the sites mentioned above, was however, updated and verified through cross-checkwith the records,maintained by local bodies (wherever available), Population Welfare Department, LHWs,BHUsand RHCs.Quantitative data regarding detailsof physicalinfrastructure,descriptionand number of facilitieslike schools,mosques,churches, temples,shrines,hospitals,clinicsetc., was obtained in interviewswith key Informants,community leaders, and Service-Providers. The methods used in Qualitative Research included Focus Group Discussions,In-depth Interviews/case study, Key Informant Interviews, social mapping and observation. Interviews with key informants, community leaders and serviceproviders alsoyielded quantitative data on, for example, social composition, migration levels,proportion of school going children, number of working women, facilities and services.The combination of qualitative and quantitative methods helped understand and pinpoint the role of servicesin determining the nature and direction of socialand cultural change. Qualitative data collection largely depends upon the type of sitesthat are selected for field research, the number of participants in focus groups, selection of persons for in-depth interviews/case study etc. As it was done in this study sites were selected keeping in view distinctive socio-culturalcharacteristicsof different regions of Pakistanat rural and urban levels. 245 Cultures of Populations: Asia Pacific The task of sampling of focus group participants proved more difficult, becausefor this purpose heavy reliance had to put on local facilitators. In majority of the casesthe sampling of focus group members had to be revised in order to give due representation to the population of site. In qualitative researchthe biggest difficulty is that in somecasesthe participantswould simply refuseto speak. Theywould answerwhat you would ask. It isvery difficult to securespontaneous responses/opinions from the participants. The reason is that the community and, of course, the participants in FGD,at first, take the researchteam as a group of strangersand hesitate to open their hearts before them or divulge confidential information. The common perception of a researchteam in any community, especiallyin rural areas,is that the team was there to get something and not to give anything. At initial stagesit was always difficult to make the participants respond frankly and spontaneously.But once rapport was established, the participants would willingly and enthusiasticallytake part in the discussions. In most of the focus groups, the participants would look to each other before giving their opinions. Sometimes,there were visible signsof attemptsto hide somevital information. For this reason it is important to win the confidence and trust of the participants. In arranging the focus groups, the role of local facilitatorsis very important. They must have rapport with local community and well versed in the knowledge of local customs,traditions and problems. Since, before the start of the study, two local facilitators (one male and one female) from each site had been selected and trained in qualitative researchmethodologies and technique during a 5-day training workshop in Lahore, the team did not face much difficulty in conducting the field researchactivity. In the processof data collection, the moderator and.the note-taker hold key positions. In this study no female focus group discussioncould be tape-recorded owing to the objections raised by participants. Even in male focus group discussions,the use of tape-recorder was not liked, Only in four sites,Lahore (urban) Mokhal Sindhwa (rural) and Sukkur Rohri, and Mehrabwala (rural) focus group discussions,Key-Informant Interviews and casestudieswas tape-recorded in local language and then transcribed into Urdu. Fromthe Urdu transcription,an Englishsummary of the data was prepared. In all the sites,the technique of social mapping was used. The social mapping was done by the members of the community themselves,which showed how they viewed the lay-out of physicaland socialinfrastructurein the site.The socialmapping technique was also used to secure the following data about the sites. 1. Number and position of facilitieslike, roads, hospitals,clinics,schools,mosques,churches, temples,grave-yards,parks (playing grounds) police stations,post offices,public call offices (PCOs),Population Welfare Centres,banks, medical stores,markets,shrines,madrasasetc. 246 Cultures of Populations: Asia Pacific 2. Socialcomposition/organisation of the community members and names of tribes, castes, languages spoken, religious sects,occupations, the pattern of residential areas:whether the houses belonging to the same caste were set-up in the same locality or they were scattered.The mode of travel mostly used by the members of community. 3. Products (industrial and agricultural) produced by the community. The local production and the commoditiesthat were imported by the community and their sources.The commodities that were exported by the community and their destinations. Data-Compilation and Analysis At the end of each focus group discussion,(recording of) Key-Informant Interview and case study, the data recorded in the form of notes was re-written with additional inputs from observation and social mapping. This data was further processedby identifying the main issuesraised by participants during FGDs.The data consisting of the main issueswas analysed in the broader socio-cultural context of the community. Wherever the need was felt, the important and more significant statements of the participants were given in the form of quotes to highlight the main concerns and views of the community on major issues.The data collection and analysisprocess at each site was completed in three stages,i.e., (1) focus group discussions,in-depth interview/case study, key informant interviews, (2) integrating this data obtained through above mentioned technique in a re-written, “neat” form containing only relevant information, (3) preparing the summaryof the findings on the basis of data so collected and analysing the summaries.The findings were verified/re-checkedwith participants/membersof the communityin subsequentinformalmeetings. Participatory Research and Local Population It is obvious that qualitative/participatory researchis more challenging and presentsdifficulties at the initial stages.In quantitative researchthere are close-ended and structured questions and the researchershave only to measurethe responsesof the respondents in quantitative terms. In participatory research, researchershave to reach the people and make them speak out their hearts. In participatory researchone has to record the feelings, the perceptions, images, fears,anxieties concerns and attitudes of the people through various techniques. Experience has shown that after initial hesitation and reservations,the participants willingly talked and co-operated wholeheartedly. In majority of the sites the community members expressedtheir liking and preference for participatory research.It was, as they said, for the first time in their lives that some one had listened to them, instead of making them listen to others. The community perception of its role in participatory researchwas shaped by their belief that it gave them a real opportunity to expresstheir opinions freely, candidly and frankly. However, some seriousquestionswere also raised like, “What was the use of such researches 247 Cultures of Powulations: Asia Pacific and surveys”?At the very outset the people would askwhat benefit the researcheffort and their participation would bring to them? What difference would such exercisesmake in their lives? Since most of the areas of the country have been covered by a number of researchesand surveys,the people have lost interest in such activities. In certain casesthey simply, refuse to co-operate. The communities are accustomedto receiving the people amongst them who are perceived to inform and educate them either on some new plan for development or new programmes in social sectorslike education, health, family planning, sanitation, drainage etc. The exercise is generally monologued. But the qualitative research method was a different exercisewhich, for sure,was accompanied by inevitable difficulties. However, towards the end, the responseof the community was always positive, encouraging and co-operative. The level of participation and the productivity of discussionvaried from site to site and from group to group. Participants with comparatively higher level of education would readily comprehend the objectives of the study and respond accordingly. Surprisingly, the female participation in FGDswas higher in both rural and urban sites,ascompared to male participation. The higher female participation could be explained in terms of growing awarenessamong the women regarding their problems and rights. Morning hours were more suitable for holding FGDsfor females;whereas maleswere available only in the evenings. The communities, in all sites,were of the view that participatory research should focus on issuesand problems which are most relevant to the communities,and these researchesshould be result oriented. The community members would invariably comment that many research teamscome and go but there was no improvement in their socialor material conditions. “hat is the useof suchresearchactivitiesthat do not bring any change in the social,economic or material conditions of the communities” they would always ask every new researchteam. Suggestions for expanding the Data-Base and Improving the Participatory Research By spending only 4 to 6 daysin a community, it was not possibleto get full socio-culturaldata on the targeted population. The more time you spend, the more information you get about a community. It is better if the team mingles with the membersof community, socialiseswith them, lives,eats and behaveslike the community and talk to them in local language. As indicated earlier, moderator has the key role to play in qualitative research.In Pakistan, however,there is seriousshortageof professionallytrained and competent moderators.The reason is that universitiesand other researchinstitutions are mostly engaged in quantitative and survey research.It is, therefore, suggestedthat programmesfor the promotion of qualitative/participatory researchshould be introduced in the universitieswith a view to creating a corps of trained and professionallycompetent moderators. The researchteamsshould avoid entering the community direct for the purpose of conducting field research.There are three channelsavailable for any researchteam to reach the membersof 248 Cultures of Populations: Asia Pacific community. Firstly, the activists/members of community based organisation (CBO) and Non-Governmental Organisations (NGOs).Secondly, the college and university students and, thirdly; the local influentials, chaudhris, numbardar, councillors etc., of these three groups, the students particularly the university students are the most useful in establishing the contact between the community and the team. In rural areas,every possible effort should be made not to hold FGDin the open, becausein that casemany unwanted personswould join the participants in their curiosityto watch and listen to the proceedings. In the context of socio-culturalcontext of our villages,it becomesvery difficult to ask these “unwanted” participants who are mostly elders of the participants, to leave the scene. If, even such a situation arises, it must be handled with care. Any mishandling can jeopardise the whole exercise. Prospects of Participatory Research in Pakistan Thisis an issuethat needs a detailed and elaborate discussion,which obviously is not possible in this Chapter. However, following observationsmay help highlight some of the aspectsof the problem. 1. In Pakistan,the ‘Social Sciences’is a neglected sector and research in Social Sciencesis rather negligible. In the Universitiesof Pakistan,the facultiesof SocialSciencessuffer from a number of problems: insufficient funds for research,shortage of staffand lack of research facilities.If measuresare taken to promote researchin SocialScience,both quantitative and qualitative researchapproaches can benefit. 2. Qualitativeor ParticipatoryResearchApproach, despite its obvious merits,is not a substitute for quantitative research.But sincein Pakistanmostof the studiesin demographic behaviour, i.e., Fertility, Family planning, Reproductive health, Mortality, Migration, STD,AIDS, HIV and Drug abuse, have been conducted using quantitative (survey)methods, need is being strongly felt to supplement quantitative data with qualitative researchin order to achieve the objectivesof population policies aschalked out in Programmeof Action of Conference on Population and Development (POA-CPD)held in Cairo in 1994. In the Universitiesof Pakistan,very little social researchhas been conducted using the PRA techniques. There, in fact, exists,a bias against PRAamong some of the senior members of the facultiesof socialsciencesin the PakistaniUniversities.The situation is likely to persistif sufficient effort is not made to create awarenessabout the relevance of PRAfor achieving desired results in population programmes. 249 Cultures of Populations: Asia Pacific CONCLUSIONSAND RECOMMENDATIONS The major conclusionand recommendationsbased on the findings of the study are presented below. Although Pakistanhas witnessed a rapid processof social and cultural change, it still retains its major ethnic, social and cultural traits, which vary from region to region and from area to area. There are four major ethnic and language groups in Pakistan.Punjabis,who inhabit the (largest)province of Punjab, the Sindhiswho live in the province of Sindh, Pathanswho are the inhabitants of NWFP and some areas of Balochistan and Baloch whose homeland is called Balochistan.Each of these ethnic groups has different language, traditions, customs,practices and socialsystems.Combined together, thesecharacteristicsare called socio-culturalenvironment. This socio-cultural environment determines the attitude, perception and behaviour of the community that lives in it towards issuessuch as gender equality, empowerment of women, female education, marriage, fertility, family planing, sex and reproductive health. In other words, varioussub-culturesexisting in Pakistanisocietymustbe recognisedasrealities, despite the fact that Islamis the common religion of more than 90 percent of its citizens,and it continues to be the primary base of their value and belief system.Ethnic diversities,cultural variations and existence of sub-cultures create strong imperatives for the population policymakersand programme managersof Pakistanto design, formulateand implement suchpopulation policiesand programmesfor the country that take into account the sensitivitiesof the communities living in different socio-culturalenvironment. The religion of Islamis raisond’etre of Pakistanand a very strong motivating force. As already stated, it is the common faith of the overwhelming majority of the population of the country. Its’ appeal, therefore, is nation-wide; and for this very reason it cannot be ignored or by-passedas a social factor affecting demographic behaviour in Pakistan.The religion of Islamfunctions not only as a basisof the value and belief system,it can also be used as an effective social control mechanismagainst pre-marital or extra-marital sex to avoid unwanted pregnancies or sexually transmitted diseases. Tribalism,SardariSystem,bradrism Casteand joint family systemexist in Pakistanas different versionsof social system.Although the processof social and political change has led to some erosion of the influence of these social forces, they still constitute an important component of socio-cultural environment. Population policies and programmes must take into account these social realities. It is not only the socio-cultural environment but also specific needs of the community that play crucial role in determining the attitude of its memberstowards health, fertility, reproductive health and family planning. For example, the community in Sikkur-Rohrisaid that their most 250 Cultures of Populations: Asia Pacific pressing problem was the non-availability of safe- drinking water. The youth in the samecommunity said that due to unemployment their marriageswere delayed. In that casethey had no other option but to resort to homosexuality,pre-marital activities,thus running the risk of sexually transmitted diseases. In a community where health care for mother and child is a pressing need in view of high level of infant/child mortality, the emphasison family planning becomes irrelevant. In a social environment marked by violence, strife, terrorism and warfare, family planning would have no appeal unlessdeterioration of law and order conditions is arrested and security of life, property and however is assured. It is, therefore, imperative that policy-makers and programme managers at national level recognise the link between political stability, (security)and strategiesfor population policies and programmes. Before providing information and services,it is necessaryto assesspeoples’ needs according to their perceptions. These perceptions are shaped by the value systemof their sub-culture. It clearly follows, therefore, that without knowledge and profound understanding of various components of socio-cultural environment, the aims and objectives of population policies and programmes cannot be achieved. Recommendations Thisstudy has identified a number of socialand cultural factorsthat are operative on national, regional and sub-regional levels,and influence each of the three components of demographic behaviour i.e., fertility, mortality and migration. In the context of Pakistan’sgrowing population problems, the significance of such a study and its findings can hardly be overestimated. It is, therefore, imperative that those who are concerned with the processof policy formulation and programme implementation in the areas of population welfare at national, regional and local levelsmust be aware of the implications of these factorsfor the formulation and implementation of population policies and programmes. For this purpose a number of recommendation are made. Theserecommendations are presented, keeping in view the expectations, preferences and needs in health, reproductive health and education of various population groups. 1. SincePakistanis a patrilineal society and male dominates the decision making processin all matters,including family planning and reproductive health, it is necessarythat in the processof policy formulation and programme execution, male involvementand participation is fully ensured. 2. Population growth is closelylinked with mortality.As a long-term measureto check population growth, population policies and programme should focus on reducing the infant/child mortality rate. 251 Cultures of Populations: Asia Pacific 3. Population policies and programmes should be so designed as not to reinforce the perception that their sole objective is family planning: rather, other aspectsof reproductive health i.e., health care for mother and child, women empowerment, environment improvement should receive equal emphasisin population policies and programmes. 4. SinceIslamis the common faith of the overwhelming majority of Pakistan’scitizensand a great motivating force, religiousleadersshould be associatedwith the design, conception and formulation of population policies and programmes. A reference for this purpose may be sent to IslamicIdeology Council. 5. Separate and special programmes for the empowerment of rural women should be designed and launched in collaboration with NGOsworking in rural areas, the elders and religions leaders. 6. Elected members of Local Bodies, should be involved in the design and the implementation of family planning and reproductive health programmes and IEC packages. Arrangementsshould be made for periodic briefingsfor elected representativesof national, provincial and local levels on the nature, objectives and significance of population programmes,and the need for their involvementand participation in the implementation of these programmes. 7. Measuresshould be taken to eradicate the evil practicesof tuition and coaching centre for adolescents.Instead school hours should be lengthened and number of holidays in educational institution reduced in order to ensure that school-going children are able to spend more time in schools.In the schoolsfunds for sportsactivitiesshould be increased. Text-booksshould be revisedas to contain information on reproductive health, environment and pollution problems. 8. In the context of Pakistaniculture and sub-cultures,for adolescentsand young (maleand female0 discussionon sex and sexuality is considered as taboo, parents and teachers should be encouraged and persuaded to serveas the sourcesof information on sex and sexuality for adolescents. 9. The scourge of drug abuseand narcoticsuse is fastspreading among the adolescentsand youth. The processbegins with smoking. Specificlaw should be framed and enforced for banning the sale of cigarettesby retailers to the minors. 10. Information, education and communication strategies for family planning should be designed while keeping in view local customs,traditions and valuesexisting adhered to in particular region or area. The IECmessagesshould be in the language of local community, using appropriate and popular symbols. 11. Although in Pakistan,the level of urbanisation is still low and the majority of population lives in rural areas,the country is witnessing a very fast rate of migration from rural and 252 Cultures of Populations: Asia Pacific urban areas.Thishasled to concentrationof population in citieswith itsattendant problems and alsolossesto rural economy.Effectivemeasuresshould be taken to check the increasing rate of migration of people from rural to urban areas. 12. In many areas, especially in rural areas,male opposition to female education still exists. After identifying suchareasand regions, male population in theseareasshould be targeted with effective IECmessageson the significance and usefulnessof female education. 13. In rural areasand in certain regions like NWFP,large familysize,particularlygreater number of sons,isdesiredfor improvementin familyeconomicstatusand security.Povertyalleviation programmes for rural areas and measure for improving law and order should become integral part of population strategiesand programmes. 14. At almost all sites, indigenous (traditional) and cosmopolitan (modern) methods in health, including reproductive health, co-exist. There is a greater need for recognition and promotion of latter to the extent that they do not produce harmful effects.It is better that programmes based on the collaboration of the two systemsare introduced with particular emphasison projecting the positive effectsof traditional methods and supplementing the former with the latter. 15. In Quetta (Balochistan-urban)easyaccessdue to unchecked and free cross-bordermovement, was said to be the main reasonsfor the spread of drug abuse and narcoticsuse. It is recommended that strict watch and vigilance should be maintained on international border with Afghanistan where due to the Taliban phenomenon. Pakistan-Afghanistan boundary has virtually ceasedto exist. 16. In Shahpak (Balochistan-rural)the participants of FGDfor youth told that asa result of the return of a large number of expatriates from the Gulf countries, young people face a lot of problems like unemployment and alienation from the prevalent socio-cultural environment. It is recommended that a special researchstudy should be launched in Mekran coastalareasto identify the nature and direction of socialand cultural change caused by the return of expatriates. 17. In Sukkur-Rohri,the participants in FGDfor service-providerssaid that a large number of maleswere involved in extra-maritalactivitiesand unsafesex.At the samesite participants in FGD for Married Women complained about the inadequacy of health servicesfor sexually transmitted diseases.It is recommended that a surveyon the incidence of STDs should be conducted in Sukkur-Rohri,Peshawarand Quetta, and the provision of health servicesfor STDsshould be made part of health and reproductive health programmes. 18. In Pakistanthe parents, particularly among the poor segmentsof society, have the proclivity to produce more children. They do it, partly, becausethey are not aware of, or do not acknowledge the rights of children to education, better health etc. In order to check 253 Cultures of Populations: Asia Pacific the population growth there is a need to mobilise the communitiesfor the recognition of and grant of basic rights to the children. 19. Effectivemeasuresshould be taken to improve and reform the educational system,especially in rural areas. 20. Finally it is recommended that similar studiesshould be conducted in other sub-cultures which have not been covered by this study like Tribal areasin NWFP,Gilget, Baltistanand Balochistan,Cholistan (SouthernPunjab) and Tharparker (Sindh). 254 Cultures of Popularions: Asia Pacific REFERENCES l l l l Arif, G.M. and SabihaIbrahim, “The Processof Urbanisationin Pakistan”,Pakistan Instirure of DevelopmenrEconomics,Islamabad. l Welfare,1999)p.5. In 1901,the population of the areasnow constituting Pakistanwas 16576,000.In 1947it was 325,00,000.In 1972, the population roseto 65309,000.According to 1981Censusthe total population was 84254,000.Similarly,the percentageof annual growth rate rosefrom 0.6 in 1901:1.8in 1947 to 3.6 in 1972.The 1998Censusshowsa fall in annual growth rate to 2.6. Ibid. qualitative Investigation into the Useof Withdrawal, Final Report ResearchReport No. 6., (Islamabad,Population Council and Ministry of Population Welfare, 1998) A Sodiq, Nafis,“Towardsa More Focused Population Policy” in Rafi Raza.,ed. Pakistan in Perspectives (Karachi,Oxford UniversityPress, 1997)pp. 276-99. Abdul Hakim,ReproductiveHealth - Including Family Planning in Pakistan (Islamabad, National Institute of Population Studies,1998) . G.M. Arif and SabihaIbrahim, “The processof urbanisationin Pakistan”,PakistanInstitute of DevelopmentEconomics(PIDE), l l G.M. Arif and Muhammad Irfan, “Population Mobility acrossthe PakistaniBorders”,The PakisranDevelopment Review, 36: 4 Part II (Winter, 1997)pp. 989 - 1000(lslamabad, PakistanInstitute of DevelopmentEconomics, G.M. Arif, “Remittancesand Investmentsat the HouseholdLevelin Pakistan”ResearchReport NO. 166.(Islamabad,PakistanInstitute of DevelopmentEconomics,1999),Seealso “Period Without a Job After Returning from the Middle East:A survivalAnalysis”,G.M. Arif, The Pakistan Development l l l l G.M. Arif and M. Irfan, “Return Migration and OccupationalChange.The caseof Pakistani Migrants Returnedfrom the Middle East, ” The Pakistan Development I (Spring, 1997)pp. 1-37 Review 36: and Pakistan Country Report (Islamabad,Ministry of PopulationWelfare, 1999) p.10 Review, 35: 4, PartII, (Winter, 1996)pp. 805 - 822 (lslamabad). Governmentof Pakistan,Population Development: 1997). l Governmentof Pakistan,Popularion and Development Pakistan Country Report for KPD +5 (Islamabad,Ministry of Population l Governmentof Pakistan.Population Growth and Its Implicationson Socio-EconomicDevelopment in Pakistan(Islamabad,National Institute of Population Studies,1998)I?I Abdul Hakim,John Cleland and Mansoor-ul-Hassan Bhatti, Pakistan Fertility and Family Planning Survey (Islamabad, PakistanInstitute of Population Studies,1998) P.115 Governmentof Pakistan,Planning and DevelopmentDivision (Populationand Social Planning Section),Population Projectionsfor 9’“/PerspectivePlanPeriod (1998-2003). Governmentof Pakistan,Population and Development:PakistanCountry Report, for ICPD 255 Cultures l of Powulations: Asia Pacific (Islamabad,Ministry of Population Welfare, l 1999) l l l Ibid., p.7 Abdul Hakim,John Cleland and Mansoor-ul-Hassan Bhatti, op. Cit., p.133. Governmentof Pakistan,PrimaryHealth Care Cell, Ministry of Health, PM Programmefor FamilyPlanning and PrimaryHealth Care, SecondEvaluation,p. 15 l PakistanInstitute of DevelopmentEconomics. l lslamabad(unpublished article) l Zakar,Zakaria,Muhammad, l l l l l l l l l Population Council, Pakistan,The Gap between ReproductiveIntentions and Bahaviour:A Study of PunjabiMen and WomenIslamabad,1997) pp. 35, 36. Abdul Hakimand others, op. cit. pp. 143, 144. Governmentof Pakistan,Ministry of Population Welfare, 199,op. tit, p.36. Governmentof Pakistan,Ministry of Health, Country Report for ICPD+ 5, op. tit, p.46. According to a surveyconducted by National Institute of Health (Islamabad)there have been so far 168AIDS-relateddeathsin Pakistan.Out of 2.3 million peoples surveyed1378have been found HIV positive. The largestnumbersof HIV positive caseshave been found in Sindh, whereasin Northern areasno suchcaseshave been discovered.The News,June 17,1999. GM. Arif and Muhammad Irfan,” Population Mobility Acrossthe PakistaniBorder”, The Pakistan Development (Winter 1947,I? 991. l Bid, p. 993. 256 Review, 36: 4 part II G.M. Arif, SabihaIbrahim, “The Processof Urbanisationin Pakistan”, Co-existenceof Indigenous and Cosmopolitan Medical Systemsin Pakistan (VerlagHansJacobs,1998)pp. 12, 13.Seealso Said,HakimMuhammad, “the Unami systemof Health and Medicine” in Robert H. Bannerunan, John Burton and Chen Ven-Chieh,Traditional Medicine and Health Coverage (WHO,Geneva, 1983) pp. 61-67 Cultures of Populations 1 ‘p t ‘4 9 Qo % 4CIFK SOCIO-CULTUREPROFILEAND DEMOGRAPHICBEHAVIOURINUZBEKISTAN Marat Khadjimukhamedov’ U zbekistan has been an independent state for lessthan ten years.According to statistical data, the population of Uzbekistan was 24.136 million people at the end of 1998. For this relatively short period, the country has witnessed improvement in social sectors. Nevertheless,Uzbekistan as a newly independent state still facesmany complex problems. It is important to better understand the demographic dynamics of fertility, mortality and migration in their socio-cultural context in order to design and implement population and development policies and programmes. Currently, Uzbekistan indicates a relatively high birth rate and an increasing population growth rate. However it is also noted that there is an increasing trend in the practice of family planning as growing numbers of couples want to use family planning methods. The Oliy Majlis (Parliament)of Uzbekistan adopted the Family Code of Uzbekistan in May 1998; this Code is a legal document regulating the rights and duties of men (husbands),women (wives), parents, children, and the relations among the family members. The present paper discussesa literature review, and also the resultsof a field study undertaken on the socio-culturalfactorsand demographic behaviour during 1999-2000.Among the important factors discussedare: 1) traditional attitudes, perceptions, and values in relation to individuals, family, community, and society acrossgenerations, 2) cultural beliefs and practices regarding population, development, and environment, 3) cultural and ethical values as represented in lifestyles,including family life and family relationships. Sociological researchin Uzbekistan has discussedsome key factorsthat shape social-cultural norms and values on: 1) family, parents, kin; 2) society - makhalla (community); 3) relatives, friends, colleagues: 4) massmedia; 5) school and other educational institutions, the systemof education. * Member, Centre ijrimoy Fikr, Tashkent, Uzbekirfon 257 Cultures of Populations: Asia Pacific The recent study was aimed at the following: - to reveal the nature and specificsof socio-culturalfactorsaffecting demographic behaviour of different social stratain the country; - to identify the attitudes of different socialstratatowards fertility and family planning; - to identify the factorsaffecting mortality; - to identify the attitudes of the population towards migration and main factorsof migration and specificsof migration behaviour; - to identify the functioning of the education system. SOCIO-CULTURALFACTORSAFFECTINGDEMOGRAfHK BEHAVIOUR Below we discussthe findings of a study undertaken in the country during 1999-2000. The purposive samplewas selected from the following four regions of Uzbekistan: The Republic of Karakalpakstan,Khodjeili rayon: Kashkadaryaregion, Yakkabag rayon Samarkandregion, Chelek rayon Tashkent(the capital- city) The methodology involved FocusGroup Discussions(FGDs)and indepth interviews at the study sitesamong the selectedage groups. In the four regions, 39 FGDsand 12in-depth interviews with couples were conducted. l l l l Nuptiality Earlymarriage On the whole, participants’ attitude towards early marriage can be described as a negative one. The main reasonsgiven were physicaland material ‘non-maturity’ of the intended spouses; the lack of life experience; the lack of practical skills of household activities. As a rule, early marriagesare initiated by parents.Participantsperceiveearly marriagesasa phenomenon intrinsic of the MuslimUzbeksculture.Many reasonsfor early marriagesgiven by participantsare asfollows: traditions,big number of children in the family,prearranged marriagesfor financialreasons. Fertility Fertility preferences In spite of economic hardships,for many families,particularly those of rural areas,a big family remainsdesirable, for participation in agriculture. Adult participants of FGD,especially in rural areas (Chelek and Khobjeili districts),say that Cultures of Populations: Asia Pacific they would like to have many children. An ideal number of children for the groups polled, is 3 to 4. The majority of FGDparticipants consider that four children would be a perfect number, but the economic conditions prevailing make it difficult to have so many children. Many young people feel that if the economic situation remainsweak, it will be impossibleto support a large family. There were very few women who said the number of children should depend upon the woman’s health. Preferencefor male children Most FGDparticipants at all sitesfeel that, ideally, in a family there should be both boys and girls. There is a strong preference for having sons.The main reasonsgiven are: father’ s societal statusincreaseswith the birth of a son; the birth of a son supposedly guaranteesa protected and well-off life for the parents, when they age, as the son normally staysin the parents’ house; a boy is the bearer of the family, and often inherits his father’s profession. In many cases,stability in the family depends on whether there is a boy. If there is no boy, parents and acquaintances could put pressureon the family. A husband can also abandon his family if his wife ‘could not’ bear a son. Aqe of the FirstChild-Birth Main reasonsgiven for the age of the first childbirth: Material (economic)independence, the ability to maintain family (it is expected of men, in the first place). Woman’sorganism is ready within these age limits to conceive, deliver and feed the child. Determining the first childbirth age for women, a main factor is her ability (maturity) to carry and give birth to the child. The main criterion is a physiological one, in this case.As for men, the preferred age of having the first child is based on his ability to maintain a family economically. In this case,the criteria of assessingmaturity and readinessto have a child are economic and social factors. l l l Age of the LastChild-Birth If the first birth started between the ages of 20 and 23, childbirth should stop around the ages of 35 and 40. Main reasonsgiven by participants concerning the age of the last childbirth can be conventionally divided into the following groups: the adherents of establishinga limit of fertile age for women and the opponents of establishing a limit of fertile age for women. Someparticipants think late childbirth is not only a regular thing, but also has positive affect for woman’s health. On the other hand, main reasonswhy late pregnancy and childbirth are considered by some to be inadmissible: 259 . Cultures of Populations: Asia Pacific Deterioration of woman’s health/the beginning of natural ageing process: Difficulties in bringing up children and generation conflicts are likely to occur due to the large gap between the ages of the parents and the children. It is inadmissiblefor moral reasons.Period of adolescence-adulttransition may coincide with the period of parents’ ageing. l l l Socio-cultural dimensions of fertility control From the participants point of view, matters related to family planning have become particularly acute in the recent years. The main reason for this is said to be the deterioration of the economic situation of some families(including the lack of permanent employment and housing etc.). Factors of Migration The most socially significant migration flow is from rural to urban areas.In urban areas,the growth of migration from rural areas is still significant, yet the magnitude of this growth has somewhat decreased. Another major type of migration is the migration from urban to urban areas.It is between 1.5to 1.7timeslessthan rural-urban migration. The main migration itinerary is from smalltowns to big cities.There is also migration within rural areas.Despitethe predomination of rural population (62%),migration among rural areasis relatively small.Rural population is characterised by low migration mobility. In 1997, rural-rural migration only 14.7 of the total in-migration number. Socio-cultural factors affecting mortality and morbidity l STD-HIV Many FocusGroup participants know what sexually transmitted diseasesare. Youths in rural areas are the least informed on this subject. Many FGDparticipants of these groups could not name a single sexually transmitted disease.Among venereal diseases,only AIDS, syphilis and gonorrhoea were named. Among the STD,the FGDparticipantsnamed fungal and communicable diseases,hepatitis and tuberculosis.The rural young people of 14-16years old appeared to be the least informed, and some had not even heard of AIDS. Participantsgave the following reasonsfor the spread of HIV/AIDS: migration increase,(particularly labour migration), immoral behaviour of husbands, poor social and family control over the women’s behaviour, inefficiency of STDand HIV detection. Someof the participants stated there are possibilitiesof decreasing the risksby using condoms.Many participants think that one can avoid being infected, by observing basic hygiene. Many FGDparticipants suggested that compelled migration and social isolation should be applied against diseasecarriers.The same measureshave been proposed for prostitutes. 260 Cultures l of Populations: Asia Pacific Domestic violence Participantsof the discussionsknow women who committed suicide. Participantsare accustomed to domestic violence towards women, even during pregnancy. The majority of women committed suicide because of rape, conflicts with the mother-in-law, financial hardships, and adultery. l Foetal, infant and children mortality As the main reasonsfor foetal, infant and children mortality, and also the physical disability of children, FGDparticipants mentioned the following: low welfare; poor and unbalanced food available for mothers and children; female diseasesand anaemia experienced during the pregnancy; physically demanding work in the house and in the field for women (imposed by motherin-law and husband), even during the last months of pregnancy; negative attitudes towards vaccinationsand immunisation; frequent pregnancies; extramarital pregnancies; parents abuse of alcohol and drugs; marriagesamong close relatives. l l l l l l l l Socio-Cultural Relevance of Services and Information The situation in Uzbekistan is characterised by poor knowledge of family planning issues, sexuality,STD,up-to-date contraceptive methods and safesexual relations, etc. Thisis related to the shortage of qualified specialistsand the absenceof a sexualeducation system.Again, people rarely visit state health institutions (women’s consultativemedical institutions, health centres for STDand dermic diseases),becausethey do not always guarantee anonymous and free aid. l inter-personal communication The parents’ role in sexualeducation of children is extremely small.FGDparticipants said that the Uzbek families (especiallyrural areas)are not accustomedto familiarise children with basic sexual literacy and education, and parents (mainly mother) at most provide children with the information on hygienic rules. However, the least reliable source of information for adolescents is their closefriends. Youth (17-24years)groups said that the parents’ intolerant attitude towards sexualeducation is often the biggest obstaclein acquiring knowledge of sexuallyrelated matters. For example, some participants said that people in Kishloks (villages)usually have a negative attitude towards girls and sexuality.Due to the traditional lack of information for children about sexual life before marriage (wedding), close relativesand friends undertake the task to inform the newly married couple in order to prepare them for the first marriage night. 261 Cultures l of Pooulations: Asia Pacific Information programmes Massmedia (including television)is the main sourceof information for the vastmajority of the population. Generally, in all the sites,there is a systemof national and local TV broadcasting. Programmesof the national TV channelsare mostly educational, whereas local channelsmainly broadcast entertainment programmes.Videos and massmedia have the strongest influence on the perceptions of sexual life among adolescents(14-16years). Most of the FocusGroup participants said the information on sexuallytransmitted diseasesis received through friends, printed media, and TV broadcasting. There were very few who said they had learned about these diseasesfrom a medical doctor. The confidence in the safety of using condoms is undermined by massmedia (including TV), when there is reporting that HIV can penetrate through the condom. Participantsof our study mentioned a gap between the available information on family planning, and the possibilitiesto apply their knowledge. l Adapting the language of IEC Participantssaid that they were extremely unsatisfiedwith the language used in the educational materialand programmes,aswell asthe manner in which these programmeswere conducted. In certain cases,it was due to the employment of lexicons that are not understood by the population, therefore rendering the material and programmes ineffective. l Availability of the information Despitethe abundance of printed massmedia and newspapersin Uzbekistan,their audience is quite limited, mainly due to high prices of some newspapers. One of major factorsimpeding rural population to have easy accessto information sourcesis the lack of publicly distributed periodicals that would highlight educational problems, not global socio-political events.One of the most acute problems is the shortage of the ‘family-oriented’ periodicals that provide the general public with information and education on familylife issues,reproductivehealth, education processetc. The nationally distributed periodicals do not meet the current demand. Health services l Care system In all sites there is a well-organised systemof the so-called women’s consultations. These medical consultativecentres are engaged in maternal and child health care. They short-listand conduct systematicmedical check-up of pregnant women, and provide consultationson family planning and reproductive health. Medical experts participating in FCDssaid there are serious problems within the health care systemof the republic. One of the major problems is, in their opinion, the shortage of funds to run health institutions.All health institutionsin all the sitessuffer from the shortage of medicinesand medical instrumentsand devicesetc. Expertsalso noted that neither new equipment, nor major refurbishing have been provided for their medical institu- 262 Cultures of Populations: Asia Pacific tions for severalyears.Rural doctors feel that urban medical institutionsare better equipped than the rural ones. l Qualified medical staff Another major problem of state-run medical institutions is the shortage of qualified medical staff.Many qualified medicsin the rural areasearn additional money with non-medical activities or private medical practice, because they are not given sufficient salaries.Those rural doctors who remain and work in statehospitals,clinicsetc. have to spend a lot of time working their land to earn more money through agricultural activity. EXPECTATIONS AND PREFERENCES FOR SOCIALSERVICES (EPEClAllY IN FEMALEEDUCATION) In Uzbekistan there is no private education system,while the state program of education is uniformly designed for all the regions of the country. Uzbekistan is rare among the developing countries, with nearly universal literacy (in 1997 literacy indicator was 99.13% of the adult population). l low salary of teachers Despite significant exempts and privileges, a low salary urges teachers to earn additional money through domesticagriculturalactivitieswhich isa main reasonfor poor quality of education. 30.16% of teachershave additional income from selling agricultural products they grow. 7% of teachersare employed part-time. It is estimatedthat 6% of teachersare engaged in smallbusiness activities,besides teaching in schools. l Perception about the education of boys and girls The resultsof the study show that participants are generally positive on the coeducation of boys and girls. However, a common problem related to coeducation has been found in all study sites.When studying, in the school subjectsrelating to either sexuality or the human body etc., boys and girls feel ashamed.Adolescentscannot afford questioning on the topic they are interested in, and even refuse to participate in discussionand so on. This results in a low level of sexual education. At some schools,separate lessonson sexual literacy and hygiene are taught for girls. However, boys are not provided with such lessonsat all. If parents need to choose whom to educate, they usually choose the son. Society perceives an educated young man as a good match, whereas a fiancee with higher education is likely not to blindly obey her mother-in-law who will attempt to make her do arduous household work. An educated young man is more likely to find a job than an equally qualified girl. He will maintain not only his family, but also his parents when they age; a girl will marry, and her education will 263 Cultures of Populations: Asia Pacific be of no practical benefit to her parents. An indirect confirmation of the fact that public opinion is positiveon the young men continuing their education isthe data on the factorsfor men affecting age at first marriage, obtained from FGDsin both rural and urban areas. CONCLUSION The situation in Uzbekistanis characterisedwith a poor knowledge of family planning related issues,sexuality, STDs,safe contraceptive methods and safe sexual relations. This is due to the shortage of qualified specialistsand the lack of a sex education in the school system.People do not often visit state health institutions (women’s consultativemedical institutions, health centres of STDand dermic diseases),becausethey do not always guarantee anonymousand free aid. The opinions of participants of rural/urban, male/female, youths, massmedia and expert groups concerning family planning issuesmay be described as quite similar and tolerant ones. The population, including the rural one, has either neutral, or positive attitudes towards family planning. In the discussions,no negative opinions were expressed,though these opinions were frequently heard in the recent years. RECOMMENDATIONS l Involving men In family planning programmes The systemof local advisory centresfor reproductive health and family planning for women now is quite well developed. However, there are no consultative-preventivecentres which would work with men, in Uzbekistan.Therefore, the establishmentof such centres is necessary to solicit the participation of men in family planning, and educate them on sexual matters.For example, at a reproductive health centre medical staff should include male doctors. Taking into consideration the typical Uzbek family, the information on the advantages of family planning should be addressednot only to women, but also to husbands,mothers-in-law etc. l Decentralising In public information campaign activities aimed to disseminatefamily planning ideas to all strata of Uzbek society, including traditionally oriented families, it is necessaryto develop ties and co-operation between governmental agenciesand progressivereligionistsand school theologians. One possibility of this interaction can be the elaboration of information materialsand topical lectures etc., based on the citations from sacred books. 264 Cultures of Populations q ?& P , ,‘$ .i %TES CULTUREANDDEMOGRAPHICBEHAVIOURINMORROCO Mokthar El Harras* 1NTRODUCTlON A vailable demographic data indicatesthat Morocco is in a phaseof demographic transition, which started about 2 decadesago. The processstarted with a decreasein the grossrate of mortality from 19 to 6.3 per thousand between 11962and 1997. However, the rate remainsrelatively higher in rural areasthan it is in urban ones (7.9 as against 5.0 per thousand). As for decreasein maternal mortality, it remains relatively insignificant, mainly in rural areas,as the rate only changed from 359 to 332 deathsper 100,000births between the periods of 1978-84 and 19859. Crude birth rate was estimated at 52.5% in 1960 and decreased to 26% in 1995 (26.6% in rural areasand 20.5% in urban areas). Under the impact of the flow of rural people towards urban areas,Moroccan urban population became three times higher between 1960 and 1994.As a result, cities became more populated than rural areas, creating thus an unprecedented historical event in Morocco. Rural migration towards cities reached its peak in the 1980sbecause of drought. The number of rural people who headed towards citieswas estimatedat 113per 1000 every year during the decade of 1970, but raised to 193 between 1982 and 1994. A significant fact is that for the first time, migration of femaleswas slightly superior to that of males.Daughtersand wives deliberately chose to join the head of the family to live together in the city. Thismigration flow has largely contributed to the “modernisation of migrant women’s demographic behaviour.” Objectives and Scope of the Study Demographic behaviour is a manifestofor social representationsand values,and brings into play ideasand beliefs,which are interpreted, in variouswaysby socialgroups and local subcultures. It is thus crucial to elucidate the socio-culturalcontext in which it belongs in order to bring out the factorswhich contribute to its reproduction, the change dynamicsand its input on individuals and society. 265 Cultures of Populations: Arab States It is important to tackle the issue of demographic behaviour not only through external observation of the effectsit has both on society and economy, but also by bringing to light the motivations which tend either to reproduce or change it, and the socio-culturalreasonswhich lie behind the utilisation or non-utilisation of available services. On the other hand, it is crucial to back up the available quantitative data with qualitative data on the actual demographic practices.The issueof demographic behaviour must necessarily be viewed from a wider perspectiveto allow an analysisof reproductive health and phenomena related to migration, urbanisation, and socio-culturalchange. No lessimportant is the study of people’s perceptions and attitudes concerning educational and demographic behaviour. The elucidation of expectationsand preferencesas regards social, educational, sanitary,and informational servicesmakesit possibleto depict the local population’s aspirationsand the gaps between the way educational and sanitary institutionsactually function and the way people expect them to. In order to reflect someaspectsof socio-culturalphenomenon of diversity of the selectedsites (urban, peri-urban, rural) and the age and sex categories (male and female adolescents,young people, men/women) involved, it has been possibleto bring out the effect of the local subculture on people’s expectations, as well as the differences and similaritiesof perceptions between sexesand generations. The immediate aim of the study is to elucidate elements which are necessaryfor the implementation of programmesdesigned for the population, and thus formulateappropriate messages in the domains of health including Reproductive Health and Education,while taking into consideration socialconstraints,family stakes,and aspirationsof the groups and individuals concerned. It is hoped that the resultsof the present study will serveto improve the ratesof participation of people in sustainable development programmes and maintenance at school, mainly as concerns little girls in the first cycle of Fundamental Education in rural areas.It is also expected that these resultswill make it possibleto identify the needs and levelsof knowledge among the target population, and to start up the project “Education for all” through the meansof interactive television. Sample In order to expound the diversity of the socio-cultural contexts, which affect demographic behaviour, it was decided to carry out the present study in four provinces including Essaouira, Fes(-Medina), El Kelaa Sraghna,and Ouarzazate. Except for Fes (Medina), the other three provinces were retained by the Social Priorities Programme (BAJ)among 13 other provinces as the most disadvantaged ones concerning the development of their socio-economicand cultural potentialities. 266 Cultures of Populations: Amb States In each of the four selected provinces, the researchteam had to choose sites.Thus,Essaouira Medina was chosen as an urban site, Ain Bida (CR)as a peri-urban site, and Zemrane Charquia (CR)and Tazarine (CR)as rural sites.These communes are characterisedby a given size of the population and number of households. Methodology The researchteam used qualitativesurveytechniqueswhose major quality is to promote participation of the local population. In each site, six focusgroup sessionswere organised and involved three age categories and people of both sexes.The population thus included male and female adolescents(age 14-18),young people (age 19-29),and adults (age 30-50). The researchteam also collected twelve life storiestold by aged people of the two sexes. The choice of the siteswhere focus group meetings could be held appropriately leads us to take into consideration the following: Facility of access regarding both the distance to the meeting location and the social image it haswithin the community (especiallyimportant for women) Confidentiality had to be guaranteed to allow for free and open discussions Neutrality had also to be guaranteed by avoiding meeting placeswhich are overloaded with political or ideological ideas Quietness and avoidance of noise and disturbing elements Availability of a relatively comfortable room. On the basisof these considerations,we held our meetings in such locations as the health centre, school, facilitator’s house, community member’s house, and the premises of the co-operative.As for time, we had to avoid weekly market days,Moslem celebrations,and visiting days to the health centre. Moreover, we considered necessaryto avoid the following mistakes: Inviting people who speak different languages (e.g. Arabic and Berber) to attend the focus group session Inviting people who share the samehouse, the samebuilding, or work in the sameplace Inviting representativesof the authority, be it administrative,social, or symbolic Bringing together people who belong to antagonist families,villages, tribes, sects,etc. Bringing together people of the opposite sex, or people with great differences of age, instruction, or property Besides,forty-five resource people were interviewed including medical doctors, male and female nurses,certified midwives,traditional midwives, male and female school teachers,agricultural engineers, male and female populisers, school headmasters,presidents of the communes, l l l l l l l l l 267 Cultures of Populations: Arab States locally elected people, CTAdirectors,people in charge of feminine clubs,FamilyPlanning centres, irrigation associations,social assistants,etc. This technique was used to define the practices, expectations and points of view of serviceand information providers. We used also national and regional statisticsto present the studied areas,to complete the qualitative data, and sometimes, to give a (( scientific)) characterto it. Thisconcerns data collected by local institutions (provincial offices, health centres, schools,communes,municipalities, etc.). At the sametime, the research team also collected local statisticaldata. At the end of the survey,the team immediately started transcription of the focus group data on networks specially designed for that purpose, and an exhaustivetranscription of data from the interviews and life stories. The analysisstagewas an opportunity for the team to study the collected data in the framework of the socio-culturalcontext of each selectedsite, and in relation to the regional environment to which the site belongs. The team tried to eliminate analytical frontiers between private and public spheres,in that it attempted to apprehend attitudes towards educational and sanitaryservices by reference to family stakesand constraints.It was mainly interested in analysing local demographic practicesand people’s preferencesand expectationsasregards health, education, and information. Finally,it gave greater importance to local perceptions, and tried to bring the reader as close as possible to field experience. Research limitations While carrying out the survey,we faced many difficulties both at the socio-culturaland the methodological level. The first difficulty had to do with the fact that the surveyedpopulation felt somewhat overused by researchersof different types, and seemed disappointed that their requestsremained unfulfilled, and no concrete programmesor projects were realised following those surveys.In some cases,people were tired of surveyson family planning. Focusgroup sessionswere also a sourceof difficulty. The main problems concerned the status of women, the meeting time and place and the number of participants. We had also to face the fear that participants in the first focus group sessionswould transmit the content of the debated questionsto subsequentones. To avoid the problem, it was decided to run all sessionssimultaneously.One of the consequences,however,was that one of the sessions addressedto a feminine group could only be scheduled in the morning, which was inconvenient for the majority of women becauseof the amount of domestictasksthey have to perform at that time of the day. As a result, a number of participants were not comfortable during the session. The statusof women turned out to be a determining factor in the courseof group discussion. The availability of a private house makesfemale participants feel secure and comfortable, and thus facilitatestheir participation. At the sametime, its permeability encourageswomen of the 268 Cultures of Populations: Arab States neighbourhood and other parts of the douar to enter the meeting room progressively,which disturbed the progress of discussions.In Zemrane,women came numerous to the meetings out of curiosity. Some of them came in the middle of the discussion,or left after 15 or 20 minutes. Others brought their babies. It was sometimesnecessaryto interrupt the discussionto point out that the number of participantswas limited, and that uninvited people could not stayin the room. In addition, meetings in a private house are sometimessubject to misunderstanding and disagreement between its residentsand the invited people. In one of the sessions,a participant refused to take part in the discussionbecausethe sessionswere run in a house, which belonged to a woman she did not respect. Another participant boycotted the meeting when she knew that the other participants had voted against her son at the local elections! Another difficulty concerning Tazarinewas the native language of the population which is Berber. In some cases,it was hard for participants to expressall their points of view and ideas clearly in Arabic. The linguistic problem was, however lessacute among men who were more educated and more open to the external world than women. That is why group sessionsin Tazarinewere, in general, lessprolific than in other sites. Socio-cultural factors affecting demographic behaviour The objective of understanding demographic behaviour in the four selected sitesraised the researcher’sinterest in the study of the traditional subjectsrelated to demography suchas fertility, mortality, family planning, abortion, morbidity and migration. Fertility In the rural areas,procreation is highly valued, but boys are preferred to girls. A woman will not stop having children till she has a boy to ensure the continuity of the family name, and to take care of his parents in their old age. In the commune of Ain Bida nearby Fb, land can only be owned or inherited by men. This social restrictive measure incites people to prefer boys to girls in order to savetheir land from becoming the property of the community in case the owner dies and does not leave a male inheritor. This is the reason why couples continue procreating till they have a male child, a u saviour Dof the family patrimony. Fertility,aseverybody knows, is strongly affected by education. But in rural areas,girl schooling facestwo major obstacles.The first hasto do with the choice between studiespursuit and marriage and the second with the choice between pursuit of second cycle studiesin urban areasor school dropping. In most casesparents prefer the second alternative in each case.The reasonsreside in parent’ tendency to prefer an early marriage model, and their fear for girls’ reputation when they are out of the family control. They are generally more favourable to the schooling of boys than that of girls. 269 Cultures of Populations: Arab States In the rural areas of south east Morocco, the girl has simply to learn how to read and write, how to acquire a basic learning and get prepared for her real duty, that of procreation and child-rearing. In fact, school is viewed as a (( shelter )) for the girl before she gets married. The N proper )) and tc ideal n duration of a girl’s schooling should extend up to the sixth grade because, all things considered, the girl is (<thedaughter of others, and any extension of her studies outside her douar of residence is a threat to the family’s honour. Since she will spend most of her life with another family (her in-laws), she is simply to acquire a basic education. Unlike studies,people think that learning a trade (sanae)is more profitable for her. Studiesmay help only in caseshe is to live outside her douar. By and large, a girl’s schooling is viewed more as a precaution than a value or an end in itself. In rural areas, couples prefer to deal with a female nurse at the health centre. Men do not appreciate the idea of having their wives genital organs examined by a male nurse, and women do not feel psychologically at ease,and are extremely embarrassedto take off their clothes in front of a man. As for reproductive health education, women state that they feel much more comfortable communicating with a female than a male nurse. In addition, when women receive information from a female nurse, they find it easierto transmit it to their husbands. In urban areas, most people believe that both sexesshould have the samerights regarding duration and objectivesof schoolattendance.Both should study in order to enhance their chances of having accessto employment. Schooling raiseswomen social status,enhancestheir chances of marriage, and incites their husbandsand in-laws to treat them respectfully.However, it is still believed that girls who are presented with a good opportunity either for marriage or a job should drop studiesto seizethat opportunity. Coeducation is favourably viewed. It is considered to be beneficial for both boys and girls, sinceit provides them with the opportunity to get used to each other and to perceive each other without prejudice. a) Pregnancy and childbirth Dealing with pregnancy does strongly differ from rural to urban/peri-urban areas.While in rural areaspeople consider pregnant women who consult doctors as <cspoiled b, not respectful, and have no senseof decency for exposing themselvesto people outside their family, and think it is shameful for women to expose their bodies to doctors who might (( mistreat N them, in urban/peri-urban areas,it is common and highly appreciated for pregnant women to be under the regular supervision of an obstetrician either at the health centre or the hospital. While in rural areas many pregnant women refuse to be examined by male doctors, and prefer to be assistedby female nursesor by their mothers in their home privacy, in urban/peri-urban areas, women are very much lesssensitiveto health staff’ssex category. 270 Cultures of Potmlations: Arab States In rural areas, there is a general negative attitude towards giving birth at the hospital. In Tazarine, it is perceived as a sinful act, and even a sort of divine revenge on women who committed a bad action. Basically,pregnant women are usually assistedby the traditional midwife ((cqablan).But they could also be assistedby the mother-in-law, the mother or the sister. They believe that traditional midwives have reassuringattitudes, are patient, and have considerable experience in handling complicated childbirth cases.In addition, domestic childbirth guarantees secrecy,and makeswomen feel more secure. In urban areas,mostwomen prefer to give birth at the hospital for reasonsof safety.A number of women, however, prefer to stay home due to the lack of adequate sanitary conditions at the hospital, even though they pay regular visitsto their doctors during pregnancy. At home, they have better sanitary conditions, and can be assistedby certified midwives, who have the reputation of being capable of performing the sameactivitiesand providing the samemedical care as obstetricians. b) Attitudes toward Abortion Another socio-cultural factor that affects fertility relates to the attitudes towards abortion. Even though abortion is practised by a considerable number of women in Morocco, it is still perceived asa cccrirne>) or a (<sin)>, and alsoasa challenge to God’s will. In rural areas,it is rejected by principle becausewomen think that their first missionis to procreate not to abort, and that a woman has no right to abort “as the fatuous in her womb is not her own creation”. Abortion is then considered an ccillicitapractice, which can only take place under compelling circumstances.In many cases,abortion is resorted to in order to get rid of unwanted premarital pregnancies, in casesof conflict with the husband or the mother-in-law, for the sakeof avoiding difficult socialsituationsfor both the future baby and the concerned young couple, or when the mother’s health is in danger. While in rural/peri-urban areasabortion is practised by experienced women in the privacy of family home, or by the support and assistanceof the mother. In urban areasabortion is mostly practised at private clinics, in neighbouring cities for the sake of secrecy,and with the consent and complicity of the husband. Urban women are favourable to abortion when medical doctors recommend it to prevent death or health problems for the mother, and in the caseof premarital pregnancies. Urban men, on their part, also espouseabortion, not only for the above mentioned reasons,but also to prevent the birth of mentally retarded children, and of children who are likely to be abandoned by their mothers, or to be brought LIP by begging mothers. c) Attitudes and perceptions towards Family planning In the four surveyed regions, people seem to be familiar with the different contraception methods including traditional, natural and modern methods. However, there are different perceptions and attitudes between generations, and between rural, peri-urban and urban areas. 271 Cultures of Populations: Arab States In the rural areas,which have been relatively modernised, a large number of women resort to contraception to limit their fertility rate. But they start using contraception only after having two or three children, which implies that family planning is associatedwith the limitation of births rather than the spacing out of pregnancies. In south-eastMorocco where traditions are still pervasivethe situation is different. People are largely non-supportive of the practice of contraception, which preventsprocreation, perceived aswomen’s first missionin this world. Contraception is also considered asa physicaland conjugal anomaly. Thisiswhy women who resort to it prefer to remain discreetabout it both at home and at the health centre. A respectful woman should hide the contraceptive pill from her family members, especially her children. Given the importance of the extended family, couples are almost non-existent. Women and younger members of the family cannot interfere with decisions made by the elder members who take on the responsibility of ensuring the continuity of traditions. Grandparents, parents and elder brothers constitute the most influential group concerning social and family life. Couplesmay havetheir own expectationsand preferenceswith regard to the useof contraception, a girl’s schooling, etc., but social rules and norms compel them to take into consideration views and opinions of the elder membersof the family.The son’swives haveto conform to role division as decided by the mother-in-law. Inequality of sexesimpairsthe functioning of couples.The distribution of power between the sexesis such that in order for a woman to use a contraceptive, she must have her husband’s consent and sometimesthat of her mother-in-law. In fact, if the husband is not informed, he may think she can no longer conceive, a fact, which could lead him to divorce her. Thesewomen have different attitudes towards contraception. Thosewho go to the health centre with a clear and elaborate idea about contraception are generally young, open to the external world, and able to speak Arabic besides Berber. However, women who speak only Berber are lessopen to the external world and lessinformed on contraception. Under socialpressure,young couples feel compelled to have children during the first year of their marriage. In case they do not have children after two or three years, the couple often breaks up because of the belief that one of the spouseshas a seriousphysical problem which prevents procreation. In most casesthe blame lays on women. In peri-urban areas, women have largely benefited from proximity to the city. They have been exposed to information concerning family planning, and gained awarenessof the advantages of birth control. Consequently,90% of women in the procreating age category usecontraceptive means,and readily go to see doctors for medical help in this regard. There have been positive effectson men too, as they have become aware of the importance of family planning, and started using preservatives.Thus the use of the condom for birth control comes in the 272 Cultures of Pomdations: Arab States second place after the contraceptive pill. Finally, two other factors,which have contributed to the generalisation of the use of contraceptive meansin this area, include the relative degree of education achieved by young women and the experiences of old women in this field. In the urban area, contraception is perceived more as a necessitythan a choice because of economic difficulties and health problems. Through contraception, women seek a degree of well being for their family, and birth limitation rather than planning. Most urban women said they cannot afford more than three children becauseof limited economic resources.The use of contraception is a joint decision made by the couple, but the responsibility of its management is taken on by women who are generally better informed on the nature of the contraceptives. The nature of relations between the couple also determines the choice of contraceptive means. A husband who is concerned about his wife’s health usually acceptsto use the condom. Mortality Effortsto reduce the rate of foetal, infant and maternal mortality and to achieve progress in the prevention of reproductive and sexuallytransmitted diseasescan only attain their objectives if one understands the socio-culturalfactorsthat affect them. The rate of foetal, infant and maternal mortality has considerably decreased in urban and per-i-urbanareas,but not in rural areas.According to medical staff,rural women contribute largely to the actual situation by insisting on staying home for childbirth. There are many other reasons including the high rate of illiteracy among rural women, premature marriagesand childbirth, a high fecundity rate, neglect of medical care during pregnancy, precarious childbirth conditions at home, malnutrition, and poverty. In addition, people call for medical assistanceonly when the case gets very complicated. Even then, doctors should sometimesexamine women in their own homes. Casesof maternal death have been reported in which the family, out of respect for extended families’ traditions according to which women should stay home for childbirth, stood against the victims’ claimsto go to the hospital. In peri-urban/urban areas, rate mortality decreasing is due to people’s awarenessof the importanceof medicalcareduring pregnancy,at and after childbirth, and of children’svaccination. Women see doctors regularly, and follow their recommendations concerning laboratory tests, scans,and vaccination. Morbidity With respect to STDsin the surveyedrural areas,one should point out that in most casesthey are first contracted by men who transmitthem to their wives through sexualintercourse.Women are aware of the risk they run, but they have no power on their husbands.They can neither force them to check with a doctor, nor can they refuseto have sexualrelations with them. The obvious 273 Cultures of Populations: Arab States consequenceis that women end up contracting the diseases,and then consultdoctorsfor medical treatment. They act as if these diseasesare solely the wife’s responsibility and not the couple’s, while decisionsregarding prevention of STDsand family planning should be taken jointly since they concern both spouses. It should be mentioned, however, that once the couple recognisesthat one of them has contracted aIberd )) (cold), they start using the condom to prevent transmission.Condoms are generally appreciatedby women becausethey allow them to take a restfrom the pill, but husbands do not like them. Men don’t propose the use of the condom. They prefer (ccontinence ~1,and respect of valuessuch as u honour )), (ctemperance )), and c(resignation to God’s will )). On the other hand, the use of condoms presupposesthat the couple should take a joint decision and achieve an agreement, whereas the use of the pill concerns the woman only, who sometimes usesit behind her husband’s back. There is a high proportion of men in the rural areasof south east Morocco who emigrate to the cities without their wives, and who easily deviate towards extra-marital sexual relations in which they take no precautions to protect themselvesagainst STDsthat their partners might have. They end up transmitting the diseasesto their wives. It is also important to mention that because women in these areas easily lose both their youth and beauty because of premature marriages,high fecundity, and successivepregnancies, men lose interest in them and seek extramarital relations, mainly with prostitutes.Other factors,which contribute to men’s conjugal infidelity, include arranged marriages where partners imposed by the family are not necessarily attractive, and the physical and psychological problems that a woman with numerous offspring suffersfrom. STDscan only be cured when both the husband and the wife are medically treated. The problem is that men rarely if ever talk to their wives about their diseasesto avoid admitting their infidelity. This is why even when they are treated and cured, they get contaminated again by their wives to whom they initially transmitted the disease.In such casesthe diseasebecomes resistantto all types of antibiotics, and the chancesof recovery become small. The only prevention of STDsthat thesewomen are aware of isabstinence. Preventionis men’s responsibility. They are the ones who decide whether they should take preventive measures, and who should admit and treat their disease.Women have no power in this regard, and are badly informed. The lexis they use to refer to STDsis limited to cccold)land ccuterusdiseases)). Evenin the rural site that has been relatively modernised, the attitudes of people who suffer from such diseasesmake things worse. In most cases,they do not see a doctor, and prefer to use self-medication.They get medicine from each other and from the pharmacistor his/her assistants. As for those who consult doctors, they usually feel too shy to talk openly about their disease, especially if they are women, They always pretend that they suffer from a uterine disease,and add no further explanationto help the doctor who hasto find out the real diseaseby hisown means. 274 Cultures of Pomdations: Arab States In the cities, women are much better informed on uterine and STDs,and seem to be aware of the seriousrepercussionsthey might have on women’s health. As for prevention, they insist on the use of the condom, sanitary conditions, regular medical check-ups, and abstinence if their husbands refuse to use the condoms. They also want more information on STDs. Migration Migration is due to a multiplicity of factors,which affect both the deserted and the host areas, and has both positive and negative effects. However, each of the sites surveyed has its own urban, peri-urban and rural characteristics,which affect the level and trends of migration, and make some aspectsmore prominent than others. In the peri-urban site,emigration isdue to a number of socio-culturalfactors,including problems related to the land status,and which seem to be extremely important. Farmerslive in a land, which is not their own property CC Melk )). It belongs to the authorities Guich,, and used to be offered as usufractto tribes asa compensation for the role they played in defending the city and the Makhzan againsttribal attacks(Siba).The precariousstatusof land does not encourage people to make new investmentsor create new constructions,and makesit difficult for them to obtain funds from Agricultural SavingsBanks. In addition, the fact that this land can only be inherited by malespushed many women and young girls to move to the city for good. Once the husband dies, many women are forced to passtheir land to the douar community.Whatevertheir standardof living, being without resources puts them in a situation where they either find a parent to give them shelter,or emigrate to some other place with their daughters and live in poverty. On the other hand, demographic growth and land division by inheritance ended up breaking it down into very small pieces, and pushed people away from the region. Proximity to the city (Fes),with the job opportunities and attractions that it offers also contributed to an increasein the emigration of young people. Eventhough this resultsin a shortage of workers in peak periods of the agricultural cycle (olivepicking, for example),parentsare largely supportive of their children’s emigration out of the region. In the rural sites,a number of people migrate to urban areas. For example, young people who pursue their studiesin urban areastend to staythere permanently, and in most casesnever resumeagricultural jobs in their original areasno matter what the outcome of their studiesis. As a result, familieswhose sonsleavethe region mustfind shepherdsfor their flock/cattle in poorer areas. Rural people do also emigrate abroad. These immigrants are usually very supportive of family members who stay in their region of origin, and thus contribute to maintain part of the population in place. Migration had a positive impact on people’s aspirations.The information they receive from their family memberswho live abroad on the quality of servicesin Europe made their aspirations concerning sanitary and educational servicesget higher. 275 Cultures of Populations: Arab States In the urban site(Essaouira), the first striking point concernsthe migration of itsJewishresidents after the Second World War), and which is considered to be both an economical and a cultural loss.People seem nostalgic when they refer to this migration. On the other hand, a number of educated people choseto moveaway from the city becauseof the risksof catching lung diseases due to the high rate of humidity in the air. It is clearthat Essaouira, which usedto be an attractivesitefor people in the past,is now pushing its own residents away. The problem is that, while it is losing its elite, Essaouirais receiving a working force, which can hardly satisfythe needs of its economy. Being a city of the Makhzan which was built out of tribal context, Essaouiradoes not benefit from compensationsor investments by its rural neighbours who have close ethnic and linguistic ties with Agadir (Haha) and Safi (Chiadhma). Recently, a number of European people started emigrating to Essaouira.They are artists, intellectuals, and tourists who come from different European countries to live in a different environment. They buy traditional housesand settle in Essaouira,and even get married with souiri Muslim girls. SOCIO-CULTURALRELEVANCEOF SERVICES AND 1NFORMATlON The above discussionof field data related to demographic behaviour and the population’s expectationsand preferencesregarding socialservicesin the four selectedsitesmakesit possible to determine the extent to which available educational and health servicesare used by the population, and the situationsin which the socio-culturalcontext encouragesor hinders utilisation of these services.It also makes it possible to explain the gaps between availability and nonutilisation of the services. Gaps Between Service Availability and Utilisation This concerns public health, sanitary, education, and information services.For convenience, each of the serviceswill be discussedseparately,despite the overlap of factsrelated to them. HEALTH The fact that availablehealth servicesare deficient in many ways, including lack of equipment, incompetent staff, difficulty of access,bad treatment of patients, etc., can partly explain their under utilisation by the population. However, socio-cultural factors also play a part in this respect. Socialconstraints,family habits, individual fears,and intra-domesticpower struggle are also factors,which influence the individual’s behaviour towards health institutions. 276 Cultures of Populations: Arab States Despitethe progressrealisedin the field of FamilyPlanning (FP)and the evolution of people’s attitudes and ambitions concerning individual and family well being, a number of households still value high procreation, especiallyin rural contexts. In the three rural siteswhich, have been surveyed,people still idealise the large family system. People desire to have children to support them in their old age, and to guarantee the continuity of their family patrimony, name, and statuswithin the community. Male children are more highly valued as they reinforce the mother’s social status,endow her with the power to impose herself to her husband, and to manipulate younger women’s life. In addition, because of hard living conditions in rural areas,a number of households rely on their children to help with land work, keep the livestock, and perform domestic tasks.This is why people refuse to consult FP services,or use them only occasionally. Also, the fact that pregnancy is perceived as a natural phenomenon which does not require any particular care explains why a number of pregnant women are reluctant to consult the Health Centre (HC)services.As long asthings seemnormal, and no complicationsarise,pregnant women in Al-Attaouia and Tazarinedo not feel the need to visit the HC services.They do not even resort to the assistanceof traditional midwives unlessproblems arise in the course of pregnancy, or the first signsof labour appear (the first pains).Another factor that may contribute to under utilisation of health serviceshasto do with lack of awarenesson the part of the population of the importance of prevention for the maintenance of health. In urban and peri-urban areas, resort of pregnant women to the help of medical doctors is perceived positively, contrary to rural areas (Zemraneand Tazarine)where it is disparaged and viewed unfavourably. Other reasons,which discourage pregnant women to consult medical doctors in rural areas,have to do with the fear to be exposed to people’s curiosity and malicious looks, to be viewed as spoiled women, and to violate their privacy and accept to be mistreated by the doctor. In brief, exposing themselvesto doctors while they are pregnant is a sign of malediction for women. Becausethey are illiterate and badly informed, rural women prefer to consult the “fquih”, herbalists,and traditional healers, in the first place, and to consult medical doctors only as a last resort. They feel safer following the example of their mothers and grandmothers. When it comes to childbirth, women prefer to stay home and be assistedby traditional midwives in order to guarantee secrecyand psychological comfort. They only have recourse to medicalassistanceat the -HCwhen the casebecomescomplicated.One should point out, however, that women want to avoid the HC also becauseof the discouraging attitudes of the health staff towards patients. Urban women, however, have a different attitude. They are more careful and seek medical help to prevent the risksinherent in childbirth, and, even when they choose to deliver at home, 277 Cultures of Populations: Arab States they ask for the assistanceof certified midwives who practiseat the HC. Thisway, they combine the advantages of giving birth in the secure privacy of their home (thus avoiding the HC poor conditions) and being assistedby experienced midwives who can use the same techniques as the ones used at the hospital. As for abortion, it is considered to be an illicit act, particularly in rural areas,and usuallytakes place in private homes using traditional treatment. The HC servicesare almostnever used in such cases.In general, women prefer to go to the hospitalwhen abortion is recommended for medical reasons.However, in the caseof premarital pregnancies, girls and women who desire to have an abortion prefer to go to private clinicsin Marrakech or Agadir. The partial utilisation of health servicesseemsthus to result from a given perception of reproductive phenomena combined with poor conditions at the HC. Contraception is another issue,which undergoes the effects of the socio-cultural context. Procreation is so highly valued in some rural areas (Tazarine)that FPis perceived as a sign of physical anomaly and conjugal dysfunction. In addition, even couples who accept the idea of FPonly start practising contraception after having at least 3 or 4 children. Thismeansthat for a number of years,these coupleswill not make use of the FPservicesavailable at the HC.They fear the risk of permanent sterility if they use contraception too early. Furthermore, fear of the side effects of contraceptive means, rumour, and misconceptions discourage a number of women to contact FP servicesat the HC, even when they desire to practisebirth control. Another problem is that women, especiallyin Tazarine,are jealous of their privacy, and resent the idea that outside people know they are using contraceptives,which may result from lack of discretion on the part of the HC medical staff. Thisinevitably widens the gap between them and the HC services. Condoms are rarely used becausethey raisesuspicion,suggestinfidelity, and are considered to encourage debauchery by conservativepeople. Religiousattitudes,which praise“abstinence” and “conjugal fidelity” relatively, succeed in relegating condoms to a position of secondary importance. Attitudes towards STDsare controversial.Thus,men who contract one of these diseasesfind it difficult to admit it. They usually reject the responsibility of treatment on women, and refuse to consult doctors. They feel embarrassedto be examined by doctors for this type of disease,and prefer to get medicine directly from the pharmacist,or to seek advice from friends who had the sameexperience. In many cases,they get the treatment but hide it from their wives for fear of having to admit their infidelity. As a result, women catch the disease,and the couple is trapped in a vicious circle (Tazarine). As revealed by field data, in urban and peri-urban contexts, there is little concern about whether doctors and nurses are males or females, contrary to rural contexts where it is very 278 Cultures of Populations: Arab States important for women to deal with female medical staff. Ruralwomen feel so embarrassedto be examined or informed on reproductive health by malesthat they prefer to give up using the HC services. Rural communities still preserve the extended family system where the old generation (parents, grandparents, and in-laws) exerts authority and standsagainst intervention of the HC staff in the reproduction systemof younger couples. In a number of cases,this attitude prevents women from being followed by medical doctors in the course of their pregnancy, or using contraception. The old generation’s authority thus standsagainst the objectivesof the HC. Being aware of the importance of large familiesin gaining socialstatusand creating allies, old people who consider themselvesas the legitimate safeguardsof the family continuity, impose their will on their children and grandchildren, and manipulate their daughters-in-law so that they acquiesceto the group strategy (Tazarine). An additional problem is that the Ministry of Health determines health programmes based on statisticsof the province and the urban community. Thesestatistics,however, do not include recent migration flows to the old city centre (Medina) of Essaouira,and the growth of the proportion of single men among these migrants. The major effect of this deficiency is that predictions about the number of births per year come true only partially, and the effective realisation of the vaccination programmes falls short of the initially predicted ones. One should also point out that the population of Tazarine has little concern about medical prevention programmes,which explains why a number of vaccinesremain unused. EDUCATION It is undoubted that the main victimsof schooling disparitiesin rural areasare little girls. They sufferfrom the highest rate of illiteracy and failure at school, and are forced to drop out of school too soon. Becauseof socio-cultural factors, the schooling of boys is highly valued and that of girls devalued. Boysare thus registered at school on a long-term basis,and unlike girls, are not under the pressureto obtain outstanding resultsto be able to continue attending school. Girls,on the other hand, are only registered on a short-term basis,and are pressuredto yield excellent results and to prove that they are “divinely gifted” to be maintained at school. It is believed that boys should attend school for as long a period as possible to enhance their chancesof having accessto employment, and securing a revenue, which would allow them to found a family and support their parents at their old age. As for girls, school is only a temporary occupation since their main vocation is to get married and bring up children. Parentsconsider it uselessto investin girls’ education since they end up living with their in-laws. In addition, jobs, which are suitable for women only, require limited instruction. 279 Cultures of Populations: Arab States Theseattitudestowards girls’ schooling are fosteredby a given perception of women’s relation to the public spaceand extra-domesticwork, their identification with domesticwork, and their being held responsible for the protection of the family honour, in spite of their weakness. AlS07 acceptance or refusal of girls’ schooling result from a given perception of the couple (one salary versustwo), and the deeply rooted belief in male dominance. It is held that male authority will only be maintained if women are deprived of instruction, especiallyat advanced levelsand their chancesof getting involved in promising careersare limited. In brief, women should be kept ignorant so that they have no meansof becoming independent. Even though the majority of surveyed people approves of girls’ schooling, and sees the problems related to the issuein technical terms rather than in termsof principles, it remainstrue that there is a strong tendency among rural people and certain urban social categories to prefer limited instruction for girls, and to consider marriage as being more important than studies pursuit. Thesepreferencesare expressedby adults and young people, both malesand females.In fact, this is the issuewhere most points of view seemto converge. In urban areas,people hold favourable attitudes towards coeducation at the different stages of schooling, contrary to rural areas where people view it negatively. In the best cases,they would accept it for the first grades of primary school, when children are still very young. The idea of having girls pursue studiesin mixed classesafter they reach a certain age and a certain degree of instruction raisesfearsamong rural people. The problem is that while coeducation is believed to be a source of failure at school, there is no guarantee that its suppressionwill allow pupils to obtain better results.Becauseof the scatterednature of schoolin rural areas,the creation of separate classeswould raise problems of distance and security,and would lead a number of people to withdraw their children from school. There is a wide belief among people that schooling should be connected with the practical needs of daily life. It is thusjudged sufficientfor children to learn how to read, write and calculate. In this case,school is only expected to give individuals the meansto read bills (e.g. for water and electricity), official notifications coming from the authorities, addresses,bus numbers, etc., and to facilitate and improve their chancesof practising a trade (agriculture or craft industry). Due to this limited vision of school, many children are deprived of the chance to pursue studies. In addition, even when children attend school, their parents do not hesitate to require their help in the agricultural tasksperformed at the family’sfarm, or to usethem asa sourceof revenue. Thus,in peak periods of the agricultural cycle (olive and fruit picking), many children and adolescentsare forced to work for the family, or for other farmers to bring money. The obvious consequenceis that children stop going to school in these periods, which disturbsthe continuity and stability of their schooling. 280 Cultures of Populations: Arab States For both objective and subjectivereasons,parents still perceive their children as “production tools”, which, in turn, affectsthe children’s schooling negatively (especiallygirls) due to fatigue and lack of time. In other cases,parents make their children participate in agricultural work in parallel to school attendance. Their main concern is that children fail at school, and find themselveswith no skills to perform a job in the future. lnvesting in both studies and agricultural work is thus believed to give children better chancesfor a vocational alternative in casethey do not succeed at school. However, being caught between work in the field and studies diminishes children’s chancesof taking full advantage of the school services. To conclude, the community expects school to fulfil both instructional and educational functions. The problem is that people’s perception of school as an institution, which primarily addresses children’s instruction, and education weakens its chances of developing literacy programmes for adults. INFORMATlON It has often been suggested that children should play a role in transmitting information, i.e., to be mediators between information centres and the local population. However, information transmission by children to adults is impeded because of the latter’s authority on them. Moreover, in a context where school is devalued, and people are disappointed by the poor resultsobtained by their children, the latter find themselvesin an uncomfortable position to act as carriersof information and modernisation. In rural areas, problems of communication between mothers and daughters concerning sensitivesubjects such as sexuality and contraception hinders the transmissionof information received at school to the rest of the family. In the same way, the lack of dialogue between husbands and wives does not favour the exchange of information between them. As regards STDs,field data reveal that in rural areas(Al-Attaouia and Tazarine),the major part of information available on STDsprevention and reproductive health is not taken advantage of, or is poorly understood. For example, people may know the namesof the most important STDs, but not the modes of their transmission,and may know the namesof contraceptive meansand the degree of their reliability and adaptability to the local life style, but have inaccurate ideas about their use directions and side effects. In fact, much of the fear people feel concerning contraception emanatesfrom distorted information or lack of information. In peri-urban areas, women do not only wish to be informed on the range of available contraceptive means, their use directions, side effects, etc., but also to be free to choose the contraceptive meanswhich is most appropriate for them. They claim that information can only 281 Cultures of Populations: Arab States have value if it enhanceswomen’s right to have freedom of choice, and to assumeresponsibility regarding the issue. Following is a summaryof the main reasonswhy part of the available information related to reproductive health remains unused: - Lack of health staff specialisedin communication (in the four surveyedsites),and who can speak Berber. - Insufficient meansof communication and transport. - Poor co-ordination with other serviceswhich are also involved in educational and popularisation services. - High rate of illiteracy among women, especiallyin rural areas. - Lackof a mediating space between the HC servicesand the local population, - Non-integration of the HC staff into the local socio-culturalcontext. 1MPLlCATlONSOF RESULTS 1N TERMSOF PROGRAMMESAND POLICIES The data analysed above can be “interpreted” in terms of its implications for programmes and policies which are in accordance with the expectations and preferences expressedby the participating population groups, in the areas of health, education, and information for policy makers,programme managers,and serviceand information providers. IN THESECTOROF EDUCATION People expect school to facilitate vocational insertion by teaching children basicknowledge of mathematics,geometry, reading, writing, etc., and offering them the opportunity to learn a trade (agriculture, craft industry) in order to enhance their participation in the development of local economy. It is also supposed to help resolvedaily practical problems, and to allow families to protect their privacy.According to the majority of opinions, the function of schoolis not limited to instruction, but also includes education (to support family education), the training of pupils for future jobs (employment), and the inculcation of fundamental religious, social, and moral values. On the other hand, school is expected to give children the meansto open up to and adapt to the external world (urban areas),and to provide them with sanitary servicesand information. One problem with people’s conception of school, however, is the confinement of its role to children’s instruction and education, and the difficulty to imagine that it could play a role on behalf of adults, and the community at large. Finally, rural people cannot help connecting schooling with employment, especially in the public sector. 282 ._.. ._. - Cultures of Populations: Arab States It should be pointed out that the sex variable has been underlined by all categories of rural population each time girls’ schooling is mentioned. Thus, the contents of the programmes, objectives, duration, location, time-schedule, and coeducation are different aspects, which causeparents concern about girls’ schooling. They underline the specific educational needs of females,give priority to marriage and the learning of a trade (senaa)over studiespursuit, stress the fact that protection of the family honour depends on girls’ conduct, and expressfear about the risksgirls run of being mistreated by maleswhen they attend mixed classes,and when they walk back home from school in the evening. In this case,the improvement of the structure and functioning of school and the raising of parents’ awarenessabout the importance of schooling for both males and females should be stressed. As for parents’ concern about the way children are treated at school, most participants in focus group sessionsinsiston the fact that school should treat all pupils on an equal basis.They expressdisappointment at teachers’ preferential treatment of pupils according to whether they are malesor females,rich or poor, good or bad, and whether or not they do overtime work with them out of class.One should mention, however, that while families complain about teachers’ unfairness,they themselvesfavour malesand successfulchildren. This sensitivity on the part of the population raises questions related to teachers’ sex, pedagogical practices in class,overtime work (that they encourage pupils to do and for which they get paid), and relations with the host community. It also raisesproblems of pedagogical and administrative control, and relations between the educational staff and parents. As for the profile of the ideal teacher, the majority of participants including men and women, young and adults, and rural and urban people agree on a number of qualities, which they consider as essential: - Human qualities: in their relation with pupils, teachers are supposed to be kind, patient, firm, fair, understanding, tolerant, honest, and thoughtful. - Professionalqualities: teachers are expected to be hard working, competent, punctual, interactive, and to love pupils and their profession. - Relational qualities: teachersare expected to be able to communicatewith pupils, prepare their own meals,and maintain relationswith the local community (females,married teachers, and native teachers usually have less integration problems than single males who come from other regions). On the other hand, people accept the fact that teacherspractiseagricultural activitiesbesides teaching, provided that this does not affect their teaching performance, and that they do not perform the activities in associationwith other members of the local community. Rural people tolerate corporal punishment of pupils, but only if it is moderate, fair, and justified. 283 Cultures of Populations: Arab States In urban and peri-urban areas, people are indifferent to the regional origin of teachers. However, in rural areas(Al-Attaouia and Tazarine),people underline their preference for native teachers,whom they believe to have more interest in their own community children, to have no integration problem, and to have easiercontact with parents (both mothers and fathers). Unlike non-native teacherswho try to transferto other regions as soon as they start working, and sometimeseven before, and thus convert some regions into permanent fields of “learning and training” for inexperienced teachers, native ones are expected to love the region, to live there for a long time, and to let the community benefit from the teaching experience they accumulatethrough the years (Tazarine). Opinions differ concerning teachers’ gender. People’s preferences depend on the experience they had with each sex category. In Essaouira,for example, female teachers are preferred for the first grades of primary school because they are supposed to be “nice and affectionate with children”. In conservativerural contexts,female teachersare also preferred for a number of reasons.First,mothers feel more comfortable with them when they want to enquire about their children’s progress:second, the rural community can accommodatethem more easily within the village, even when they are single; and third, their integration within the community women’s group is considered to be beneficial, especiallyif they can teach women manualjobs. In other cases,however,people would like to avoid femaleteachersbecauseof “maternity leaves”, the difficulty to adapt to hard living conditions in rural areas,jealousy towards girls, lack of control over classes,and mistreatment of children, perceived by people as being due to hard working and living conditions. Male teachersare preferred for reasonsrelated to hard work and competence, adaptation to hard living conditions and problems of transport in rural areas,and authority and firmnesswith pupils. It becomesthus clear that preferencesfor male or female teachersreflect a given perception of femininity versusmasculinity,and have nothing to do with gender, generation, or regional origin. In conclusion,attitudes towards teachers,whether malesor females,depend on their capacity to adapt to rural life, to respond to the needs of the local population, and the quality of their relations with members of the local community. In brief, they should be able to accept the challenge. As for schoolprogrammes,surveyedsubjects,especiallyin rural areas,seemedrelatively shocked when they were asked whether they wanted any modifications of the programmes. They find it difficult to propose additions or changes to “programmes which are not taught adequately”. However, people insistthat school syllabusshould be lightened. This measureshould allow “teachers to better explain lessons,and pupils to better understand”. It is believed that short programmes,which are well understood, have better value than long ones, which are lesswell 284 Cultures of Populations: Arab States understood. People also stressthe importance of creating new vocational programmes, and adding practical subjectssuchassewing, embroidery, computer science,technology, plasticarts, foreign languages,etc. to the syllabusto enhance learners’ chancesto haveaccessto employment. Finally, it is hoped that the jobs which pupils practise in the vacation periods (agriculture, carpentry, wood sculpture, etc.) be introduced in formal school programmes. In regions which are relatively far and enclosed (Tazarine),adaptation of the programmes to local characteristicsis perceived as a way of marginalising the region, and reducing its capacity to adapt to modern life. As for school time planning, expectations differ between urban and rural areas.In Essaouira, for example, people prefer discontinued school time-schedulesand the actual vacation system. In rural sites,however, people raise the problems of conflicts of school time scheduleswith the agricultural cycle peak periods, on the one hand, and with the weekly market day, on the other. They also consider discontinued time-schedules to be inconvenient in autumn and winter, especially for pupils who live in distant villages. IA’ THESECTOROF HEALTH The population categories interviewed hope for an improvement of sanitary equipment, the quality of patients’ reception at the HC, medical examination, and follow-up checking systems. They underline the necessityto reinforce sanitary supervisionin HCA, to offer free medical care, to make accessto HCA easier by bringing them closer to the population, and to help isolated areas (Tazarine)to open up. People complain about long waits, and lack of co-ordination between the servicesof sanitary institutions,and would like HCA to coverall the needs of patients, instead of focusing on FPonly, or transferring patients to hospitals of the closestcities. Due to people’s modest incomes, it is desirable that the HC provide free medical consultation, and free medicines. Also, the reinforcement of relations between the HC and women requires the appointment of a female nurse and a woman doctor to the HC. On the other hand, people have fearsregarding contraceptives,which are partly due to lack of information, but alsoto the feeling of mistrustvis-a-visthe health staff.They question the latter’s good intentions, and wonder if they tell them the truth. This is why they require “transparent and honest” sanitary education. What the population seemsto aspireto is that reproductive health education and information on STDsbe generalised to young unmarried people; that it addressescouples, not only women; and that it opens up to other family memberswho havean impact on decision-making regarding contraception (parents and in-laws), instead of being restricted to the couple immediately 285 Cultures of Populations: Arab States concerned. It is hoped that the organisers of information sessionstake into consideration the communicationproblems of people who speakonly Berber,that sessionsbe organised according to a regular, well-establishedschedule,and that men and women be formally notified and invited to attend the sessionsat the HC. People insist that the use of audio-visual means is crucial in educating and convincing the population about the validity of FPstrategies,and the prevention of STDsand uterine diseases. They believe that schools should also deal with reproductive health through demonstrative visual means,and should disseminateto the youth precise and detailed information on the use directionsof contraceptivemeans,and the modesof STDstransmission.In order to avoid problems related to embarrassmentand shyness,it is suggested that coursesdealing with reproductive health be taught by male teachers,more particularly in mixed classesor exclusivelymale ones. Finally,people cherish the idea of having sanitary institutions,which combine the efficiency of medical equipment and competence of medical staff with the advantages of a welcoming and reassuringatmosphere. For Programme Managers and Service Providers in Education and Health The field data collected for the present study can be used by programme administratorsnot only for service provision but also information transmission.Resourcepeople who have been interviewed propose measuresto improve educational and sanitary services,and to ensure efficiency in information transmission,especiallyas concernsreproductive health. Managersof educcrtional programmes are invited to take into accountthe following problems and proposals: - Classesare sometimes overcrowded, school curricula are “overloaded and long”, and schooling fees are expensive. These conditions have a negative impact on both teachers and pupils, and on the quality of information disseminatedto pupils. - Girls’ schooling is still impeded by socio-culturalobstacles,the most important of which are concern for family honour, and the identification of girls with traditional roles as spouses and mothers, and which incite people, especiallyin rural areas,to prevent their daughters from studiespursuit. It is believed, however, that the situation could be improved if boarding schoolsare built, and second cycle classesof Fundamentaland SecondarySchoolare offered in proximity to or at least within the reach of the population. This is supposed to increase the number of schooled girls in a significant way, especially if parents are made aware of the beneficial effectsof schooling on their daughters,and are provided with materialsupport (e.g. offering children part of school material). No lessimportant are factorsrelated to rural people’s sensitivityabout coeducation (mixed schools)and the readjustment of school time schedulesaccording to the wishes of people who fear for their children’s security when they leave school in the evening. 286 Cultures of Populations: Arab States - Teachersare sometimescompelled to teach coursessuchasphysicaltraining or schooltheatre, for which have no training. Suchtraining is therefore recommended to make teachersmore comfortable while teaching these courses. - Eventhough literacy development for the benefit of adults is valued by the population, its carrying out is impeded by people’s perception of school as an institution which addresses children exclusively,the negative effects of the failure of previous programmes, and the impact of hard working conditions as well as the problems of transport in high mobility areas.In addition, literacy development for the benefit of women is likely to suffer from the effects of social constraintsimposed on them either by the family or the community. It is t herefore desirable to make people aware of the positive effects of adult literacy, while taking into account work and time constraints, and restrictions on women’s mobility. Besides,stressshould also be put on the fact that the offering classesto previously schooled women can only be beneficial for their children’s education. - The low level of teaching performance in rural areasmay be explained by a multiplicity of factors. The present survey findings suggest measures,which could contribute to improve this level. Such measuresinclude the availability of housing for the teaching staff, the appointment of teachers to schools in their native areas, the development of pre-school programmes, and the readjustment of vacation periods to the agricultural cyclesand the weekly market days. - Peoplesharethe feeling that programmestaught at schooldo not respond to the requirements of the job marketand the needsof local economy,and asa consequencedo not allow learners much choice for possible vocational alternatives.Therefore, it is recommended that vocational training programmes be implemented in rural areas, in addition to the insertion of practical courses(sewing, music, computer science, technology, plastic arts, culinary arts, etc.) into the school curriculum in order to better prepare pupils for the requirements of the job market. - Today,the agriculturalsectoristhreatened becauseof the ageing of farmers,younger people’s resentmentof agriculturaltasks,and the risksof interrupting intergenerationalcommunication of knowledge because of the younger generation’s attitudes. Hence the need to set up programmes liable to improve pupils’ knowledge in the domain of agriculture, and to put them in contactwith realitieswhich are specifI c to the agricultural sectorof their native areas. Managers of health programmes are invited to take into account the following problems and proposals, especially in the area of reproductive health: - The first step liable to lead to an increasein the number of usersof health servicesconsists 287 Cultures of Populations: Arab States in an improvement of the equipment (ambulances,testsmaterial, ultrasound machines,etc.) allotted to them, and the quality of medical and paramedical staff appointed to HCA. However, unlessthe reception conditions at the HCA are also improved, such measureswill not be fruitful, and people will continue to prefer traditional practices with regard to pregnancy, childbirth, abortion, and contraception,with all the risksinherent in suchpractices for people’s health. - Free distribution of contraceptivesto the population generally raisestheir suspicion, and depreciates the value of contraception in their eyes.It is therefore advisable to sell people the contraceptive pill, even though at a symbolic price only, and to avoid distributing it in proximity of the villages. The pill has more value in people’s eyeswhen it is offered at the HCA. - Given the rural population’s sensitivity to social pressure and people’s curiosity, sanitary institutions should respect patients’ concern for privacy and reassurethem that secrecywill be kept. Thiswill enhance their trust in the HCA and encourage them to use reproductive health servicesmore often. - Given the insufficiency of medical coverage in rural areas,the role of traditional midwives should be reinforced. They should be provided with the appropriate training, and encouraged to assistin medical interventions performed at the HC. Thisway, they will gain more competence in their domain, and will perceive themselvesas assistantsrather than rivalsof the HC medical staff. - In areascharacterisedby high migratory flows (Tazarine),it is essentialto take into account the effects of the migratory cycle and migrants’ return to their native villages on both contraceptive methods and vaccination, and to propose adequate solutions in the light of this characteristicfeature. - It would be interesting to take advantage of deeply-rooted cultural practicessuch as traditional treatment through “burns” (Al-Kay:Tazarine),or its modern version: preference for injections,to promote the useof the latter in people’s treatment aswell asthe useof vaccines for mothers and babies. CONCLUSIONS,RECOMMENDATIONSAND 1MPLICATIONSFOR FUTURERESEARCH As the foregoing analysisclearly indicatesthat demographic behaviour in the four sitesunder study is largely determined by religious beliefs and social symbols. The latter define, among other things, children’s value and women’s status,and convey both individual and family stakes on which solutions to sex and intergenerational conflicts depend. 288 Cultures ofPotm/ations: Arab States The impact of the socio-culturalcontext on demographic behaviour differs from one site to the other. It either favoursor impedes the adoption of positive attitudes towards reproductive health depending on the extent of socio-economicchange achievedby each site,and the degree of people’s opening to urban values. Data gathered during the researchshow that the demographic behaviour of a considerable proportion of the rural population is still far from the influence of institutional sanitary services and educational activities organised for the benefit of the population. This situation persists becauseof the inability of availableservicesto cover people’s needs, and their lack of adaptation to the socio-culturalcontext. For villagers, it is hard to imagine school as playing a role in reproductive health education. It is perceived as an institution whose unique role is to instruct and educate children. It is supposed to implement the existing programmes, and to modify their contents so that they are better adapted to the requirements of the job market. Differences regarding people’s demographic behaviour and expectations towards social servicesis rather the result of the area (rural/urban) people reside in than age category. Thus, disparities between rural and urban areas,the impact of economic conditions, and the shortcomings of educational, sanitary,and informational servicesin each of the four sitesseemto have similar effectson the different age categories. Morocco hasachieved undeniable progressin both sanitaryand educational fields (including reproductive health education). However, the dysfunction and shortcomingsunderlined by the population and serviceand information providers should incite people in charge of education and sanitary services to make the reforms already existent more important, and to adopt adequate choices. The socio-cultural characteristicsof the concerned areas should incite these people to refrain from adopting foreign models without paying due attention to the constraints, expectations, and preferencesof the local population. It is only at this price that availablesocialserviceswill be able to integratethe local socio-cultural context, and that problems of frustration and mistrustwill be overcome. The findings of the present study suggesta number of steps,which are likely to contribute to the achievementof the fundamental objectives, set by the present project: - In order to raisethe awarenessof local “actors” about the importance of collaboration and exchange in information transmission,it would be advisable to organise “focus group” sessionswhich involve people from different services(educational, sanitary, agricultural, social, technical, and so forth) and who would discussthe various problems related to education of the population including reproductive health education. 289 Cultures of Populations: Arab States - It is important to elucidate time perception in given socialcontextsto make the appropriate choices concerning people’s education and contraceptive methods (sincethe majority of contraceptive methods are time-related). Suchchoicesshould respond to the needs of local populations. In this respect,it is suggestedthat a comparativestudy be conducted to address the question, and to elucidate the different evolution rhythms of the four sitesat both the economic and social levels. - The present study identified a number of mediators between social actors and the local population. For a better understanding of the mediation phenomenon, it is suggestedthat a future study look at this mechanism more deeply in order to identify other profiles concerning mediators, and to better grasp the characteristicsof the context of mediation, and its effectson the contributor and on the statusof the mediator in the community. - The useof “local facilitators”raisessimilarquestions.The only difference is that the mediation in this caseis between the researcherand the local population. On the whole, the experience at this level was successful,but questions remain as to how the surveywould have been conducted if “facilitators” had had the required sociological training and had been more involved in the course of the surveyand the focusgroup sessions.The experience has been so stimulatingthat it would be interestingto further investigatethis “methodological formula”, and to provide “facilitators” with longer and more appropriate training related to field data. -Another aspect, which needs further investigation, has to do with power relations and decision-making mechanismswithin families. In such a study, the accent should be put on the emerging power relationswhere the new authority figures seemto be young migrants, young educated people, active women, “rebellious” adolescents,etc. The present study revealed the impact of masculineauthority and the influence of the older generation on decision-makingwithin the family,however, it did not show the extent to which the younger generation and women manage to change the situation, and the mechanismswhereby they are grabbing or at least influencing the decision-making power. - Finally, it is also important to investigate the impact of internal and external migration on the functioning of educational, health, and sanitary services,and the flow of information between urban areas and the host developed countries, on the one hand, and between urban and “deserted” rural areas,on the other. Sucha study would allow a better planning and interventons for educational, health, and sanitary programmes, and better overall formulation of policies. 290 Cultures of Populations: Arab States BlBlfOGRAl’HY l l CERED. (1997).Situation et Perspectives DBmographiquesau Maroc, Secretariatd&at B la Population, Rabat. Fargues,P. (1990).La Transition de la MconditC dans /es Pays Arabes. Cahiersde la CERED. (1993).Migration et Urbanisation au Maroc, Direction de la Statistique,Rabat. Krueger, R.A. (1994).Focus Groups -A practical Research, SagePublications, ThousandOaks-London-NewDelhi, SecondEdition. MCditerranCe,TomeII. Guide for Applied CERED. (1995). L’Exode Rural, Direction de la Statistique,Rabat. l Morgan, D. (Ed., 1993).Successful Focus Groups,Advancing the Stareof the Art. SagePublications. CERED. (1993).Wcondit& Inf6condit6 et Nouvelles TendancesDgmographiques, Direction de la Statistique,Rabat. l MinistQe de la SantePublique (Janvier 1996). l CERED.(1995).CroissanceDCmographique er D&eloppement du Monde Rural, Direction de la Statistique,Rabat. l EnquCte de Panel sur la Population Navez-Bouachrine,F. (1994).Etudesdes PratiquesSocialeset de I’Acceptabilite des Servicesde SantCMaterno-infantileset de Planification Familiale,Vol. I, Ministere de la SantkPublique. l CERED.(Octobre 1996).La Migration Fkminine, Ministi?reChargede la Population, Rabat. l l l l l l CERED.(1996).Famille au Maroc - Les RCseaux de la Solidan% Familiale, Minis&e Chargede la Population, Rabat. l Direction de la Statistique(1997).RCJW de 1994 (S&ie Communale),Vol. I, II et V, Minis&e Chargede la Population, Rabat. l Direction de la Statistique(Octobre 1996).RGPH de 1994 (S&ie Provinciale:Ouarzazate, Essaouira,Fes-Medina,et El KelaaSraghna). Direction de la Statistique(1995).Recensement 1994, Popularion LCgale du Maroc, MinistGre Chargede la Population, Rabat. Remy,J., Ruquoy,D. (1990).Methodes d’Analysede Contenu et Sociologic, Facultes UniversitairesSaintLouis. Stewart,D.W.,Shamdasani,P.N.(1990).Focus Groups:Theory and Practice.SagePublications. l l Direction @n&ale de I’Urbanismeet de I’Amknagementdu Territoire (1997), Perceptions et Attitudes des hus et des Responsables Locaux a I’ggard de la Migration Interne, ProjetMIAT,Minist&e de I’interieur, Rabat. et la Sank (EPPS), DHS,Rabat. l Zuggari, A. (1996).L’tcole en Milieu Rural. ElMaarif ElJadida. Zurayk,H., Younes,N., Khattab, H. (1994). Rethinking FamilyPlanning Policy in Light of ReproductiveHealth Research.The PolicySeries in ReproductiveHealth, No I, the Population Council. Zurayk,H., Younes,N., Khattab, H. (1994).Field Methodology for Entry into the Community.The PolicySeriesin ReproductiveHealth, No 3, the Population Council. 291 Cultures of Populations 5 ?& P . , .+4, ‘, %TES CULTURE,SOCIETY,ANDDEMOGRAPHIC TRENDSINYEMEN Waheeba Fare’e* INTRODUCTION T he population of the Republic of Yemenis estimatedto be 14.8million (1995),with a crude brth rate of 45 per thousand and a crude death rate of 8 per thousand. The population growth rate is estimated at 4 percent. It is geographically divided in four specific regions: I) Highlands (Mountainous) 2) Midland Elevations(Plateau)3) CoastalAreas 4) Desert Areas. Theseregional differences also manifesttribal differences, thus making it a multi-cultural and a multi-tribal population. The various sub-culturesin the country provide a fertile field for undertaking demographic studies. Such knowledge would be important for a better understanding of the perceptions and attitudes of Yemeni people towards development programmes. The rural population comprisesof 75 percent of the total population, thus posing a challenge to design and implement appropriate programmes, especially providing the much needed social servicesas education and health. The family sizein Yemenis large, with an averageof 6.74 membersin each family.The average household size is 6.98 persons.This number is relatively close in both the urban and rural area becauseof the high fertility rate. Yemenisociety is gradually moving towards modernisation, and education is one of the most important means to achieve this. This area is getting attention in the hope of increasing the prosperity for the society.Notwithstanding this, however, the illiteracy rate is still 36% for males and 72% for females. Previous studies that have been undertaken have reviewed demographic dynamics and behaviour in Yemen. Somehave dealt with explaining about the various sub-cultures,customs, and traditions that have an influence on population policy. * Rector, Queen Arm University, Sona’a, Yemen 293 Cultures of Pomdations: Arab States FERTILITY AND MOTALITY Severalstudiesreveal a high fertility rate in the country due to the socio-culturalvaluesthat allow a young age at marriage, polygamy, and marriage of widows. In addition, short birth intervalsalso contribute to a high number of births per woman. The high fertility rate has led to a high dependency rate. Women and children suffer from malnutrition, morbidity, violence, deprivation, and unemployment. The availability of health servicesis limited and an overwhelming majority of Yemeni mothers do not have accessto or seek essential health services. Maternal and child health servicesare extremely limited and it is estimatedthat lessthan a quarter of pregnant women receivepre-natal care during pregnancy. Again, due to socio-culturalnorms the majority of them still do not have awarenessabout the importance of maternal and child health services.Most women give birth at home; a study revealed that 84 percent of births in an urban area also take place at home. Generally, it is expected that persons who are not fully qualified would attend births, and grandmothers,elder femalerelatives,and traditional midwives provide such services.This is one of the major factors in increasing the risksboth of infant and maternal mortality. Migration The percentage of Yemeni migrants is estimated at 20% of the population, who are at the productive age. The majority who make up this group are males,which leads to a number of social problems, despite the economic returns for the country (from emigration), while at the sametime, the internal migration, from the rural to the urban areas,due to urbanisation, is more than 4%, notwithstanding the legal and illegal migrants, who come from the neighbouring African countries. There is increased urbanisation due to internal migration continuously accelerated by the influx of people to them for work, education and better standardsof living, urbanisationis setting in. Many migrants are leaving the land, which cannot sustainthem anymore. In fact, 35% of the population is living in urban areas,and this third of the population isa big burden for the services in the cities. For example, the number of migrants to the capital city amounts to 52% of the total migrations to the other cities.Thishasalso contributed to the growth of shanty-dwellingsaround cities without health and education facilities. As regards international migration, a large percentage of Yemeni people are working abroad and also a smallpercentage of ‘legal’ and ‘illegal’ migrants come to Yemen from neighbouring African countries. There has also been an increasing trend of return migration of Yemenisworking abroad. Overall, the migration patterns indicate that it generates psychological,socialand economic suffering for the Yemeni family, whose provider (often male) migrateseither to the major city or 294 Cultures of Populations: Arab States overseas.Left behind with scarceresources,the women have to bear a large share of the family and economic responsibilities. Scope and Findings of the Study In this paper we shall now discussthe field researchundertaken on socio-culturalfactorsand demographic behaviour in the selected sitesin the country. In the study sample,four rural regionsand four urban areaswere chosen,to give an approximate representationof Yemeniculturesand sub-culturesin accordancewith its geographic divisions. The following four areaswere selected as sitesfor data collection: Urban. 1- Sana’aCity 2- Amran Governorate Agricultural area. 3- Ibb Governorate Agricultural area. Mukalla Coastalarea. 4- Hadramout Governorate The data collection was conducted by the way of focus group discussion(FGD)with men and women, and groups of teenage boys and girls (12-15 years). Interviews took place with 13 groups of women and 15 groups of men. The major findings indicate that the following socio-cultural factorsaffect the demographic behaviour. Nuptiality Choosing one’s spouse The traditional method of spouseselection is common at the study sites.The mother or sister selectsthe bride It is seldom that a groom would select his own bride. However, it is the family that carries out the required procedures. It is note-worthy that in some cities such as Mukalla, Sana’aand Ibb rural areas,the young man chaseshis own bride. In Ibb rural areasit was found that young men and women in villages know each other before marriage. Young girls in Mukalla saythat it is important to know each other before marriage and this opinion is common among all women from samplegroups in Mukalla with the exception of low income groups. This opinion is shared by most men in Mukalla. However, elders suggest that introduction to each other might only be done through photos and correspondence. Supporters of pre-marital acquaintance report that such practice could be undertaken through family channels,work and study situations. Such practices are reported to be common in Ibb and Ibb rural areas. There remainsa strong tendency of young age at marriage for women. 295 Cultures of Populations: Arab States The Appropriate age for Marriage: Therewas more than one notion with regard to early marriageof the girl. The general opinion is that the appropriate age is 20 years. Part of the group saysthat the appropriate age is 15, the other saysthat it is better before 18.For example, the teenage girls in Umran said that the appropriate age for marriage iswhen the girl is able to undertake responsibilitiesand is not minor nor older. In some casesit was considered better if the girl would have finished school. There were different trends among the male teenagers in Mukalla: they said that the appropriate age for a girl to marry is after finishing the intermediate level, if she was not engaged to anybody then she could complete her education. The views of the teenagers differed about early marriage. Within a group some agreed to early marriage, while others thought that the appropriate age for marriage is 18 years for girls and 25 years for boys. The students in the remaining groups said that they support early marriage, but they define the age to be between 18and 22 years.Other students,however, said that the appropriate age is between 16 and 18 years for girls and between 25 and 27 for boys. But the studentsof the third group defined the age to be 15yearsfor girls and 20 yearsfor boys. Cultural dimensions of fertility Religion confirmswomen’s role aswives and mothersand it elevateswoman position and her socialsecuritywhile pregnancy raisesfamily prestige and it is considered as a meansto preserve marriage. With regard to the family structure,the data revealedthat there existstrong family ties in a patriarchalmanner.The extended family is a sourceof emotional and socialsupport; marriage and reproduction are an important ritual for family stablity. According to Islamic tradition, marriage is an important event in the indivudual’s lifecourse.Religion and socialcustomsconfine sexual relations only to marriage. Women are encouraged to be pregnant immediately after marriage. Large familiesare still the norm in Yemen. Health servicesand family planning This study confirmed the importance of setting up general health service centers that also provide family planning and reproductive health servicesat community level. Thiswould assist couples to seek advice on planned families,thereby having an effect on high fertility. The contraceptive prevalence rate is extremely low when compared to some other Arab countries, like Tunisia(50%) and Egypt (47%). Most of the femalestudentsin the FCDindicated their willingnessto the useof contraceptives. However,the majority of couples remain hesitant to the useof contraceptives.Another group of female studentsexpressedtheir views as favorable towards family planning in the caseof lower socio-economicgroups, large families,and if it helped improving maternal health. 296 Cultures of Populations: Arab States The resultsof the study confirm that Yemeni women still do not plan their familiesuntil they have had severalchildren, and when the family begins to feel the burden of bearing financial aswell as health stresses. The sourceof knowledge about family planning is reported to be female teachersand housewives,in citieslike Sana’a.In other placesknowledge about traditional practicesof family planning are better known. In some casesit was also reported that women found out from the women’s gathering (the tefritah), and some NGOsworking in different parts of the country. A few participants also reported encountering it in the magazinesand TV. In Sana’a,there were alsosomefemaleteacherswho were opposed to familyplanning quoting religion and other cultural beliefs. It was the group of housewiveswhich came out as the most positive towards family planning. It was interesting to note that there was widespread knowledge about family planning, while in practice most young men believe that the high rate of population growth is not important. However they feel that in situations related to maternal health, it is acceptable to practice family planning. At the study sites it was indicated that the massmedia has an important role in getting women to use methods of contraception. It also revealsthat residing in urban areasincreasesthe possibiliesfor women to use contraceptivesbecausethe availability is easierand the increasein awarenessamong women on the significance of family planning is better than it is in rural areas. Women’semployment also seemsto encourage the practice of family planning, asthe participation of women in economic activity increasestheir commitment and concern for their personal matters. l Socio-cultural factors affecting mortality and morbidity Maternal health Most institutions providing maternal and child health servicescater only to women, while men are neglected. The most important problem is lack of awarenessamong the youth relating to infectiousdiseasesand lack of knowledge to protect themselvesagainstthem, thereby increasing their risks. The female studentsin all FCDsin Mukalla stated that due to the poor health and nutrition of mothers, the foetal and infant mortality are negatively affected. The situation is exacerbated due to the lack of trained medical and paramedical staff in the health centres. The female students felt that this could be improved through proper nutrition of mothers and improved health and sanitary conditions at the maternal health centres. 297 Cultures l of Populations: Arab States Migration At the study sitesit was confirmed that young men usuallymigrate to citiesand other countries leaving behind women, children, and older persons.Thisaccentuatesthe burden on women to cope with the absence of men in the rural as well as urban areas,and take on extra burden of financial and family responsibilities. Education as a major socio-cultural factor affecting demographic behaviour l Children’s Education There is a common attitude reported at the study sitesthat different social groups of men, women, young girl and boys that a mother’s role isimportant, especiallyregarding the enrollment of girls and boys to school. This opinion is expressed by working women, housewives,young girls and boys and different groups of men. It is clear that parents play an important role in the education and in the enrollment of their children in school, among the educated groups. In other words, wherever husband and wife are educated, they are more likely to participate in taking positive decisionsconcerning the education of their children. This is clearly seen in the report groups in Mukalla, Ibb and Sana’a.It does not seemto be the casein farming familiesin Amran, where tribal situationsare apparent. Overallall the paternal role seemsto be the dominant force regarding chidren’s education, particularly female education. It is note-worthy that women generally are more interested than men in following up the children’s educational problems. Thismatter is clear in cities and in Ibb’s rural areas. Regarding the different insitutions that play a role in education, the study pointed out the following: the family, school, TV, street, neighbours, relatives,friends and the mosque. The role of teachers All samplegroups requestedthat a teachershould be seriouswith a strong personality,flexible, good hearted, good moralsand humble. In addition to that, a teacher should not intimidate the students,should refrain from the use of corporal punishment and humiliation. He/she should be punctual and regular. It is note-worthy that young girls in Mukalla have requestedthat the female teacher should be unveiled so that her communication is clear and understandable. Regarding the choice between men and women in the teaching field, it is clear that there is a tendency which ignores teacher’s sex but focuseson competence. There is also the view of preference of women as teachers,particularly in lower income groups. There also existsamong some conservativegroups a preference for gender segration in schools. 298 Cultures of Populations: Arab States Servicesand Needs to be Provided by the School to the Local Community At the study sites, the participants expressed the view that following additional services should be provided which would benefit local cornunities: l l l Opening classesfor illiteracy eradication to teach local people how to read and write. Educating local people and making them be known by the teachers.This should include health education and training on first aid procedures. To teach sewing to women and some professionaltraining to men. CONCLUSION The Yemenisocietyappearsto be a well connected society,with one language and a common Arab culture. The educational statusof parents,and especiallyof mothers, promotes a favourable attitude towards family planning and birth spacing. This study indicates that religion plays an important role in family life, thus affecting demographic behaviour. Certain beliefs support women’s maternal role. Yemeni women significantly contribute to family income in both rural and urban areas.Although men in some communities, in which research was conducted, seem to provides basic economic support to their family, women also play an important role in supplementing family income. With migration of men to cities and abroad, the numbers of familiesheaded and supported by women is increasing. The extended family still formsthe basisof Yemenicommunityand there is not much difference observed at the study sitesbetween rural and urban areas. It is recommended that since there is a lack of researchon socio-culturalfactorsin relation to demographic behaviour, additional indepth studies should be carried out in different parts of the country in order to design population and development programmes. 299 Cultures of Populations: Arab States REFERENCES The World Population Council: “Family,Gender and Population policy, Views Fromthe Middle East,Cairo 1995. l The Central StatisticsOrganisation:Fertility and FamilyPlanning in Yemen:DifferencesConstraints,Sana’a,August 1996. l The CentralStatisticsOrganisation,Impactand Trendsof Intermediary determinantson Fertility in Yemen,Sana’a,August 1997. l The United NationsPopulation Fund (UNFPA), Population Issues,1998. l l l l l l l Abdu MohammedNasserAl-Qubati, The Impact of the lnrermediary Dererminantson Fertility and Its Trendsin the Republic of Yemen,the Central StatisticsOrganisation, Sana’a,1997 l Muna Dirhim Al-Aghbari, MohammedAhmed Ghutheim,TahaniSa’eedAl-Kheibah and others, the Efficiencyof UsingReproductive Health for MOtheFS in Yemen, Sana’a1997. l UNFPA,Population Issues:A Setof Media Materials(Informationfor Public Release), New York, 1998. l NajeibahAbdullah Abdulghani, Najeibah,Salih Bahubeishi,ReproductiveHealth & Rights, National Population Council, Secretariat, A study presentedto the SecondNational Conferenceon PopulationPolicy,Sana’a,1996. l Health and Ferrilify, Second National Conferenceon Population Policy, Sana’a,26 October 1996. Reproductive National Population Council, the National Strategy, 1996. Tariq Qaid Mohammedand Ali QassimIsmael, Social Study on the Concepts of PopulaGon Culture in the Agriculture Institutesof Yemen, Sana’a,Ministry of Agriculture and Irrigation, 1995 Ahmed Shuja’aAl-Din, Abdu Ali Uthman, Abdullah Ali Al-Chouly: The Marginal Groups in Yemen: A Field Study of their Economicand Social Conditions in the YemeniCities,Ministry of Planning and Development, Sana’a1996. lntissarAbdulla Bajil,Ahmed Abdurrab Mohammed, TahaniSa’adAl-Kheibah, Fertility and Family Planning, the Contrasts and Constraints(or Limitations),the Central StatisticsOrganisation,Sana’a1996. Judy Jacobson,BarbaraAbraham, Karla Makhlouf Oppermeyer,Family, Gender and Population Policy (Views from the Middle East), the World Population Council, Cairo, 1995. 300 l l l l l l l l Abdu Nasserand Others,Demographic Trends, the National Conferenceon Population Policies, Sana’a,1996. The Central StatisticsOrganisation,Demographic Surveyfor maternaland Infant Care,Sana’a,1997. The CentralStatisticsOrganisation,Men and Womenin Yemen, A StatisticalPicture, the United NationsEconomicand SocialCommittee on WestAfrica - ESCWA. The CentralStatisticsOrganisation:Internal Migration in Yemen: Featuresand Trends, Sana’a1996. (See):ThairaShalan,L’lnterferenceEntreLes ClasseEtCategorieSocialeDansLaSociete Yemenite,TheseDe Doctorat,UniversiteParisX Nanterre, 1993. Op. tit See:CentralStatisticalOffice, Hadramaut GovernorateOffice, Hadramautin Figures, 1997-IssueNo.8 - Mukalla -May 1998. Dr. Waheebaand others: economicand social effectson women whose household immigrated to petroleum countriesSana’a-1995. Cultures of Popularions v*%KA DEMOGRAHYFROMTHESOUL Ms.SilvlaSalinasMulder’ DEMOGRAPHY.,TRENDSAND PEOPLES B Olivia is located in the heart of South America, bordering Chile, Argentina, Paraguay, Brazil, Colombia, Venezuela, Ecuador and Peru. The last National Censusperformed in 1992 registered a population of 6.4 millions. Its actual population is estimated at 8,328,700 inhabitants, 4,184,910 women and 4,143,790 men. The population is distributed in 1,098,581sq. Km, with a comparativelylow population density of 7.6 inhabitants per sq. km and an average annual growth rate of 2.3 percent. If this growth rate is maintained, the population will double in about 30 years (INE,DHS 1). An approach to the age configuration presents a predominantly young population. According to the Census of 1992, 23% of the total population was composed by people between 10 and 19 years, and the age pyramid shows that 42% of the population is younger than 15 years of age, compared to 4% of the population that is older than 65. The research was performed in three of the nine departments of Bolivia, namely La Paz, Chuquisacaand Beni. Thesethree departments represent the three ecological zonesto be found in the national territory: highlands (LaPaz),in the western part and occupying 16%of the territory; the valleys(Chuquisaca)in the central region with 19%;and the lowlands (Beni)in the northern and eastern parts with 65% of the territory. With respect to the fertility rate, the national trends in the last 15years present a progressive decrease.Information from 1998’ reports a global rate of 4.2 (compared to 4.4 in 1994),specifying a rate of 3.3 for the urban areas and of 6.4 for the rural ones. While the urban rate has decreased in the last years, the rural trend has remained unchanged. Data is also available for each of the three ecological zones: 4.0 for the highlands, 4.4 for the valleys and 4.4 for the lowlands. It should also be noted that these changesin the fecundity rate have affected all age groups, but have been of higher intensity among people in the age groups between 25 and 29 years and between 30 and 34 years. ’ Anrhropolgist, Spectalisr on Gender and Developmenr Issues, Lo Pa.?, Bolivia I National 4 yeorr. Demography and Health Survey, 1998. This Survey is performed every 301 Cultures of Populations: Latin America The mortality rateshave also shown decreases.The global percentages in infant mortality in 1994were 75 per each 1000 born alive, and the data for 1998 reports 67 per each 1000. In the caseof mortality among children under 5 yearsold, the decreasehas been from 116to 92. The official maternal mortality rate continues to be 390 deaths for each 1000 born alive, being one of the highest in the region. The National Demography and Health Surveyof 1998 reports no data for maternal mortality. Even if Bolivia is among the countries with the lowest density and growth rate, it must be considered that these indicators hide important regional disparities. In global terms the population density in the highlands and valleys is much higher than in the lowlands. It is estimated that 43% of the total population lives in the highlands, 30% in the valleysand only 27% in the lowlands. The population growth, however, is higher in the lowlands and valleys than in the highlands. Bolivia is going through a demographic transition linked to an urbanisation process,in which the lowland cities have played an important role as attraction poles, capturing most migrants who are farmersfrom the highlands. Almost none of the migrating populations hassettled down in rural areas. Until the midst of this century, two thirds of the population lived in the rural areas. In 1976 the National Censusshowed 2,687,646 rural and 3,694,846 urban inhabitants, equivalent to 58% and 42% respectively.In 1992the Censusrevealed a shift in the percentageswith only 42% of the population living in rural areas. At the same time, between 1976 and 1992 the urban population grew at a rhythm of 4.16% and the rural stayed stable or even decreased in some cases.The growing population processeshave been distributed among three capital cities: La Paz(highlands),Cochabamba(valleys)and SantaCruz(lowlands),where 60% of the population is concentrated. This urban concentration processis more acute among the younger population. According to the Bolivian Young People Diagnosisperformed in 1997,the capital cities concentrate 46.3% of the adolescentsand 51.9%of the young people2 of the country. In the caseof SantaCruz, the urban young population is four times larger than the rural one. Evenif not reaching the same proportions, the cities of La Pazand El Alto show the sametendencies (Baldivia28). The migration processesalso present gender trends. Among young people, men and women have migrated in similar proportions; but among adults, temporary and permanent migrants are mostly men. This change in the composition of the rural population has certainly led to modifications in the sexual division of labour and has determined a relevant increasein women’s dutiesand responsibilities,mostoften not accompaniedby an adjustmentto their specific needs of those products and servicesoffered by private and public institutions. 2 The age caregotier 302 used in this study were defined as follows: imdol odolercence: IO-12 years: adolescence: 13.18 yean: young people: 19.24 yeon Cultures of Populations: Latin America In an article published two years ago, Pacheco points out three synchronic migration processes,which are related to this demographic change: 1) from rural to urban contexts; 2) from Eastto West;and 3) from traditional to commercialagriculture. Added to the previous is the phenomenon related to the temporal and permanent migrations to neighbouring countries, mainly Argentina, which hasnot been sufficientlydocumented (48).Thislastmigratory behaviour is of particular relevance in one of the sitesstudied, namely San Lucasin the department of Chuquisaca. According to an analysisquoted by Pacheco(SNAG/FAO/PNUD,qtd. in 48), the mentioned population movementsreflect the existenceof some phenomena related to changes in the productive structure of the rural area. Among the most visible are the following: 1) a slow though progressiveprocessof urbanisation, which implies that lessand lesspeople from the rural area depend mainly on an agricultural income to subsist;2) the impossibilityof traditional agriculture to sustain the rural population; and 3) the development of a mechanised agriculture in the lowlands that stimulatesthe development of regional labour marketsasmuch asit diminishesthe global demand for workforce. Among the most important expulsion factors, Pacheco cites the fragmentation and small landholdings, and the intensificationin the useof land, which havenegativelyaffectedthe volume and efficiency in agricultural production. This should be associatedwith the increasing levels of poverty, which severalstudies point out. According to the World Bank, approximately 60% of the urban population and 90% of the rural population have income levelsbelow the poverty line (gtd. in Pacheco52). On the other hand, the Human Development Report of 1994 (UNDP)speaks of 30% and 83% respectively. The highest percentages for rural poverty, however, are given by the Interamerican Development Bank (BID),which determines a 41% of poor urban population compared to a 93% in the rural areas (qtd. in Farahand Alemhn 77). Kreidler, former National Planning Secretary,alsoanalysesthe relationship between migration and poverty concluding that “a crisisin traditional agriculture is linked to the cities’ incapacity to offer minimum living and working conditions to large groups, which come to form part of the urban poverty quarters” (14). The data and analysisof the linkage between demographic behaviour and poverty has also served many authors to contradict Malthus’ thesis3and sustainthat, at least in Bolivia, poverty is not directly associatedwith population. In the words of Hugo Moldiz Mercado, “the lack of correspondence between population and satisfactionof basic needs is related to how national wealth is redistributed and not to the excessof population” (5). Thisanalysishas in many cases supported the argument that family planning policies and programs were meant to reduce selectively the birth of millions of potentially hungry. 3 R&en Molrhus war on economisr and a prierr born in England in fhe midst of the 18th century. His orgumenr that misery and hunger existed due 10 the of living means led him to propose birth conlml policies, including otwnion. popularion grows much fasrer than rhe production fanlhot :he 303 Cultures of Populations: Latin America However, from the perspective of human rights, which include sexual and reproductive rights, the issueof family planning or contraception policies has other connotations and implications. They focus on the right of every individual to decide freely and responsibly how many children to have. Nevertheless,what neither of the described positions seemsto have been able to capture is what different people in the various contexts think, feel, and want. Thus,in many if not most caseseven interventions aimed to promote reproductive rights have not considered people’s wills, aspirations and decisions. These ethnic, gender, and generation gaps, deeply based on a specific idea of how things should be, have diminished the potential results of well-meant actions.Within this framework, most approachesto fertility - decline or growth - are bio-demographic and neither consider the cultural context or individual actions (Angin and Shorter 556). From another perspective, questioning the traditional urban-rural analysisof poverty, the anthropologist RamiroMolina establishesthat between urban and rural native-languagespeakers the percentages of population with UnsatisfiedBasicNeeds are very similar.He then concludes, “the principal variable that affects the UnsatisfiedBasicNeeds is the language. Consequently, the language or ethnic-linguistic group is determinant, and not the differentiation between the urban and the rural” (29). In Bolivia 34.3% of the population speaksQuechua, 23.0% Aymara and 1.6% other indigenous languages. Language is the best indicator of the multicultural characterof the country. A censusrecently performed in the lowlands’ establishedthat around 150,000were lowland indigenous people, living 38% in the east, 38% in the Amazon area and 24% in the Chaco region. Thisdata only includes indigenous rural population, not taking into account the indigenous people settled down in the different urban centres. This rural population, which is composed by a diversity of ethnic groups, showshigh fecundity ratesand low life expectancy rates. In the population pyramid the group between 25 and 29 yearsrepresentsonly one third of the total. The female percentages are smallerin all age groups (gtd. in Molina 31). Emigration among these indigenous groups is relatively low, showing percentages between 2 and 3. However, if the high mortality rate is taken into account, even these low emigration rates could drastically decrease the rural lowland indigenous population. In relation to female and male migration, the collected data shows a higher percentage for men (54%), but also reflecting a comparatively high female migration percentage of 46% (qtd. in Molina 31). With respect to the possessionof legal land property documents, data of the lowland indigenous people showsthat half have titles and half do not. It should also be mentioned that 82% of the lowland indigenous population does not have basic identity documents (qtd. in Molina 36-37). 4 indigenous 304 Census of the Lowlands. Cultures of Populations: Latin America In relation to the departments visited during the study, the population calculated for Chuquisacafor the year 1998was 563,000, of which 204,000 was located in the urban areasand 359,000 in the rural areas.Thisdata indicates a department that still maintains a predominantly rural population of 64%. It should be mentioned that the only other department with a predominantly rural population is Potosiwith 64.9%. On the other hand, the population data for the department of La Paz presents a total of 2,314,OOOinhabitants. Compared to Chuquisaca, the rural-urban distribution establishes a concentration of 67.9% in the urban areas (1,570,OOO inhabitants). Only 743,000 people live in the rural areasof La Paz. Finally, the population estimated for Beni is 351,000 (Direcci6n de Politicasde Poblaci6n 5). Segregated urban-rural data is not available for this department alone. However, the calculated percentage of urban population is 66.5 (INE,DHS2). PURPOSEAND OEiJECTlVES OF THESTUDY The purpose: To contribute to a dialogic and interculturalperspective5in the design and execution of policies, programs, projects and services,by providing qualitative information about socio-culturalfactors that affect demographic behaviour in the cultures of the departments of Chuquisaca,Trinidad, and La Paz. General objectives: l l To identify and analysesocioculturalfactorsthat affect demographic behaviour in different culturesand cultural worlds of the departments of Chuquisaca,Trinidad and La Paz. To implement and validate a participatory training-research methodology. Specific objectives: l l l l To analyse the dynamics of demography from the perspective of men and women as actors. To determine and analyse the main coincidences and differences that exist between and among different generations and genders within the samecultural group. To identify and analyseamong the different generation and gender culturesthe coherence and/or gaps between norms, discourseand behaviour. To identify in each context the needs, demands and proposals of men and women of different age groups in relation to health, education and communicationpolicies,programs, projects and services. to Xower AIM, “we con speak of (1 kind of mrerculrumlky wherever o relations of people or human groups of o culrure wirh respecr ID another cullural our rhat o mulriculrural, plural and diverse reoliiy con orconnof be inwculfurol. “the otherYond, ox o consequence, the existence of interculruml communicorlon 5 According r&non beiween two cultures incurs-. lnterculrurolify refers mainly to the orriruder and and cultural pmducfs” (83.84/. Other authors point group, its members or rheir features From rhis penpecfiw, interculturality is linked fo the will and positive artirude loward~ devices. 305 Cultures l l of Populations: Latin America To establishthe implicationsof the findings with respectto the design and implementation of policies, programs, projects and servicesin the different locations. To determine recommendationsfor the design and execution of policies,programs,projects and services. With respect to human resources l Totrain men and women from the differentsitesin qualitativeresearchmethodsand techniques. THESCOPEOF THESTUDY The present study is defined as a qualitative, socio-culturalresearch,which “gives privilege to depth over the numeric existenceof the phenomena, comprehensionover description,location within a context over statisticalrepresentation” (Szaszand Amuchastegui 22). The researchwas undertaken in five sitesduring a total period of 4.5 months, starting July and ending in mid-November 1999. Considering the qualitative approach and taking into account the quantity and diversity of sites,cultures,and cultural worlds studied in a very limited time, it is important to emphasiseits exploratory character. The former certainly requires a package of flexible, adaptive guidelines, instead of a rigid methodological design and thematic predefinition. Consequently,neither the researchin itself nor the individual site reports6 have been strictly addressed with a comparative purpose. Although sevenbasic thematic pillars were predefined and discussedin each context, once on the field an exploratory, adaptive attitude oriented our attention towards particular issuesof interest, as well as towards (complementary)methodological and technical alternatives. From another perspective, if we consider that the findings of the study should serve the design and implementation of demography-related policies, programs, projects and services7, we can speak of a “strategic research”. In the words of Spradley,“instead of beginning ethnographic projects from an interest in some particular culture, area of the world, or theoretical concern, strategic researchbegins with an interest in human problems. Theseproblems suggest needed changesand information needed to make such changes” (15). Within this strategicframework,it becomesmostimportant to addressthe studyasparticipatory, meaning that the processgenerates opportunities for people to expresstheir opinions, needs, demands and proposals. As defined by Rivera, it becomes important to “produce knowledge and relevant researchresultsnot only for the researcherand the academic community, but also for the interestsof the studied group” (qtd. in Peredo et al. 92). Ultimately,this strategic-ethical challenge implies that fieldwork should be addressedas a negotiation processin the methodological and thematic sense. 6 Five efhnogmphic Workshop. 306 draft site repam were prepared (in SponishJ for the National 7 See UNESCO’s concepruol and methcdologfcol research purpore. framewar~ referalsofothe Cultures of Populations: Latin America Considering the previous,we can also conclude that besidesestablishing guidelines for interventions’, strategic researchalso has an exploratory function and should lead to its future translation into a specific researchproject (Spradley 11). PEOPlEAND SITES:BASICINFORMATION On one hand the geographic scope of the study was determined by the interest to capture sample areas representing the main ethnic and cultural configurations in Bolivia: Aymara, Quechua and lowland ethnic groups. Added to the former came the rural-urban variable, which in the processproved to be more complex than what can be expressedby such a dual vision. A third factor taken into account for the definition of the siteswas the social-class,in Bolivia’scase deeply ingrained in ethnicity. Lastbut not least,we tried to combine a representation of different social and cultural siteswith operative factorsand interestslinked to the objectives and tasksof our allied institutions’. From the intention to combine all these interestsresulted the selection of five socio-cultural sampleareas,located in the three great regions of the country: highlands, valleysand lowlands. In cultural terms,Aymara, Quechua, and lowland indigenous people were included. Thisethnic and cultural richnesswas also expressedin a linguistic diversity (Aymara,Quechua, Sirion and Spanish),which sometimesmeant the happiness of being able to understand each other, and other times the frustration of not communicating. KEYGROUPS ORGANISED: Adult women (22-49yearsold), married(with stablepartner)with children. Adolescentand young women (15-21yearsold), singleand without children. Adult men (22-49yearsold), marriedwith children. Adolescentand young men (15-21yearsold), singleand without children. METHODOlOGlCAL APPROACH,DESCRlPTlONAND PROCESS A starting point: “socinl constructionism” The methodology proposed is within the conceptual framework of social constructionism, which shareswith other intellectual trends the idea that the “subject playsan active role, guided by his/her culture, in the structuring of reality” (Gergen qtd. in Amuchastegui 146). The approach is directed towards the points of view of the subjects.Thus,attention is focused on the discoursesthat expressthem. 8 In this case referred to policies, progmms, projects and servicer. 9 The “QuHhuo and Spamsh lik?rocy P!vjeojecrof LlNFPA. locared in Chuquisoco and Porosi, and Espemnza Bolivia, a NGO with work in the deparrmenrs of Chuquisoco ond Torijo, established with us muruollywpponing and beneficial relorionr 307 Cultures of Populations: Latin America “This type of research makes us more sensitive”: from facilitators to protagonists The methodological dimension to the study was an essentialpart of the process.Within this framework, a key strategy has been the formation of local facilitators.Thisenabled us to operationalise the research,giving us at the sametime the opportunity to qualify and empower men and women as protagonists, researchersand multipliers at the local level. The selection of facilitators responded more to opportunities and possibilitiesgiven in each context than to specificcriteria, capacities,or experience. We believe that “anyone is a potential researcher”.In each context the general idea was to haveone facilitatorfrom and for each gender and generation group defined”. The initial training was decentralisedand took place in each particular context. To initiate the process we considered it fundamental to share ideas, experiences and knowledge of what “doing research”meant for each individual. Thisallowed usto bring the idea of being a researcher closer to the people, without losing the required rigour while adding a more human and less dogmatic approach. Afterwards, emphasis was given to prepare the facilitators to facilitate - motivate and conduct- and register the group interviews considering the techniques to be used and issuesto be addressed.The interview guides were reviewed and adapted with the facilitatorsin each site. Throughout the training our key messagewas: you are to listen and not to teach”. The theoretical component of researchand facilitation was reinforced through permanent follow up, evaluation and feedback during the whole fieldwork process.The three membersof the researchteam (director and two assistantresearchers)accompanied the interview sessions. The facilitatorswere in charge of organising and inviting the people for their group interviews, on the basisof basic guidelines received about the profile and number. Another moment in the facilitators’formation processwasthe NationalWorkshop.Ail facilitators - 13men and 12women - attended the event and had the opportunity to sharetheir experiences and lessonslearned. They also worked together with other researchers,experts, and decisionsmakersof population policies and programmesin the review of the draft reports of each context and the definition of recommendations. The National Workshop was followed by an internal workshop with all the facilitatorsabout intercultural research.This encounter between regions, ethnic groups, and cultures served as “raw material” for the workshop, which was essentiallyparticipatory and self-reflective. Applying strategic thinking throughout the research process We tried to apply strategicthinking by: . Developing the right “products” to negotiate with various institutions different kinds of support (e.g. we offered certain information needed by a specific project and received in 308 Cultures of Powulations: Latin America exchange additional financial, human, and logistical support). For this purpose, it was a key challenge to convince people that research is an investment that will bring benefits. Establishing operative, strategic, and political alliances with networks, institutions and organisations,on the local and national level. . Making decisions always answering the following question: what can be changed and what should not be changed? On one hand this required clarity to distinguish the means from the ends. On the other, it challenged our creativity and innovation capacity. Building a team, which meansmore than establishingcontractual relationswith someone. We understand that a researchis more than “the sum of its parts”. It implies the existence of a team that works and thinks together, and at the sameit requires considering the individual inclinationsand preferencesin the organisation and distribution of tasks.Thislast issue meansthat functional criteria are not necessarilythe sole factorsand that it is important to consider that people think and produce knowledge with mind... and heart12. Keeping all involved actors permanently informed and feeling they were part of the project. Thiswas certainly also a decisiveaspect to maintain confidence and credibility. l l l Fieldwork: Techniques and instruments Technically the research was approached using the following, mainly anthropological, researchtechniques, which emphasisea dialogical methodological perspective. l Group interviews Traditionally focus groups respond to an interest to contrast diverse subjective perceptions about a certain topic. Many times “the option for focus groups in researchhas been efficiencyoriented, becauseit is considered a technique that allows to obtain information in little time and with low costs” (gtd. in Pando and Villaseiior 229). Different from the focusgroups, so called “group interviews” presupposea certain continuity of the group in time. If optimum conditions exist, this should mean severalmeetings with one samegroup during the researchprocess,or at leasta longer encounter that allows more collective in-depth analysis. A group that begins as an addition of individual motivations and experiences, ends up with integrating though at the sametime differentiating dynamics and group identities. The second moment in a group’s history is the clarification phase, when the task becomes clear and anxieties as well as resistanceare expressed. Following this phase comes the consolidation period: The group is in its maximum functioning and “what the individual expresses- or silences- will be understood as emerging from collectivelatency,inter-crossedwith the subject’s individual history” (Pando and Villasefior 231). I.2 For example, when we organised rhe wiring ofthe rite repnr each one was in charge of(II Iearl one repon and the dirttibution crireria WI (when possible) each one3 pftV3Ke. 309 Cultures of Populations: Latin America During this group evolution at leastthree elementscome into play: information, emotion and production. Within this framework, group interviews include the analysisof the relational and power-linked elements that appear in each group: Beyond the information offered by the subjects of rhe study, one should analyse and rake into account the impact - befween fellow-object - which rakes place in the inferaction. The age, gender, social class and ethnic group differences, as well as the power relations that arise under these conditions, are elements that come into play during the interview and which if is necessary to recognise and analyse as part of the research data. (Rivas 206) During our research it was certainly not possible to establish a more or less permanent or periodic relationship with the groups. However, periodicity was substituted by extended “workshops” of about eight hours that allowed the group, at least partially, to go through the different phases. Sometimesthe activity was divided in two sessions.In any case, it was each facilitator’s responsibility to determine how, where and when he/she and the invited people wanted to carry out the six to eight-hour interview. Furthermore,the workshops were conceived as training - research- reflection-proposal scenarios. l l l “In these two days we felt happy, we learned about everything”. “All the question seemed right to me, everything was fine, some of us did not answer very good, probably totally wrong, but it was fine, I hope it is not only for just this time, f’d like to continue with this type of courses...” “For me it was good to continue learning... keep coming here to support us, to help us to be more open, not to be quiet, because we can give our best . ...” l “As a rural sector we never valued what we know how fo make, what our hands make... if seems that we are domesticated, that it is the case forwomen.... Thank you for ralking to us.” However,it mustalsobe saidthat the specificcharacteristicsand needs of each context demanded an adaptive approach, meaning that issuesaddressedand techniques used varied. Nevertheless, changes did not affect the concept and thematic organisation of the interview13. Also important to mention is the note-taking process.A specific instrument was designed to enable an organised and codified note-taking process.It also left room for commentsand observations, emphasisingthat what should be registered was verbal as well as body language and attitudes observed. 13 The inrewiew guide was organised o family; 4. Maternity and potemiry,’ 310 around seven rhemoric oreas: 1. To be - womon and man 5. Contraception and STD’s,’ 6. Services; 7. Migrarion. odulrs in the community: 2. Conceptions of a couple: 3. Conceprions of Cultures of Powulations: Latin America The group interviews were conceived as “workshops”, and the utilisation of different researchand popular education techniques (“generating techniques”) was very important (e.g. role play, cassette-debate,picture interpretation, drawing). The approach aimed to create dialogic experiences for people of different genders and generations “among themselves”,meaning that discussionswere to take place among gender and generation specific groups, and that the facilitator should also belong to this group. Two basic assumptionssupported this proposal: That a communicationallinkage would existamong the participantsand with the facilitator, not only in practical terms but, most important, given the existence of a shared sensemaking weft and the transmissionof meanings. That, partly asa consequenceof the previous, the dialogic experience would take place in an atmosphere that would promote wellbeing and confidence. l l In-depth interviews From a reductionist approach, interviews are understood as technical opportunities to “gather” information provided by so-called key informants. However, interviews generate an interaction that leads to a processof joint, dialogic knowledge construction, in which the relationship between the researcherand the interviewed person also calls for attention as a knowledge-constitutive historical factor (Rivas206). From this perspective, the interviewed person is not just a witness who narratesa happening from a temporality and spacenotion that apparently do not have anything to do with the event. The informant is an active subject, a protagonist who recreatesin his/her narrative the experience and re-signifiesits history. In other words, he/she reconstructsor re-elaboratesexperience. The informant function thus ariseswithin a dialogic relation promoted by the interviewer, who, on the other hand, pays attention to the informant and keeps his/her company with the intention to comprehend the narrative and give room for the personal and spontaneous forms of discourse(Rivas221). If we agree on the previous, it mustbe considered that “the samenarrated expressionimplies a - most of the times unconscious and involuntary- selection and thus interpretation of the happenings” (Rivas215)and the data. Within the broader category of “in-depth interviews”we can distinguishtwo typesof interviews used during fieldwork: Theme-focusedinterviews: Basedon semi-structuredquestionnaires that were prepared for each particular case.This type of interview was mostly utilised in the case of institutional keyinformants (e.g. hospital, municipal government and policy-makers). 311 Cultures of Populations: Latin America Focalisedlife histories: Life storieshave become documents with much value because they “allow to register direct information of the protagonists of the social and historical reality” (Peredo et al. 91). The person’s life narrative guides the interview. As Rivaspoints out, “it was central to encourage in-depth data, achieving more or lessspontaneous narrativesaround the topic selected” (214).Within this general framework, the interviewer triesto revivelived processes and focalise towards an exploration and reconstruction of certain life scenario. Start-off questions are open and general, and during the process new, not previously prepared questions, are formulated. This re-production processis for the others and for the interviewed person himself/herself, thus constructing, reinforcing or affirming his/her identity. In our study focalised life historieswere used to addressthose people who were out of the gender and generation norms, for example: single adult women, couples with no children, divorced men who take care of their children, and others. Participant observation Participant observation was the mechanismto avoid reducing the research processto the specific,particular“events” (e.g. interviews).It createda time connectionand flow that alsoallowed us to capture daily life data. During the few days that we stayed in each context the facilitators assumedtheir role “day and night”. During the facilitators’ workshop we also gave them an introduction and key guidelines to use a field diary (e.g. registering the place, datum, time, origin and other relevant information to contextualisethe note), so that registered observations could later be used as data. The field diary was used as a historical document. Thus,no written text could be eliminated or changed. New thoughts and ideas, even about the same issue, required always a new entry. Our two main problems... l Linguistic diversity It is not exaggerated to say that this research has been a five-language study: Spanish, Quechua,Aymara,Sirionoand English.More than being able to capturethis richness,the language diversityhasposed somepractical,methodologicaland even political problemson the levelof: Basiccommunication with the participants. Translation,with lossand/or change of meaning. Data analysis. Writing the report: Who is going to read it? It should be noted that in Bolivia very few people speak English. Work organisation and division of tasks:Only the project director speaksEnglishand none of us speak any of the indigenous languages. l l l l l 312 Cultures l of Populations: Latin America Studying the high class... it is easier to study the “others” People from the high-middle and high classare not used to be “research subjects”. If the case,they have experience as researchersbut not as researched.In Bolivia “studying down” has been the general research trend. While in the rural areas facilitators and interviewed people expressed that they were lucky to participate, in La Paz it was considered a loss of time, and group sessionshad to be minimised as much as possible. SOCIO-CULTURALFACTORS,DEMOGRAPHICBEHAVIOUR AND POLICIES:MEN AND WOMEN AS ACTORS Demography has traditionally been addressed as a statisticalproblem. Consequently, the cause and effect relations of its different factors and dimensions have been analysed only as “rational” or “irrational” responsesto certain conditions. People, asactive creatorsand modifiers of valuesand meanings, seemto have little to do with demography. They are born, get sick, die or migrate within - or outside of- certain demographic trends. At the most they are considered in terms of their calculated, rational or irrational responsesto certain factorsor phenomena. Thus,as has occurred with respect to all human issues,the quantitative approach has led to the treatment of actors as objects. This type of research gives priority to “the variability and regularity of behaviour and looks for objectivity, confidence and representation and statistical validation through the verification of the cause-effect relations established between those concepts and variables” (Lerner 13).Furthermore, quoting the sameauthor, “all considerations about the subjective,symbolic and value issuesthat give senseand meaning to the conducts and actions of the individuals are omitted”. People are seen as needy or as victims, without taking into consideration their different active responses,abilities and potentials. Thismacro perspectiveallocatesthe determinantsof people’s behaviour only in the structural, external sphere, thus analysing the particular group and individual responsesas more or less adapted, rational or expected. For example, in an article that analysesthe relation between migration and rural employment, Pablo Pachecoconcludes: “These movementsare part of a complex circuit of population flows determined by the development of the marketsand the road expansion, among others” (51). Distinct analysisstressother structural causesfor demographic behaviour, but despite of the various approaches and different conclusions,most show one important contradiction: being demography in its core a human issue,in its analysispeople become invisible. Fromsubjectsthey become objects of demographic processes,which seem to inevitably predetermine their behaviour. CarlosAramburu (1998)refersto the distance between demography and anthropology as an “epistemological deafness”and callsfor a dialogue that could only be fruitful and beneficial for both on a micro and macro level. 313 Cultures of Populations: Latin America Within this lastapproach, other effortshave been made to study demography and population from an ethnographic perspectivewith the goal “to give human agency its central place within, not outside of, the structuresof society” (Angin and Shorter 557). Researches,like Angin and Shorter who studied the fertility decline in Turkey,turn their attention to the concrete men and women and conclude that “people make their own evaluationsof what their goals with regard to reproduction should be, what signifies good and bad behaviour, how men and women should be, how men and women should relate to each other and negotiate, and how they should understand the having or not having of children”. In the sameline, the Mexican Roberto Castroaddressesthe conception of the social order as an “inter-individual negotiations’ weft” (qtd. in Szaszand Amuchastequi 24). However, fewer studieshave posed their interest in the relativismor “‘negotiated’ conduct”‘” of individuals, addressing peoples changing decisionsin time and place. Thisapproach leads us to the conclusion that even if some more or lessgeneral patterns and/or cause-effectrelationships can be identified, at the end the behaviour and decisionsof every individual respond to specific conditions and negotiations processes. In Bolivia research- quantitative and qualitative - hasin general terms received little interest. The efforts have been dispersed, the resultsfrequently not disseminatedand mostly not used. Despite this overall negative diagnosis, NCOs, academic institutions and individuals from the socialscienceshave contributed to the generation of qualitative knowledge. Challenged by the diverse and complex multicultural reality, investigators from various disciplines have tried to understand the reasonsand motivations of people beyond Westernrationale. In recent years another relevant diversity issuehas been linked to generations, their specific needs, interests and expectations. Studies on adolescent populations multiplied in the 90’s, while from the Stateside efforts were directed to the creation of a specific Program within the Ministry of Health to addressadolescence.How connected theseeffortswhere, isthe key question. Knowledge production could certainly help to build bridges or narrow the prevailing gaps between what decision-makers’think and what people want, taking into account their specificity and differentiated needs, interestsand expectations.Evenif researchhasnot been a priority in any discipline or sector, probably the main problem has to do with the technical, political and other difficulties to articulate research findings with policy, program and project design and implementation. This is, it seems,not a specific problem of Bolivia, but a more generalised challenge that we all have to face (seeBronfman et al. 2000). The “translation” of researchfindings to policies and programs is a key issuethat concernsat the sametime those worried with efficacy and efficiency and those fighting for the expansion and observation of people’s individual and collective rights. 14 and Shorter use this concepr nniculadng Foucaulr’s defimrions of negormrion and conduct. For the first concepr rhey quote Foucaulr in rhe following Fermi “It is n mml ~frucfure of acrions brought 10 bear upon possible oclionr; if inciter, if inducer, if reducer, it makes easier or more difficult; in rhe extreme it consrrclins or forbids absolutely; if ix nevenhelesr always a way of acting upon and wring subject or acting subjects by virtue of rheir being or being capable of action”. On the other hand, they indicate that “the word “conduct” is chosen deliberately 10 indicate borh the loding of others and the choosrng of “a way of behavrng wirhin a more or 1es1 open field of possibiliner” (qld. in 557). 314 Cultures of Populations: Latin America CULTURES AND CULTURALWORLDS,POWERAND RESISTANCE As all concepts in language, the notion and meaning of culture are historically determined, and thus vary in time and space.Culture as a concept is also defined and addressed in different ways buy different interest groups. For example, for the governments and elite groups the preservation and promotion of culture is mainly referred to fine arts, consequently understanding asperipheral and marginal - or even asuncultured- the popular and massivecultural forms. In this elite discoursesocietyis conceivedascomposedof people with and people without culture, or civilisedand uncivilised.Eventoday this discoursecan be identified in many analyticalperspectivesand social policies, despite its oftentimes not explicit manifestation. On the other hand we find the definition of culture as referred to all what is human. This holistic perspective addresseesculture as a sense-makingsphere. According to this approach, culture works as an organising and explanatory background, which gives senseto all human. In other words, a sense-makingweft that human beings themselveshave or are weaving. Cultures interact, confront and influence each other. They are permanently re-created in a dialectic processbetween change and resistance.The notion of resistanceis very important. It is linked to the acceptance that power is not possessedbut exercised in every interaction. Todaythe notion of culture asbeing shared by a group hasbecome insufficientto understand and explain diversity and inequality within this so defined cultural group. Within the framework of a new pluralistic approach, the conceptual tendency has been to organise the “diversity within diversity” in a hierarchical manner, speaking of “cultures” and “subcultures”. For this study the concept of “cultural world” has been taken from Dirks et al. to substitute the use of “subculture”. The main argument is that the proposed concept seems more powerful and meaningful in termsof demands and proposalsand lessorganised in termsof a value and importance scale.With respect to the origin of the concept, the authors point out that “one of the core dimensionsof the concept of culture has been the notion that culture is ‘shared’ by all members of a given society.But asanthropologists have begun to study more complex societies,in which divisions of class,race, and ethnicity are fundamentally constitutive, it has become clear that if we speak of culture as shared, we must now always ask ‘By whom?’ and ‘In what ways? and ‘Under what conditions?“’ (3). DlVERSITYAND INEQUALITY:TWO SIDESOF THESAME COIN Bolivia as many other countries in the world is known for its cultural diversity. Despite the many historical attempts to strive towards and homogeneous nation, today we can see that far from the uniformity ideal, the country is if not more as diverse as before. 315 Cultures of Populations: Latin America One of the lessonslearned in this senseis that even domination leavesroom for resistance. Thus and despite the unequal relations, which take place in the confrontation of the distinct world visions,new cultural formsthat expressthe dynamics,coexistenceand historicalcontinuity of the differencesare permanently re-created. Thesechallenge us to discoverthe appropriation processesthrough which each culture reconstructscontinuously its meansof resistanceand affirmation, and how these are expressed in the particular ways people understand, live and act demographically. Diversity, in all its expressions,is supposed to be a value in this postmodernist period. However,in a country in which the notion of citizenshipisassociatedwith a certain gender, ethnic, classand age standard, the issuebecomesmore complex and we have to addressnot only diversity but also its social organisation in a very unequal and hierarchical society. In the words of Peredo et al., the now common approach to societyas diverse“should not lead us to forget that Bolivia besides being diverse is also stratified” (64). Modernisation and development have been built on the asymmetryof internal colonialism in a country in which around 60% of the population are considered indigenous or belong to one of the original nations”. Other authors like Salazarhave also stressedthe importance of considering the present coexistenceof distinct and unequal historicalperiods (17). The systemworks through ethnic discrimination and penetrates other systemsof exclusion, thus configuring complex power relations in which class,gender, ethnicity and age are interconnected. Within this framework, ethnic discriminationis hidden behind the half-castediscourse that has been used to ignore the differencesand maintain the inequalities. Among other factors inequalities - as present living conditions and opportunities for the future - are expressedin the increasing concentration of property and power, tremendous economic disparities,the unequal supply of and accessto servicesin quantitative and qualitative terms,and other socialand cultural phenomena as exclusion,violence and discrimination. Most authors have privileged the analysesof these asymmetriesin relation to the rural-urban dichotomy. However, Molina proposes the thesisthat the essentialdetermining factor is not the localisation urban-rural, but its relation to the language spoken by the population (29). Consequently, discrimination takes place essentially between the indigenous and the nonindigenous population (37). Due to the age composition of the population, the cultural confrontation and negotiation processesalso have a particular age mark. As a whole, in Bolivia the rights and privileges of adults prevail over those of the young, adolescentand child population. Furthermore,the policies and programs are conceived by adults, reflecting their points of view. From the perspectiveof gender issues,the 80’s and the 90’s have been characterisedby an increasinginterestand knowledge production. The work of severalNGOslinked to the women’s 316 Cultures of Populations: Latin America and/or feministmovementswas a decisiveinput to capture public attention around unequal gender relationsand women’s situation,which had been hidden behind classand ethnic analysis. In the 90’s the gender problem became a State issue.Just to mention is the installation in 1993of the Sub-secretaryof Gender Issues,now a Direction within the Vice-Ministry of Gender, Generation and FamilyAffairs. As Roberto Lasernapoints out, national data are not only to be applied to diversepopulations with particular social characteristics,but also to the very distinct, unequal human conditions, which derive from national policies as well as from the local social and political dynamics. “Unfortunately, the perceptionsof the Stateand of somesocialgroups are defined from exclusion, not giving room to this other Bolivian who is different, in a context of cultures and identities which vary very much” (gtd. in Molina 24). The consequencesof this hierarchical structuring of diversity are reflected in all institutions, norms and discoursesthat organise social life and thus mould and at the same time affect the individual. As Riverawrites, while modernisation and recognition of plurality takes place within the frameworks of public policies and norms, in daily life the phenomena of exclusion and discrimination continue to reproduce themselves(20). SUMMARlZlNG... l l l l l l l The study did not assumea bio-demographic perspective. Men and women were taken asdemographic actorswho think, feel, negotiate and decide. Culture is understood as all that is human. Within this framework, culture is dynamic and permanently changing. Diversity exists within diversity: Cultural worlds in each cultural group were taken into account. The issueof power is considered as present in all human interactions. Diversityis not taken as a synonym of inequality. Resistanceand change were considered in each context. BEYONDSTATISTICS: UNDERSTANDINGDEMOGRAPHICBEHAVIOUR Basedon our fieldwork and combining a quantitative and qualitative approach, this chapter aims to contribute to an understanding of the main social and cultural factors that influence demographic behaviouP. 16 Particularly in relation 10 rhe morbidiry and monoliy issues, il should be nored that the study has focused factors of monaliiy and morbidity in Bolivia other causer and influenriol on sexuoliry, repmducrion and r&red orpem, nor including 317 Cultures of Populations: Latin America ‘Women are like trees; we give flowers and reproduce”: fertility In the last decades and important reduction has been observed in the national fertility rate, which decreased from an average of 6.5 in 1976to 4.14 children per woman during the year 2000. However, the national average is still the highest in South America. A rural-urban approach shows interesting differences in an 18-yearperiod: YEAR 1976 1992 1994 1998 URBAN 5.2 4.2 3.8 3.3 AREASRURAL 7.8 6.3 6.3 6.4 AREASTOTAL 6.5 5.0 4.8 4.2 We can observethat after a first period of important reductions in the urban and rural fertility rates, the decreasing tendency has only continued in the urban areas.Thisis an example to be aware that general trends and averageshide particularities and disparities. The social, cultural and economic tensions that mould demographic behaviour as well as the specific responses remain hidden. To addressfertility patterns in Bolivia we could ask three main questions: Why is the fertility rate in Bolivia the highest in the region? Whichare the socialand culturalkey factorsthat are influencing a reduction in the fertility rate? Which are the social and cultural dimensions that act as resistancefactors against fertility decline? Keeping these questions in mind, we should start by emphasising the predominantly Andean composition of the country’s population (Aymara and Quechua), of which we have inherited the ideal of the large family. For example, in the Quechua community of Padcoyo women pointed out that a family with many children was a “happy family”. Also in the lowlands we found among some adults the ideal of a numerous family: l l l “I have thirteen children, five are men and the rest women, but I would have liked to have fifteen”. Adult man,Trinidad The large family is also a responseto particular “objective” conditions and needs. In the rural settings children’s workforce is essential.From very early ages (5 years or even younger) they take the responsibility of shepherding and increasingly assumeother taskswithin the familiar division of labour. 318 Cultures of Populations: Latin America Also important in the decision about the number of children is the lack of social security in the rural areas17, which meansthat daughters and sonsmust take care of their parents, their land and animalswhen they are old: “It is not always good ro have children because children make mothers suffer. But the children also take care of us”. Adult woman,Padcoyo The former is seen as part of the reciprocity systemthat guides the traditional indigenous socialorganisation. If the infant mortality rate is added to the former considerations,then we can understand that having many children is also a precaution measure: “If you have many [children] one or two may go the wrong way, but rhe orhers will stay with their parents”. Adult women,Padcoyo Thus,in the rural areasthe number of children is a subsistenceand socialreproduction issue: “l/t is imponanr] rhat the community doesn’t die. disappears”. If there are no children the communiry Old man,Achacachj. The reduction in fecundity rates does not always correspond to changes in the set of social and cultural values that guide the demographic behaviour of a certain group. While this issue cannot be of considerable importance for majority groups, it is a survivaltopic among minorities. For example, among the Sirion we found that the mandate to have children is very strong and their survivaldesireasan ethnic group haseven changed their endogamic practices.An important strategyfor the Sirion to increasetheir population is to consideraspossiblesexualpartnerspeople from other groups. On the other hand, changes in the patterns of production and economic factors seemto be the main restrictionsin the rural areasto comply with the large family model: “I only wanf to have three (children) because there is no employmenr and rhe situation is hard”. Adult man,Ellbiato 17 lhis issue also offecfr some urban groups, mainly rhose who ore migrants and/or work in the informal seclor. 319 Cultures of Populations: Latin America In urban La Paz,adults and youths also pointed out economic factors as determinant with respect to the family size, but added other considerations related to an idea of what good parenthood means. Many expressed that they would have liked to have more children, but emphasisedthat more children mean lessquality in the education and attention given. For all groups that participated in the study the “traditional” or actual family model consists of mother, father and children’*. However, social and economic changes strongly linked to migratory processeshave influenced the diversification of family models, which are not recognised in the cultural discourse.Single mothers and woman as heads of the family are just a few examples”. Another interesting information is that the percentage of single women in the age group from 20 to 49 years has increased from 15.6%to 33.4% between 1989and 1998. But despite the changes, the idea or definition of a family is linked to traditional gender mandates and expectations. Thus, particularly in the Andean contexts, single people are not considered citizensin plenitude. Marriage, understood in its broadest senseashaving a partner, is part of each individual’s life cycle and is a condition for the participation of men and women in the different eventsand spheresof the community. The notion of male and female complementarily is essentialto Andean worldview: “Marriage makes a man and a woman to be respected”. Adult man,SanLucas With marriage people from a community acquire a set of obligations and rights. Among the last ones is the right to accessto a piece of land: “Some marry only to get their parcels”. Youngman,SanLucas Taking into account the previousanalysis,we can understandwhy someinformantsmentioned that women want to get pregnant so they will marry afterwards. Thisis even more understandable if we take into account that an age-norm accompaniesthe law of marriage, which makesa distinction between the possibilitiesof men and women to find a partner, giving the women a more restrictiveperiod in their life cycle: “Men can find a partner until they are older... On the contrary, it is more difficult for women to find a partner when they are older”. Youngwoman,ElAlto 18 We mua poinr out that HolmLwg (1978) refers lo rhe existence of polygamy among rhe Smond. However, dudng our fieldwork informonu emphasised rhot rhe communiry has now rqulored monogamy through (I specific norm. 320 Demography and Health Survey of 1998 menrionr 1996 of households headed by women. which seems on underestimored figure but helps fo hide the issue. The Suwey also informs that the percentage is higher in the urban cemres than in the rural areas, on affirmation that might hide changes in family partems generared by tempomy mole migmrion. I9 The National of Populations: Cultures Latin America At a certain age bachelors and single women are not considered normal. While rural participants mentioned lazinessand promiscuityamong the possiblecauses(the first one for men and the second one for women), the middle classadolescent group20associatedsingle men to homosexuality and single women to feminism. Furthermore, couples that do not have children are not recognised as a family. It is expected of each “normal” person and each establishedcouple to have children: “[A personwithout children] is like he/she would not exist in this world: thispersonis death”. Adult man,Trinidad Women and men who cannot or do not want to have children (a strange phenomena considering the strong social pressure)are diminished in their femininity and masculinity: “[/f a woman] doesnot have [children], this means she is not useful”. ‘They call the women ‘mule’. They call the men ‘ox’ and they criticisethem”. Adult woman,Padcoyo Usually,as an expressionof machismo, when a couple does not have children the woman is considered responsible. Infertility is oftentimes associatedto curses. On the other hand, it is expected of each man-father to have at least one son to “prove” his manhood and give the family social position and prestige. As expressedby a new father, “I’m very happy with my last boy, he will make it to the Government. Women lack the drive and they don’t study”. Transcriptionof filmed material*’ Thus, many couples have progressivelyincreased the number of planned children until the heir of the family name was born. It should be noted that in Boliviachildren automaticallyinherit their father’s last name and so guarantee the continuation of the paternal lineage: “For the men it is important to have sons to call the son with their last name”. Adult woman,Trinidad It is also important to consider that despite the decreases,the fertility rates obtained in the 1998 Surveydid not correspond to the number of children women said would like (or would 20 The groups belonging. of the Southern It must be said quarters fhar xome of Lo Pa ore ben of the poniciponts defined did by ifs class in fhe not live 21 During as pan our sroy in Son Lucas a of the follow-up procerr Chileon filming team was also working in rhe rite of the UNFPA Bi-Alphobetization project. 321 Cultures of Populations: Latin America haveliked) to have.43.9% of the interviewed women declared that their ideal number of children was two, while 20.2% mentioned three. It should be noted that the youngest age group (15-19) also showsthe lowest ideal number of children (2.1), while the age groups between 40 and 49 manifest the highest average ideal of 3.1. Compared to previous years, a decreasecan also be observed in the ideal number of children, which has a clear generation mark. The younger women want fewer children. According to the Survey,the ideal number of children is very similar in all the different contexts. Thusthe gap between “children had” and “children wanted” is particularly notorious in the rural areas. However, previously mentioned social, cultural and economic tensions must be considered to understand the responseswithin the particular contexts. One key factor that mustbe taken into account to understand the gap between children had and children wanted is gender socialisation.The direct associationand female mandate of the woman-mother could be found as a constant in the different rural, urban-marginal and urban areaswhere the study took place: Women are like trees: we give flowers and reproduce”, Woman,SanLucas of their life”. Youngmiddle-class woman,LaPaz “I think that it is not until a woman is mother that she finds the meaning The former is related to the lack of power that the women have to decide over their bodies and reproduction. An illustrative example was provided in Achacachi, were doctors from the hospital mentioned that men who migrate temporarily want to keep their wives permanently pregnant to ensure their fidelity. Within this gender framework, and despite the recognition of some changesin gender roles and opportunities, sexual initiation in a couple was identified mainly as a male decision: “Men usually choose women but women don’t choose”. Adult woman,Padcoyo A high rate of adolescent maternity should be noted. In 1998, 12%of the women between 15 and 19 years were already mothers and 2% were pregnant. Of this percentage 52% corresponded to women with no education. Desegregated data shows that the percentage of women of this age group that are mothers is twice as high in the rural areasthan in the urban ones: 18.4%vs. 9.2%. The samehappens with respectto pregnant women, where the difference 322 Cultures of Populations: Latin America found is 3.4% vs. 1.9%.A regional analysisalso reflectsimportant differences:In the lowlands of Beni and Pando the incidence of adolescent maternity is four times the percentage found in other departments22.Thiswould seemto contradict the thesisthat the level of education is related to the fertility rate because the lowlands are the region where the highest percentages of women with intermediate and high school education are found. Also important to note is that the percentage of men and women who know and use contraceptive methods is considerably higher in the lowlands than in the highlands and valleys. Finally, although sexual initiation is earlier in the lowlands (18.1 years)than in the highlands (19.6)and valleys(19.3),the difference does not seem to justify the much greater incidence of adolescent maternity. Further analysisis needed to identify key factors. It is important to mention that despite the national norms that prevent it, very often early motherhood leads to school abandonment23.Socialpressureis added to the new responsibilities and needs and leads to desertion. The District Education Director of San Lucasmentioned, for example, that adolescent mothers are allowed to continue their studiesin a normal way after the child is born. During pregnancy they “rest” to keep the school’s prestige and avoid problems with other parents. However, “sometimeswhen these situationsarisethe studentsleave, they disappearand the next year they don’t register...even though we talk to them a lot. Bur the reality is thar some of rhem go to work to Argentina, SantaCruz, Cochabamba, they comeback with other ideas”. Director,ReneBarrientosSchool,SanLucas About sexuality, adult and young women of San Lucasidentified a gap between “what should be” and “what really happens”: “Very few are virgins when they marry, but most have experience”. Despite context particularities, generation and gender differences, we can affirm that in general adolescentsare subject to an ambivalent discourse.They are expected to be sexually responsible but they do not have the basic conditions and means. On the other hand, since having information is interpreted ashaving had more opportunities and experience, an informed adolescent is frequently synonymousof a promiscuousadolescent. From a broader perspective we would argue that the problem is a more general one that characterisesa society,which aims to promote and respect the rights and participation of young and adolescent people, but remainsruled by ideas, valuesand interestsof adults. Sirion woman who told us that she did not even had her fu’st menrrruotion when her master rook her to his cattle ranch. 22 A 23 According to the 1998 Survey peggnoncy (~ccounu for 3.8% of the coser of school abandonment among women between I5 and 24 yeon old. 323 Cultures of Populations: Latin America Three main factorscondition the sexual behaviour of adolescents: The fear to be discoveredin their sexualactivities. The unexpected character of their sexualrelations. The desire or fear of becoming pregnant. l l l Our general findings - with exception of the lbiato - have shown important communication gaps between parents and adolescent sonsand daughters. Hierarchical,authoritarian relations characterisemost of the testimonies. However,both partsfeel unsatisfiedand would like to changethissituationbut do not know how: We did not receive orientation from our parents but we want to guide our children. There are rimes when hey get drunk and get together very fast”. Adult man,Achacachi “My parents did not allow me go to go out with guys and did not know I was going out with him. When they found out they prohibited me to see him... The first time fthat we had sexual relations] if was very late and 1 was afraid of going home at that hour. 1 thought.... that the best was to escape with him. When they found us my father asked for a detention order for him and he went to jail for two days... Then I escaped with him again and when they found us we were both beaten. They also cut my hair...“. Marriedwomanof ElAlto, 20 yearsold Parents’rejection to new valuesand their strictdiscipline may resultin unwanted pregnancies: 7he prohibition of the parents to fall in love when you are young can bring problems, unril it can end up in a pregnancy. That is for hiding all the time” Student,Rem5BarrientosSchool,SanLucas On the other hand, the parents mentioned that young people, particularly women, have lost the minimum respect for adults and older people. In their opinion, accessto education has led to tensionsand ruptures in the traditional intergenerational “norms”: “The difference of the youths with respect to the adults is in education, they no longer pay attention to their parents. The parents are relegated.” Adult men,SanLucas 324 Cultures of Populations: Latin America In the rural areasthe relation between education and early motherhood also has to do with accessdeterminants. As pointed out by the director of the school in San Lucas,going to school representsfor most adolescent and young people of distant communitiesthe need to move and live alone at early ages: “Theproblem is that parentsdo not live in the community.70%of the youth have problems becausethey don’t have their familiesnear. Theyare studentswho comefrom the neighbouring communitiesand rhey comeafter working in places like Argentina, or within our country in SantaCruz, Cochabamba, Sucre, La Paz, where they have gone to make 300 Bsor perhapsabout 500 Bs.for subsistence.Theyare self-educatedand they save that little moneyand spendif throughout 365 days...Theyhave their own rooms sometimesin dark placeswhere one cannot conrrol his/her srudents... We have one or two pregnancies they begin too early in sevenrhor eighth grade”. The communication gap, asa phenomenon with context and group-specific formsand manifestations,affects the adolescent and young people in particular because it inhibits or at least hinders their accessto fundamental means (information, knowledge, affection) for a good health and wellbeing, particularly in sexualand reproductive health. Theseresourcesare essential to promote autonomouschoicesand decision-makingprocesses.The prohibitions and limitations do not restrainyoung women and men to establishrelationshipsand start their sexualactivities. However,they leavethem vulnerable and exposed to unwanted risksand consequences. Takeninto account the former arguments,young people and adults recognised friends asthe primary information providers of adolescentsin mattersrelated to sexuality and reproduction: “You speak with friends because the father is going to go out with a stick”. Adult man,ElAlto Sincethe information they obtain is oftentimes incorrect, partial and/or not actualised, this oftentimes leads to unexpected and unwanted pregnancies: We can also fail due to a lack of currentinformation”. SanLucas 1998statisticspoint out that 92.3% of women and 90.7% of men in the population between 15 and 19 years of age knew some contraceptive method. However, numbers hide the issueof quality and use of this information. 325 Cultures of Populations: Latin America The discussionabout the power of information asa key factorto promote changesin behaviour, attitudes and practiceswithin the framework of informed sexual and reproductive decisions,is particularly important in the case of adolescent and young people, but also with relation to fathers and mothers. From our findings we can conclude that the processing, use and capacity to transmit information goes through individual and collective filters, which reflect the social and cultural patterns of the specific context and are conditioned by the multiple gender, generation and ethnic power relations. Thuswe can affirm that individuals need more than information to make and/or promote informed decisions. For example, having information about modern contraceptive methods will not necessarily determine their use, even if their comparativeadvantagesare recognised. The National Survey of 1998 showed that 86.7% of the interviewed women and 87.0% of the men knew modern methods. The data revealsan important increasecompared to 1994, where only 76.7% of the women said they knew modern contraceptive method?. In the rural areasthe percentage of women who reported knowing a modern method is 67, 12points higher than in 1994.However, in 1998only 48.7% of the women behveen 15and 49 yearsand 67.1% of the men between 15 and 64 years reported having used contraception at least once25. Other approaches to the issueof use reveal that in the rural areasthe percentage of use of any contraceptive method only reaches30% of the women, reaching only 19%women with no formal education. At leastpartially asa consequence,the age of the first birth increaseswith the educational level, 21 yearsamong women with no formal education and 23.2 among the ones with at least high school level. It is also relevant to consider that data obtained in 1998 showed that while the fertility rate among women with no formal education reached an average of 7.1, the rate decreased to 2.7 for women with education at high schoolleveland higher. Most interestingisthat the gap between children wanted and children had reduces drastically among the women with high school education. While in 1998the women with no education wanted an averageof 3.8 children and actually had 7.I children, the women with higher education wanted an average of 2.1 children and actually had an average of 2.7. On one hand this data can present a correlation between formal education, decision-making and fertility rates.However,it is important to note that in Boliviathe traditional formal education has not necessarilycontributed to higher autonomy of all people within diversity,becauseit has tended to the imposition and homogenisation of western patterns and values, including those related to population issues.On the other hand, statisticsalso alert us about gender and ethnic discrimination in accessto education. 79% of the Bolivian population can read. The percentage of illiterate woman is twice ashigh as that of men, namely 28% compared to 12%.In the urban areasilliteracy only reports 9%, 4% 24 Dora for men is nor available for1994. 1998 was the firsr rime that the Norionol Demography and Health Survey (ENDSA) included men. 326 25 The higher percenroge of men is probably in the dam. due 10 the inclusion ofthe condom Cultures of Populations: Latin America for men and 14%for women, representing in this casea relation 3 to 1. In the rural areaswe find a global percentage of 38, 25% men are illiterate compared to a 51% in the case of women (Molina 26-27). On the other hand, analysing the level of education we find that in the urban areas5% men and 13%women never attended school, while in the rural sitesthe percentages rise to 19%and 40% correspondingly (Molina 28). In general women’s education is culturally undervalued. Their traditional gender roles and attributes do not require their advanced education. If the language variable is introduced the analysisturns more complex. In the Spanish-speaking population only 9% never attended school. Among the population that speaks one native language the percentage risesto 54, which meansthat more than half of the population in this group never attended school.“In other words, the native languagesare associatedto the absence of education and illiteracy” (Molina 29). The relation language-accessto formal educationreproductive decisions (fertility) is particularly important if we consider that most of the nativelanguage monolingual people are women. Taking up again the issueof use of contraceptive methods, it is significant that among users of any method in 1998the preferred one continued to be the rhythm, which had been used by 33% of the total number of women and 46% of the women in unions. Among other traditional methods, our informants referred to “recognised” ones like exclusivebreastfeeding, control of the mucusand interrupted coitus, but also described other utilised procedures: Difficulties in the accessto health servicesrelated to geographic distances,quality of care barriers, communication difficultiesand other factorsare also important influential factorsrelated to accessand supply of contraceptive methods. In the caseof adolescentsand young people, the ambivalent discoursedescribed above is also a key aspect to addressaccessbarriers. On the other hand, partners’ rejection to the use of certain methods and the widespread idea that some methods produce health problems and/or sterility, are also social and cultural factorsthat condition the relation between information and changes in body related to the use of modern contraception: Also influential in the decision as to whether to use or not a modern (or any) contraception is religion. For somewomen children “just come”. Although religion as such almost did not appear explicitly in our fieldwork findings, it is important to emphasisethat particularly Catholic and Evangelic ideas are ingrained in other sociallyand culturally established“laws” and norms. In this sense,many of the issuesand influential factors addressed until now have a religious ideological background, particularly so those related to gender roles, attributes and power relations. 327 Cultures of Populations: Morbidity Latin America and mortality ?Vhen we get sick it is until death”. In a poor and multicultural country like Bolivia,the issuesof mortality and morbidity open an almost inexhaustible complex panorama for analysis.As stated before, we will focus on sexual and reproductive issuesthat appeared in our fieldwork. To start off with some statisticsit is interesting to consider that the general life expectancy at birth hasincreasedwith the passof time. While between 1970and 1975the averagelife expectancy for men was 44.58 years and for women 49.01, for the period between 1995and 2000 the number of years increasedto 59.80 in the caseof men and to 63.44 in the caseof women. What this meansin termsof quality of life, income and other human and economic development indicators is topic for another research. On the other hand, the infant mortality26rate for the period 1995-2000is half the one registered for the years 1975-1980,namely 65.6 vs. 131.2for each 1000 born alive. According to the Surveyof 1998, the registered global infant mortality rate was of 67 per each 1000 born alive. The highest incidence of infant mortality corresponded to the highlands. INFANTMORTALITY: l Highlands:82 Valleys:61 * Lowlands:53 l Child mortality also showsa descending trend. Between 1993and 1998it was of 92 for each 1000born alive, showing a decreaseof 38 if compared to the years 1983-1988.Nevertheless,an approach to rural and urban conditions once again reveals great hidden disparities. Child mortality is twice as high in the rural areas (125 vs. 66), while infant mortality is 80% higher. Children of women without formal education have four times more probabilities to die than those of mothers with high school or higher education. During fieldwork, rural and urban-marginal informants stressedthat if a child dies before his/her first year, one should not be sorry”. Afterwards “one gets atfoched co the baby”. Woman,Padcoyo According to the National Surveyof 1998, the reasonsfor the descending trends in infant mortality are related to increasedaccessto health services,including antenatal care and delivery. Among children of mothers who neither had institutionalised antenatal care nor delivery the infant mortality rate is 118,compared to 38 in the caseof women who attended a health centre for both services.During 1998, 63% of the future mothers received medical antenatal care, compared to a 50% registered in 1994.The increasewas higher in the urban areasthan in the 26 Infant monoliry: pmbobiluy Child monoliry: probobiliry 328 fo die donng the first yeor of fife ro dre before the fifth birthday. and believes rho, “help ‘digest’ the sod 27 Xavrer Albd describes different pm&es reoliiy of so many children’s deaths, even creoring somerimes a cerroin ofmasphere of lack of concern with rerpecr 10 this fan” (Alb6 er al. 123). Cu/tures of Populations: Latin America rural ones and 59.2% of the women with no formal education did not receive institutionalised antenatal care, compared to a 7.8% among women with at least high school education. Therut’uchi is the first haircutin the Andeancultures,which takesplaceapproximately when the child is two or three yearsold. Thisis the period when the highestriskof infant and child mortality hasbeen overcome.A specialcelebrationtakesplace,which marksfor the child his/her transitionto a responsibleindividual with specificobligations. The named godparentsand invited friends cut the locksand deposit them in a plate togetherwith moneyor other materialgifts.Thegifts constitutethe initial capitalfor the child’s“real” life. Fromthen on his/heractiveparticipationin the domesticand production activitiesis expected(Alb6 et al. 84). Also mentioned as an important factor is the fecundity descent, which implies that the proportion of high-risk pregnancies hasdiminished. It is important to consider the rural and urban particularities addressedat the beginning. In our research we have explored one of the multiple aspectsthat influence infants’ and children’s morbidity and mortality: breastfeeding. Statisticsobtained in 1998 point out that breastfeeding is a widely spread practice in Bolivia. 97% of the children born during the three years prior to the Surveyhave been breastfed sometime and 53.2% of those who were two and three months old were breastfed exclusively.This last percentage reduces to 35.6% during the next two months of live. Nutrition habits do not vary with respect to sex of the child, but are influenced by the mother’s level of formal education. While children of mothers with basic education are breastfed exclusively during 3.3 months, the average period for children of mothers with higher education is only 0.7 month. As an average,Bolivian children are breastfed during 17.6months. Breastfeedingtrends show almostno statisticalvariationswith respectto residence,education, child’s sex and other variables.However, in Chijipina Chico men marked gender privileges and differentiated needs by expressing that boys have to be breastfed for a longer period: With respect to maternal mortality, Bolivia is after Haiti the country in Latin America and the Caribbean with the highest maternal mortality rate: 390 Women die for each 100.000 born alive: Women die [during and after delivery] because they don? eat well, or because of the work they have to do on the field and because a lack of control and because men mistreat them.” Youngwoman,SanLucas 329 Cultures of Populations: Latin America Cultural conceptions about pregnancy and delivery, aswell asbarriers that difficult or hinder women’s accessto health services,are relevant issuesto be addressed. In general termswe found that particularlyin the rural areas,pregnancy is considereda natural component of a woman’s lifecycle, which should thus not interfere with her regular tasksand activities. This does not mean, however, that the notion of risk is absent and that precaution measuresare not taken within the framework of the particular objectiveand subjectiveconditions, possibilitiesand limitations. Thus,in relation to precautions to be taken during pregnancy, we found that physicalaswell as psychological measuresare considered in a holistic care approach. Finally,the samestatisticalsourcepoints out that 77.8%of the women with no formal education gave birth at home, while the percentage decreasesto 9.8% among women with high school and professionaleducation. Many women in the rural settings emphasised that men are the ones who finally decide where women give birth. The female group in Padcoyo also mentioned that oftentimes women give birth at home becausethere is nobody who can look after the children, the house and the animalsif they go away to a health centre. On the other hand, it should be noted that preference and consequent decisionsregarding place of delivery are oftentimes the result of previous bad experience in a health centre. This could be related to the fact that the percentage of institutional deliveriesis considerably higher for first deliveries (77%) than for subsequent ones. Quality of care in the health servicesis certainly also a key accessinhibitor to formal, western medicine, which has an impact on the incidence of mortality and morbidity particularly in rural contexts. Next we will map the main cultural barriers and communication gaps that we find determinant on the basisof our fieldwork. Despite general norms and expressedgood intentions, at least in most rural health centres the decision about who is going to be present at the delivery is always taken by the providers. Oftentimes partners and/or other relatives are not allowed to accompany and support the woman during delivery. The midwife interviewed in San Lucasmentioned the importance of women’s decision with respect to the position she choosesfor delivery. In many places like San Lucas,most maternal deaths are due to retention of the placenta, which produces haemorrhage and leads to death. The placenta is alsoa key cultural element for the first birth rite. It needs to be buried after the child is born: 330 Cultures of Populations: Latin America “Theplacenta is always buried with bouquetsof flowersbecausethere is the believe rhat children spiritsmighr show up... We\/,this is a custom that comes from our grandparents, they said that for a man to be hard-working the placenta should be buried at the doorstep and for a women it should be buried in a cornerof the house... in the kitchen”. Adult Man, transcriptionmaterialfrom the filming team,SanLucas However, in most hospitalsthe placenta is not given to the mother and/or relatives. Sobreparro refers to complicationsand death of women after delivery and derives, it is said, from having ignored precaution measureswith food, work and climate. Other informants of Achacachialso mentioned that the woman must drink herbal teas,particularly broom, and also bath with its water. In Trinidad adult men said that the women must avoid exposure to the sun, although they must be kept warm. In addition to cultural gaps, “objective” expulsion factors are also important to take into account when assessingaccessto institutionalisedhealth services.Mistreatment,bad information, inadequate conditions of infrastructure and equipment and the scarcity of medicines are just some examples. It is also fundamental to consider that in some places accessto a health centre is physically impossible due to distance, lack of transportation meansand other limitations. In the casea complication arisesduring delivery, then men point out the need to take the woman to the hospital or health centre. 55% of the deliveries in the last three years prior to the Surveyof 1998 registered some complication. There seemsto be no direct correlation between the rate of complications,antenatal care and place of delivery. SUFFERED COMPLICATIONS: With antenatalcontrolsand delivery in centre:56.1% Only with antenatalcontrols:51.4% Only with delivery in centre:59.9% With none of the above:52.7% Statisticsdo not show antenatal care as a measureto prevent complications during delivery. Also, the high percentage of women with complicationsin the category “only delivery in centre” could represent the situation mentioned above of accessto a health centre related already to the appearance of complications.Also, the percentage given for women who neither had antenatal controls nor delivery in a health centre could be underestimated due to limitations in accessto such information. 331 Cultures of Populations: Latin America On the other hand, it is not possible to addressthe problem of maternal mortality without discussingthe issueof unsafeabortion. According to the Bolivian law, abortion is legal in some caseswhen pregnancy is the consequence of enforced sexual relations (violation and other offences).However,mostabortions are performed under illegal and unsafeconditions.A number of 40.000 to 50.000 abortions per year is estimated, but very precise data is not available due to their illegal character. The causesthat lead to provoked abortion2’ are many,frequently linked to economic reasons. Oftentimes a provoked abortion is the result of an unexpected and then undesired pregnancy, particularly when the woman is single: They are insulted...Nobody wants her, people do not look at her, people reject her”. Adolescentwoman,Achacachi Yt is like dying”. I&year old singlemother,SanLucas In the rural contexts provoked abortion is associatedto hail, which is very damaging for the crops. Thus,when it hails the authorities look for the guilty woman and punish her: “The “yatiris” ratify if [she] had an abortion or not. In the past the tits were pressed to see if she had aborted. lf ir had hailed they brought all the single women together to press their breasts. To revert the [damage ofl hail the woman who had aborted had to perform a ritual”. Man, ChijipinaChico Despite the discourseand sanctioning measures,when we went to the market in Warisata (near Achacachi)we found a woman who sold a liquid she said was to “cure those who had aborted and also to abort”. Different methods to provoke an abortion were mentioned by men and women during our fieldwork, which also reflect the linkage between unsafe abortion and poverty”. While those women who have money “go to a clinic”, the majority is vulnerable to unsafe conditions and practices of non-qualified personnel. Poor women also turn to other dangerous methods like carrying heavy things or eating hot food; drinking certain herbal teas, ginger or strong coffee with salt; inserting a spoon in the vagina; taking some pills and others.” Abortion as a consequence of gender physical and/or psychological violence was also addressedfrequently: 28 In El Alto adult women called provoked obonion “foilwe” referred to “abortion” in the core of o rponroneous one. (fracoso), while they fo dam obtained from JNF, in 1999 pow’fy urban population and 81.6% ofthe rural popolorion. 29 According 30 Variour informanrs 332 in the differem conrexf~. affected 51.5% of the Cultures of Populations: “In the Latin America communities,man mistreatsthe woman with the purpose to provoke a miscarriage” Informantof the Tribunalof SanLucas In the casesof mortality as a consequence of spontaneous abortion, the issueof distance to the health centres is once again determinant. Also mentioned was the idea that an unsatisfied craving can causespontaneous abortion: “One can have abortionswhen having cravingsor it can be done on purpose taking hot domesticmedicines”. Youngwoman,SanLucas Up to here we have focused on issuesrelated to reproduction. However, we consider that it is also important to broaden the approach to other factorslinked to gender and sexuality. Gender socialisationis an important determinant that affectsin diverse mannersthe mortality and morbidity ratesof both men and women. Gender norms that regulate the sexual behaviour of men and women, and particularly the prevailing double morality, are important within this framework. While fidelity is expected of women, men are culturally “allowed” and even encouraged to have extramarital sexual relations to prove and reinforce their manhood: From the perspective of a young rural woman, maternity and migration are aggravating circumstancesin relation to male promiscuity: When we have children men changeand they leave us for another woman. Men even they are married they leave their wiveswhen they have to travel”. when Male gender-encouraged promiscuity, frequently without protection, is a risk factor for the man and all his sexual partners. It is interesting to mention that according to the statisticsfor 1998, the number of sexual partners among men increaseswith the educational level. When the issueof STl’sis addressed,it is important to consider the socialand cultural barriers that inhibit - or at least difficult - a timely attention and resolution of the problem. As a young man of San Lucassaid: “Maybe they are afraid of that illness and they don’t want the community or anybody to know, right? And instead of getting cure they let the illnessadvance”. 333 Cultures of Populations: Latin America The construction of the “invincible, strong macho” is among others a cultural inhibitor to recognise and consequently treat illness,considered synonym of weakness: “I am a man, nothing happens to me”, Adult man,Achacachi Men do not (want to) recognisethemselvesaspotential carriersand transmittersof STI’sand are thus reluctant to preventiveand curativemeasures,putting others, particularlywomen, in danger. To finalise the issueof STI’sit is interesting to quote the following causesof STl’sthat were mentioned: “You should not have [sexual relations] when she is with her period because a friend who did it was infected two days later” Adult man,ChijipinaChico. “[STl‘s] are transmitted because the husband urinated the woman...” Adult woman,TokePucuro With respect to AIDS, we should start emphasising that it is still not an issuein the public agenda, most probably due to its low incidence in Bolivia3’.For most people it is something that concerns “others”. Within this framework, it is understandable that participants did not give priority to its consideration and discussionduring our fieldwork workshops. The sexual division of labour is another factor that affectsin a differentiated manner health conditions of men and women. In the case of men, we could to a certain extent argue that becauseof their gender rolesand assignedgender characteristics, they have more risky,physically demanding jobs. On the other hand, women suffer from work overload. The women of Padcoyoargued that the sexual division of labour has a compensatory logic: Although women work more, their work is easier. Today many women also participate in the productive and public spheres,but the private, domestic chores continue to be mostly a female responsibility: “Now the women not only cook, they also work and there is not a big difference”. Youngman,Yapusiri Finally, since the issue of gender violence in its distinct manifestationshas already been mentioned and analysed, we will just give some statisticsthat justify the approach to domestic 31 For the period between 334 1985 and 1999 the Ministry ofHealth and Social Prevision hod reginered a fatal number of 367 cases. . Cultures of Populations: Latin America violence as a public health issue.In Bolivia 98.4% of the acts of violence against women take place in the domestic realm, and the aggressor is typically a man (Cutierrez 35). Furthermore, data disseminatedby the Ministry of Health and SocialPrevisioninforms that of every 10women, between 5 and 6 are affected by some kind of domestic violence Migration “If we don’t move we don’t know where luck is”: As mentioned in the first pages, migration has changed the population distribution in Bolivia in an irreversiblemanner during the lastthree decadesof the 20th century.Among young people, men and women have migrated to the cities in similarproportions, but among adults temporary and permanent migrants are/were mostly men. Modifications in the composition of the rural population have certainly affected the division of labour, gender and generation roles, family models and other aspects.Thishas determined a relevant increasein adult women’s duties and responsibilities,most often not encompassedby an adjustment of those products and servicesoffered by external institutions and organisations to their new, specific needs. On the other hand, if the reasonsand motivations of migrants were to be addressed, most authors would agree to refer to economic, production and employment determinants. Without disregarding the importance of these, we also want to include in the analysissome other “less objective” factors that have to do with people’s identities, aspirations, desiresand dreams. By doing so, we also want to combine an analysisof the attraction and the expulsion forces of migration based on our fieldwork results. One of the main issuesis education. In the rural contextsformal and informal education plays an important though ambivalent role with respect to migration. It gives empowering material and symbolicresourcesthat could fosterrural development,but isat the sametime a key expulsion factor to the urban centres, where the people expect to find better living possibilities.Having gone to school gives people the “opportunity” to “defend themselves”in the city, said the adult men of Achacachi.Young people of SanLucasexpressedthat “you can go to work in the citieswhen you know how to read and write”. ‘We can find a better job, an easierjob, no longer with a shoveland a pick.” In SanLucaswe had an interview with a representantiveof the TreverisFoundation about this issue.Our informant commented with us that the Co-ordinating Committee of this Foundation is concerned about the impact of its educational actions: 335 Cultures of Povulations: Latin America “The project did not have the purpose to train maids and this result worries us. We support men in their education and they get a high school degree but for what? They go to Argentina to work as helpers in construction work. The men go as non-qualified labour force and their incomes do not improve that much. The challenge for the year 2000 is to offer them some technical abilities”. If material living and working conditions in the cities are to be taken into account, then we can agree that in general there is a wide gap between people’s aspirations and what they encounter as opportunities. However, such an evaluation definitely requires a more complex analysis,which should include other symbolic and non-material mobilising aspectslike prestige and social status. We can conclude that the so-called myth of progress is the main attraction factor that captivatespeople with an partially unreal, idealistic image of city life an opportunities: “to be better we go to La Paz: Youngwoman,Achacachi Introducing a gender perspectivein the analysiswe can certainly affirm that young women’s new desiresand aspirationsare a key force for rural-urban migration and have changed the sex composition of migrating population: We no longer want to stay in the house, we want to improve, to be better.” Youngwoman,Yapusiri Within this complex articulation of expulsion and attraction factors, the desire to accessto higher levels and better education is a key decision factor. For many the drive is to obtain a professionaltitle: “...Veterinary to work in the cities, mechanics because they make money easily, tailoring, I would like to get out of the community, I will do whatever is easier” We don’t want to work in the field, we want to be nurses, trainers, promoters, leaders in our communities” Youths,Yapusiri Some informants said that if education would be better in the rural areas they would not migrate. Nevertheless,asa consequenceof migration somepeople havein fact accessedto better education, while others have dropped out to be able to migrate and work. Thislast issueis particularly relevant in relation to migration to other countries, for example to Argentina32. 32 In 1999 the Bdivion population in Argentina cheap workforce (qrd. in Pachem 52). 336 was esfimofed in more than a million, with (1 wry high proportion ofindigenous, rural people who had been taken as Cultures of Powlations: Latin America Conceptions and expectations about the ideal partner can be influential with respect to migration. Achacachialso said that they migrate to find good men and new women as partners. On the other hand, in the rural areasthe possibilitiesto cover the costsof establishing a union are frequently linked to temporary migration of the man or permanent migration of the couple/family. Finally,it is important to emphasisethat even if the general trend showsincreased migration to the cities, many people return to their communitiesafter having spent some time in the city: 7hey want to go for a time to learn something but they will return. They go for 12 or 13 year and many return ‘different’“. Adult man,Ellbiato It is also relevant that in most casesmigration does not mean that the linkages to the rural community of origin are broken. The notion of temporary migration can be applicable even for long-term periods of absence.The survivalstrategiesthat many migrants implement in the cities are frequently a rural-urban combination. Finally, migrants still “belong” to their communities and they always come back for the important celebrations. Nevertheless,the former does not mean that conflict isabsent.Thosewho do not migrate tend to resentthe “abandonment” of the others. Regardlessof how “true” they are, the perceptions of how migrant people transform themselvesreflect the issueof change and resistanceto change: When the youngsters leave they turn rebellious, they fight with their parents. Those that come back to the community they don’t belong anymore; they bring illnesses, they abandon their wives with 3 or 4 children and they want to get divorced”. Informantof the Centrefor YoungPeasantRuralWomen,SanLucas Despitethe attraction forces,rural indigenous people are not ingenuous about the socialand ethnic discrimination and violence implied in living in a Bolivian city: “...Racism affects a lot. All the people exploit us”. Youngwoman,ElAlto Other informants referred to sexual violence, bars and crime as elements that affect urban quality of life. Ultimately, it is an issueof evaluating alternatives,given you have alternativesto choose from... 337 Cultures of Populations: Latin America SOCIO-CULTURALRELEVANCE OF SERVICES AND INFORMATION: GAPSELYWEENAVAILABlLlTYAND UTlLlSATlONOF SERVICES AND INFORMATION On the basis of the above discussionand analysis,the present section aims to provide a descriptive and analytical approach of main the gaps identified between supply and demand of services(education and health) and information that influence demographic behaviour. Health services: alternatives and gaps To begin we would like to discussthe following question: what isa health service?- For many people the idea is linked to the existenceof a certain infrastructure.Murillo de la Calvez,however, proposes a broader concept, which includes “all those forms of attention that are conceived, invented and put into practice in a community to solvethe health problems” (gtd. in Garcia230). Within this framework, Garciapoints out three strategiesto protect health: formal or occidental medicine, informal or traditional medicine and self-assistance.From our experience we would add a fourth one, namely religious medicine that can refer to traditional, indigenous beliefs and practicesand/or to those associatedto Catholic and Evangelicreligions. Including self-assistance under traditional medicine, we have identified tripartite health systems. ( 338 Religiousmedicine Cultures of Populations: Latin America Considering the existence of the various service alternatives, people decide where to go depending on the particular characteristicsof their health problem. It is not an excluding system, but rather one of complementary specialisation.The relevance and importance given to each “pillar” differs, as a general trend, in rural and urban contexts, as do the “starting point” and Urban trend directionality. In rural contexts people search 12 for traditional servicesfirst or rely on self-assistance.Western medicine providers often complain that people arrive to the centre/hospital when it is too late. In the urban contexts, particularly among the middle and higher 2 1 classes,the processis exactly opposite: if people do not obtain satisfactoryresultswith western medicine, Rural trend they try traditional advice and treatment. We can go further affirming that very often the samedoctors advice you to drink some traditional herbal tea or follow a “traditional” treatment. In both contexts the religious component has more specific functions that do not “compete” with the other servicealternatives. Even if this is a very schematicand sequential vision that does not allow for more complex analysis,it gives us a notion of complementarity rather than of contradiction or exclusion. The preferences,decisions- whenever a decision is possible- and accesspossibilitiesof people are conditioned by factorsthat structure and characterisethe supply/availability of services.In this section we will focalisethe analysison the provision of western medical services,which are mostly public in the sitesvisited. The private-public dilemma in western medicine is mainly an urban issue.In general, urban middle-classpeople prefer private servicesbecausethey associate them with prestige and quality. However, due to the economic crisisthe demand for public servicesamong middle-classpeople has also increased. From our study we conclude that to analysethe accessibilityfactorsrelated to western health services,the following six aspectsmust be considered33. l Existence/location of a service In rural sitesthe distance to a health centre is key to determine accessto the servicesoffered, particularly so in areas with a low population density and very scattered housing. Distance is very important in terms of the time needed to reach the location, the availability and costsof transportation. It is also relevant, according to peoples testimonies,because they often do not have anyone to watch over the other children, house and animals.Reaching a health centre can be a one-day trip. Due to all of the issuesmentioned above, going to a western health centre is frequently seen as the last option. When nothing seemsto work, the distant centre is considered the last alternative. Ultimately, “nothing can be lost with trying”. However, a decision is not enough when the conditions addressed in the first paragraph are not given. It is interesting to mention that some NC0 projects (not precisely in the areas contemplated in the study) have been working with mobile systems.This alternative approach can be very 33 We c~ncenfrofe on the conclusions of this rrudy, thus nor necessarily oddresing oil exisnng/porsible barriers and gaps. 339 Cultures of Populations: Latin America effective to democratise access,promote preventive medicine and have a regular basis for follow-ups. However, it is not necessarilyso successfulto attend complicationsand other emergencies that depend on time and/or require the possibility of permanent communication. Mobile servicesare also quite expensive and thus less sustainable.Most of them have been implementedwithin the frameworkof subsidisedNC0 projectsthat havelimited time and funding. l Quality of care (human and technical) One key factor that inhibits people’s accessto western health servicesis the bad quality of care. Frequently in official discourses“objective”, concrete problems are hidden and addressed in termsof cultural barriers3“.Added to this we found that everything that cannot/does not want to be understood by western logic and standards,falls in the category of “culture”, visibilising communication gaps that have to do with more than language barriers. Interest and will are assumptionsto establishcommunication and they presuppose that what the other has to say is considered valuable. In the caseof hierarchical relations, this is highly improbable. During our experience in/with health centreswe confronted lessthan ideal servicesand care in human and technical terms. It is thus hard to imagine what lesspowerful people sometimes have to go through when they “access”to western medicine. Depending on the location, class, gender and economic situation, a problem will be described as “cultural” or recognised as a quality of care issue. It should be noted that frequently providers differentiate between “quality” and “warmth” in health care35.Thisdual vision givesthe idea that quality of care can be reached without taking into consideration the human components, which, it is thought, can be addressed at a later stage (when the “main problems” have been solved”). On the contrary, the experiences with midwifes and traditional healers emphasisethe affective components, the physical context and warmth in the provider- user relation. Their approach to quality of care is holistic, rather than hierarchical and sequential in terms of the different components. No wonder, thus, that mistreatmentis one of the main complainsand reasonspeople give for not attending a western health centre. This quality problem affectsall people involved in the service provision, including the administrativeteam. Frequently it is precisely in the reception where people receive the worst attention and care. Among the most common technical quality of care problems we can refer to the bad conditions of the infrastructure and equipment and the lack of medicines and lab products. Some people also mentioned the fact that in the most remote centres the existing medicines are old and have been disregarded for use in other (urban) facilities.Thiscreatesdistrust,which is also a factor that conditions accessnegatively. 34 Just as on example we con mention fhe rinrotion that had not permane”, water. 340 ofthe Hospital in Quillocollo 35 In Spanish %lidad y colidef. Cultures of Powlations: Latin America Another critical issueis that people demand to be treated by specialists,while most providers in rural areasare just finishing their studiesand can only give general attention. In addition to the lack of experience and specialisedpreparation, most providers only stay in the rural centres for short periods, not being able to establishsolid, trustworthy provider-client relations. Other critical aspectsrelated to quality of care include convenience of the hours of attention that often to not take into account the daily dynamics people have (particularly women), and the permanence of the providers. In places where the provider can only be reached sporadically, people do not count on him/her. The uncertainty leads to privilege other alternatives when a health problem is confronted. l Capacity/usefulness of the service to solve the particular health problem Besidesthe technical factors,which often determine that a health problem cannot be solved in a centre, its characterisationand the attribution of different causeswill guide the search for one type of provider/service. Samesymptomscan lead to different diagnostic results.Spiritual and psychological causes,people reported, are always overseenand/or not taken into account in western centres. On the other hand, western centres are considered most suitable for complicated, emergency situations, although caseswere reported when midwives/traditional healers had solved problems after doctors had given up. l Cultural sensitivity/interculturality Beyond some indicators that we could generalise,it should be emphasisedthat the definition of “quality of care” is a socially and culturally constructed idea, which requires research and analysiswithin the particular contexts.We do not necessarilymean researchand analysisin formal terms, but the challenge to discoverthe expectations and preferencesof specific groups. Thisis ultimately a demand for changes in medical education (Rance 1999),which has done little to promote intercultural researchand build cultural bridges. As mentioned above, frequently the cultural gaps have been addressed in terms of barriers that difficult access.Within this framework, the main concern has been to change the patients’36 “beliefs and practices” to achievethe “unconditional” acceptance of western medicine. Cultural barriers, attitudes and beliefs from the side of the western providers are seldom questioned. This,once again, reflects the unequal power relations. In previous sections some of the cultural issuesthat are of particular relevance for the users/clientswere described and analysed. Recoveringthe placenta for its burial after a child is born is one example. Another strong complaint refers to the (informal) norms and practicesthat inhibit the partner’s and/or relativespresence during delivery. This is not specificallya cultural demand. Furthermore, in urban middle- and high-classhealth centres the partners/relatives’ presenceis an unquestionable right and their participation is even encouraged by the providers. 36 The use of the word “potienr” ir on purpose to reflect the expected passive role of the user. 341 Cultures l of Populations: Latin America Economic conditions Although the Basic Health Insurance (Seguro Bcisicode Solud) offers more than 40 free health provisions, its observance is not totally guaranteed, particularly in remote health centres/posts. The free serviceshave conditions and restrictionsand frequently people need to pay. For example, if the caseis severeand the person has to stay in the hospital/centre for an extended period, this is not coveredby the Insurance.Added to the specificserviceand medicine costs,we need to consider the possible economic burden of transportation and lodging for the accompanying persons. From a very different perspective, it should also be mentioned that sometimespeople are suspiciousand distrustfree servicesbecausethey relate them to bad quality. They are willing to pay (more) for a better service.It should also be noted that traditional providers are not necessarily the cheapestalternative, but they can be willing to accept payment in species. Education and information: issues of accessibility and utilisation The separation between “education” and “information” for the purposes of this section. Education is based on information. On the other hand, information aims to “educate”. In both casessome key issuesare a) accessibility;b) the contents in termsof sent and received messages; c) the value and utilisation possibilitiesof the knowledge/information; and d) the groups privileged and excluded as target groups. This section will not only concentrate on rural gaps. Issuesthat are of interest/relevance for urban, middle-classpeople are alsoaddressed.The approachwill alsoconsiderformal and informal services.Once again, the analysisis not exhaustivebecauseit focuseson the main findings of the study and our prioritisation. l Geographic and economic accessibility The problem of distanceis alsoa key factor in the caseof education servicesin the rural areas, where students often have to walk more than an hour to reach their school. In some remote locations the accessibilityis even weather conditioned. During some months (the rainy season) some communitiesare hard to leave/reach. Sometimes,particularly after students conclude the primary phase, they have to migrate to another location (town or city) to continue their education. Thiscertainly has direct and indirect economic implications that will condition the decision. The direct ones are related to housing and food expenditures. The indirect implications derive from the fact that they no longer collaborate in the economic activitiesof their parents. It should also be noted that the need for migration hastraditionally been traduced in lessopportunities for women to accessto secondary education. 342 Cultures of Powlations: Latin America In addition to the bad salariesestablished for rural teachers, the location, living conditions and frequent isolation are also factorsthat determine the quality of the education offered. While we stressthe important role that many teachers play in remote communities as advisors,counsellorsand leaders, it is also relevant to mention that in many casesirregularity, bad quality and abuse are the norm. In general no supervisionand control are possible due to the geographical restrictionsand limited resourcesthe Ministry has for this purpose. l Contents and approach In the following paragraphswe will not concentrate on formal, “physical” accessto education servicesand information. We will prioritise a qualitative approach to the issueof accessto knowledge, analysing someof the existing gaps between availability, ideology, value and (future) utilisation. Traditional formal education in Bolivia is characterisedby a memoirist,conservativeand elitist approach in contentsand pedagogy. Thus,it is a hierarchical,civilisationsystem,where exclusion goes beyond formal indicators of enrolment and abandonment. Language barriers, alien, irrelevant contents and cultural subordination are just some manifestations.The gap between the academicapproach of schoolsand the practical knowledge and skillspeople need in their future life is very wide. Within this ideological framework, sexual education is hardly imaginable. If something was/is offered it is under the umbrella of the biological and/or pathological approaches. The Educational Reform (1994)has now reached studentsin 7th grade in some experimental schools.It is meant to be a revolutionary change to intercultural, bilingual education. Gender perspective, education for sexuality and health, democracy and environmental education are the four transversals.However, it will still take a long time until the Reform can be implemented in all grades and until it is a generalised, well implemented change. In urban areasmiddle- and high-classpeople tend to choose private schoolsthat work under diverse agreements and with different levelsof articulation to the Reform. The private schools are supposed to be of much higher quality and more up-to-date in approaches and contents. Nevertheless,the general appreciation made about Bolivian education often applies to those private servicestoo. This allows us to understand - at least partly - the dissatisfactionexpressed by middle-classadolescentsand youths. They said that what they had been taught in school was not useful for them to go through life. Finally,we would like to emphasiseagain the limited incidence/importance of knowledge/ information in the decisionsand actions of people, particularly if the assumptionis that people will/will not do something becausethey know. 343 Cultures l of Populations: Latin America Target populations Undoubtedly children, adolescentsand young people are among the priority groups in the supply of education and information programs and services.However, few if any efforts have given attention to fathersand mothers and their specificneeds and interestswith respectto their relationshipswith adolescents/youths. If any education/information is offered to mothers (and, eventually, fathers),it is concentrated on pregnancy, early motherhood and contraception. After the study we consider fundamental that the resourcesand energies are directed both sides- to adolescentsand their parents- to enable an encounter. Fathersand mothers also need the means (knowledge, negotiation tools and others) to solve the challenges they find in every encounter with the younger generations. WITH RESEARCH BEYONDRESEARCH: POLICYAND PROGRAM RELEVANCEOF THEFlNDlNGS The issue of research relevance is more complex than it appears to be at first glance. Utilisation of the findings for the design and implementation of policies, programmes and/or projects is an indicator that shows - many times - the relevance of the information and knowledge produced, taking into account the needs and interestsof the specificdecision-makersand the particular context. The relevanceassessmentis more complicated when the findings are not used. In these casesthe causescan be multiple and do not necessarilyimply that the researchis irrelevant. Taking the quality of the researchand the need for the data produced as given, we can identify at leastthree gaps that need to be bridged to ensuredthat researchleadsto informed decisions:communicational gap, strategic gap and political gap. INFOlUvtATION/KNOWLEDGE CANBEUSEDTO: l l l l l Solveproblems Supportpredeterminedpositions Makestrategic,political decisions Articulatesocialmovements Sensitisepeople/audiences Thissectiondoes not aim to make an exhaustiveanalysisof the gaps and factorsthat condition them. Different authors have developed various explanatory and analytical models for this purpose. However, we will shortly discussthe communication, strategic and political issuesto 344 Cultures of Populations: Latin America share our ideas and highlight the challenges we consider we will have to face if our aim is to promote changes based on our researchfindings. Communicational gap The communicational gap refers to difficulties in how to transmit the data. The issuesto be considered can be of diverse nature, including the need to translate the report, to adapt the language to the particular audiences,to summarisethe results,to use the appropriate arguments and to establishthe best communication media to reach each audience effectively. Strategic gap Information and disseminationare communicationalactivitiesthat per se will hardly produce any changes. There is not direct correlation between the volume of relevant information/ knowledge we receive today, and the decisionswe make based on it. Traditionally the role and responsibilitiesof the researcheronly contemplate the dissemination of results.However, new trends - particularly in so-called“Third World countries”- emphasisethe need to improve the synergy between researchand decision-making, challenging the role and contributions of research and researchersto change. Many researcherstoday are “not only” researchers.We are also “mediators”, “negotiators” and “advocates”, who use data based on researchto promote a cause. The promotion of a causeleads us a step beyond communication: the need for a strategic/ advocacyapproach. There are not recipeswe want/can give, but experiences have shown that: a) advocacy is permanent, creative and often unplanned; b) the research or project design needs to consider funds for advocacy: c) the active involvement of the decision-makersfrom the beginning of the processis key. A central idea in strategicthinking is that opportunities do not exist, they are created by the people who can identify a positive situation within a particular context and take advantage of it for their own goals and purposes. This demands continuous attention and analysis of the surrounding dynamics,aswell as fast decisionsand actions. Political gap To closethe political gap the researchhasto be (made) relevant not only in terms of the data produced; it needs to be (made) politically relevanP7.Thisimplies an approach to researchas a political endeavour. Researchis the result of a certain analysisand prioritisation of issues,which will not always correspond to the identification and vision of the problems that decision-makers will make. On the other hand, research produces knowledge and knowledge is power. Furthermore, through researchone can aim to change power relations. 345 Cultures of Powulations: Latin America SOMECOMMONASSUMPTIONS ABOUTTHERELATIONBETWEEN RESEARCH/KNOWLEDGE AND POLITICALWILL: l that knowledgeper se leadsto politicalwill. l that political decisionsare always/oftenrationaland “objective”. l that certaindecisionsare not takenbecauseinformationis missing. l that decision-makers “do not know” about certainproblems. The political approach is based on the analysisof the complex dynamics in politics and the explicit and implicit interestsof the different actors: “Researchis only one input among many other elements equally legitimate to be considered by decision-makers”(Trostleet al. 169).Cost and effectivenessare central issuesfor decision-makers.It is key to question then the importance, role and potential impact of the specific researchwithin the existing dynamics:Who is going to be (politically)benefited? Who is going to lose?Are the researchersprepared to face the political implications of their endeavour? Theseare some of the questions that can guide the construction of the political discourse that needs to accompany the development, dissemination and advocacy of a researchand its findings. “The value of applying researchis increasedby understanding which type of researchis related with determined type of policies, where this type of policiesis developed and the mechanismsthrough which researchcan penetrate their elaboration process” (Trostleet al. 4). Where are we? We can argue that our research is relevant and useful because it warns about existing problems, guides the actors to new alternativesand better decisions,and re-conceptualisesthe problems in innovativeways (seeWeiss,qtd. in Trostleet al. 1).However,work, time and resources are yet needed to translatethe findings to a causefor advocacy,to design strategiesfor incidence and to penetrate the decision-making spheresin different levels. Being critical we must also recognise that the participatory nature of the methodology implied the involvement of actorson different levels,but has not constituted a base for political incidence (it was not meant assuch either). We can affirm that the interactionswith stakeholders created the interestand a fertile atmospherefor alliancesand joint work that could be capitalised. 346 Cultures of Populations: Latin America However,broad disseminationof the findings is still a challenge and, assaid above, a strategic advocacy design and campaign would need a specificplanning and the required resources.We think this issueeven addressesethical problems that remain unsolved for the team38. And what about the relevance of our findings? We consider that what we can say in this stage about relevance of our findings is not much. The challenge that we would have to face now, were the processto continue, is precisely to demonstratethat our findings can be relevant for different audiences.Within this framework, we can now only provide a very general appreciation based on those aspectswe consider the strengths of the researchand the potential use of the data. In general termswe would like to stressthree strengthsof the researchrelated to processand results.We emphasisethe participatory methodology that could, as a model, be replicated by other initiatives.Furthermore, the participatory methodology could be capitalised as a strategic pillar to promote change, asit is suited to create the conditions to build socialbasesand alliances on different levels. The second strength has to do with the theoretical approach chosen to address the demographic issues.It is innovative and helps to understand the oftentimes-inexplicable numbers. Added to the former is the combined quali-quantitativeanalysisof demographic behaviour that resultsenlightening, givesresponsesbut alsoleavesnew questionsto answerand challengesto face. Third, it is important to stressthe approach to “cultural worlds” within larger cultural groups, that has enabled us to identify particular perceptions, needs, interestsand expectations. Taking the former into account, we consider that all actors can benefit from the researchin termsof the information and knowledge it offers and the implied challenges,opportunities and possibilities.As an example, the report could be used for training events as a basic reference document for analysisand planning. The experience and lessonslearned can also be usefuland enlightening for other researchers. As said before, the methodological approach and other elementsof this study are adaptable and replicable. For planners and decision-makersit is vital to be aware, know and consider the particularities within the cultural groups to close the gap between servicesoffered and people’s needs, demands, expectations and preferences.Particularlyso if the present problems and consequent political costsof a centralised, homogeneous approach are considered. Programmerscould use the findings to qualify their strategiesand interventionsin termsof effectiveness,client-satisfaction, costsand impact. Sincethis year is pre-electoralin Bolivia,the findings could be usefulfor present and (possible) future decision-makersto develop attractive, innovative proposals to addressunattended issues 38 Very few people - even decision-mokenwill be able ro read the repon m English. We have tried 10 obrain funds for (I rranslarion rho! would enable a brooder dirreminadon process, but hove not been successful until now. We olro wonr 10 sIren rhor dwing the Narionol Workshop the focilirarors requested to have access to the final report. They denounced rhnt many researchers never refurn their findings 10 rhe people. However, c~cceu, we undentond, does nor only mean obroming of a copy of rhe repon but also being able fo read ir. lhe issue 15even more complex if we consider the cultuml, educational and linguisrtc chnronerirrics rhe porriciponrs dercnbed earlter in rhe repon. 347 Cultures of Populations: Latin America and solve existing problems. The researchcould be useful for a political platform. The risk we can envision emerging in such a case is the possible abuse and manipulation of the data for political purposes. Eventhough the lossof control is something unavoidable after the dissemination of results, strategic mechanismsto minimise the riskswould need to be designed and implemented. On the other hand, service providers could use the findings based on the assumptionthat they are interested in improving the servicesoffered in order to satisfythe clients. Thiswill also depend on the benefits the providers can identify/obtain if they improve their performance. In the case of information providers, the study illustratesabout the general need for information, particularly in remote areasand among specific groups (women, adolescents).In more general terms, it emphasisescritical aspectsrelated to the contents, relevanceand quality of the information available, challenging the information providers to produce and disseminateinformation that will contribute to the empowerment of the individuals and the development of a culturally diverse, multilingual country. Finally,we want to emphasisethat the data could servefor the empowerment of the particular local groups and “cultural worlds”. Information is key to demand for the observanceof human rights and claim for good services.The challenge remains, once again, in the capacity to use/translate researchfindings in political agendas. DATA COllECTlON, COMPILATION AND ANALYSISFOR IMPROVING KNOWLEDGEBASE FOR LOCALPOPULATION: A POLITICALAND TECHNICALPERSPECTlVE According to someauthors, the lack of consciousnessin government spheresand among the population in general is due to the limited information available and the lack of researchand studies (censusand surveys)about demography (Torrez31). Furthermore, others emphasisethe bad quality of the available data that cannot be used to make informed decisions:The indicators elaborated with data of the mentioned eventshave frequently shown contradictory and incoherent results” (CONAPO,PL-48031). In addition to the technical problems, it is important to note that concrete, uncontrollable factors like the dispersed population, migration, geographical accessibilityand weather conditions difficult the collection of data, particularly in remote, rural settings39. However, even if the previous arguments can be partly true, the other side of the coin is that this lack of (quality) information is to a great extent not a causebut a consequence of the little political will and interest governments have shown to find out, reveal and consider what the different Bolivian men and women think, feel and want. 39 A concrete, presence 348 example is rhe delay ofthe Norionol Census due fo the long ond intense rain penod lefr many communities in isolorion. Cultures of Powulations: Latin America Despite the formal recognition of the diversenature of the country, daily dynamicsand colonialist contradictions reaffirm the homogenous mestLzo40 national project that aims to attain “development” through the “civilisation” (meaning westernisation) of the indigenous people. Being informed about the others does not mean to take them into account ascitizensand valuable counterparts. Governmentshavehistoricallybeen characterisedfor their “from to top for the bottom” attitude in the design and implementation of global, homogeneous policies, programs and services. Within this context, ethnic exclusion and discrimination are reflected in the design and implementation of statisticaldata collection, expressedin the under recording and omissionof social and cultural indicators (Molina 24). Evennow, the efforts to invert the planning logic and promote processes“from the bottom to the top” are still far from achieving the design and effective implementation of democratic, intercultural and dialogic national policies. Furthermore, most local, municipal plans are based on diagnoses that hide the social and cultural explanatory dimensions of complex realities. The expected participatory nature of the diagnostic processesis reduced to the provision of information (data), not taking into consideration the importance of cultural interpretation to discoverdiversity beyond apparent similarity, subjectivity beyond apparent objectivity. “Demographersare very consciousthat public registers- official census,baptism certifications,marriageand divorceregistrations,deathand burying certificatesare not pure, exactor objectiveinformationsources.Neitherare they politically or scientificallyneutral...In the bestcasethe public registriesand statisticsreveala particularclassificationof a society,aswell assomeof it basicsocialvalues, through that which isjudged assufficientlyvaluableto be told and registered” (Scheper-Hughes 271). The political issuesaddressedabove also have a technical dimension that questionsthe social and cultural validity, pertinence, relevance and accuracy of the demographic and population indicators traditionally used. As examples we can mention that indicators like “percentage of single women” and “age of marriage” do not make sense in contexts where establishing a stable partner relation and living together are not necessarilysynonymousof marriage. Another example is the indicator of “adolescent pregnancy” that does not seemto be culturally pertinent in groups like the Siriono, where the concept of adolescence does not exist and couples move together even before puberty (at 11or 12years).Consequently,the useof alien categoriesinhibits an approach to the insiders’ systemsof representationsand meanings. 40 HoWcarte. 349 Cultures of Populations: Latin America Sincethe colonialiststructuresof the country are not questioned, even the local development paradigm reproduces ultimately the explicit and implicit exclusionand homogenisation purpose of national development notions and practices.Different realitiesare fit into a particular, western worldview. The challenge to articulate a nation and, at the sametime, respect the right to be different, is not an easyone. Politicaland technical dilemmasare confronted. How different are we? How different do we want to be? How different can we be to live under a common national project? - Theseare some of the questionsthat reflect the political connotations and relevanceof discovering, revealing and addressing diversity. l Beware of statistics and averages Most social costsof inequality affect the historically marginal indigenous populations. The official data has been biased due to the omissionof key information that is important to identify with some precision the population groups most affected by poverty and their marginal and unequal conditions (Molina 37). As Farahand Aleman point out, “there is no other problem that has more statisticalinformation than poverty, in terms of its incidence, degrees, types and localisation maps” (78). However, since the main efforts have been oriented to define methods and techniques to measureit, little attention hasbeen given to its conceptualisationand explanation within the framework of socialand cultural diversity. One of the main questionsto be addressediswhich would be the mostappropriate indicators to represent such a complex socio-culturalreality as the rural one. Molina emphasisesthat “...officia/ data of the census and surveys should be reprocessed to allow us a statisrical desegregation of social and ethnic belonging, which would show levels of inequify, unequal opportuniries and redisttiburion imbalances very marked in the country on the regional and local-municipal levels”. (24) The previous paragraph also alerts about the problem of averagesas the starting point for the design and implementation of policies, programs and projects. Suchan approach does not respond to specific group needs and demands and, at the sametime, reproduces the health, education and information inequities. Thus,the lack of key information, the type of indicators utilised and the measurement systemsall express the inconsistenciesbetween the discourse favouring the most disadvantaged and the political will to effectivelytarget inequities. Furthermore, all these factorsinfluence and limit the possibilities to develop proposals and alternativesthat can offer effective and sustainablesolutions, which simultaneouslyrespond to specificlocal situationsand contribute to a global national development project. 350 Cultures l of Populations: Latin America Challenges for qualitative research It is key to advocate for researchas an investment for development. Within this framework the quali-quanti discussionseems a false dilemma, since both approaches are needed and complementary. The previous paragraphs have highlighted the limitations in the approach and nature of statisticalinformation to respond to social and cultural questions and issues.Here we want to note someof the challengesthat qualitativeresearchhas to face to be able to offer solid, complementaryand explanatory data that will guide decision-makers,programmersand serviceproviders. The possibilitiesand implications of generalising the findings are probably the main weaknessesidentified when the contributions of qualitative research to broader decision-making processesare questioned. The perspective to articulate researchto policy-making in a proactive manner is quite innovative and still under discussionamong researcherswho do not feel that it is their role to become politically active. Thus, until now little attention and priority has been given to explore rigorous, effective strategies to generalise local findings for broader use. Furthermore, “we are so used to think that official and government policies can only be built on hard data - an accumulation of objective and neutral facts, represented in statisticalnumbers and flow charts-that we can hardly imagine seriouspublic policies and programmesthat flourish from in-depth case studies or from interpretative analysisand moral-philosophic arguments” (Sheper-Hughes293-294). We emphasisethat the issueof generalisation is a challenge of strategic importance if qualitative research aims to offer inputs beyond the local level; or, better said, if it is expected to articulate the local level to the national policy and programme development. Added to the previous strategic issuewe must addresssome conceptual and methodological problems in the collection and analysisof data in an intercultural context. Generally the issues and questions of interest result from motivation outside the specific context, and most of the times the fieldwork guidelines are so predetermined that they leave little room for discovery. Qualitative researchthus also becomesa question-answerprocess,in which the researcherdoes not question his/her preconceptions or own categories.In other words, you look at and analyse others through your own suppositions and codes, and this can bring misleading conclusions. Consequently it is important that qualitative research contributes to the identification of new, relevant categories “from inside”, and is not limited by western schemes that distort and “uniform” diverse realities. A third issuethat we would like to stressis the importance of the subjects’ participation as a key methodological and strategic issue.Earlier in the report we have detailed our conceptual framework and methodological approach to participation. Here we just want to emphasisethat information and self-awarenessare power and that, depending on the approach, a research processcan contribute to the empowerment or debilitation of the local populations. 351 Cultures of Populations: Latin America CONCLUSIONSAND RECOMMENDATIONS Bolivia as a diverse, multicultural developing country, struggles between the pressuresof globalisation, modernity and liberal capitalism, and the challenge to constitute a nation that responds to the needs, interestsand demands of groups and individuals with particular needs, interestsand demands. The persistenceof more than thirty ethnic groups and the increasing public appearance of previous silent social actors, show that the homogenisation model of the 1950’s has not succeeded. Old identities resist and/or adapt to change, and new ones arise permanently. The State and other development institutions and organisations have to respond to such complex and dynamic realities,trying to addressthe particularitieswithout losing a global development vision. On the other hand, international eventslike the Population and Development Conference of 1994and the Women’s Conference of 1995 have modified substantiallythe way in which population issuesare perceived and complexly linked to human and sustainabledevelopment. Individual rights, gender and generation empowerment, and equity are some of the challenges now addressedas development investments. Within this framework, multiple transformations occur, which include and/or influence demographic changes, at the same time that demographic variables affect the development targets. Among the most important changeswe can mention the descent of the fecundity rates, the urbanisation process,the dispersion of the rural population and the expansion of education and health services.However, those general trends present major rural-urban, ethnic, gender and age differencesand disparitiesthat frequently remain hidden and unattended. The omission and/or the type of policy and programmesimplemented havegenerally reflected the excluding, hegemonic and colonialist development patterns. In the rural areasmore than 90% of the population is poor, with very limited accessto basic services,education and health. Exclusionand access,as we have emphasisedthroughout the document, are also culturally and socially conditioned. Migration to the urban centres and to foreign countries is thus motivated by the possibility to accessto better living conditions and to social mobility. However, the achievement of these goals is more complex than probably envisioned by the migrants. Migratory patterns challenge the capacity of the Stateto respond to the increasing demand for servicesand infrastructure.Furthermore,they challenge the stratification, socialand cultural segregation of a colonialist country. Ultimately,with migration poverty moves to the cities. Despite the general pessimisticapproach, some positive transformationscan be highlighted. The Popular Participation Law representsa historical change to the traditional vertical planning model, allowing the 314 municipalities to define their own local development plans with the participation of the different local organisations.Within this framework, the National Dialogue 352 Cultures of Populations: Latin America of the year 2000, which congregated numerous sectorsand social actors, concluded that the municipal governments would even expand their competence over health and education. It is expected that such a decision will be formalised shortly. With respect to information, there is a need to review statisticalcategories,collection, analytical and disseminationprocesses,while at the sametime there is an urgent need for qualitative complementation and explanation. Furthermore, synergy between research and policy/programme design and implementation requires to be increased,challenging both researchersand decision-makerson the local, departmental and national levels. Among the macro changes the Education Reform also represents a major transformation, having moved from a homogeneous educational approach to diversified, culturally sensitive bilingual education. However, as in the caseof the other global changes, its implementation is slow and has frequently shown that the assumptionsmade and the expected resultswere not realistic.Worldviews and deeply rooted traditions are not easily transformed with the determination of an official norm. Accessto education certainly influences demographic behaviour, particularly so in the caseof women. It theoretically enables female studentsto obtain information and make autonomous decisionsupon that. However, since gender and other accessgaps have narrowed, more and more attention has been given to identify the other factors (e.g. curricula,hidden and omitted contents,institutional culture, schoolnorms)that reproduce gender and colonialist patterns in and outside schools. Our study has shown the relevance of gender socialisationas a key influential factor that conditions demographic behaviour and limits human, equitable development. With variations in the ways and meanings, our findings reflect that gender subordination, violence against women and the role of the woman-mother are reproduced in all contextsand particular groups, limiting women’s autonomy and, within this framework, conditioning her demographic behaviour and preferences.On the other hand, the feminisationof poverty and its influence on demographic changes is also a key issueto consider. More and more adult women are heads of their households and, simultaneously,an increasing number of young women and girls take over domestic responsibilitieswhile their mothers go out to earn money. Theseprocessesaffect the education opportunities and health conditions of women and their families. It is important to note that socialtransformationsgenerally precede cultural adaptation, and that consequentlynorms,policiesand programmesare usually“behind” the changes.Forexample, we cannot say that we discovered the existence of diverse family forms, but it seemsimportant to emphasisethat actual policies, norms, institutions and servicesare based on and reproduce the western, nuclear family model. With respectto the health sector,the BasicHealth Insurancerepresentsa major improvement, guaranteeing - in theory - free accessto more than 70 servicesto individuals nation wide. From 353 Cultures of Populations: Latin America a gender perspective,and considering the high ratesof maternal mortality and the percentage attributed to unsafeabortions, the free attention of haemorrhageswithin the first six months of pregnancy is particularly relevant. However,the multiple social,economicand cultural factorsthat inhibit accessto health services and impact on the mortality rates seem more difficult to address, even given the existence of political will. While the official indicators and the Ministry’s priorities stressthe importance of institutionalised deliveries within the framework of maternal mortality prevention (maternal mortality has been recently mapped), only few, isolated efforts seem to focus on the multiple and complex variablesthat define accessibilityto the health centres.The main challengesare to increase coverages,train traditional birth attendants (husbands,relatives, neighbours) and to improve the quality of care in the centres, taking into consideration technical and human aspects,as well as socialand cultural expectations. On the other hand it is important to emphasisethe progressmade in the lastyearsin relation to adolescent health. A specificProgrammeexistswithin the Ministry of Health that congregates public and private efforts, and recently the National Norm, Rulesand Clinical Protocolsfor the Attention of Adolescents’ Health were presented. On the other hand, differentiated servicesfor adolescentsare now offered in some health centres.Ail these measuresare of highest priority considering the actual number of unwanted adolescent pregnancies, although it should be emphasisedthat adjustments are still needed to ensure that the servicesprovided satisfythe users and that the information offered is helpful to make informed decisions. Despite IEC campaigns,the gap between people who know modern contraceptive methods and those who usethem iswide. Also, the rate of STI’sis considerablyhigh. It thus seemsthat cultural conceptions as well as other factorsthat influence adolescents’decision-makingprocessare not appropriately addressed. Thisaffirmation is also valid in the caseof adult couples. Statisticsshow that 18%of the couples never discussedabout issuesrelated to family planning (National Demography and Health Surveyof 1998). It is also relevant to mention that no sectorseemsto have paid specificattention to the needs of parents - mothers and fathers- who have the challenge to respond to the information and guidance needs/demands of their adolescent sonsand daughters. The parents themselvesare under the pressureof self-education as parents and adaptation to the present times and trends. Someprogrammesand projects addressthe work with parents asa complementary strategy,but generally the generation gap is conceived in terms of the needs, interests and demands of adolescents. As a synthesis,our study has served to identify that the needs, interestsand demands for servicesand information of particular groups (cultural worlds) are not met, or at least not adequately met. Despite some improvements at the national policy and programme design 354 Cultures of Populations: Latin America levels,health, education and information providers in the field do not assimilatethe notion of a differentiated approach, required not only because specific groups need and want different things, but becausetheir perceptions of the sameservices/information vary. Furthermore, in rural areas the urban models are reproduced, imposing changes and/or inhibiting accessand utilisation.Diversityis intrinsicallyarticulated to social,economic and cultural disparities. Thus, homogenous approaches only perpetuate social, economic and cultural gaps and inequalities. Within this framework we think it is of strategic importance to encourage and support sociocultural,strategicresearchand, at the sametime, to promote the creationof inter-sectorialnetworks that bring the different actors together, promote exchange and foster a synergy between researchers,financing agents and policy makers.This implies that researchis recognised by the directly and indirectly involved stakeholdersasan investmentfor development and transformation purposes. Also required is the training of local researchersand their preparation for the dissemination of results,advocacy and policy influence, and political will is a key assumption. On the other hand, training aswell as researchprotocols should whenever possible consider the observance and analysisof differences and inequalities. This is a key condition to demand policy makersand programmers to pay attention on particular needs and interests.Within this framework, regular, institutionalised data collection (e.g. the Census)should include social and cultural relevant categories and strategic indicators. Also in general terms, IECstrategiesshould focus more on the different conditioning factors that inhibit or difficult autonomous decisions,particularly so in the caseof women, adolescents and other groups that need to be empowered given the particular socialand cultural characteristicsof the context. The disseminationof the individual and collectiverights seemsvery important to strengthen citizenship. It isalso fundamental to encourage the (political) participation of those traditionally excluded, so that their needs, interestsand points of view are considered in the local, departmental and national development plans. Affirmative actions should be broadly explained and used to overcomethe historical gender, generation, ethnic and social gaps and disadvantages.This is a valid recommendation for education, health and information services.Non-discriminationand pro-empowerment media policies should be advocated, as well as servicesthat respond sensitivelyto the particular needs and interestsof the more disadvantaged groups. Violence seemsto be a key issuethat should be addressedwith maximum priority by all sectorsand in all spheres. It is also interesting to note that some particular groups, which are mainly defined in terms of specificroles and relationships (e.g. parents, couples),do not receive appropriate attention in quantitative and qualitative terms. Thus, it is recommended that differentiated servicesand information be provided to these groups, considering the particular challenges,rights and obligations of being a mother, a father or a (male or female) partner. 355 Cultures of Populations: Latin America On the other hand, health serviceshave as the main, viable challenge the improvement of their quality of care,which needs to be addressedfrom a holistic, culturally sensitiveperspective. Simultaneously,the role of traditional health providers cannot be ignored and should be strengthened and qualified, particularly so given the difficult characteristicsand circumstances that frequently encompassa health event. Furthermore, the official recognition of traditional medicine should go beyond formalities and be reflected in policies, programmes and specific interventions The implementation of the Education Reform needs to be strengthened and accelerated, promoting the corresponding socialand cultural changesin the environment. Particularattention must be developed to bridge the gaps between the establishednorm and its execution. In all the casesinter-sectorialwork is needed if the population affairsare to be addressedas development issuesand within the rights and equity approaches.Undoubtedly. the main conditions for successare the political will to carry out the changesand the consequent allocation of technical and financial resourcesto implement them. 356 Cultures of Populations: Latin America BlBLlOGRAPHY Note: Referencesof literature in Spanishhave been translatedby the author. l Aliaga, Sandra,Mery Quit6n y Maria Elena Gisbert.Veinte Hisforiasde un Mismo Tema: Aborto. LaPaz:The Population Council, 2000. Amuchastegui,Ana. “El Significado de la Virginidad y la lniciacibn Sexual”. Para Comprenderla Subjerividad. Comp. lvonne Szaszy SusanaLerner.Mexico: El Colegio de Mexico, 1996. Angin, Zeynep and FredericC. Shorter. “Negotiating Reproductionand Gender during the Fertility decline in Turkey”. 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Molina Rivero, Ramiro.“Loshijos de Nadie...“: Etnia,Pobrezay Discriminacicm”.lnforme Social Bolivia 4. Ed. CEDLA,FES- ILDIS.LaPaz: CEDLA,FES- ILDIS,1999.23-45. Lagarde,Marcela.Los Cautiverios de /as Mujeres: Madresposas, Monjas, Putas, Presas y Locus. Mexico: UniversidadNational Aut6noma de Mexico, 1993. Lerner,Susana.Introducci6n. Para Comprender Comp. lvonne Szaszy Susana la Subjetividad. Lerner.Mexico: El Colegio de Mexico, 1996. Ligouri, Ana Luisa.“El SIDAy la salud reproductiva”. Mujec Sexualidad y Salud Reproductiva en Mkxico. Eds.Ana Langer, Kathryn Tolbert. Mexico D.F.:The Population Council, EDAMEX. LlanosCervantes,Elvira.“El embarazoen mujeres aymarasmigrantes.Un estudioen zonasurban0 popularesal oestede La Paz”.Mujeres en /OS Andres. Condicionesde vida y salud. Eds.Ac.c. Defossez,D. Fassiny M. Viveros.Bogota: UniversidadExternadode Colombia,1992. Change. A Global Perspective. Pine Forge Press,1996. PachecoBalanza,Pablo. “Migracionesy Dinamicade1EmpleoRuralen Bolivia”. Informe SocialBolivia 4. Ed. CEDLA,FES- ILDIS.La Paz: CEDLA,FES- ILDIS,1999.47-74. Pando,Manuel y Martha Villaseiior. “Modalidades de EntrevistaGrupal en la lnvestigaci6nSocial”.Para Comprender la Subjetividad. Comp. Ivonne Szaszy Susana Lerner.Mexico: El Colegio de Mexico, 1996. Peredo,Elizabeth,Ruth Volgger, lneke Dibbits. Trenzando ilusiones. La Paz:TAHIPAMU,1994. Quiroga, Giancarla.La Discrimination de la Mujer en 10sTextosEscolaresde Lectura.La Paz: SecretariaNational de Educacicm,Universidad Mayor de SanSim6n,UNICEF,1995. Rance,Susanna.“Necesidadde Informaci6n sobre el Aborto. J EsG Revistade Epidemiologia ComunitariaIV (2). 359 Cultures of Populations: l l l Latin America Rance,Susanna.TratoHuman0y Educaci6n Medica: Investigaci6n-acci6ncon Estudiantes y Docentesde la Carrerade Medicina, UMSA, La Paz.La Paz:Viceministeriode Asuntosde Genera,Ceneracionalesy Familia, 1999. Riquer, Florinda et al. “Agresi6ny violencia contra el genera femenino: un asuntode salud pliblica” Mujer: Sexualidad y Salud Reproductiva en Mexico. Eds.Langer,Ana, Kathryn Tolbert. MCxicoD.F.:The Population Council, EDAMEX. Rivas,Marta. “La Entrevistaa Profundidad: Un Abordaje en el Campode la Sexualidad”. Para Comprenderla Subjerividad. Comp. lvonne Szaszy SusanaLerner.MCxico: El Colegio de Mexico, 1996. a Rivera,Silvia.“Pr6logo”. Sermujer indigena, chola o bilocha en /a Bolivia posrcolonial de /OSarias 90. Comp. SilviaRiveraCusicanqui. LaPaz:Subsecretariade Asuntosde Genera, 1996. l l l Sadik,Nafis.“Una NuevaEraen Materia de Poblaci6ny Desarrollo”.Dia Mundial de la Poblacidn II de Julio. Ed. Direcci6nde Politicasde Poblaci6n.La Paz,1995. 10. Salazar,Cecilia.MujeresAltefias.Espejismoy simulaci6nen la modernidad. LaPaz:Centro de promoci6n de la mujer GregoriaApaza, 1999. Salinas,Silvia.M& Ail6 de Sueiiosy Contradicciones:Identidad, Podery Sexualidaden Adolescentesde Zonas Peri-urbanasde La Pazy El Alto. La Paz: Educaci6nen Pobaci6n(UNESCO, MECD, UNFPA),1998. 360 l l l l l SgnchezParga,Jose.“Cuerpo y enfermedaden las representacionesindigenas de 10sAndes”. Mujeres en /OSAndres. Condicionesde vida y salud. Eds.Ac.c. Defossez,D. Fassiny M. Viveros.Bogot6:UniversidadExternadode Colombia, 1992. Scheper-Hughes,Nancy.“Demografiasin ntimeros.El context0 econbmicoy cultural de la mortalidad infantil en Brasil”.Anrropologia de/ Desarrollo. Comp.Andreu Viola. Buenos Aires: PAID&, 1999. Seoane,Guillermo, Ver6nicaKauney Julio C6rdova.Diagn6stico: Barrerasy Viabilizadores en la Atenci6n de ComplicacionesOb&ricas y Neonatales. La Paz:MotherCare,USADI,Marketing S.R.L., SNS,1996. Soruco,Maria Teresay MarcelaLascani. Percepcionessobre el AcosoSexual en Bolivia. LaPaz:Subsecretariade Asuntosde GCnero, 1997. Spedding, Alison. “Mujeres de clasemedia en Bolivia”. En “Memoria del Taller: Reflexiones en torno a “mujeresde clasemedia”. LaPaz: ILDIS,TAHIPAMU,1995. * Subsecretariade Asuntosde GCnero. Fundamentos Tehicos para una Prcicrica no Discriminatoria.La Paz:Subsecretariade Asuntosde Genera, 1997. l Szasz,Ivonne. “La condici6n socialde la mujer la salud”. Las Mujeres y la Salud. Comp. SoledadGonzelezM. Mkxico D.F.:El Colegio de Mexico, ProgramaInterdisciplinario de Estudiosde la Mujer, 1995. y l Cultures l l of Populations: Latin America Szaszlvonne y Ana Amuchastegui. “Un Encuentrocon la Investigacikm Cualitativaen Mexico”. Para Comprender /a Subjetividad. Comp. lvonne Szaszy Susana Lerner.Mexico: El Colegio de Mexico, 1996. l Zolla, Carlosy Virginia Mellado. “La funci6n de la medicina domesticaen el medio rural mexicano”. Las Mujeres y la Salud. Comp. SoledadGonzalezM. Mexico D.F.:El Colegio de Mexico, ProgramaInterdisciplinario de Estudiosde la Mujer, 1995. TorrezPinto, Hugo. “Hacia una Contextualizaci6nSocio-Demografica y Cultural de Bolivia y susAreasInvestigadas”. Mujer: Embarazo, Alimentackh y Salud. Ed. CONAPO,PL-480.La Paz:SecretariaTecnica del ConsejoNational de Poblacicm,1991. l l Towsend,Wendy. Caza y Pesca de 10sSiriono. LaPaz:lnstituto de Ecologia,UniversidadMayor de SanAndres, FUND-ECO,1996. Trostle,James,Mario Bronfmany Ana Langer. De /a Investigacih en Salud a la Politica: La Dificil Traduccih. Mexico D.F.:lnstituto National de SaludPublica,Manual Moderno. l l Unidad de Politicasde Poblaci6n,Investigaci6n y Analisis.Aspectos de la Poblacidn Boliviana. La Paz:Ministerio de DesarrolloSostenibley Planificacicx-r, 2000. Velasco,Carmen,Claudia de la Quintana y GretzelJove. Salud Reproductiva en Poblacibn Migranre. El Alro y Areas Rurales de1 Departamento de La Paz. LaPaz:FNUAP/PROMUJER, 1996. l Viceministeriode Asuntosde Genera, Generacionalesy Familia.Bolivia 5 Afros despuh de Bejing. Poder, Oportunidades y Autodererminacidn Mujeres en el Nuevo Siglo. La Paz: para /as Viceministeriode Asuntosde Genera, Generacionalesy Familia,2000. 361 SOCIO-CULTURALENVIRONMENT ANDDEMOGRAPHICBEHAVIOURINECUADOR Marco PossoZumarraga* INTRODUCTION T he Republic of the Ecuadorlocated in SouthAmerica, with Colombia to the north and Peru to the south and easthasthe PacificOcean to the west. It hasan extension of 257,000 Km., including the territory of the GalapagosIslands,which is located 1000 km off the coastof Ecuador in the PacificOcean. The population is estimated to be 12.5 million, with a growth of 2.1 per cent (1999 estimates).The urban population is growing rapidly and it estimatedto be 60 per cent. Migration to urban areasand international migration toward the major urban centres in particular to the European Union countries is evident in all estimates. Social Structure A complex socialstructureexistsin the country. During the two lastdecadesof economic crisis, a profound transformation in the socialfabric of the Ecuadoriannation hastaken place. Castilian is the official language, the quichua, the shuar and the other ancestrallanguages are in use by the indigenous communities.The mulfierhnic and multiculfural characterof Ecuador,isa product of the historic formation of the society an ethnically diverse group live in the country, thus a ncrtionnl culture does not exist, on the contrary. In any event, a new culture is being evolved through transformation and interchange. Ecuador presents a group of cultural manifestations whose wealth and diversity have become a potential for the future development of the country. Family, Gender and Health The cultural forms of the family socialstructure have changed throughout history, generating processesof anomie and changing roles. The heterogeneity in which family formations take place within the urban and rural social context in Ecuador makes it difficult to find a uniform family model. What can be seen is the existenceof different modalities,as a result of the varying conditionsrelated to culture, socio-economicstrata, ethnic group, region, etc. * Marco Porno Zumarmgo is fhe president of Avxiocion de Poblacion (AEFQ), Quito-Ecuador 363 Cultures of Populations: Latin America In the country, the entry of petroleum in the economy and the agrarian reform have not only changed the structureof the country’s economic administration, but also family structureaswell. Thesechangesare currently becoming alarming as familiesaffected by their exclusionfrom the economy and consequently non-participation in productive activities leave them without the resourcesneeded to satisfytheir basic needs. The modernisationof the economic,socialconditionsand the transitionto a new development model has destabilised older family forms, pushing them to “adjust” to the current situation. Separation and divorce rates have been reported to increasetenfold, as well as the number of female-headed households,although the figures for Ecuadormay be lower than the averagefor Latin America. Likewise,‘occasional’ and ‘consensual’relations have become more common not only among the poor, who form a large population of the country. Thisform of unions seemto have an effect on the stability of most familiesas they become exposed to greater tension and are vulnerable in sustaininga traditional type of family. Sincea large number of women live (or are forced to live) alone or as heads of households, the responsibility for their own and their family’s survivalhas grown since the sixties.Motherhood often does not count on the support of marriage and the elderly are not provided with care by their sons,which tends to increase the load of women. The concept of the monogamic unit has changed, women have begun to work for wages and the children are being cared for by closerelativesor others, in day care centres.Thischange, seemingly insignificant, is considered as a basic component of the instability of marriage and thereforeof familydisintegration.The familyis the firstsocialisationunit for children. By socialisation we mean the learning processthrough which the child values principles, norms and practices that allow him or her to become a socially and culturally apt being and an actor in society and in the community. In terms of health in the rural highlands, a high number of births take place in the home, with help from midwives, mothers or mothers-in-law. If the mother dies in childbirth, the child usually dies too. lf it survives,however, it is placed in the care of relatives.lf a child is born with physical impairments that the parents consider to be insurmountable, it is left to die. Similar behaviour pattern is observed in the coastalareasof the country. In the rural areas,both in the highlands aswell as along the coast,women work throughout the entire period of pregnancy practically without medical care or adequate food, as compared to city women (Quito and Guayaquil)who have more frequent prenatal care and better nutrition. Childbirth in Quito and Guayaquil cities usually takes place in hospitalsor medical centres.The father and other relativesplay an important role to assistthe mother. In Guayaquil area, due to multiple partnerships and the male practice of leaving the woman during pregnancy, one can find in the samehousehold children from severalpartnerships, both 364 Cultures of Populations: Latin America of the father as well as of the mother. Fathersusually do not provide financial support, placing a triple burden on the woman - as mother, father and economic supporter. Child labour in rural areas is considered to be part of the child’s learning process: work demandsare made according to age and capacity.However,most boys from 12yearson, migrate from their places of origin and join the early work force. The Scope of the Study The present field study was undertaken to analysethe socio-culturalfactorsthrough qualitative researchmethods. Sincethere is a need to complement the quantitative studieswith qualitative data, the study’s general objective was to carry out a qualitative exploratory investigation to comprehend the incidence of the socialand cultural factorson the behaviour of the demographic variablesand on the definition and elaboration of population policies and programmes. Severaltaskswere fulfilled prior to data collection, such as: a) The analysisof a state of the art studiesabout socialand cultural factors. b) The selection of the locations where the researchwas undertaken. c) Assurethe representation of the major ethnic groups in the country. d) The coordination with the local authoritiesin the selectionof facilitatorsand key informants in the communitiesand e) Logistics. Severaltechniques were combined to collect information, including focus group discussion, in-depth interviews, social biographies based on interviews with leaders of the communities. The study does not have a national representative sample, but reflects the socio-cultural milieu of four selected locations. The criteria for the selection of these is as follows: They are representative of rural and urban areas Have an indigenous representation and mix race Incorporates indigenous nationalities, where different languages are spoken . Community willingness to participate in the study. l l l The selected siteswere: 1. lluman 2. Chachi 3. Sibambe 4. El Valle The resultspresent the point of view of the selected group of respondents on severaltopics: 365 Cultures of Populations: Latin America A. Adolescents The education of adolescentsand the schoolconstitutesan important and indispensablefactor in their lives,in order to get a professionand income to improve the economic conditions of the family and the community. In all the locations, adolescentsrealisethe importance of equal rights for men and women to receive education. Theyconsiderthat the relationshipbetween teacherand student should be basedon dialogue, understanding and good behaviour rather than coercion. Theyvalue the punctuality and regular presenceof their teachersin the schoolactivities.In one of the locations,the adolescentspreferred particular schoolsas these schoolshave fulltime classes,becausein public schools“many classes are left incomplete and teachersare unable to finish the calendar asestablishedin the schedule”. The healthcare of adolescentsis considered the responsibility of their family, they inform that traditional medicines are practised widely. The public health servicesare appreciated however high cost of the medicines,the medical personnel and paramedic is a concern of the family and community. They report that their migration due to lack of work in rural areasplacesthem at high risk to diseaseand violence.Most were sensitiveand honestabout the physicalviolencein the relationship of their parents and siblings. It was also noted that communication on health education is practically omitted by parents; the communication channels like radio and TV give sporadic and incomplete information. B. Youth Generally it was agreed that education is considered as the responsibility of the parents; the mother often helps them aswell as older brothers and sisters. In all the sites,the youth recognise the importance of education, they consider that it is the principal factor to get good opportunities in life In their view, education must be linked to the demand of jobs. Secondary education should permit them to have potential opportunities of work so that it can generate income. They do not consider that TV influences their education, but they recognise that there are some “good and bad,” programmes, which show violence, and can have a negative influence on young people. Youth in urban and rural areasof both sexesconsider that couples should know each other before getting married, in rural areasthe ideal age to get married is 20 or 25years,although in reality the age at marriage is lower. Someyouth at the siteshad received information about sexual relationships, contraceptive methodsand sexuallytransmitteddiseasesand HlV/AlDS but they considerthis not to be sufficient. 366 Cultures of Populations: Latin America C. Adults At all the study sites,adult men and women, recognise that the mother bears the burden of education of children, although generating incomes is the responsibility of the couple. They reported that education should give the sameopportunities to men and women, although the tendency persiststo prefer the participation of the male children in higher education ascompared to women. Adults were found to be not very well informed about STDand HIV/AIDS, especiallyits causes and prevention. The adult women consider that the prevention of the STDis the responsibility of men since “the women stayat home.” Women generally have received information on family planning and contraceptivesmethods. D. Parents(Mothers) The parents in all the study areas confirm the mothers’ central role in the education of the children, although they recognise that it should be the responsibility of the couple. Parentsand particularly mothers recognise the equality for children of both sexesand also for girls and boys to receive equal education, however, mothers saythat there is a preference for male children to go out to receive education, whereas the daughters are more useful at home and they have to get married and make a home. Parentsalso informed about the negative influence of the television on the children because “it distractsthem from work.” As regards entry in marital unions, most of them agree that people should know each other before getting married but they are opposed to the sexual relationships before the marriage. SElEC7EDRECOMMENDATIONS Education Education servicesshould give priority to the following programmes: l l l Improve the attendance and the execution of the schedulesof teachers Recruit teachers from the community or require teachers to live in the community. The language should be suitable for indigenous communities. Availabilityof didactic material,books for the librariesand laboratoriesto improve education. 367 Cultures of Populations: Latin America Health l l l l l l l l Restructurethe medical personnel to meet the needs of the community. Have permanent doctors, odontologist, paediatrician, etc Provide more medicines in the communities. Improve communication between health personal and community. Hold severalmeetings on Reproductive Health topics for parents, mothers and men. Provide systematic information for prevention of high-risk diseases through Schools, Medical Centresand Massmedia. incorporation of the traditional medicine in the medical services. Install pharmaciesin each one of the communities,with natural medicine like with modern medicines. For policy makers Finally,it is necessaryto mention someaspectsin general characterthat addressbroad issues: Establishmechanismsof coordination between health and education,where the participation of the school, family (father and mother) can generate actions through communication. Encourageactivitiesthat support the development of human resourcesin the community. Improve civil society participation to solvethe problems of the community. incorporating in the design of the policies and programmes of education, health and information on socio-cultural beliefs, security, etc. of the population, and the mechanismsfor their participation. Finally,integrated economic and social policies need to be developed. A move needs to be made away from the current lack of articulation towards a “socio-cultural and economic” policy addressing human development. l l l 368 Cultures of Populations: Latin America BIBLIOGRAPHY “La Cultura Sexual de /OSAdolescenfes”, l Rodrigo TenorioAmbrosi,Maria SoledadJarrin, PaulBonilla, 1995. “Cuadernos de la Realidad Ecuatoriana No. S”, Centro de Investigacionesde la realidad ecuatoriana,Quito - Ecuador,1992. l l “Culturas EcuaforianasAyer y Hay”, Jilyan Benitez,Alicia Car&s, 1999. “Ewe Lo Propio y lo Ajeno”, Coordinadorade las OrganizacionesIndigenas de la Cuenca Amazbnica,1997. l l l l l l l “Geografia de la Pobreza en el Ecuador”, CarlosLarrea,JaimeAndrade, Wladimir Berborich, Diego Jarrin, CarolinaReed,Quito Julio de 1996. “LA Familia Eje de la Acci6n Social: Aspectos Operarivosy Analisis de Experiencias”, Memoriasdel Seminario,AEPO,Agosto, 1994. Fecundidad y Morfalidad, CONADE,UNFPA, AEPO,Quito, 1996. Migracibn y Distribucidn Espacial,CONADE, UNFPA,AEPO,Quito, 1996. Familias Rural y Comporremental Demogrdfico, CONADE,UNFPA,AEPO,Quito, 1996. Reproduccidn Intergenerational de la Pobreza, CONADE,UNFPA,AEPO,Quito, 1996. 369 Cultures of P Populations 5 % -- I ?!!H q+@?KA UNDERSTANDINGSOCIALCULTURAFACTORS ANDDEMOGRAPHICBEHAVIORINGUATEMALA A case of Adolescents Elena Hurtado * INTRODUCllON AND BACKGROUND A dolescence is a transition period characterised by biological, physiological, social, and psychological changes. It involves sexual maturity and the start of sexual activity. Adolescence is defined by the World Health Organisation as the period from 10 to 19 years of age. However, the chronological definition of adolescence does not necessarily correspond with socio-cultural definitions or with the adolescent’s view of their own life and changes. In both developed and developing countries, most work on adolescents has been conducted from the demographic perspectivewhich does not take into account the definitions, perspectives, interests and concerns of adolescents themselves(Eyre et al. 1998). Moreover, many demographic surveysdo not consider adolescentsasa distinct population group different from children and adults. Although adolescentscomprise 27 percent of the population in Guatemala(MSPAS1998),no specific studieson adolescentscould be located. For example, out of five diagnostic and operational research studies recently conducted by non-government organisations (NGOs)with the technical and financial assistanceof the Population Council in Guatemala,not one dealt with adolescents’ sexual behaviours or reproductive health (Enge 1998). These studies focused on adult family planning usersand non-users,adult cognition and language related to sexuality, and knowledge, attitudes and practices regarding reproductive health and family planning of men and women, all in Mayan areasof Guatemala. The last Demographic and Health Survey(DHS)conducted in 1995 provided limited information on adolescentsas it included the age category 15-19years. Thissurveyfound that 17 per cent of young women aged 15-19already had a child, and four per cent more were pregnant 371 Cultures of Populations: Latin America for the first time at the time of the survey.Thus, at least 21 per cent of the women 15-19years interviewed in 1995 had already started on the path of motherhood. According to analysesand comparisonsof the 1987GuatemalanDHSsurveyresultswith those of eight other different Latin American countries (Samara 1997, Wulf and Singh 1991), in Guatemalaaround 28 percent of young women become mothersbefore their eighteenth birthday; the percentages range from 26 percent in El Salvadorto 14 percent in Brazil. Combining these data with what is known about age-specific fertility rates, Guatemala trails closely behind El Salvadorand Honduras with the third highest age-specificfertility rate for 15-to 19-year-oldsin Latin America. Guatemalanfemalesare among the most likely, in both Central America and the entire Latin America region, to make an adolescent transition to motherhood. In some regions and social groups in Guatemalapregnancy at an early age may be part of the cultural pattern and happens within the confines of early marriage or consensualunions (Samara1997),but in the cities these pregnancies are generally unintended and unwanted and occur in couples that are not living together. Many of these pregnancies end in unsafeabortions becausespecialisedmedical servicesin Guatemalaare scarceand expensiveand, asin all of Latin American countries, abortion is illegal. Unfortunately, the illegality surrounding such abortions can produce adverseconsequencesincluding death asa resultof unsafeproceduresand long-term health effectssuchasgynaecologic problems and infertility (TheAlan GuttmacherInstitute 1994) Sexual education through schoolsis limited and general lack of education is an important problem. More than 10 per cent of the male adolescentsand youth lo-19 years and 15 percent of the female adolescentsand youth have had no schooling (MSPAS1998).Gender discrimination is a related problem, especially,but not limited to the poor socio-economicstrata,affecting directly adolescent girls. In a surveyin a Mayan Indian community it was found that girls more than boys never attend school. The reasonsgiven for girls never attending or leaving school were that they have to perform household chores such as cooking and taking care of younger siblings or that parents could not meet the expensesassociatedwith their attending school. In contrast, the reasonsgiven for boys not attending or leaving school were that the boy did not want to attend or did not like school (Hurtado 1993, unpublished data). The present study provides information on the beliefs, motivationsand experiences of adolescents regarding the transition from childhood to adulthood, adolescent sexuality, sexual behaviour and reproductive health that can be usefulto develop information, education, communication and counselling (IEC, Counselling and services)interventions for adolescents and youths. Cultures of Populations: Latin America METHODOLOGY The methodology applied was qualitativeand participatory in nature. The report was primarily descriptive and relied on adolescents’and relevant others’ words as primary data. Study population The study population came from four sites:one poor ladino peri-urban community adjacent to the city of Quetzaltenango in the department of Quetzaltenango (Llanosde1Pinal)and three rural Mayan Indian communities in Comitancillo, SanMarcos, Nahuala, Solo16and San And& Xecul, Totonicapan’. Three linguistic groups were included: Spanishspoken in Quetzaltenango, Mum spoken in Comitancillo and K’iche’spoken in Nahuala and Totonicapan. Most of the adolescentswith the highest unmet social, medical and educational needs were expected to be found within these ethnic and socio-economicgroups. The methodology for data collection was as follows: Qualitative and participatory data collection employed the following techniques: 1) Rapid survey of adolescentsand youths to find out about the topics of interest to them. As mentioned, in each site, interviewswere conducted with 32 adolescentsor youths, halfmale and half-female (the total was 128 interviews). 2) Focus Group Discussions were held with 16 groups of adolescentsand youths, two female groups and two male groups in each site. Two sessionswere held with most groups until all the topicsof the study were covered.An effort was made to makethe sessionsasdynamic and participatory as possible to keep adolescents interested and prevent sample loss. Group discussionswere also carried out with two groups of men and two groups of women in each community. Of these, one group of men and another groups of women were parents of adolescents. 3) Fieldwork with adolescentswas enhanced by including, in FGDscognitive tasks such as free listing, and ranking procedures, by using pictures to stimulate discussion,and by projective techniques such as scenarios. Forinstance,participantswere shown a seriesof pictureswith a baby boy or girl, a school-age boy or girl, an adolescent boy or girl, a youth, an adult man or woman and an old man or woman and were asked with which picture they identified with themselves.This task led to discussionabout the terms used for this age group and characteristicsof this age group, without introducing the investigator’sdefinition of adolescent or youth. Free listing was used for questions about the activities of adolescentsand those that are considered risky. Ranking procedures were used when adolescents were asked their actual and preferred sourcesof advice on sexuality and problems. population is divided inro two ethnic groups of roughly equal size: the indigenous populntion who are descendontr of rhe Mayor and other peconquesr groups, and lodinos, who regardless of ethnic origin or phenotype, speak Spanish, wear European-style clorhes, and view rkemselv~?r os dercendontr of the Spanish ond other European groups or of mixed indigenous and European descent; rhe ladtnos conslilule the non-tndigenovr population of Guoremala. I Guaremala 373 Cultures of Populations: Latin America 4) Observation and in-depth interviews were conducted in facilitiesof health programs in each site where selected health providers were interviewed. Also, a few teachersand staff of NGOsworking in the study communitieswere interviewed. 5) Information on the general characteristics of the sitesand populationsstudiedwas obtained. Qualitative data gathering proceeded from the rapid surveyof adolescents/youth, to focus group discussionswith adolescents,youth, men and women, to individual interviewswith service providers. Observationswere performed during the course of fieldwork. A workshop for adolescentsand youths was conducted at the end of the study in two communities of Solola and Comitancillo where participants wanted their questionsdiscussed.The actual number of groups and informants from whom data was gathered in each site is presented in Chapter 3. Data collection instruments The data collection instrumentsdeveloped and used in this study were: l Rapid survey interview. In addition to background information (sex, age and school attendance), this interview guide had four open-ended questionsto find out what topics did adolescentswant to discussin sessions:general, health-related, related to interaction with the opposite sex, and related to problems of adolescents.Finally, adolescentswere asked if they wanted to participate in focusgroup sessionsand those who responded affirmativelywere written down on a list. l Focus groups guides. Two discussionguides were prepared for focus group discussions with adolescents,two guides for groups with youths, one guide for adult men, one guide for adult women and one guide for parents of adolescents. l Interview guides. Three interview guides were developed to interview teachers, health providers and NC0 staff in each community. l Observationguides. Two guides to record community and institutionalcontext observations, respectively,were developed. Limitations of the study Severallimitations were encountered in the conduction of this study: 1) During the time of the year when the study was conducted it is school vacation in Guatemala.Therefore, many adolescentsleave their town looking for jobs in other places in the country and in Mexico. 2) Thoseadolescentswho could be located in their communitieswere helping their parents in the harvestof maize. Thismade it difficult to engage them in the study activities. 3) Adolescents manifested a marked interest in not just engaging in interviews and group discussions,but learning skills or crafts that would help them earn some money. This accounted for three (out of 16)groups not wanting to participate in a second session. 374 of Populations: Cultures Latin America 4) Finally, due to the requirements of the UNESCO/UNFPAProject2funding the study, too many groups and informants were included and too many topics addressed,which made it difficult to analyseresultsand summarisethem in a coherent report. It would have been better to focus the study entirely on adolescents. Analytical Procedures As mentioned, qualitative research is primarily descriptive and relies in the participants’ words as primary data. Qualitative data analysiswas performed asa continuous processfrom the beginning of the data collection. Central to this processwas the organisation of field notes. Analysis involved examining field notes to discover patterns and themes. Epilnfo was used to analyse the rapid surveyresults.The computer programme DtSearchwas used for text retrieval and content analysisof the focus group transcripts.The interviews were analysed by hand. Ethnicity It is natural, when talking about socio-cultural diversity, that the issueof ethnic diversity is addressedin the first place. Guatemala,one of the poorest countries in Latin America, has been highly sociallystratified historically and has a very unequal distribution of income. Roughly half of the population is indigenous -i.e. descendantsof Maya and other pre-conquest groups, who have maintained a separateidentity during the past 500 years - while the other half, referred to as ladinos, speakSpanish,wear Europeanclothing, identify with the national Guatemalanculture, and are of both indigenous and European origins. Ethnicity and socialclassare intertwined, with the indigenous population being generally quite poor while ladinos are members of all socioeconomic classes;however, the upper and mid-upper socio-economicclassesare almost exclusively ladino. Guatemala underwent a civil war during the 80’s. Guerrilla take-oversof rural indigenous hamletstriggered massivelevelsof stateviolence, including death-squad executionsand military counterinsurgency attacks. Many indigenous leaders and anthropologists felt that the government used this counterinsurgencywar asa disguisefor ethnocide against the Mayan population. Ironically,one of the consequencesof the war hasbeen a strong movementtowardsMayan ethnic and religious revitalisation. In 1986, Guatemalanlinguistswho are native speakersof Mayan languages organised themselvesnationally as the Academia de la LenguasMayasde Guatemala(ALMG)and voted in new alphabets for writing the 26 Mayan languages and hundreds of dialects spoken in Guatemala. The activities of the members of this Mayan academy include advocating the use of the new alphabets for writing Mayan languages and pressing for bilingual education: at the same time they encourage indigenous customs,such as the wearing of distinctive customsand the use of the Mayan calendar. The Mayan ethnic and religious revitalisationhas implications for the study and provision of reproductive health servicesin Mayan areas. 2 UNESCO/UNFPA Population Project INT/96.P62: Undemanding Sock+culruml Factors affecting Demographic Behaviour and Implications for the Formulation and Execution of Policies and Pmgmmmes. 375 Cultures of Populations: Latin America From the population’s perspective, ethnic identity is defined by K’iche’ women by their sense of belonging to their community of origin and by their identification with the MayaK’iche’ culture. To them, their culture is defined by their territory, values, language, clothing, costumbreor custom,oral tradition, religion and socialorganisation(CabreraPerez-Armifian1992). Union, marriage and sexual behaviour Traditionally, when a boy from the rural areasliked a certain girl, he took her by force and made her his wife. Abduction or repro is still a common practice in both ladino and Mayan rural areasof Guatemala(Asturiasde Barrioset al 1997). Another common practice of abduction is robo or theft. The difference between rapt0 and robo is that in the latter, both parties agree to flee and live together without the previous consent of the girl’s parents. It is an accepted cultural way to start a relation as a couple, but not the preferred one, especiallywhen the girl’s parents do not approve of the young man or when they think their daughter is too young to get married. In the Mayan cultural environment, the rites related to robo provide an opportunity to ask the girl’s parents for forgiveness,to ratify her decision in front of her parents, to reconcile both familiesand legitimise their relation in front of the community.On the other hand, in the la&no cultural environment, the robo of an under-age girl might lead her family to initiate a legal proceeding by which the boy or young man can be put in jail and the girl be restored to her home (Asturiasde Barrioset al 1997). In K’iche’communities, marriage is formalisedthrough severalconsecutivepetitions made by the man’s parents and the Mayan priest, who is the mediator between both families.In the past, parents chose the girl, without having the approval of the boy. Currently, the boy chooseshis mate and parents consult with both parties (CabreraPerez-Armifian1992). When a K’ekchi’ male is ready to get married and has chosen a girl, he consultswith his parents. They confer about it and select severalhonourable people to represent them during petitions or tzaamaanc. When these honourable people accept, they are given information about the girl. On a Sunday, the intermediaries visit the church, the different cofradias or brotherhoods and the girl’s home. Generally, intermediaries visit the girl’s parents three times and, during the third time, they agree on the date of the ceremony and on who will cover minor expenses.According to tradition, the ceremony has to take place on the Sunday,after the girl has had her period. Major expenses(food, candles, copal and incense)and the clothesworn by the girl are covered by the boy and his parents (Winak 1995). Sometimes, the boy does not follow tradition and visitsthe girl’s parents by himself. During this visit, the boy agrees to work without pay for the girl’s family. During the first two weeks, he does not even get a chance to talk to the girl; he has to work hard and well to impressher parents.After the initial two weeks, the girl is allowed to servewater to the boy and starta simple friendship with him. After a month, the girl is allowed to take lunch to the field where the boy 376 Cultures of Populations: Latin America is working; this givesthem more time to talk and get to know each other. If her parents approve of his work and manners,the girl will be allowed to wash his clothes.After two months, the girl’s parents ask the boy to find an intermediary to start the tzaamaanc or petitions (Winak 1995). According to a study of women in a peri-urban settlement in GuatemalaCity, half of them initiated sexual relations with their boyfriends before marriage. About a fifth of them (18%) started their sexual life through rape. In the majority of cases,males had already had sexual intercoursewith other women (Asturiasde Barrioset al 1997). Males from this peri-urban area initiated their sexual life when they were 12-20years of age. Concerning males, culture reinforces their identity through premarital sexual experiences. It is believed that the sexualimpulse, which startsduring adolescence,hasto be relieved in order to avoid physical problems, homosexuality or traumatism;therefore, boys have to learn about sex and sexual relations with women early on. In fact, they are urged to look for sexual experience with female sex workers, girlfriends or older women (Asturiasde Barrioset al 1997). The civil marriage generally takes place at the municipality. After the legal ceremony, the couple isallowed to startthe pre-maritalcourserequired by the church. According to the K’ekchi’, this wedding is a public and community testimonyof the couple’s union in front of Christ. Culture: beliefs/traditions According to the K’iche’ traditional conception, biological reproduction in women is defined as a symptom of health and of compliance to their most important social function. Midwives, who are responsible for the community’s births, do not assimilateor transmit western concepts that are not congruent with this conception, which also hasa lot to do with the rejection of family planning in K’iche’ communities (CabreraPerez-Armifian 1992). Among the K’iche’, religion, either Catholic or Protestant, is also one of the main barriers regarding family planning. Familyplanning is regarded asa great sin, and the expression“God decides how many children we should have” is very common. Some equate family planning to abortion, which they know is prohibited by the church and the state (Ward et at 1990). In some Kaqchikel, K’iche’ and Tz’utujil communities,abortion related to family planning, is one of the health problems mentioned by the population (Solares1995). According to the K’iche’, the Maya value systemis different from that of the la&no population, which is conceived as more materialisticand lessindustrious. There is an indication that they are proud of this fact and they do not want to acquire ladino practices. They believe that family planning is a modern ladino invention, and a sin, especially for the Mayan population. They believe they have the obligation to have as many children as God wants and this is related with their senseof duty and the value they place on work. According to them, people who plan their familiesare lazy and do not want to work (Ward et al 1990). 377 Cultures of Populations: Latin America A study conducted in Totonicapan (Lima 1996)identified asthe key factorsthat influence the low practice of family planning in Mayan communities: traditional beliefs, lack of information, incomplete or erroneous information, the role of women, moral and religious beliefs, lack of economic resourceswhich make accessto servicesand family planning methods difficult and the bad image of APROFAM(the main family planning private voluntary institution in Guatemala) and its family planning promoters. In the peri-urban settlement in GuatemalaCity studied, there is a belief that the possibility of becoming pregnant is positively associatedto the frequency of sexual relations. Severalwomen who became pregnant while they were having premarital relations also expressed this idea; they thought they would not get pregnant if they had sporadic intercourse (Asturiasde Barrios et at 1997)and were surprised that they did. As family planning is conceived as a sin in K’iche’ communities,fear of disapproval is one of the most important barriers to its acceptance (Ward et al 1990).Also, K’iche’men do not accept family planning because they think their wives can be unfaithful; they can have extra-marital relations without the fear of becoming pregnant. They also believe that begetting children is a proof of their manhood (Ward et al 1990). It is clear that the K’iche’ are very suspiciousof the reasonswhy outsiders come to the community to promote family planning. They believe that there is a plan coming from another country to diminish their population (Wardet al 1990). Women from a rural ladino community view family planning as a way to end their reproductive life, not as a way to space pregnancies. Somewomen from rural and semi-urban ladino communities believe that the use of family planning methods is bad because they adversely affect their health and menstruation (Santizoet al 1995). To some K’iche’, oral contraceptivesare a synonym of family planning and therefore, are conceivedassomething negative.They believe oral contraceptivescauselossof weight, a general waste and cancer. Somethink they are toxic and affect the child in the womb and the mother. As pills supposedly cause visible side effects, they are lessacceptable for fear of disapproval (Wardet al 1990).Generallyspeaking, K’iche’women are afraid of side effectscausedby different methods (Bertrand et al 1993). K’iche’ males indicated that the use of condoms is not common in their communities. According to adults, condoms are more commonly used during adolescence. This method is associatedmore with the prevention of STDs(Ward et al 1990)than with birth spacing. Other contraceptive methods are not well known among the K’iche’ and commentsabout them are very negative. Vasectomyis not accepted, as it is related to the loss of manhood. Voluntary sterilisationis acceptable only when prescribed by a doctor (Wardet al 1990). The option of voluntary motherhood is increasing among young K’icbe’ couples who live in urban areas,where there is a tendency to form nuclear familiesand people work for a salary. 378 Cultures of Populations: Latin America Thiswas observed in the town of SantaCatarina. On the other hand, this option is rejected in SanVicente, a very traditional village (CabreraPerez-Armifian 1992). The barriers to condom useamong people from GuatemalaCity include decreasedsensitivity during sex, vaginal irritation or infection, the assumption that condoms will break, and the implication of a lack of trust between partners. Both sexes recognise that alcohol inhibits condom use because men who have been drinking may forget to use a condom, or may be unwilling or unable to use one (Bezmalinovicet al 1994). Socio-culturalnorms among people from GuatemalaCity that encourage men to indulge in sex and women to be passiveand uninformed about sexual matters increasewomen’s vulnerability to STDsand HIV/AIDS. Moreover, norms that discourage women from being knowledgeable and communicativeabout sex serveasbarriers to partner communication, a prerequisite for the adoption of STDand HIV/AIDS protective behaviours (Bezmalinovicet al 1994). Gender specific status and roles Statusand roles K’iche’ women participate in community life at four levels:i) as a complement in the subsistence activities of the family through commerce and migration; ii) as health agents regarding their role in biological reproduction and the preservationof health at the family and community level; iii) by their accessto formal and non-formal education; and iv) by their participation in socialand religious activities (CabreraPerez-Armifian 1992). K’iche’ women do not participate directly in the local power structure, but they are present in transfer ceremonies, community assembliesor political events.Generally, the role of women in the political sphere is more inductive than one of representative leadership. Power, in the senseof hierarchy and statusof authority, is concentrated among elder women and they exert this power over adult and young women (CabreraPerez-Armiiian 1992). The domestic unit is the space shared by the family group and it includes the house, the patio, the yard, the latrine and sweat bath or remuscal,and the milpa (maizeplants).Thisspace combines production and reproduction relations (CabreraPerez-Armifian 1992). K’iche’ rural families are patrilocal, patrilineal, monogamy and extended. When males get married, they bring their wives to their father’s home and they live there until they inherit land to build their own home (CabreraPerez-Armifian 1992). The tendency in the highlands is that daughters inherit less land than sons do. However, when there is enough land, inheritance is equitable. The pattern of inheritance is important to women becauseif it is not equitable, their dependence isincreased(CabreraPerez-Armifian1992). 379 Cultures of Populations: Latin America Division of labour The spacedistribution in the domestic unit is based in the organisation of work. Symbolically, it is divided into female and male spaces;female spacesinclude the patio and the kitchen. Here, women are responsible for animal breeding, production of handicrafts,selection and storage of grains. Women prepare food, cook, serve food and eat when the rest of the family has been served.Objectsand servicesfound in the domesticunit and the community makewomen’s work easier or more difficult (running water, stoves,troughs, etc.) (CabreraPerez-Armitian 1992). Work in the domesticunit is based on co-operation,which promotesmutual inter-dependence between males and females.This co-operation takes place at different levels:among genders, different age groups or femalesliving in the domestic unit (grandmothers, mothers, daughters and nieces). Co-operative domestic work is based on an equitable distribution of all domestic chores among females and children in the house. Elderly women perform outside chores (commerce, cultivation and harvest, gathering firewood and health preservation); young women or adults with children stay at the domestic unit performing household chores (animal breeding, corn grinding, cutting wood, washing clothes). Children contribute, especially in tending flocks of domestic animals, or handicrafts, commerce, fetching water and wood (CabreraPerez-Armifian 1992). In some circumstances,the traditional division of labour between men (cultivation of land) and women (elaboration and preservation of products of the land) is broken and they join efforts to manufacture mud bricks, gather firewood, or during planting and harvest (Cabrera Perez-Armiiian 1992). Animal breeding does not correspondto the samedivision.Womenare responsiblefor animals bred and cared in the domestic space (chickens,pigs, sheep, goats). Men are responsible for cows, bulls, mules, horses,as their food depends on the existenceof pastures,normally located far away from the domestic unit (CabreraPerez-Armifian1992). Regarding the cultivation of land and animal breeding, the socialdivision of labour is broken with the temporary absence of men (migration and commerce)and women take charge of all these chores. The division by age group resultsin older women assumingchores that require greater displacement and temporary absence from the domestic unit (CabreraPerez-Armifian 1992)while younger women stay home. Decision-making K’iche’women haveto obtain permissionfrom men to act outside the domesticunit and even when they get it, the control of kinship relationsand elders from the community is also important and a reflection of women’s subordination. In terms of gender, subordination is an effect of the control of marriage alliances in fertile age women. In terms of age, this control becomes less 380 .“._ _“-~-__.--_.“.- .I .- Cultures of Populations: Latin America important as women get older and have already demonstrated their fertility (Cabrera PerezArmiiian 1992). Very few women from la&no and Mayan rural and semi-urban communities practice family planning, as this type of decision depends on men. They know something can be done to control the number of children they want, but they do not have the individual ability to decide and plan their family. Most couples talk about how many children they want to have when they get married or when they do not want more (Santizoet al 1995). Maternal mortality Maternal mortality in Guatemala is 230 maternal deaths for 100,000 live birth, which is among the highest in Latin America. In 1995, qualitative research was carried out in eight Mayan rural communities in Totonicapan (three communities),Solola (three communities)and SanMarcos (two communities). The methodology used included open-ended standardised interviews with 100 pregnant women (half primiparousand half multiparous),20 traditional birth attendants (TBAs),community leaders, health personnel, personnel from non-government organisations (NGOs)and focus group discussionswith women in reproductive age (two groups in each community) and men (one group in each community). Qualitative resultsdescribed the main knowledge and practices,especiallyregarding specific “danger signs” during pregnancy, delivery, the postpartum and the neonate. For example, women regarded as complications during pregnancy lack of appetite, nausea, stomachaches, swelling and aches(body, back, legs and feet) while men regarded weaknessand a lack of desire to work as the major problems. TBAsmentioned lack of appetite, haemorrhage, premature rupture of membranesand swelling as complications during pregnancy. Although all “danger signs” of interest to physicianswere not mentioned frequently, asked directly about them, TBAs tended to agree that they represent complicationsor problems becausethey threaten the life of the woman and/or the new-born. The relation of the TBAswith the government health services appeared as one of the factors affecting referral to institutional prenatal care by the midwife. Also, TBAsconsider that they can handle appropriately most cases. Severalrecent casesof maternal mortality in the study communities were documented and factors impeding the utilisation of MOH emergency serviceswere identified and described. In each community, factorsrelated to physicalaccessibility(hospital or health centre too far away), economic resources(lack of money to pay for transport), traditional socio-cultural beliefs and practices,perceptions of bad quality of care and actual quality of care (inconvenient hours of service, culturally inadequate services,long waiting times) were found involved in varying degrees. Appropriate communication channels, especially inter-personal channels, to reach Mayan rural populations were identified and recommendations of individuals interviewed to 381 Cultures of Populations: Latin America improve maternal and neonatal health and to establish community maternity serviceswere proposed (Hurtado 1995). The principal resultsemerging from the Guatemalastudy bear on socio-culturalfactorsaffecting demographic behaviour, particularly the family and economic roles of Adolescentsand Youth and their consequenceson the health and family life of Adolescentsand Youth. It explores also information and education needs as expressed by the various groups under study, and more specificallythat of the teenagers, as they see themselves,as they are seen by adults, malesand femalesor by their parents etc. Thisstudy is meant to underline the needs of IECof the teenage groups, especially girls. It was carried out in four small Guatemalan communities, three rural Mayan Indian communitiesand one peri-urban community with both Mayan and La&no population. Major differences expected between the communities’ study resultswere not found. The specificgroups included in the study were adolescents(13-16years),young people (17-21years), women, men, parents, and serviceproviders. Union and marriage patterns There are three ways of forming a couple: by rapfo, robo or formal marriage. Traditionally, when a boy from the rural areasliked a certain girl, he takesher by force and made her his wife. It was abduction or rapfo, still a common practice in both ladino and Mayan rural areas.Another common practice of abduction is robo or theft. The difference between rapt0 and robo is that in the latter, both partiesagree to flee and live together without the previousconsentof the girl’s parents. It is an accepted cultural way to start a relation as a couple, especiallywhen the girl’s parents don’t approve the young man. In the Mayan cultural environment, the rites related to robo provide an opportunity to ask the girl’s parents for forgiveness,to ratify her decision in front of her parents, to reconcile both families and legitimise their relation in front of the community. In K’iche’communities, marriage is formalised through severalconsecutivepetitions made by the man’s parents and the Mayan priest, who is the mediator between both families.In the past, parents chose the girl, without having the approval of the boy. Currently, the boy chooseshis mate and asksfor the girl and the girl’s parents’ permission. The situation is very different for la&no women, who started living with a man before their eighteenth birthday without any ritual. Some decided to get married because they became pregnant; a few went to live with the boy for fear of being taken by force; others were robbed; some decided to go with the boy asa way to flee from their own home; somemade the decision together with their partner. 382 Cultures of Powulations: Latin America Sexuality and Health Traditionally,no education is provided to K’iche’youngsters regarding sexuality.It is believed that it is not something you learn, but comesfrom experience. Parentsdo not teach their children about physical or relations development and most have limited knowledge about the subject. On the other hand, male adolescentsknow more about these topics. In the city, women are expected to remain uninformed about issuesrelated to sexuality.An unmarried woman who knows about sexualmatters,including family planning methods,isviewed with suspicion. Few men and women receive any formalised sex education. Most learn about sex through their first sexual encounter. Both ladino and Mayan women from the rural area mentioned that they did not have any knowledge about how a woman gets pregnant until they had their first sexual relation or until they gave birth. Women from semi-urban communities made more emphasison the fact that their parents never talked to them about sex or pregnancy. Fertility Guatemala is one of the three countries in Latin America with the highest fertility rate for 15-19-years-old(with El Salvadorand Honduras).Guatemalafemalesare among the most likely, in the Latin America region, to make an adolescent transition to motherhood. Pregnancy at an early age is part of the rural and Mayan culturalpattern and generally happenswithin the confines of early marriage or consensualunions. However,according to a study of women in a peri-urban settlement in GuatemalaCity, half of them initiated sexual relationswith their boyfriends before marriage. Women do not discusswith their partners about sex and family planning. K’iche’ women have little knowledge about the period in which they can get pregnant: only 5% of the women interviewed identified this period correctly. They also have limited knowledge about contraception methods and family planning services.Generally speaking, K’iche’ women are afraid of side effects caused by different methods. They believe pills cause cancer or general waste by example. In the peri-urban settlementin GuatemalaCity,there is a belief that the possibilityof becoming pregnant is positivelyassociatedto the frequency of sexualrelations.Severalwomen who became pregnant while they were having premarital relations also expressed this idea; they thought they would not get pregnant if they had sporadicintercourseand were surprisedwhen it occurred. Many women defer to men making decisionsregarding the initiation of sexualrelations and the use of family planning. 383 Cultures of Populations: Latin America Mortality and health Maternal health Women get sick more often than men do, becausethey have to work very hard, they do not eat well and they have too many children. The majority of K’iche’women who use public health serviceshave to walk long distances:sometimesmore than two hours. Maternal mortality in Guatemalais 230 maternal deaths for 100,000 live birth, which is among the highest in Latin America. Qualitative resultsin eight Mayan communitiesdescribed the main knowledge and practices, especially regarding specific “danger signs” during pregnancy, delivery, the postpartum and the neonate. For example, women regarded as complicationsduring pregnancy lack of appetite, nausea, stomach-aches,swelling and aches (body, back, legs and feet) while men regarded weaknessand a lack of desire to work as the major problems. Traditional birth attendants (TBA) mentioned lack of appetite, haemorrhage, premature rupture of membranesand swelling as complications during pregnancy. Although all “danger signs” of interest to physicianswere not mentioned frequently, asked directly about them, TBAstended to agree that they represent complications or problems because they threaten the life of the woman and/or the new-born. The relation of the TBAswith the government health servicesappeared as one of the factors affecting referral to institutional prenatal care by the midwife. Also, TBAsconsider that they can handle appropriately most cases. Use of health services Use of biomedical prenatal servicesis low in reproductive-age women in general (45 per cent according to the 1995DHSsurvey),but it is even lower among adolescent pregnant women (below 30 per cent and 13 per cent without any prenatal care. Currently there are very few programsthat provide information, education and communication(IEC),aswell as health services to adolescents.Furthermore, where these exist, their coverage is limited. Talksabout reproductive health and family planning given at the local health centresare not well accepted, especiallybecausethey are given in Spanishand mostwomen do not understand this language. Both Mayan and ladino women said that they preferred to talk with members of their own ethnic group about family planning and related subjects.Mayansprefer servicesfrom community-based distributors and educators. A community-based strategy is the best way to serveMayan women with family planning methods and the leastappreciated is the MOH health centre or post. Women, who are the main usersof health services,complain that these are inefficient because workers are regularly absent and they come from other places; discriminatory and/or paternalistictreatment; lack of medicinesand lack of understanding of the ethnic explanatory models of illness. 384 Cultures of Populations: Latin America Alcoholism and drugs One of the topicsmostfrequently mentioned by adolescents,both asa general topic of interest and asthe main problem facing adolescentsin thesesmallcommunities,was alcohol consumption. Adolescentsrequested information on prevention and treatment of alcoholism. Although none of the group participantsrecognised having seenor used drugs, they alsodemanded information on this subject. HIV/AIDS The adolescentsand young people in the study had very limited information on STDsand HIV/AIDS transmissionand protection. They knew that some diseasesare transmitted by sexual intercoursebut they do not know which, or what are their symptoms.In addition, they think that transmissionalways occurs “from prostitutes to men”, and do not feel particularly vulnerable. Regarding AIDSthey only know the diseaseis fatal. Migration Regarding the cultivation of land and animal breeding, the socialdivision of labour is broken with the temporary absence of men (migration and commerce)and women take charge of all these chores. The division by age group resultsin older women assumingchores that require greater displacementand temporary absencefrom the domestic unit while younger women stay home. Regarding adolescents’ education at school, a positive finding is that parents agree with whatever the schoolsteach about sexualdevelopment, although they would not like the schools to teach about family planning. Lackof school education was mentioned as one of the problems faced by adolescentsin both K’iche’ communities. Most of the adolescents participating in the study had had some schooling. However, the information they had got regarding topics discussedwas very limited. In natural sciencesand “health and security” classes,schoolsimpart someknowledge on sexualdevelopment. However, the information provided is anatomical and schematic.Schoolsdo not provide detailed information or advice about behaviours to adolescents.Apart from school, no programs providing information on sexualityand reproductive health to adolescentsand their parentswere available in these small communities. The problem in the communities is not disregard for the existing services,but the fact that those servicesare simply not available, particularly for adolescents.Schoolteacherssaid that the topic of sexuality and sexual development is addressed in some classesbut in a very anatomical 385 Cultures of Populations: Latin America and superficialway. State-runhealth centreshave not implemented programsspecificallydirected to adolescents.Sometimeshealth promoters conduct health education activitiesfor adolescents. None of the health providers was familiar with the Ministry of Health’s document entitled “National Plan for the Integrated Care of Adolescents”. They had received some booklets on adolescence,but had not had specific training or counselling on the topic. RECOMMENDATIONS Information to adolescents and parents It seemsto be important that health and information servicesmust addressthe special needs of adolescentsstarting from age 12 or earlier. The needs of different types of adolescents,for instance those in school and those out of school have to be taken into consideration. Most parentsand serviceproviders agreed that today it is more necessarythan before that adolescents receive information concerning their sexual development and behaviours. For parents, it is appropriate that schoolsprovide this type of information, although most of them would prefer the schoolsnot to discussfamily planning. This emphasisesthe need to provide information to out-of-school adolescents. Adolescentsand parents desperatelyneed also accurateinformation about HIV/AIDS prevention. The group sessionsthat were held seemed to them a good way to receive information. Also, the school, the Church, the community leaders, the community health promoters and health serviceswere identified as potential sourcesof information. Different models of health and information servicesto adolescentsshould be designed and tested. A training of schoolteachers,of parents and of other relevant adult figures in adolescent sexuality could be part of these models. The potential use of the massmedia still needs to be examined and tested. Girls’ schooling promotion Girls’ schooling promotion must be an important part of policies and programs. One of the most effective meansof encouraging delayed childbearing among adolescentsis by promoting education, particularly girls’ education. Participatory approach One of the effective means to study and work with adolescentsis promoting participatory techniques. Adolescentsas well as adults should be involved in defining their problems aswell as in designing and implementing solutions. The methodology used in this study could be improved and turned into a manual to be used by organisationsworking or wanting to work with adolescentsin other parts of Guatemala. 386 Cultures of Powulations: Culturally-sensitive Latin America programs Policy makersand program managers intending to provide health and information services to adolescentscould compare the proposed messageson behaviour with the realities expressed in this study, and devise more culturally-sensitiveapproaches for reaching adolescents and young people. 387 Cultures of Populations: Latin America REFERENCES AND BlBLlOGRAlWY l l l AED(1995)A Tool Box for Building Health CommunicationCapacity.USAID/HealthCom Project. Alan GuttmacherInstitute (1994)Clandestine Abortion: A LatinAmerican Reality.New York: The Alan GuttmacherInstitute. Alvarado, F. et al. (1996)Problem&icay Opcionespara la Niiiez y la Adolescenciaen el SectorSaluden Guatemala.Redd Barna Guatemala. Bruce,J. 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(1992)AdolescentSexualActivity and Child-bearing in LatinAmericaand the Caribbean:Risksand Consequences, WashingtonDC,Population ReferenceBureau. Cultures of Populations Printed 392 by Panoply - Illustration: 0 Artville Population Dynamics and Sustcrinable Development With enormous diversity of the various societies and cultures in the different regions, there is a lucid need to decentralise population programme activities and devolve these to local level communities utilising participatory methodologies of development. There can be no one formula that will solve all problems and questions instantly, and the best way of setting about finding appropriate answers is to listen to the people concerned. In other words, specialists must give the initiative to the participants themselves who are often labelled as “beneficiaries”. This can be achieved by taking into account their own perceptions of changes and continuity, of how they themselves want their socio-cultural universe to be constructed and managed, and of what they perceive as their demographic needs or desires to be. In part, this kind of change towards policy planning and programme management requires us to review previous programmes and interventions in order to advance the “best practices” and “lessons learnt”. fast experience illustrates vividly that population programmes, implemented by the people and not by institutions or organisations are the most successful. The book analyses how sensitivity to socio-cultural knowledge is crucial for active participation thus creating the sense of belonging to policies and programmes that people can adopt as their own. The established, new, and the emerging methodologies of socio-cultural research are also addressed because these are invaluable tools to further the understanding, promotion, and utilisation of action-oriented, participatory and policy relevant socio-cultural research.