Panel Title: Education, health and
demographic changes in South Asia
Convenor: Neelambar
Hatti, Dept of Economic History, Lund University, Sweden Co-convenor:T.V.
Sekher, Population Research Center, Institute for Social and
Economic Change, Bangalore, India.
Wednesday
7 July, 8–12 & 13–17
Panel Abstract: In recent times,
South Asia has experienced dramatic changes; lives at all levels
have been profoundly affected by attempts at global integration.
Phases of ongoing liberalisation have aimed at ‘structural
adjustments’ in different areas of the societies. In almost
all the countries, two sectors, health and education, crucial for
human development, have been at the forefront of these efforts.
The interventions seek to ‘reform’ these sectors from
the perspectives of access, quality, productivity, community involvement,
decentralisation, users choice, efficiency in resource allocation
and use.
With poverty and illiteracy extensive, gender discriminations common,
and deprivation widespread in the subcontinent, the reforms have
brought about mixed but controversial results. Views on the impact
of reforms tend to be largely polarised. Some have argued about
the transitory nature of deprivation and emphasize the need for
rapid and vigorous implementation of reforms. Others point to the
growing social and economic disparity in the absence of public social
safety nets.
Dimensions of concerns are broadly same in education and health
sector issues which aid social capital formation. Rural and urban
areas exhibit situations that are essentially similar in many ways
among the countries. Insufficient public investment in health sector,
private participation in the health care delivery services, urban
bias, poor quality of services, lesser community control, etc are
some core issues in the sphere of public health in south Asia. Similarly,
poor state of public funded schools, rising illiteracy and drop-out
rates, declining participation of women in schooling, mismatch between
general and technical education, private control of quality education,
low user’s charges in government sector, virtual free higher
education, etc. are some critical areas that need greater attention
in education. Inevitability of structural changes in these two sectors,
with great direct social relevance, and primacy from the point of
basic amenities make them singularly unique for greater evaluation
in a contemporary and changing scenario. There is a need to examine
existing policy options and programme implementations at micro-level.
Better understanding of the ongoing changes, the process of social
exclusion and community responses, witnessed in these two sectors
as affecting and affected by the gender relations in south Asia
is essential; it facilitates exploring new forms of discriminations
and strengthening remedial measures in terms of community and institutional
arrangements. Education and health juxtaposed with lower status
of women are two significant determinants of demographic dynamics
in south Asia that need attention. Demographic changes as reflected
in fertility, mortality, migration, family planning etc, in the
context of strong son preference in these societies also reveal
some of the gender discriminatory patterns that have existed for
long and have only recently begun to undergo changes.
Papers accepted for presentation in the panel:
Paper Giver 1: K.
Srinivasan and S.K. Mohanty,
International institute for Population sciences, Mumbai, India.
Paper 1 Title: Health care
utilization by source and levels of deprivation in major states
of India: Findings from NFHS-2
Paper Abstract: There is an increasing body
of evidences, coming up in recent years, derived from analysis of
data from the National Sample Survey and other sources that the
public health services are being increasingly used by the relatively
better off sections of the society, leaving the poor and deprived
to the medical and health services from the private sector. We propose
to check the validity of the above findings using an independent
data source, i.e., National Family and Health Survey-2. Thus the
paper has twin objectives, first of assessing the differential in
use of general health care and family planning services by socioeconomic
strata of the population in rural and urban areas for the major
states of India and secondly, to compare the findings with those
of 52n d round of NSSO.
The analysis has been presented in 5 sections. Initially, we construct
a household deprivation index to measure the extent of deprivation
and validate the same with nutritional status of women and food
intake in the household. In section 2 we have examined the utilization
of general health services and the patterns emerging from the analysis.
In section 3, we studied the utilization of family planning services,
with emphasis on limiting methods. In section 4, we compare our
findings with that of NSSO findings. Finally, we have presented
a few implications of our study.
Some of our findings differ significantly from those of the NSS
though there are some agreements. Our analysis does not appear to
validate the NSS findings widely circulated in national and international
circles that the public health services is disproportionately used
by better off section of the society, with the exception of undivided
Bihar and Uttar Pradesh. In the state of Bihar and Uttar Pradesh,
the public sector is almost non existent for general health services.
In many other states public health system still continues to play
an important role in treatment of illness and continues to be main
provider of family planning services, particularly, limiting methods
irrespective of level of deprivation. However both the NSS and NFHS
data agree on the increasing use of private health services in the
country.
Paper Giver 2: Minna
Saavala, University of Helsinki, Finland
Paper 2 Title: Familial Power
Relations and Male Involvement in Reproductive Health in India
Paper Abstract: When reproductive health issues
are addressed, it is generally taken for granted that reproduction
is the sphere of women. Consequently, we know fairly little about
the role and attitudes of men concerning childbearing, contraception,
and sexually transmitted diseases in South Asia. We need to revise
our approach to men both in academic and policy-oriented research,
in order to involve males in HIV and STD prevention, improvements
in child mortality, controlling unwanted pregnancies and other reproductive
health issues. This paper explores familial power relations by using
material from an anthropological field study in South India, and
shows how families negotiate on reproductive issues. It is argued
that improvement in male reproductive responsibility is related
to the intensifying of conjugal communication in the context of
extended family relations. This in turn reflects the rise in age
at marriage, which is related to higher female school attendance,
among other things. Understanding the male roles in reproductive
decision-making helps us to find ways to involve them better in
reproductive health policies.
Paper Giver 3: Ismail
Radwan, The world Bank, Washington DC, USA
Paper 3 Title: Private Sector
Health Care for the Poor in India
Paper Abstract: Fertility, mortality and morbidity
have slowly and steadily declined in India since independence but
remain unacceptability high both compared with countries in the
region and those at similar income levels. While the root causes
are poverty and low levels of education, government stewardship
of the health sector bears some responsibility. Since independence,
public financing and provision of health care services has been
the mainstream of health policy. Public sector health programs in
India have faced well-recognized problems such as inadequate access
by the most vulnerable groups, poor quality and coverage of primary
and secondary facilities and until recently an excessive focus on
sterilization and inadequate focus on maternal and child health.
At independence, according to the Bhore Committee report, less than
8% of all medical institutions in the country were maintained by
wholly private agencies. By the early 1990s this figure had reached
close to 60%. There is also mounting evidence that the poor are
increasingly using the services of private sector health providers
in India as the public sector is failing to reach and service such
vulnerable groups in India. A recent assessment of the public subsidy
to the sector has shown that the poorest 20% of the population capture
only 10% of the subsidy less than a third that captured by the richest
20%.
Empirical studies have shown that the quality of primary public
services provided by the public sector did not improve significantly
between 1987 and 1996. Moreover, income, education and the overall
quality of state administration are more important than specific
public health interventions in explaining differences in demographic
and health indicators during the period 1981-1991.
Despite the prevailing situation described above, government and
international agencies have been slow to assess the role of the
private sector in determining health outcomes for the poor in India.
Previous studies have focused almost exclusively on the role of
the public sector despite the fact that the private sector is an
increasingly dominant or significant provider of a variety of primary
health care services of importance to the poor.
Without effective government stewardship, private health care institutions
in India have grown in the absence of an explicit policy to define
their role. This has raised questions regarding the quality and
legality of care as well as the exploitation of the poor. Although
several studies have established the rapid expansion of the private
sector in both the provisioning and financing of health care services
in India there is little information on the manner in which different
parts of the private health care system operate either alone or
through interactions with the public sector. Moreover, studies that
have been completed in this area have not gone as far as focusing
on implementation.
This paper seeks to answer the following question: Given the importance
of the private health care financing and provision of services,
how can the Government of India better utilize the private sector
in health services delivery to the poor? Within this broad framework,
there are three policy objectives of particular focus;
Ý Increasing coverage: especially for essential health care priorities.
It is assumed that the most important health goals both for the
Government of India (GOI) and from the perspective of the poor
are those captured by the Millennium Development Goals (Child
mortality, maternal mortality and reproductive health, communicable
diseases (especially Tuberculosis, Malaria, HIV/AIDs) and malnutrition).
Ý Improving the quality of care: A significant number of private
health care providers in India (especially in the rural areas)
are untrained practitioners. Although reliable data on their numbers
are difficult to compile, it has been estimated that they number
well over 1.25 million. These providers are not registered, qualified
or regulated. There is evidence that the quality of care they
provide is extremely low and can at times actually harm the health
status of the patients. The Supreme Court has ruled their operations
to be illegal and labeled them “quacks”. This highlights
the need for prudent regulation of the sector.
Ý Reducing expenses for the poor: Due to well-known asymmetries
of information, the poor are especially vulnerable to exploitative
charging practices. Without access to affordable health insurance,
they face the largest health care bills as a proportion of their
income. Moreover, they face the largest out of pocket expenses
that can often lead them into an unsustainable spiral of indebtedness
and increasing poverty.
Paper Giver 4: Mohammad Amirul Islam,
Sabu S. Padmadas and Peter
W.F. Smith,
Division of Social Statistics, University of Southampton, United Kingdom
Paper 4 Title: Degree and Determinants
of Men’s Contraceptive Knowledge in Bangladesh
Paper Abstract: We examined the degree of men’s modern
contraceptive knowledge in Bangladesh and the associated determinants
using the 1999-2000 DHS. The reported number of modern methods known
among men aged 15-59 years measured the degree of knowledge. Although
contraceptive knowledge was universal in Bangladesh, the degree
of knowledge differed among certain subgroups. About 19% of men
reported having had heard of 4-5 modern methods (mean: 6.9). Results
from multinomial regression analyses showed that older, educated
and those who were currently using modern methods were more likely
to have had reported a high degree of knowledge (p<0.001). We
conclude that men who had a low degree of knowledge seem not properly
informed about the wide range of contraceptive options. It is imperative
that family planning intervention strategies in Bangladesh should
focus on the degree of contraceptive knowledge to improve the uptake
of more male-based modern methods.
Paper Giver 5: Md.Shahid Perwez,
Ford Foundation International Fellow, The University of Edinburgh,
Edinburgh, UK
Paper 5 Title: Post-Colonial Understanding
of Female Infanticide in North and South India
Paper Abstract: In the ongoing debate on the adverse sex
ratios in India, the issues of female infanticide and female foeticide
have acquired crucial importance in the eyes of officials, demographers
and urban middle class. Gender selective deaths are known throughout
human history and they could result into serious disproportion of
women in a society. Despite several attempts to understand this
practice from various perspectives e.g. anthropological and demographic,
the subject of female infanticide and female foeticide remain comparatively
partially understood due to its convolution and differentiation.
In this paper, I address the question of why female infanticide,
which was claimed to be effectively controlled in colonial India,
has appeared in post- colonial India in communities and regions
where it was previously unknown.
I will examine the subject of female infanticide in North and South
India in the light of empirical data. Brief fieldwork conducted
by the author in a North Indian population, inhabited by a Rajput
clan, suggests that the practice is comparatively on decline in
the wake of various developmental projects including transport,
health and communications that resulted into some prosperity, though
marginal, of the region. In the South, however, where there are
increasing signs of female infanticide in some regions and some
groups amidst development and prosperity. In the backdrop of these
contradictions, this paper attempts to present and comprehend such
complexities of female infanticide through an examination of kinship
and marriage rules, changing forms of economic relationship, health
infra-structure and education, son-preference/daughter neglect,
overall prosperity and patriarchy. A major thrust of the paper would
be on how the status of daughters and women are being shaped at
the household level. The paper employs a cultural perspective based
on ethnographic materials.
Paper Giver 6: Suresh Sharma,
Institute of Economic Growth, Delhi, India
Paper 6 Title: Reproductive and Child
Health Status in India: District Level Analysis
Paper Abstract: Paradigm shifts in India’s population
policies since the International Conference on Population and Development
(ICPD) in 1994 at Cairo have been brought forth with additional
emphasis on a package of quality reproductive and child health (RCH)
services geared towards an improvement in the quality of life. The
Ministry of Health and Family Welfare sponsored district level Rapid
Household Surveys in 504 districts of India for monitoring and evaluation
of the RCH program. The study has elicited district level indices
on RCH status, using factor analytical techniques. Thereby, the
study highlights socioeconomic, cultural and infrastructural predictors
of inter-district variations in the indices on RCH status. The study
highlights the backward districts that are to be focused upon in
the initial phase to bring about optimal results in terms of stated
objectives of improvements in the quality of life and also the relative
significance of alternate predictors to be emphasized for the purpose.
Paper Giver 7: Girish Kumar,
Centre de Sciences and Humaines, New Delhi, India
Paper 7 Title: Public Hospital Reforms
in Madhya Pradesh (India): Perceptions and Trends
Paper Abstract: In the realm of the health sector, for a
long period, people had suffered on account of various factors,
including absence or near- absence of health delivery institutions
and poor quality of services. With the progressive reduction in
budgetary allocation in the health sector since the eighth five-year
plan (1992-97), the matter was further aggravated. It is estimated
that recurring expenditure on salary and establishment alone accounts
for nearly three-fourths of the total health budget in most of the
states. Although the low budgetary allocations have affected the
healthcare facilities at all levels, the worst sufferers are the
hospitals at tehsil (sub-district) level/ muffasil (rural) towns
and health centres located in remote areas.
Caught in the quagmire of shrinking budget on the one hand and growing
demands for catering to the health need of the ever-increasing number
of people on the other, most state governments have resorted to
alternative options. These options are based largely on the concept
of public-private partnership (PPP). It is rooted in three fundamental
assumptions: one, it will reduce the financial burden of the government;
two, strengthen the capacity of the private sector to cater to the
healthcare needs of the people; and three, create space for the
participation of other stakeholders and community at large in improving
the quality of healthcare through new management structures. During
the past decade varying models of PPP have evolved across the provinces
in India. The unfolding of 1991 economic reforms (leading to deregulation
and privatization) and 73rd&74th constitutional amendments,
1992 (creating space for community participation at the local level)
together provided necessary backdrop to this end.
The institutional structure developed for PPP in Indian province
of Madhya Pradesh is known as the Rogi Kalyan Samiti (RKS), loosely
translated as Patients Welfare Society. Apart from introducing the
user’s fee, the new management has also created space for the
community-centered actions. In fact, the RKS seeks partnership of
all the concerned actors at the local level to raise funds for the
upkeep of the public hospitals and, in turn, ensures their participation
in the management of health services. This includes, administration
at the local level, charitable organizations, donors, leading citizens
of the area, people's elected representatives as well as the hospital
staff. The Madhya Pradesh scheme of PPP is all the more unique in
the sense that unlike in other provinces, where partnership has
been sought mostly from market forces (excepting the areas where
NGOs are being involved), the RKS seeks direct involvement of the
users (community) and service providers (doctors, para-medicos)
under the new management structure for running the public hospitals.
Thus if the motivational factor in the case of former is profit,
the latter instance is of meeting the social goal and, by extension,
raising the social capital.
The paper proposed for the Conference is based on empirical data
collected from nine hospitals (case study method) located at different
levels in five selected districts of Madhya Pradesh. Apart from
taking stock of on-going health sector reforms in the state, the
paper critically examines the decision making process as well as
sharing of responsibilities by different stakeholders under the
aegis of RKS. It also aims at assessing the strength of institutional
arrangements developed for ensuring transparency and accountability
of the new management structure and above all, its reach and impact
in terms of catering to the healthcare needs of the primary stakeholders,
more specifically of the poor patients and their level of satisfaction.
Paper Giver 8: Neelambar Hatti,
Department of Economic History, Lund University, Sweden and T.V.
Sekher, Institute for Social and Economic Change, Bangalore,
India
Paper 8 Title: Lives at Risk: Declining
Child Sex Ratios in India
Paper Abstract: In a seminal article in 1990, Amartya Sen
suggested that world-wide, particularly in Asia, millions of women
were missing from the population totals of many countries. He also
noted the alarming fact that the sex ratio for female children in
China, India and South Korea is actually deteriorating while the
overall sex ratio for females in those countries has marginally
improved. In India, the widening gap in the ratio of girls to boys
is brought to light in the census of 2001, confirming a trend that
has been in place since 1901. This is most pronounced in the youngest
age group, thus indicating the scale of injustice as well as the
long-term social and economic consequences implied.
While the 2001 census shows that the overall male-female sex ratio
has marginally improved from 927 women per 1000 men to 933 per 1000
during the last decade, the number of girls to boys in the youngest
age group fell from 945/1000 to 927/1000. The regional disparities
also appear to have increased; the northern states generally exhibit
a worsening trend in male-female sex ratio as compared to the southern
states. The Census evidence suggests a clear cultural preference
for male children, particularly among north Indians. The sharpest
decline for the age group 0-6 years is observed in the northern
states, particularly in Haryana (820/1000) and in Punjab (793/1000).
Even in South India, with relatively better social development indicators,
there are districts and taluks showing alarming trends in child
sex- ratio. The census lists ‘sex-selective female abortions’,
‘female infanticide’, and ‘‘female neglect’
– typically through giving girls less food and medical care
than boys- as “important reason commonly put forward”
for this shocking anomaly. The new figures point to the use of new
technologies to determine the gender composition. Furthermore, as
social norms are changing toward smaller families, the availability
of and access to new technologies provide an easy way for parents
to achieve such goals.
The precarious situation of female children in modern India before
birth (their chances of being born at all), at birth and during
the first six years of childhood needs to be addressed. This paper
provides a macro-level analysis of the trends in sex- ratio for
the age group 0-6 years using the Decennial census data from 1901
to 2001 and other secondary sources. The paper also discusses issues
related to sex-selective abortion, female infanticide (still prevalent
in some parts of India) and discrimination and neglect of girl child.
It is important to examine the nexus of economic, social and cultural
factors that underlie daughter discrimination, thus shifting the
focus from 'son preference' to 'daughter discrimination'.
Paper Giver 9: Saswata Ghosh,
Council for Social Development (CSD), New Delhi, India
Paper 9 Title: Gender Differences in Treatment-seeking
Behaviour during Common Childhood Illnesses in India: Does Maternal
Education Matter?
Paper Abstract: Gender inequalities, in one form or the
other, with considerable contextual differences, are ubiquitous
and all pervasive in South Asia. In health, these are manifested
in differences in mortality (observed by overall sex ratio) in almost
every country in this region. India is no exception in this regard.
Discrimination and gender gaps have been observed even in early
years of life. Beside other factors, discriminatory treatment-seeking
practices among children during the post-neonatal and later childhood
period probably contribute to this. There are numerous studies,
which have established the positive effect of maternal education
on child health and survival. But there are contradictory evidences
that whether maternal education reduces gender bias in treatment-seeking
behaviour or not and the debate over it remains inconclusive. By
using National Family and Health Survey (NFHS-2), 1998-99, the present
study observed that the gender bias in treatment seeking behaviour
does exist among illiterate and middle school educated women when
child is affected by acute respiratory infections and reduces considerably
among higher educated mother. In case of diarrhoea no evidence of
gender differences in treatment seeking behaviour has been found
statistically irrespective of the level of maternal education, even
after controlling all other spatial, demographic and socioeconomic
factors.
Paper Giver 10: Damodar Sahu,
Institute for Research in Medical Statistics, New Delhi and V.
Jayachandran, UNICEF, New Delhi, India
Paper 10 Title: Why immunization Level
fails to catch-up in India: A community based analysis?
Paper Abstract: In spite of Government of India initiative
to improve immunization coverage in India over time, it continues
to be very low in certain parts of the country particularly in the
rural area where two-third of the population lives. A number of
studies have been examined correlates of immunization coverage in
India and other countries, mostly on individual level information.
However, recent research emphasized the importance of community
level variables. The present study used multilevel analysis to know
the effectiveness of community level indicators and their linkages
with individual level indicators to guide program managers to achieve
the convergence.
Objective:
1. To examine the linkages of various demographic, socio-economic,
maternal care (level-I: individual level variables of children and
parents) and community-level factors (level-II) that may affect
immunization coverage in rural India.
2. To assess the effectiveness of the community level variables
like health services and infrastructures available at the community
level on immunization coverage, by controlling the effects of other
individual level factors in rural India.
Study design: We propose to use two--level model to examine the
linkages of various socio-economic and programme factors that may
affect infant survival. Accordingly we shall be incorporating variables
at two levels- level-I: individual level variables of children and
parents; and level-II: community level variables; from data collected
under National Family Health Survey, 1998-99, India. The main focus
of the analysis will be on assessing the effectiveness of the community
level variables like health services and infrastructures available
at the community (or cluster) level on immunization coverage, by
controlling the effects of other individual level factors in rural
India.
Hypothesis: There is a strong positive relationship between immunization
coverage and the availability of health services in the community.
(Whether there was a health centre facility i.e. primary health
centre or community health centre/rural hospital, or government
hospital/dispensary or private hospital/clinic within 2km of the
sample cluster, weather all-weather road within the cluster, whether
opportunity of higher education (middle school or above) within
2 km of the sample, whether health or family welfare film show organized
at community in the past one year) in the community (or cluster).
Data and Methodology: The India’s National Family Health Survey,
1998-99 (NFHS-2) data used for this paper. A child-based file is
created to include selected child-specific information from birth
history, and mother and household characteristics. The present study
will be based on most recent births born three years preceding the
survey because the desired data on immunization coverage in NFHS-2
were collected only for these births. Two-level logistic model where
children (level I) are nested within a cluster (level II) has been
estimated using iterative generalized least squares (IGLS).
Preliminary findings: The findings of the present study have positive
impact immunization coverage on some of the individual level variables
such as demographic (male children), socioeconomic (literate mother’s,
mothers from high socio-economic status), and maternal care variables
(mothers who have received ANC, received TT, and delivered in institute).
In addition, community levels variables, availability of all-weather
road in community was noticed to be more important for immunization
coverage. In order to increase the immunization coverage in rural
areas in developing countries like India, infrastructure facility
such as availability of all-weather road to the community, which
is basic need of commutation, is to be facilitated.
Paper Giver 11: M. Niaz Asadullah,
Oxford University, UK
Paper 11 Title: The Effectiveness of Private
and Public Schools in Bangladesh and Pakistan
Paper Abstract: Using labor market earnings data from Bangladesh
Household Income and Expenditure Survey (HIES) 2000 data, this paper
empirically tests the effectiveness of private and public schools
in Bangladesh. Earnings gap of private and public school graduates
are decomposed following Oaxaca-Ransom (1994) approach to see whether
there is any earnings advantage for individuals educated in private
schools over public school graduates. For Bangladesh we do not find
any evidence of superiority of private schools over public schools.
Attendance of private schools has negative returns in wage work,
which is primarily because of differences in returns to individual
characteristics among private and public school graduates. The finding
is also true for publicly funded private schools.
In addition, we use Pakistan Integrated Household Survey (PIHS)
2001 data to provide a cross-country perspective to our analysis.
For Pakistan, the raw data suggests existence of a private school
attendance premium. However, once private school premium is fully
decomposed following the Oaxaca technique, we find that most of
the premium is attributable to differential human capital endowments
of the individual, not to the differences in returns to these endowments.
The finding that private schools in Pakistan, instead of those in
Bangladesh, are at least as effective as their public school counterparts
perhaps reflects the differential public policy towards private
schools in the two countries.
Paper Giver 12: N. Ajith Kumar,
Center for Socio-Economic and Environmental Studies, Cochin, India
Paper 12 Title: Entry Barriers to Medical
Education in Kerala, India
Paper Abstract: Kerala, the southernmost state in India,
stands apart from other states in the country in terms of its achievements
in providing access to schools and Arts & Science colleges irrespective
of gender and socio-economic background of the students. But the
present study, which examines the financial and non-financial barriers
to enter medical courses, finds that there are innumerable barriers
before children from unfavorable socio-economic background to access
medical courses much sought after now for its job potential. The
study uses a representative sample of students in the medical education
institutions in the government sector.
The study finds that the present system of subsidizing only the
fee component of the private cost has placed an undue burden on
the students or their families as fees constitute only a small component
of the educational expenses of the students in the government run
institutions. The educational grants and scholarships provided by
the government and universities do not cover even a fraction of
the non-fee academic expenses. The student loans were not found
attractive to the students as educational loans are not subsidized
in India and the interest repayments do not wait for the completion
of the course. It is found that access to medical education is mostly
limited to the upper middle income and high income groups which
forms less than ten percent of the population. If the State wants
to bring down the entry barriers, it must think of providing larger
number of scholarships and the quantum of scholarships should be
enhanced to meet the non-fee academic and maintenance expenditure.
There is also a need for changing the student loan scheme.
Finance is not the only barrier for entry. The medical education
in the State is heavily biased against the rural population. Students
of government schools and rural schools find it difficult to get
admission to these courses. There is also gender bias. First generation
students whose parental education is low are not finding it easy
to get admission. Thus, the system leaves very little scope for
social and occupational mobility. The academic implications of narrowing
the range of students admitted to medical courses are also important.
The medical courses are not able to access the latent talents from
90 percent of the households in Kerala. As a result, almost all
students come from more or less the same socio-economic background.
The lack of diversity in the background of the students has some
serious academic and professional implications. It becomes difficult
for these students to communicate and empathize with patients who
come from diverse and lower backgrounds. The urban elite students
may also be not willing to work in rural areas. The gender bias
in admissions also has implications on the health of women and children
especially in the rural areas.
The study finds that the present method of entrance tests adds to
the difficulties of the disadvantaged groups as the success in these
tests largely depends on the special coaching provided in costly
coaching institutions located in cities. The study suggests that
better mobility through higher education can be attained only if
the huge disparities in school education are brought down considerably.
Paper Giver 13: T. Nirmala Devi,
Andhra University, Visakhapatnam, India
Paper 13 Title: Changing Profile of Education,
Health and Demographic Sectors in South Asia
Paper Abstract: The macroeconomic policies of the South
Asian countries during the last five decades following their independence
have not facilitated the creation of sound social infrastructure.
The paper delineates the factors responsible for the region’s
low levels of development. The marginal improvement in literacy
levels in the1980s and 1990s continues to impede the development
process and adversely affect the quality of life in the region with
the exception of one or two countries. The slow rise in female literacy
levels and the presence of sizeable number of dropouts' point to
the gaps in the policy implementation in regard to strengthening
the primary education and empowering women. Sri Lanka with an impressive
enrolment rate at both primary and secondary levels and Maldives
with nearly cent percent enrolment at primary level stood as exceptions
to the general trend. Incidentally, gender disparity is least in
these countries. The fact that the infant mortality rate and the
maternal mortality rate in the region did not register significant
decline, in spite of considerable improvement in the overall health
status, testifies the inadequate health services and low nutrition
levels among the people in general and women in particular. Access
to safe water, sanitation, medical care, nutrition and the overall
calorie consumption per person in the region are not satisfactory.
South Asia experiences rapid population growth notwithstanding the
decline in the decadal growth rates. The deceleration in the population
growth rate during the 1980s and 1990s was appreciable only in Bangladesh
and to a certain extent in India, while the ineffective implementation
of population policies in Nepal and Pakistan had resulted in marginal
fall. Over population has obviously hindered the developmental process
in South Asia, whereas the East Asia’s relatively higher population
growth rates could not deter the region’s socio-economic development.
Gender bias in the South Asian region impedes the access of women
to education, health and sufficient nutrition. In this regard, except
Sri Lanka, Kerala State in India and to some extent Maldives, where
positive changes in the sectors of education, health and demography
took place, the situation in South Asia is not encouraging. It is
felt that the governments in the region need to display strong will
and embark on capacity building exercises and increase social spending
to ensure a better quality of life.
Paper Giver 14: A A Jayachandran,
Population Foundation of India, New Delhi, India
Paper 14 Title: Better Understanding of
Reproductive Characteristics of Adolescent Girls in Four Selected
States and India
Paper Abstract: Adolescent populations constitute the largest
proportion in the history of mankind and about 85% are living in
the Developing world. Adolescents' share in India's population is
currently one-fifth of the total population and any issues related
to adolescents have rake up significant interest.
Adolescents' fertility poses a major concern in India as about 19%
of the total fertility has taken among 15-19 age group (NFHS-II).
This paper tries to feature some reproductive characteristics of
the adolescent girls in selected states and India to have an insight
into have an insight into the wide-varied profiles stages in various
states. National Family Health Survey I and II data are used in
this paper to find the changes occurred in the reproductive characteristics
of Adolescent girls. States are selected to show how different characteristics
are possessed by different states in India. Selected four sates
are Kerala, Maharashtra, West Bengal and Uttar Pradesh to get the
whole spectrum of picture.
Different reproductive characteristics would be analysed like, age
at marriage, age at first pregnancy, knowledge and awareness about
contraception, HIV-AIDS, RTI/STI and their contraceptive use and
desire for children etc. The study would be an interesting one since
adolescents shape the future course of fertility of any population
and the use of excellent data set (NFHS-1 and 2) makes the study
more important.
Paper would be using different statistical applications to draw
conclusions and expected to draw useful policy measures.
Paper Giver 15: T.V.Sekher,
Institute for Social and Economic Change, Bangalore, India
Paper 15 Title: Fertility Transition:
The Case of Rural Communities in Karnataka, India
Paper Abstract: Most developing societies are now experiencing
demographic transition at varying levels. In a vast country like
India with high demographic diversity and heterogeneity, the levels
and stages of fertility decline differ significantly from state
to state. Given this situation, it is interesting to have a look
at demographic transition in South India ( a population of 220 million
in 2001), which has now entered its last phase with fertility rates
registering significant decline during the last two decades well
ahead of other parts of the country. However, in view of the average
level of economic development in this part of the country, the South
Indian experience has revived discussions on the determinants of
fertility reduction, notably about the respective role played by
endogenous (cultural and historical features) and exogenous (economic
transformations and governmental interventions) factors in popularizing
family planning.
The present paper has aimed at understanding the channels of fertility
decline in the South Indian State of Karnataka through an analysis
of socio- cultural and spatial differentials. It has also attempted
to capture the self- sustaining nature of fertility reduction by
bringing out the fact that fertility decline in one social group
is fuelled by low fertility behaviour in other groups. For this
purpose, employing focus group discussions and individual case studies
to gather qualitative data from different social groups, three village
studies were carried out during 2002-03. It was observed that villagers
were trying to cope with new 'risk factors ' by modifying their
behaviour, and one among them was the fertility behaviour. The varying
fertility in the villages appeared to be the consequence of level
of development in and around the village and the "risk perceptions"
among the people. Though the diffusion mechanism and imitation factors
were relevant to a great extent, their impact varied considerably
across communities and geographical locations.
Paper Giver 16: Binitha V Thampi,
Institute for Social and Economic Change, Bangalore, India
Paper 16 Title: Determinants Female Autonomy
and the impact of Autonomy on women’s well being in Kerala,
India
Paper Abstract: Female autonomy has widely been acknowledged
as a major factor that contributes to better demographic outcomes.
Female autonomy is a multi-dimensional entity, which refers to different
aspects of women’s life. The well quoted study of Dyson and
Moore in the Indian context on ‘On Kinship Structures and Female
Autonomy’ (1983) define Autonomy as ‘the capacity to manipulate
one’s personal environment and the ability – technical,
social and psychological to obtain information and to use it as
the basis for making decisions about one’s private concerns
and those of one’s intimates’. Female education and work
participation are being considered as the two major proxy variables
of women’s autonomy. Studies conducted in the context of developing
countries have documented the relative significance of these two
factors, particularly that of female education, in determining better
demographic outcomes such as low fertility, child mortality and
better health status of women etc. These studies have considered
female autonomy as an intermediate variable in their conceptual
framework. The National Family Health Survey (NFHS II), of India
conducted during 1998-99 has measured female autonomy in terms of
certain indicators on household decision making and mobility status.
The state of Kerala in India has drawn considerable attention in
the recent past due to the paradoxical nature of its development
with high level of achievements in the social sectors despite its
relatively low per capita income, which is being known as ‘Kerala
Model of development’. The achievements of Kerala in terms
of better demographic outcomes such as low fertility rate, infant
and maternal mortality rates etc. have largely been attributed to
the high levels of educational attainment of women. Also, Kerala
has low levels of female work participation rate compared to the
rest of the states in India.
In this context, an attempt has been made to understand the factors
determining female autonomy in Kerala and the relative significance
of the two proxy variables of Autonomy. Again, more important is
to understand the indicators of women’s, that are often expected
as the outcome of women exercising their autonomy. Hence, the association
between female autonomy and selected indicators of their well being
such as incidence of domestic violence, contraceptive acceptance
has also been analysed.
The Autonomy has been measured in the NFHS (II) in terms of household
decision making power, mobility status and access to the resources.
Using the scores assigned to the variables on these dimensions,
a composite index of autonomy is constructed. In order to examine
the factors determining women’s autonomy, a multivariate regression
analysis has been carried out with autonomy index as the dependent
variables and a set of explanatory variables have been employed.
They are:
1. Age of women in five year age groups from 15-19 to 44 -49
2. Education (illiterate, literate, primary, secondary, higher)
3. Place of residence (urban/rural)
4. Family structure (extended/nuclear)
5. Religion (Hindu, Christian, Muslim)
6. Caste (scheduled caste, scheduled tribe, other backward caste,
others)
7. Standard of living index (low, medium, high)
8. Work status (working, non-working)
The descriptive statistics of the variables and regression output
are not provided here. The significance of the explanatory variables
is explained below.
The regression analysis shown that education is having a negative
relationship with autonomy with a moderate (5%) level of significance.
Also, the caste and the standard of living are found to be insignificant
in determining female autonomy. The younger age groups have shown
a very significant negative relationship with autonomy. Muslim women
do have significantly less autonomy compared that of Hindu women.
Also, living in the nuclear families and in the urban areas as well
as participating in the work force significantly enhances the autonomy
of women.
Multiple Classification Analysis (MCA) is performed in order to
assess the gross and net effects of the explanatory variables on
women’s autonomy. This analysis allows us a more accurate assessment
of each factor under consideration, controlling the effect of other
variables, with women’s autonomy. The results are summarized
below.
The analysis carried out has shown that education per se does not
have a very significant bearing on women’s autonomy, where
as their age, family structure, religion and work status do have.
The gross effect of family structure and area of residence remained
same after making allowances to other factors and both are highly
significant statistically indicates the independent influence of
these two variables on women’s autonomy. Hence, living in nuclear
families and in urban area significantly enhances the autonomy.
The age of women does have large net effect on autonomy and in the
younger age groups it is negatively significant and a threshold
age group 35-39 above which the relationship has turned out to be
positive. The threshold age of 35-39 implies that women are less
autonomous during their reproductive career, which might adversely
affect their reproductive decision making. However, their enhanced
autonomy in the higher ages may influence positively the reproductive
decisions of their daughters or daughter in laws.
Also, the impact of autonomy on two selected indicators of women’s
well being such as contraceptive use and incidence of domestic violence
are not unidirectional. Autonomy is having a significant positive
association with contraceptive use where as education is not showing
a similar significant relationship with contraceptive use. Religion
is showing significance in terms of Muslim women having considerably
low levels of contraceptive use compared that of Hindus or Christians.
Also, the family structure is statistically significant and women
belongs to nuclear family do have more contraceptive use.
Quite contrary to our expectation, it is found that autonomy index
has a positive and significant relation with prevalence of domestic
violence. Also, the household standard of living has a negative
and significant relation with domestic violence. The work status
also shows positive association and it is statistically significant
too. These indicate that poor women who are working and are more
autonomous are more likely to experience the violence within the
family domain. It may also be true that the exercise of autonomy
might leads to violence in any society under cultural transition.
Hence, the increase in violence along with enhancement in autonomy
that emerged out of our analysis has to be further probed with primary
inquiry.
Paper Giver 17: Shanti Nandana Wijesinghe,
University of Gothenburg, Sweden
Paper 17 Title: Reconstruction, Reconciliation
and Mental Health: A Conceptual Analysis
Paper Abstract: Almost all conflicts can be seen as resulting
from factors related to health and development in our contemporary
world. Therefore, an understanding of issues on health is essential
for reconstruction, reconciliation and resettlement of communities
divided by conflict because it is imperative to improve their life
styles as well as own social and cultural environments.
The number of people affected by wars has increased during last
few decades. Conflicts cause individuals to violate human rights,
and also on the other hand, civilians are vulnerable to greater
psychological and physical pressure as a result of on going war-related
violence and terror in contemporary world. These include refugees,
internally displaced persons (IDPs), children, unaccompanied miners,
and children heads of house hold, the physically and mentally disabled,
the detainees, and prisoners of war. Moreover, Women are more increasingly
vulnerable to physical and psychological pressure from conflicts.
Therefore, the impact of increased mortality and morbidity due to
psychological pressure must be addressed in reconstruction and reconciliation
efforts both at the conceptual and practical spheres because these
concepts are directly correlated with the aspects of peace and development
in contemporary societies. To address mental health needs of these
affected population groups the new approaches, management efforts
are required.
This paper tries to understand the relationships between the concepts
of reconstruction, reconciliation and mental health in order to
provide conceptual ground for the ongoing peace building efforts
in nationally, regionally and globally. The paper is also explained
the nature and forms of concepts; reconstruction, reconciliation
and mental health in terms of post conflicts situations in contemporary
societies.
Paper Giver 18: J P Singh,
Department of Sociology, Patna University, Patna, India
Paper 18 Title: Health for All in Rural
India: Problems and Prospects
Paper Abstract: In the main the paper attempts to assess
how far different governments of post-Independent India have been
able to achieve what they have targeted during the successive plan
periods in the field of health-care, especially in rural areas.
The study is necessitated because rural areas tend to record a higher
incidence of mortality than urban areas, showing a considerable
contrast. In view of this objective the paper has sought to assess
the availability of health infrastructure in rural areas of different
states. A study of this kind would help us understand the differential
patterns of population morbidity and mortality that obtain in the
country and ultimately throw some light on the issues of varying
patterns of health transition across the states. For the purpose
of data the study heavily depends on the state level statistics
derived from village directories of the 1991 census. But in course
of arguments data from other secondary sources such as National
Family Health Survey are also used to corroborate the arguments.
It has been contended in the paper that the government has achieved
a lot in the field of health-care, but it has to achieve a lot more,
particularly in rural areas, in order to translate the lofty ideals
of 'Health For All' into a reality.
Paper Giver 19: Dr. Fathima Kutty
Kapil, Andhra University, Warzail, India
Paper 19 Title: Impact of Education on
Social Customs and Practices in India
Paper Abstract: Dr. Radhakrishnan defines education as the
instrument for social, economic and cultural change. For social
and national integration, for fostering moral and spiritual values,
and for increasing productivity, education should be properly utilized.
The importance of education is not only in knowledge and skill,
but it is to help us to live with others. The social implications
of literature are as important as the economic. It is through education
that we acquire the passion and the perspective to fight against
caste prejudices, class privileges and group antagonisms. The most
important aim of education is to help us to see the other world,
the invisible and intangible world beyond space and time. Telugu
literature gave us a second birth, to help us to realize what we
have already in us. The meaning of literature is to emancipate the
individual and we need the education of the whole man physical,
vital, mental, intellectual and spiritual.
The most important problem, which attracted the attention of educated
progressive leaders, was that of the marriage of children. In India,
marriage was performed after the girl had attained puberty but gradually
child marriages increased in the Indian society. Child marriage
caused early widow-hood, stoppage of education of girls, early motherhood,
weak progeny, maternal mortality, etc. In fact, it was a national
malady, and all, irrespective of caste, colour, creed or religion,
more or less suffered from it.
Due to education and through literature and Dramas under changing
circumstances child marriages were eradicated. Kanyasulkam and Varasulkam
were the two evils prevalent in Andhra. The spread of women's education,
and the establishment of schools brought about some changes that
helped in eradicating these practices. The practice of Sati and
the eradication of the same are brought to light.
Paper Giver 20 : Shankpal Pramod,
Health Alert Organization of India, Dhule, India
Paper 20 Title: Incorporating Peer Educators
in Adolescent Reproductive Health Information Dissemination in Schools
and Communities of Rural India
Paper Abstract:
Issues: Due to cultural implications/barriers, adolescents are forbidden
from discussing HIV/AIDS issues in public. Due to this adolescents
in post primary schools receive wrong information on HIV transmission
in youths and sexuality health issues from their peers & other
sources like pornographic material. HIV community leaders faced
a long-standing demand to correct this wrong information received
by adolescents. This is due to belief that adolescents are good
listeners especially when it involves their peer. They also understand
their likes better because they speak in same language.
Methodology: Between May-August 2003, our 10 year old NGO carried
out community baseline survey in 6 Post-Primary Schools in rural
constituency of Mah. State. The aim was to determine how post primary
adolescents receive HIV/AIDS & sexuality information & how
we can improvise on these issues. From these schools we formed 24
groups of peers. [Each group consisted 16 peers]. We trained these
16 selected peers over six sessions by NGO Team. The aim was instituting
peer-counseling services in this selected target population of school
children. Total 55 protocol interviews in 14 rural secondary schools
in this tribal region with 3-4 interviews per school, with principal
or deputy; biology, life skills or guidance teachers; plus others
doing youth activities. NGO volunteers Focused group discussions
with 4 school governing boards of teachers, parents and students.
Results: Adolescent’s activities were monitored over five month's
period after which post intervention evaluation was done with questionnaire.
These peer educators helped in disseminating correct information
to their peers, additionally there was 70% improvement in level
of their peers knowledge of sexuality & HIV/AIDS. This approach
also increased leadership quality and general well being and self
assertiveness of most of peer educators who were elected prefects/senior
prefects in various schools.
Conclusion: For resource poor settings we need to encourage use
of peer-educators counseling as a means of having better impact
policy for sex education & HIV /AIDS control. NGO’s should
concentrate on reaching school adolescents community in isolated
population. Sex education & sexuality development will be at
optimum level by using this model. This model will prove very effective
for HIV prevention in resource poor developing nations.
Paper Giver 21: Jos Mooij and
Manabi Majumdar, Centre for Economic
and Social Studies, Hyderabad, India
Paper 21 Title: Education, Decentralization
and the Indian State
Paper Abstract: Despite a widespread and increasing acknowledgement
of the importance of education for development in India, the actual
progress made is far from satisfactory. More than fifty years after
Independence, still more than thirty per cent of the children between
6 and 10 years do not attend school. There is an increasing dualism
in the schooling system, where more well-to-do families send their
children to private (and usually costly) schools, and those who
cannot afford to do this send their children to government schools,
if at all. The state has clearly failed, both in universalizing
education and in providing sufficiently good quality education that
would continue to attract the well-to-do. The outcome is a kind
of deadlock: when the politically influential middle and upper classes
lose their interest in good quality government schooling, the result
is an overall neglect on the part of the state.
One of the recent policy initiatives that is potentially interesting
in this context is decentralization. In the whole of India different
kind of initiatives have been taken place to shift power from the
central or state level to lower levels of politics and administration.
This has also happened in the case of education. The question is
whether and to what extent these developments have affected, or
are going to affect, access, exclusion and interest in government
schooling. Primarily based on a review of the literature, but also
using some examples from West Bengal and Andhra Pradesh, this paper
will discuss these questions.
Paper Giver 22: Mattias Larsen
and Neelambar Hatti, Department of
Economic History, Lund University, Sweden
Paper 22 Title: Joint Families and Son
Preference: A Field Study on Declining child Sex Ratios in Karnataka
state of India
Paper Abstract: Human population exhibits definitive characteristics
in terms of its sex composition. In most parts of the globe fewer
females are born, yet females, as compared to their male counterparts,
typically survive longer to exceed the males numerically at any
given point of time. However, this demographic attribute eludes
India where males decisively out-number the females and women constitute
less than half of the total population. Sex ratio is a direct indicator
of women’s status and welfare. The sex ratio changes are usually
analysed in a framework that underlies (relatively) greater deprivation
and discrimination of females, as opposed to males, in the south
Asian cultural set-up. A change in sex ratio of children, aged 0-6
years, reflects the sum total of intra-household gender relations.
While the 2001 Indian census shows that the overall male-female
sex ratio has marginally improved from 927 women per 1000 men to
933 per 1000 during the last decade, the number of girls to boys
in the youngest age group fell from 945/1000 to 927/1000. The regional
disparities also appear to have increased; the northern states generally
exhibit a worsening trend in male-female sex ratio as compared to
the southern states. The Census evidence suggests a clear cultural
preference for male children, particularly among north Indians.
The sharpest decline for the age group 0-6 years is observed in
the northern states, particularly in Haryana (820/1000) and in Punjab
(793/1000).
Important factors in this process of change are; a decline in fertility,
parents desire to plan the gender composition of the family, patrilineal
inheritance patterns which links the importance of having a son
with old age support, the existence of dowry, the cultural importance
of sons as solely responsible for the performance of the parent’s
funeral rituals, and a lower status of women. It is thus a combination
of social, economic and cultural factors, which underlies the increasing
discrimination against daughters. There is a need to analyse the
factors at play themselves as well as how they combine to create
a situation with negative changes in child sex ratio in the context
of overall societal change. To examine these features, an attempt
is made in this paper based on a field work carried out in selected
villages of Karnataka State, India.
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University
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Last updated
2006-01-27
