PIP: Family planning in Malaysia is discussed. Family planning began in Malaysia about 15 years ago through the efforts of voluntary family Planning Associations in the various Malay states. In 1966 the Malaysian Parliament passed the National Family Planning Act setting up the National FAmily Planning Board to formulate policies and methods for the promotion and spread of family planning knowledge and practice on the grounds of health of mothers and children and welfare of the family. In 1967, the board set a target of 40,000 new acceptors of family planning and 90% of the target was reached. This represents 3% of the child-bearing married women aged 15-49. The target for 1968 of 65,000 new acceptors is being achieved. A survey of acceptors is to be carried out from December 1968 to April 1969 to ascertain how many women who accepted family planning continue to practice it. Malaysia's crude birth rate declined from 46.2 in 1957 to 37.3 in 1966 before the government program was instituted. Abortion attempts have been frequent. The main method of contraception used is oral contraceptives. According to a 1957 survey, 31% of the married women in the metropolitan areas and 2% of rural women were using contraception. Presently, in Malaysia there is a need to: 1) train personnel to provide services, 2) inform and motivate families to accept family planning, 3) continue a broad educational program, 4) reform Malaysia's antiquated abortion law, and 5) integrate family planning services more fully into the general health services of the country.
The objectives of this article are (1) review the contribution of traditional midwives to family planning communication in several Asian countries; (2) organize knowledge gathered from various studies into general guidelines for the most effective use of traditional midwives in family planning programs; and (3) present hypotheses for future research. In certain countries where pilot projects have tested the potential performance of traditional midwives in family planning programs, results have been encouraging. In other nations, more research is needed to determine the contribution traditional midwives can make to the family planning program.
PIP: Traditional midwives are found in almost every village and in many urban neighborhoods in the developing world, delivering the majority of births in these areas. Several Asian nations have begun to recognize the potential contribution of traditional midwives to modern family planning and health programs. A total of about 17,000 traditional midwives have been trained as family planning recruiters in Indonesia, Malaysia, the Philippines, and Thailand. Because traditional midwives deliver a large number of births in Asian nations, the potential is great for them to reach large numbers of women regarding family planning -- particularly poor, illiterate women. There is much to be learned from the traditional health system and governmental health and family planning programs should join hands with these older systems.
PIP: It is generally believed that extended families encourage high fertility, but a review of the theoretical discussions and empirical research examining the relationship between family type and fertility fails to show any support for the customary belief. Nuclear families consist of husband, wife, and their immediate children. The extended family is broadly defined as any group of related persons living together which includes but is larger than the nuclear family. The main theoretical discussions of extended family and fertility are by Davis (1957); Davis and Blake (1956); Lorimer (1954); and Goode (1963; 1964). In the patrilocal extended family, the wife wants to have offspring as early as possible to strengthen the family line and her own status in the household. In a truly joint household the authority of the elders continues after marriage; the reproductive behavior of a couple is subject to their influence. Less intimate or less intense interspousal communication precludes the possibility of discussion on fertility-related problems and family planning. Younger age at marriage and lack of privacy contributes to higher fertility. According to Goode extended family behavior is characterized by more rules for behavior, while nuclear families emphasize the conjugal bond. Since most affinal and consanguineal kin are excluded from day-to-day decisions in the nuclear family there are weaker reciprocal controls.
PIP: Responses to questions relating to breastfeeding in the World Fertility Surveys of South Korea, Indonesia, Nepal, Sri Lanka, Malaysia, and Bangladesh are analyzed. Of these countries, the percentage of ever-married women who had breastfed in the last closed interval was between 94-99%, except for Malaysia (81%) and average number of months breastfeeding took place was from 16.5-19.2, except for Malaysia (7.3). The infant mortality rate in these countries was 33/1000 live births for South Korea, 45/1000 for Malaysia, 51/1000 for Sri Lanka, 137/1000 for Indonesia, 150/1000 for Bangladesh, and 152/1000 for Nepal. Responses, however, might vary according to different interview situations. Assuming that the reporting errors are of similar magnitude and direction, the relationship between duration of breastfeeding and the birth interval can be studied. But it is possible that breastfeeding was prolonged due to other reasons for which conception was delayed; thus the regression of breastfeeding duration on the birth interval is not as logical as the regression of the birth interval on the breastfeeding is, especially when habitual breastfeeding can be avoided. The negative relationship between breastfeeding and infant mortality does exist, assuming that a woman breastfeeds all her children for similar durations. Some breastfeeding differentials are place of residence (less for rural areas), education (reduces duration), and religion (Christians have shorter duration than Muslims, Hindus, or Buddhists). In South Korea the mean length of breastfeeding of women aged 25-34 and 35-44 are 17.5 and 20.5, and women using contraceptives are 26% for 25-34 and 20% for 35-44. South Korea also has the highest level of breastfeeding, highest incidence of ever use of contraceptives, and a very low level of fertility. Nepal and Bangladesh have a high level of breastfeeding but since their contraceptive incidence is low, their fertility level remains high. Some areas of further research include influence of breastfeeding on infant and child mortality.
PIP: While Malaysia's National Family Planning Board is primarily responsible for family planning activities, several organizations and ministries, both governmental and voluntary, participate in various service programs. Current population policy attempts to go beyond family planning. Population education, treatment of infertility, and cancer screening are offered as well as family planning, to make the program more useful to greater numbers of people. The government also wishes to improve the status of women thereby giving them alternative choices of lifestyle. Rural women are reached through the Ministry of Agriculture's community development program. While the National Family Planning Board receives only 0.12% of the national budget, this figure is not expected to increase. Tables giving vital rates show that population fell below the 30 per 1000 mark for the first time in 1977. A higher rate of fertility decline has taken place between 1967 - 1977 than occurred from 1957 - 1967. Current demographic objectives are to reduce crude birthrate to 28.2 per 1000 by 1980. This goal would require 817,963 new acceptors. While the pill accounts for 80% of acceptor's choice, the proportion using condoms has increased from 1.4% during 1969 - 1970 to 11.4% in 1979. Despite reported side effects with the pill and the illegality of induced abortions, virtually all acceptors are well satisfied with the program in its current form.