[Induced abortion as a cause of maternal mortality in Latin America]. / El aborto inducido como causa de mortalidad materna en America Latina.

PIP: Due to the restrictive abortion legislation which operates in almost all Latin American countries, knowledge about the incidence of induced abortions, their associated complications and related mortality is unreliable and approximate. There is little doubt, however, that the incidence of induced abortion in Latin America is among the highest in the world. The number of deaths due to complications from unsafe abortions is severely underestimated throughout the region. Based on Royston's method called the "maternal mortality route", the authors estimate that the actual number of abortion-related deaths in Latin America is between 5000 and 10,000 per year. Thus, compared to the estimated 4-6 million annual induced abortions, the abortion-related mortality rate would range from 83 to 250 deaths per 100,000 abortions. It is clear from the calculations presented that induced abortion in Latin America is a serious public health problem associated with deaths and health complications which could largely be avoided through the provision of accessible and appropriate family planning methods and the availability of high-quality abortion services. (author's)^ieng

[The epidemiologic transition in Latin America]. / La transición epidemiológica en América Latina.

The concept of health transition is considered to include two interrelated processes: transition of health care and epidemiological transition. The latter encompasses three basic processes: (a) replacement of the common infectious diseases by noncommunicable diseases and injuries as the leading causes of death; (b) a shift in peak morbidity and mortality from the young to the elderly; and (c) change from a situation in which mortality predominates in the epidemiological panorama to one in which morbidity is dominant. Latin America is characterized by a heterogeneous health profile in which different countries are in various stages of epidemiological transition. However, in most of them, the transition experience is unlike that of the developed countries and is distinguished by: (a) a simultaneous high incidence of diseases from both the pre- and post-transitional stages; (b) a resurgence of some infectious diseases that had previously been under control; (c) a lack of resolution of the transition process, so that the countries appear to be caught in a state of mixed morbidity; (d) a peculiar epidemiological polarization, not only between countries but also in the different geographical areas and between the various social classes of a single country. This experience is called a "prolonged polarized model."

[Elements for a theory of transition in health]. / Elementos para una teoría de la transición en salud.

This article presents the basic elements for developing a theory of the health transition. Such elements include the definition of concepts, the specification of a framework on the determinants of health status, the analysis of the mechanisms through which changes in health occur in populations, the characterization of the attributes that allow us to identify different transition models, and the enumeration of the possible consequences of the transition. The propositions are presented with a sufficient level of generality as to make them applicable to different contexts; at the same time, an attempt is made to provide them with the necessary specificity to account for different national experiences, thus opening a space for future comparative research efforts. Through the systematization exercise presented in this paper, we hope to contribute to the progress of a topic that has gained growing importance during recent years. Such importance is due to the enormous potential that health transition theory has for understanding and transforming the growing complexity of our times.

Elements for a theory of the health transition.

This article presents the basic elements for developing a theory of the health transition. Such elements include the definition of concepts, the specification of a framework on the determinants of health status, the analysis of the mechanisms through which health change occurs in populations, the characterization of the attributes that allow us to identify different transition models, and the enumeration of the possible consequences of the transition. The propositions are presented with a sufficient level of generality as to make them applicable to different contexts; at the same time, an attempt is made to provide them with the necessary specificity to account for different national experiences, thus opening a space for future comparative research efforts. Through the systematization exercise presented in this article, we hope to contribute to the progress of a topic that has grown in importance during recent years. Such importance is due to the enormous potential that health transition theory has for understanding and transforming the growing complexity of our times.

[The role of induced abortion in changing fertility in Latin America]. / El papel del aborto inducido en la transición de la fecundidad de América Latina.

The data and estimates presented suggest that the incidence of induced abortion in Latin America is high. In individual countries the average total abortion rate, ie lifetime induced abortions, seems to be between one and two per woman of fertile age, if not higher. The incidence of induced abortion in Latin America appears to be among the highest in the world, comparable to several East Asian and East European countries. Apparently the practice of induced abortion was already quite extensive in urban Latin America in the 1960s at a time when the use of contraception was low. As of the 1980s, induced abortion accounts for about one quarter of deliberate fertility control, and contraception for the remaining three quarters. The high incidence of induced abortion is due to an imbalance between the strong motivation for smaller families and the imperfect availability and utilization of contraception. The motivation for smaller families is widespread and contraceptive prevalence has been increasing steadily since the 1960s, yet many barriers exist to its universal and effective application. Contraceptives are not always available when needed; frequently access is difficult, particularly for young, single, and poor women and men; knowledge about reproductive functions and contraceptives is deficient and erroneous among large proportions of women; and at times the use of contraception is at odds with deeply in grained cultural and social patterns, as well as with personal sentiments. For these and other reasons, contraceptive failure is not uncommon. Consequently, the incidence of unwanted pregnancy is high and many women/couples resort to induced abortion.

[Abortion in Latin America. Induced abortion and its causes]. / El aborto en America Latina. El aborto inducido y sus causas.

PIP: Although abortion legislation is restrictive in Latin America, the limited available data confirm the region¿s high volume of abortion. The average number of abortions per woman in Latin America is around 1.5, according to estimates of various authors. Abortion contributes an estimated one-fourth of deliberate fertility control in the region. Abortion rates depend on the degree of motivation for limiting births and the availability and use of contraception. The motivation for smaller families preceded widespread introduction of modern contraception into Latin America. Fertility began to decline before 1960 in a few countries and declined more rapidly thereafter, due principally to induced abortion. The decline continued as contraceptive usage increased rapidly and substantially in the 1970s and 1980s. Abortion rates remained high, basically because the desire for smaller families was widely diffused, while barriers of different kinds hampered access to modern contraception. Inadequate contraceptive supplies, restricted choice of methods, lack of access for women who are poor or single or adolescent, misguided fears about health effects, and poor understanding of the operation of health services may all constitute obstacles to contraceptive use. Contraceptive failure is not infrequent and is another factor in the persistence of abortion. Even within the framework of restrictive legislation, steps could be taken to reduce the problem of abortion: improving the supply and availability of contraceptives, improving the quality of services, promoting sex education, and improving the status of women.^ieng

Induced abortion and fertility.

Even in countries with high rates of legal induced abortion, contraceptive use and marital patterns nearly always have a greater impact on fertility levels than does abortion. As a rule, extremely high rates of abortion--three or more abortions per woman of childbearing age during the reproductive years--are required for the fertility-inhibiting effect of abortion to rival that of contraceptive use. Nevertheless, the absolute effect of abortion on fertility (defined as the amount by which the current total fertility rate, or TFR, would increase if no abortions were performed) is often substantial. In most of the countries examined, the TFR would have been from about 20 percent to nearly 90 percent higher than it actually was (other things being equal) had no induced abortions been performed. Among developed countries, the Soviet Union, Japan, Eastern European countries, Israel and the United States have the highest total legal abortion rates, ranging from one abortion to more than five abortions per woman of childbearing age during the reproductive years. Among the developing countries for which reliable data are available, South Korea, China, Cuba and Singapore have rates of about 1-2 abortions per woman of fertile age. However, a number of other countries in Latin America and Asia, for which the data are deficient, probably have equally high rates.

PIP: Even in countries with high rates of legal induced abortion, contraceptive use and marital patterns nearly always have a greater impact on fertility levels than does abortion. As a rule, extremely high rates of abortion--3 or more abortions per woman of childbearing age during the reproductive years--are required for the fertility-inhibiting effect of abortion to rival that of contraceptive use. Nevertheless, the absolute effect of abortion on fertility (defined as the amount by which the current total fertility rate, or TFR, would increase if no abortions were performed) is often substantial. In most of the countries examined, the TFR would have been from about 20% to nearly 90% higher than it actually was (other things being equal) had no induced abortions been performed. Among developed countries, the Soviet Union, Japan, Eastern European countries, Israel and the US have the highest total legal abortion rates, ranging form 1 abortion to more than 5 abortions per woman of childbearing age during the reproductive years. Among the developing countries for which reliable data are available, South Korea, China, Cuba and Singapore have rates of about 1-2 abortions per woman of fertile age. However, a number of other countries in Latin America and Asia, for which the data are deficient, probably have equally high rates.

Reflections on the demographic conditions needed to establish a U.S. stationary population growth.

Abstract It is assumed that in the long run U.S. population growth will have to cease, as otherwise life will become physically impossible. Various hypothetical possibilities of achieving such a type of development are investigated. Alternatives of reproduction rate trends are considered in terms of alternatives of interactions of assumed age-specific fertility and mortality trends and these are computed and evaluated. The various computations then indicate the nature of childbearing attitudes and behaviour, which the 'average population' would have to adopt in order to achieve the desired stationary population growth after a certain period of time. On the other hand the results presented in the paper also indicate that a certain population growth (of the order of 30-50%) and change in age structure is inevitable in the coming 5-10 decades given the initial childbearing behaviour.