An assessment of the Thai government's health services for the aged.

PIP: In 1998, the Health System Research Institute of Thailand conducted a comprehensive review of the health services available to elderly people. As part of this review, data were gathered based on the services provided in public facilities. Four methods of data gathering were used; namely, 1) interviews with policy-makers and implementers, 2) surveys of elderly people in the community, 3) exit interviews with patients at hospitals, and 4) observations in hospitals. Results of this review were summarized, which includes findings obtained through the latter three methods in the following areas: coverage of elderly people's card scheme, payments, travel to a health facility, care provided at the facility, and outreach services. The paper concludes with a discussion of policy recommendations.^ieng

Urban ties of rural Thais.

This article analyzes interpersonal linkages between villagers and urban dwellers and the effect on circular migration in Thailand. "Using data from Northeast Thailand, it examines the prevalence of urban social contacts, selectivities involved in such linkages, the characteristics of the urban contacts themselves, the salience of the interpersonal relationships, and the potential for the urban contact to act as a sponsor for the villagers. Furthermore, using a prospective research design, the impact of social contacts on subsequent rural-urban mobility of villagers is examined." A distinction is made between Bangkok and Northeastern Thai urban centers in order to illustrate some of the obstacles to the decentralized urbanization program in Thailand.

Contraception after childbirth in Thailand.

PIP: Data from the Third Contraceptive Prevalence Study conducted in 1984 in Thailand were analyzed to learn the extent of contraceptive practice after childbirth. Focusing on those women who had a birth within a given period prior to the survey, for some purposes the analysis was limited to those women whose most recent birth occurred within 1 year of interview, while for others it was extended to women whose most recent birth occurred within the last 2-4 years. The number of women in 4 years following childbirth in the Contraceptive Prevalence Survey 3 sample were 3442 in the unweighted ever married group and 3342 in the unweighted currently married group; the figures were 3447 for the weighted ever married group and 3342 for the weighted currently married group. Thai couples adopted contraception in very substantial proportions and very soon following the birth of a child. Based on women interviewed within 1 year of most recent birth, over half started some contraception by the end of the 6th month and almost 4/5 by the end of the 1st year. The timing of female sterilization was quite different from initiation of all other methods. Female sterilization in Thailand occurred primarily during the immediate postpartum period, while women are still in the hospital after delivery. Relatively few women sterilized in the 2 years following the 1st postpartum month. Of women in their first 2 years following childbirth, 17% were sterilized by the end of the 1st postpartum month and only an additional 3% by the end of the 2nd year. Initiation of temporary methods was not linked to the immediate postpartum period but occurred throughout the 1st year following birth. Contraceptive use during the 1st year following childbirth was more likely among menstruating women than among women who were still amenorrheic. Methods other than female sterilization predominated among women who already experienced the return of menses, suggesting that the return of menses was an important stimulus to their adoption. The data suggest that the proportion of Thai women exposed to risk of unwanted pregnancies for any extended period of time following childbirth is quite modest.^ieng

Contraceptive practice and fertility in Thailand: results of the Third Contraceptive Prevalence Survey.

The Third Contraceptive Prevalence Survey in Thailand was conducted in 1984. Results indicate a continuation of the rapid rise in contraceptive use among married couples that has been taking place over the past 15 years. Prevalence levels are approaching those common in economically advanced countries. Sterilization is now the most common method, although a fairly broad range of other methods is also widely used. Only modest levels of unmet need for contraception for either limiting family size or spacing children now exist. Fertility rates have fallen since the previous survey, done three years earlier, but to a lesser extent than would be expected from the increased use of contraceptives. Family size preferences are concentrated at small family sizes. A comparison between the Buddhist majority and Moslem minority, made possible through a special sample design, reveals substantial differences between the two groups. Contraceptive use is lower and fertility levels and preferences are higher among Moslems than among Buddhists.

PIP: The 3rd Contraceptive Prevalence Survey (CPS-3) in Thailand was conducted in 1984, sampling 7,576 ever-married women aged 15-49. It was based on a weighted sample scheme, interviewing approximately equal numbers in each of the 4 major regions and in Bangkok, including the same 24 provinces as in the previous CPS-2, and a supplementary population of southern Moslems. Results indicate a continuation of the rapid rise in contraceptive use among married couples that has been taking place over the past 15 years. Prevalence among currently married women has continued to increase from 53% in 1978 to 65% in 1984; approaching rates common in developed countries. Female sterilization is the most common method (23.5% of all married women) although a range of other methods is also seen (pill, 19.8%, injectables, 7.6%; IUD, 4.9%, male steralization, 4.4%; condom, 1.8%; and other, 2.6%). Low levels of unmet need for contraception for either limiting family size or spacing children now exist. National total fertility rates had fallen since the previous survey (from 3.68 in 1981 to 3.36 in 1984), but to a lesser extent than would be expected from the increased contraceptive use. Family size preferences are concentrated in small family sizes, slightly higher for rural women and women with 4 years' education, but with group averages ranging from 2.3 (urban women currently married 5 years with 4 years' education) to 3.4 (all currently married rural women educated 4 years). A comparison between the Buddhist majority and Moslem minority reveals that contraceptive use is lower and fertility levels and preferences higher among Moslems than among Buddhists. Contraception practice by region, racial/language group, work status; % having undesired pregnancies by rural and urban residency; source of supply (government or private); and method are also examined.

Infant feeding practices, postpartum amenorrhea, and contraceptive use in Thailand.

The findings from Thailand's 1984 Contraceptive Prevalence Survey suggest that an earlier trend toward reduced breastfeeding may have halted, with the initiation of breastfeeding virtually universal in rural areas and very common in urban areas. Breastfeeding duration, although quite prolonged on average, shows substantial rural-urban, regional, and educational differences. The introduction of supplemental food including infant formula and, to a much lesser extent, condensed milk, is very common and occurs when the infant is very young. Thus duration of breastfeeding in the absence of any supplemental food is very short, with a median duration of only one month. A sizeable minority of women start practicing contraception during postpartum amenorrhea. As amenorrhea is of only moderate duration, however, the extent of overlap in protection against pregnancy is very modest. Furthermore, the resumption of menses is clearly associated with a substantial increase in contraceptive practice.

Rural-urban mobility in Thailand: a decision-making approach.

This paper has analyzed a theoretical model of mobility decision-making. The model relies entirely on individual-level factors rather than macro-level factors as determinants of migration decision-making. The individual-level variables included in the model are: recent mobility history, urban social contacts, information about urban areas, evaluations of different locations, migration plans, and actual movements in the period subsequent to an initial interview. The empirical results indicate that with some exceptions there are relatively strong links of the type suggested in the model among these variables. The model was evaluated separately for two groups of villages for movement to Bangkok and for movement to Northeast Thai towns. Thus, four submodels were estimated, providing an opportunity to observe how robust the model is with respect to varying destinations and origins. Although certain differences are found among the four submodels, the overwhelming feature is their similarity. Where differences do exist, they generally reflect differences in the effectiveness of prior mobility as a predictor of other variables in the process. Clearly, a villager's previous history of movement is a key factor affecting subsequent movement and the entire decision-making process. The primary effect of having friends and relatives in a particular urban center is to increase the amount of information a villager has about that urban center. Information has a significant effect on evaluations and plans. Except in one submodel, evaluations have a significant effect on plans; and the existence of plans--which to some extent represent a culmination of social contacts, information, and evaluations--is the only factor other than previous mobility which has a significant direct effect on subsequent movement. Thai policy makers are searching for ways to stimulate the growth of regional urban growth centers and reduce the growth of Bangkok. From the standpoint of intervention, a key variable in this process would appear to be information. Not only is information level related to evaluations of an urban area and mobility plans, but, compared to other variables in the model, it appears to be relatively amenable to modification by inputs deriving from a source external to the village itself. It appears difficult to modify evaluations or migration plans directly, though both could be indirectly influenced by informational inputs. Movement history would be difficult, if not impossible, to manipulate; while villagers could be sponsored for short trips to town, this is not likely to produce much long-range effect.(ABSTRACT TRUNCATED AT 400 WORDS)

A multilevel model of family planning availability and contraceptive use in rural Thailand.

This paper assesses the ways in which the availability of family planning program outlets influences the likelihood of contraceptive use in rural Thailand. It focuses on a village-level measure of actual availability of sources rather than respondent perceptions of availability. Individual-level and village-level data collected as part of the second Thailand Contraceptive Prevalence Survey are used to test three hypotheses about the effects of actual availability: that (a) availability of family planning outlets increases the likelihood of contraceptive use; (b) it enhances the effect of a desire for no more children on the likelihood of use; and (c) it weakens the positive relationship between education and the likelihood of use.

Breastfeeding in Thailand: data from the 1981 Contraceptive Prevalence Survey.

PIP: Studies in the decade from 1969 to 1979 have indicated a moderate and relatively steady decline in the duration of breastfeeding among both rural and urban women of all classes in Thailand. Nonetheless breastfeeding is almost universal among rural women and practiced by most urban women. Important additional information on Thai breastfeeding practices became available from the 2nd round of the Contraceptive Prevalence Survey (CPS2) conducted on a national sample of 7038 ever-married women throughout Thailand in 1981. Data from the CPS2 does not show conclusively whether there has been a decline in breastfeeding since 1979, although some of the evidence points to a decline among urban women. What emerges is support for the data of the preceding decade, with additional confirmation of substantial rural urban, educational, and regional differences in overall breastfeeding patterns. New information is gained on the behavior of Thai mothers with respect to full breastfeeding, supplemental feeding and postpartum amenorrhea. Full breastfeeding is discontinued fairly early, within the 1st few months after birth. No sharp differentials in this practice are obvious among the population of women. Because of the early switch to mixed feeding, the period of postpartum amenorrhea is not long. The baby's diet is supplemented mainly with rice mixed with fruit and eggs, or some other ingredient. It is not known if milk products are introduced into the diet, or to what extent supplemental foods constitute the diet of the infant.^ieng