Volume 54, Part 1, 2000

Author Oysten Kravdal
Social inequalities in cancer survival

Social differentials in survival from twelve common types of cancer were assessed by estimating a mixed additive-multiplicative hazard model on the basis of individual register and census data for the whole Norwegian population.

The excess all-cause mortality among cancer patients compared with similar persons without cancer diagnosis was significantly related to education, occupation, and income. Excess mortality was, on the whole, about 15 per cent lower for men or women who had completed a post-secondary education than for those with only compulsory schooling, taking into account age, period and registered differences in tumour characteristics and stage at the time of diagnosis.

The data do not provide clear indications of whether differences in host factors, such as co-morbidities and immune functions, or differences in treatment and care are primarily responsible for these inequalities in cancer survival
pp. 1-18

Author Alaka Malwade Basu
Gender in population research: Confusing implications for health policy

In this paper I discuss some of the health policy implications of an increasing trend in population research and in its interpretation and presentation - a trend to 'political correctness' - defined not in the popular, often derogatory, sense, but as an ideological commitment to certain principles.

For one of these commitments, that to the notion of gender equality, greater strength and legitimacy is today commonly sought by tying it to other less controversial goals such as that of better health. But straining for connections between gender and equality and positive health outcomes often unduly constrains the research question, the research methods, and the interpretation of the research.

When health policy seeks guidance from this research, it can receive signals which are too often incomplete, silent on the many trade-offs of specific policy measures, and, ultimately, perhaps even detrimental to the very goals of gender equality and social justice from which they are derived. Examples of all these possibilities are discussed.
pp. 19-28

Authors Larry Bumpass and Hsien-Hen Lu
Trends in cohabitation and implications for children's family contexts in the United States

This paper documents increasing cohabitation in the United States, and the implications of this trend for the family lives of children. The stability of marriage-like relationships (including marriage and cohabitation) has decreased - despite a constant divorce rate. Children increasingly live in cohabiting families either as a result of being born to cohabiting parents or of their mother's entry into a cohabiting union.

The proportion of births to unmarried women born into cohabiting families increased from 29 to 39 per cent in the period 1980-84 to 1990-94, accounting for almost all of the increase in unmarried childbearing. As a consequence, about two-fifths of all children spend some time in a cohabiting family, and the greater instability of families begun by cohabitation means that children are also more likely to experience family disruption.

Estimates from multi-state life tables indicate the extent to which the family lives of children are spent increasingly in cohabiting families and decreasingly in married families.
pp. 29-41

Author Michael Murphy
The evolution of cohabitation in Britain, 1960-95

The recent rise in cohabitation in Britain is analysed using data from large-scale surveys. There are major inconsistencies between different sources, and retrospective estimates are higher than values reported at the time.

Retrospective data show markedly smaller numbers of cohabitation events just before survey date. I discuss reasons for discrepancies and conclude that no 'objective' measure of cohabitation exists and that comparison of different types of data requires care. I combine the data to produce a much larger data set than hitherto available.

Although cohabitation prevalence increased substantially during the 1970s and 1980s, there was little change in such characteristics as duration of cohabitation, ages of those cohabiting, and whether it occurred before first marriage or ended in marriage or breakdown. However, since the late 1980s, the average length of cohabitation has increased markedly, which may indicate a qualitative change in the nature of cohabitation in Britain.
pp. 43-56

Author Weiguo Zhang
Dynamics of marriage change in Chinese rural society in transition: a study of a northern Chinese village

This analysis uses data from an intensive village study to investigate the impacts of institutional reforms on marriage in rural China. The study finds that age at marriage has been declining significantly both for men and women. The 'exchange marriage' and the 'mercenary marriage' have re-emerged. An increasing proportion of marriages occur between men and women in nearby villages, though there is no significant increase in village endogamy. Both bride price and dowry have increased significantly, and the ratio of value of dowry to bride price has undergone a dramatic equalisation. The young, including young women, have much more decision making power regarding their marriages. Changes in marriage are the consequences of both change in the socio-economic environment brought about by deliberate rural reforms, and strategic or tactical responses of rural Chinese to the rapidly changing context in which they live and work.
pp. 57-69

Authors Susan Scott and CJ Duncan
Interacting effects of nutrition and social class differentials on fertility and infant mortality in a pre-industrial population

Inadequate nutrition of both the mother and her offspring at each stage of its development - before pregnancy, in the womb, in infancy and during early childhood - played an important role in the patterns of sub-fertility and infant mortality in a saturated, marginal, pre-industrial community.

It is suggested that the three social classes had different diets but all were deficient in some essential constituents. Differences in nursing practices in the social groups contributed to differential exogenous mortality and to malnourishment and maternal depletion in the subsistence and (paradoxically) in the elite classes, producing an interacting web of effects and generating a vicious circle from which they could not escape for 150 years.

Although the population apparently preferred daughters, the persistent generation effect of low birthweight girls bearing low birthweight daughters probably contributed to the steady-state conditions in this compromised community.
pp. 71-87

Authors John Knodel, Jed Friedman, Truong Si Anh and Bui The Cuong
Intergenerational exchanges in Vietnam: Family size, sex composition, and the location of children

This study examines variations in intergenerational support by family size, family composition, and location of children in Vietnam. Results from two regional surveys confirm the central role of children in assisting elderly parents but relationships with family size depend on the type of support considered. Co-residence with married children varies little with family size but incidence of material support, and the numbers providing it, increases with the number of children.

Non-co-resident sons and daughters differ minimally in providing material and social support. In the north, co-residence with married children is limited largely to sons while in the south more flexibility is evident.

While having a son increases the chance of co-residence, having more than one son has no additional effect. Although future elderly will have smaller family sizes this is unlikely to have a major adverse impact on their well-being except possibly for northern elderly without sons.
pp. 89-104

Author Carole E Kaufman
Reproductive control in apartheid South Africa

Since its inception in 1974, the South African family planning programme has been widely believed to be linked with white fears of growing black numbers. The programme has been repeatedly attacked by detractors as a programme of social and political control. Yet, in spite of the hostile environment, black women's use of services has steadily increased.

Using historical and anthropological evidence, this paper delineates the links between the social and political context of racial domination and individual fertility behaviour. It is argued that the quantitative success of the family planning programme is rooted in social and economic shifts conditioning reproductive authority and fertility decision-making.

State policies of racial segregation and influx control, ethnic 'homeland' politics, and labour migration of men transformed opportunities and constraints for black women and men, and altered local and household expectations of childbearing. Women came to manage their own fertility as they increasingly found themselves in precarious social and economic circumstances.
pp. 105-114