INTERNATIONAL SOCIAL SCIENCE REVIEW

29

AN ANALYSIS OF REPRODUCTIVE HEALTH COMPONENTS IN YEMEN

By T.S. SUNIL and VIJAYAN K. PILLAI

Introduction
Over the last five decades, efforts to control global population growth have focused on family planning policies and programs. Since the 2004 International Conference on Population and Development (ICPD),' demographic studies on understanding fertilitycontrolling behavior have concentrated on reproductive health. The 2004 ICPD broadened the narrow view of population control to include individual health by asserting that population growth could be managed through the economic, political, and social advancement of women.^ This parallels the recent shift in focus of population control studies from limiting family size to improving women's health and protecting human rights.^ Despite this change, fertility-controlling behavior has yet to be thoroughly investigated in many countries. One such example is the People's Republic of Yemen. To be sure, some demographic studies have tried to unravel the complex fertility condition in the Middle East." But these studies have neglected several countries in the region primarily due to the lack of availability of national data. This study attempts to address this gap in the literature by focusing on three factors in the continuum of the reproductive process (age at marriage, contraceptive use, and abortion/miscarriage) to understand the fertility-controlling behavior of Yemeni women. The importance ofage at marriage as a means of population control was first addressed in the late eighteenth century by the political economist Thomas R. Malthus who advocated postponement of marriage as a means to balance population size with limited resources.' Early age at marriage (in some societies, marriage before the age of fifteen) has resulted in early childbearing, greater health risks for both mother and infant, and often defines the social and economic characteristics of that society.'' The use of contraceptives is another major factor that influences the fertility-controlling behavior of women. The use of contraceptives to control population growth affects the health of the mother and child, the ability to avoid unwanted births, and the timing and spacing of children. Other factors that influence the use of contraceptives by women include communication between spouses,' preferences and perceptions of the attitudes of her partner," and husband's approval." The third fertility-controlling behavior addressed in this study concerns the use of abortion. Availability of abortion as an informed choice of birth control is generally considered a human rights issue in many countries. In countries where contraceptives are not easily accessible to women, abortion is considered the most viable form of birth control. Abortions have played a crucial role in achieving a decline in fertility in many developing countries.'"

T.S. SUNIL is an Assistant Professor of Sociology at the University of Texas-San Antonio; VIJAYAN K. PILLAI is a Professor in the School of Social Work at the University of Texas-Arlington.

30

VOLUME 80, NUMBERS 3 & 4

These three factors represent the major components emphasized in the United Nations' definition of reproductive health. They influence a woman's informed ability to engage in sexual relationships, her ability to make effective, acceptable, and affordable choices regarding the use of contraceptives, and her access to safe and appropriate healthcare services during pregnancy." In other words, a woman's reproductive health can be explained by the extent of control she possesses over decisions regarding age at marriage, timing of sexual unions, pace of childbearing, access to contraceptives, as well as access to information concerning childbirth and the prevention and treatment of reproductive related illness.'^

Background
Since the unification of Yemen in 1990, several structural reforms and policy changes have been introduced to control that country's population growth. One ofthe major achievements in this area has been the adoption of a national policy on population control. The National Committee for Population and Family Planning tried to reduce Yemen's death rate by at least fifty percent by 2000, reduce its total fertility rate by six births per woman over the same period, decrease infant mortality by six deaths per 1,000 live births, and lower maternal mortality by fifty percent from its 1991 level. Yemen is still in the early stages of demographic transition. Its annual population growth currently stands at 3.3 percent. The current fertility rate of Yemen is about 7.0. This reflects a high birthrate, forty-four per 1,000 population, and a declining mortality rate, eleven per 1,000 population. Yemen's infant mortality rate, however, still ranks as one of the highest in the world (seventy-five deaths per 1,000 live births). This includes an under age five mortality rate of eighty-five percent recorded within the last decade.'^ From the late 1980s through the late 1990s, Yemen experienced a high maternal mortality ratio of 351 maternal deaths per 100,000 live births.'" While this number seems low, maternal deaths represent about forty-two percent of all deaths for Yemeni women between the ages of fifteen and forty-nine. Lastly, by 2002 the average life expectancy for the population ofYemen stood at fifty-nine (fifty-seven for males and sixty-one for females, respectively). This represents a fourteen year increase since 1990 but it remains four years below the average for less developed countries." Based on key social and economic indicators (notably, GNP, exports, debt), Yemen ranks among the twenty-five poorest and least developed countries in the world."" According to the latest Human Development Report, Yemen is ranked 144 out of 173 in the Human Development Index." Recent national surveys indicate that nearly three-fourths ofthe population live in rural areas. This has a significant impact on the character of Yemen society. Marked differences are observed in educational levels between men and women, with the highest gender gap occurring in enrollment rates (thirty-one percent).'* Furthermore, while nearly ninety percent of urban households have electricity, only thirty percent of rural households are electrified. Approximately forty-eight percent ofthe population is younger than fifteen years ofage, and unemployment has reached thirty percent." AGE AT MARRIAGE: Marriage has been universal in Yemen; few men and women remain single throughout their lives. Children born outside of marriage are not common, and about forty percent of marriages are consanguineous.^" Although the minimum age of marriage is set at fifteen by law, girls in Yemen marry as young as twelve. Recent estimates, however, show that there has been a slight delay in first marriages in Yemen.^' As in the case of other traditional societies in the Middle East, the reasons for young age at marriage in Yemen are deeply rooted in the social and cultural characteristics of that society.

INTERNATIONAL SOCIAL SCIENCE REVIEW

31

Age at marriage is important for understanding both the fertility behavior of Yemeni women as well as the economic and social conditions of that society.^^ Since reproductive life begins with marriage, early age at marriage, as in many developing societies, signals the initiation of early reproductive life and a longer duration of reproductive years that begins immediately after marriage. CONTRACEPTIVE USE: The use of contraceptives is another important factor in understanding the fertility-controlling behavior of Yemeni women. Though the government lacks an explicit population policy, policy makers and government officials strongly believe that rapid population growth is a hindrance to the country's social and economic development. They support the use of contraception and encourage family planning to improve maternal and child health. In its efforts to provide better access and knowledge about contraceptives, the government, in 1996, established the Yemeni Family Care Association (YFCA). This agency provides prenatal services to pregnant women, including information on child nutrition and immunization. The number of centers around the nation increased more than three-fold in the early 1990s, from 75 in 1991 to 235 in 1995." Additionally, family planning services are generally offered through the Ministry of Public Health, YFCA, and various pharmacies throughout the country. Despite such efforts, contraceptive use is still not common in Yemen. Yet, improvements in this direction are encouraging given the brief period since the unification ofthe country (1990). Indeed, the prevalence of contraceptive use among married women doubled in less than a decade from ten percent in 1991/92 to twenty-one percent in 1997.'* Aside from the social and economic characteristics of women, several other factors need to be taken into account when studying the determinants of contraceptive use in Yemen. These variables include the level of education and the occupation of the husband," husband-wife communication regarding family planning,^' and the husband's approval of contraceptive use." Most studies show that the educational level of the wife is more strongly and inversely correlated with family size than that of the husband.^' An educated husband and wife are more likely to discuss the timing and number of children and the use of different contraceptives. Education beyond the primary level is often associated with an openness to new ideas, a higher standard of living, exposure to an urban environment, higher occupational achievement, and more options and interests outside the home. Women's education is positively related to knowledge and use of contraceptives and negatively related to family size in high fertility countries. The use of modem contraceptives in both developing and developed countries thus increases with the number of years of female education.^' In contrast, fertility differences between rural and urban women are due more to changes in their marital pattern (increase in age at marriage) than to differences in contraceptive use.'" The rational process of fertility decision-making involves communication between spouses.^' Studies reveal that limited communication between spouses regarding family size and family planning translates into low levels of contraceptive use.^' Like some countries in sub-Saharan Africa, in Yemen one finds that the husband's disapproval is one ofthe major reasons for nonuse of contraceptives." When communication between spouses exists, couples are more likely to use contraceptives. At minimum, this increases the period between pregnancies. ABORTION: Abortion is the least discussed concept ofthe three proximate determinants of fertility. In some countries, abortion is considered the preferred method of fertility control. Perhaps the 2004 ICPD bolstered discussion on abortion among policy mak-

32

VOLUME 81, NUMBERS 1 & 2

ers. Differing opinions on abortion in Muslim states are further complicated by religious beliefs.^" In Muslim communities, the question on use of abortion revolves around the timing of ensoulement which, within many religious schools, varies from 40 to 120 days. While these religious schools may disagree on allowing abortions, they all support the use of abortion in specific situations when the health of the mother is in danger." As in most Muslim countries in the Middle East, the use of abortion is not a widely discussed topic in Yemen. Prior to unification, abortion was prohibited except to save the life of the mother. Differences between theological ideas and political opinions regarding abortion, together with the lack of accurate demographic data and restrictive abortion laws that existed before unification, make it difficult to estimate the prevalence of abortion in Yemen."* It is also difficult to ascertain the prevalence of abortion in Yemen from the few questions that try to address the topic in national surveys. These surveys often combine questions concerning induced and spontaneous abortions which complicates the situation further. Consequently, literature on abortion in Yemen is quite limited. Studies conducted outside the Middle East note several reasons for the use of abortion as a method of fertility control." In countries where contraceptive use is restricted, abortion is viewed as a method to limit family size.'* This trend is also found in societies where other contraceptive methods are available. In many societies (particularly in South and Southeast Asia), sex-selective abortions are performed to maintain the desired number of sons and daughters.^' For example, in Bangladesh, where abortion is illegal, most abortions are performed for this reason.* In addition to sex preference, age, parity ofthe mother, marital status, education, place of residence, religion, and ethnicity were other factors that influenced women who obtained an induced abortion."'

Data and Methods

This study uses data derived from Demographic and Health Surveys (DHS) conducted in 1997. The 1997 Yemen Demographic and Maternal and Child Health Survey (1997-YDMCHS) is only the second national survey conducted since the unification of the country (the first took place in 1991). In interviews with 10,414 of 11,158 eligible ever-married women between the ages of fifteen and forty-nine, the survey obtained information concerning fertility, family planning, infant and child mortality, maternal and child health, and nutrition. It also gathered information on female circumcision as well as the height and weight of mothers to measure maternal malnutrition."^ This survey also collected information regarding characteristics of households, living conditions, school enrollment, employment, general mortality, disability, fertility, and child survival rates. The areas covered in the survey of women of reproductive age include demographic and socioeconomic characteristics, marriage and reproductive history, fertility regulation and preferences, antenatal care, breastfeeding, and childcare. The authors of this study employ several additional variables to measure the level of women's decision-making power in the household, particularly concerning the use of contraceptives and husband-wife communication regarding different aspects of the reproductive process. The list of selected variables, values assigned, and distribution of these variables is presented in Table 1. The disparity in actual and ideal number of children is also calculated. This measure is derived from information regarding birth history and responses to the question, "If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?" The difference between ideal and actual number of children is used to calculate the disparity in the number of children.

INTERNATIONAL SOCIAL SCIENCE REVIEW

33

Women who participated in the study were also asked questions to determine the disparity in gender preferences in children. Specifically, they were asked: "How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter?" Studies have shown that women with wide disparity in these indicators are likely to seek out fertility-controlling measures such as contraceptives and/or abortion." The three dependent variables used in this study are age at marriage (AGEM), ever use of contraception (EVERUSE), and ever had abortions or miscarriages (ABORT). Although abortions and miscarriages have different medical and political connotations, the responses are combined in a single question in the original survey. The independent variables are: region, place of residence, source of drinking water, electricity at home, occupation of women before marriage, education of women, desire for additional children, husband's approval of family planning, wife's approval of family planning, current occupation of husband, current occupation of wife, discussion of family planning with one's partner, children ever born and their current ages. Since AGEM is a continuous variable, a multiple regression analysis has been conducted to understand the influence ofthe independent variables. A logistic regression analysis is performed on the dummy variables, EVERUSE and ABORT. Disparity indexes are calculated by taking the difference between responses to ideal number of children and actual number of children. Gender specific disparity in children is determined by taking the difference between the reported ideal number of male/female children and the actual number of male/female children.

Analysis and Results

The univaritate distribution ofthe variables selected in the study is presented in Table 1 (see page 34). About 19 percent of ever-married women in both the twenty to twenty-five and twenty-five to twenty-nine age groups, and 8.2 percent of women in the forty-five to forty-nine age group responded to the survey. Nearly half of the population lives in the plateau and desert regions of Yemen. About two-thirds of the population lives in rural areas. This is evident upon examining the source of drinking water and access to electricity; more than half of the population (57.6 percent) depends on non-pipe sources of water and lack electricity in their homes. Results from the survey also indicate a sharp discrepancy in the level of education between husband and wife in Yemen. While almost half (48.2 percent) of male adults have some form of education, less than one-quarter (21.1 percent) of women have attained a similar level of formal leaming. Similar differences are observed in terms of the occupational status of husbands and wives. About half of the males (45.3 percent) are engaged in professional and service-sector jobs, but only 3.5 percent of women work in such occupations. Over two-thirds of Yemeni women (73.4 percent) reported that they either do not work or do not have regular work. With regard to family planning, nearly half of the women reported that they do not have any desire for more children and approve of family planning. Additionally, 58.7 percent stated that their husbands "do not approve" or that they are "not sure" about their husband's view on family planning. In a male-dominated society such as Yemen, approval ofthe husband or head ofthe household (usually a male adult) is required to pursue family planning. The survey also revealed important information concerning abortions and miscarriages, age at marriage, and family size. About seventy percent ofthe women had at least one abortion or miscarriage and nearly forty percent used some form of contraceptives.

34

VOLUME 8L NUMBERS 1 & 2

Table 1: Social and Economic Characteristics ofthe Population in Yemen, 1997

Variable Variable Name & Value AGE 1 2 3 4 5 6 7 REGION 0 1 2 PLACE Percentage 10.4 18.5 18.9 16.3 17.1 10.6 8.2 Variable Variable Name& Value WATER 0 1 ELECT 0 1 DESIRE 0 1 Percentage

Age of woman 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Region Coastal Mountainous Plateau & Desert Place of residence Rural Urban Education of husband No education Some education Education of woman No education Some education

Water source Non-pipe Pipe Electricity at home No Yes Desire for more children No more children Wants more

57.6 42.4

50.4 49.6

23.9 27.8 48.2

50.3 49.7

0
1 EDUCNH 0 1 EDUCNW 0 1

71.7 28.3 48.2 51.8

Husband's approval of FP HAPPROV Disapproves 0 Not sure 1 Approves 2 Women's approval of FP Disapproves Not sure Approves Ever had abortion WAPPROV 0 1 2 ABORT 0 1 EVERUSE 0 1 AGEM 0 1 2

36.0 22.7 41.3 32.6 13.7 53.7

78.9 21.1 29.4 45.3 45.3 73.4 23.1 3.5

No Yes
Ever use of contraception Never used Used some Age at marriage Less than 15 15-18 19 and above

69.6 30.4 60.4 39.6 26.5 54.8 18.8

Occup. of husband OCCUPH No work/reg. work 0 Agri. self employed 1 Professional/Service 2 Occup. of woman OCCUPW No work/reg. work 0 Agri. self employed 1 Professional/Service 2

The percentage of women marrying at an early age (younger than fifteen) decreased from 30.7 percent in 1991/92 to 26.5 percent in 1997. This increase in age at marriage is particularly evident in the fifteen to eighteen age group. The average age of Yemeni women when they first marry is approximately sixteen. Distribution of ever-married women according to the number of children bom shows that Yemeni women prefer large families. The average number of children bom to Yemeni women is about 7.2. Table 2 (see page 35) presents a regression outcome regarding age at marriage. Women who live in the mountain, plateau, and desert regions of Yemen marry at a younger age compared to those who reside in coastal areas. Significant differences also are observed among women who live in households with electricity. Women who worked before marriage and have had some education are likely to marry at a later age compared to those who had not. Social and economic characteristics of Yemeni women thus have a significant influence on their age at marriage.

INTERNATIONAL SOCIAL SCIENCE REVIEW

35

Table 2: OLS regression" on age at marriage Variable Constant Region Mountain Plateau and Desert Place of residence Urban Source of drinking water Pipe Have electricity Yes Occupation before marriage Yes ^standardized 16.499 Standard error 0.083

-0.142* -0.178*

0.095 0.078

-0.013

0.087

0.016

0.072

0.035*

0.079

0.071*

0.067

Education of women Some e d u c a t i o n 0 . 1 7 1 * 0 . 0 8 1

A logistic regression*' which measures ever use of contraception is presented in Table 3 (see page 36). In addition to social and economic variables, other variables such as husband-wife communication, approval of the use of contraceptives by the husband, approval ofthe use of contraceptives by the wife, and children ever bom are found to be statistically significant in explaining ever use of contraceptives among Yemeni women. The chances of using contraceptives increase 1.61 times among women living in the mountain region compared to those living in the coastal region. The odds are also higher (1.38 times) among women living in the plateau and desert regions. Use of contraceptives is also 1.75 times greater among women living in the urban areas as compared to their rural counterparts. Economic conditions, such as having pipe water (1.13 times) and electricity (1.44 times) in their homes, also increase the chances of Yemeni women ever using contraceptives. Education and occupation levels of husbands and wives are significant factors of contraceptive use among Yemeni women. The chances of a Yemeni woman ever using contraceptives are 1.39 times higher among women who have a husband with some education, and 1.55 times higher for women possessing some level of education. Similar results are observed in the occupational levels of husband and wife. Husbands employed in professional and service jobs are more likely to use contraceptives (1.11 times) compared to unemployed husbands. Higher odds of ever using contraceptives are also found among women who work in the professional and service sectors as compared to those who do not work. The odds of those women ever using contraceptives ftirther increases if their husbands work in the same occupational sector.

36

VOLUME 81, NUMBERS 1 & 2

Table 3: Logistic regression on ever use of contraception.

Variables Region Mountain Plateau and Desert Place of residence Urban Source of drinking water Piped water Have electricity Yes Education of husband Some education Education of wife Some education Desire for more children Yes Husband approval of FP Not sure Approves

Exp(P)
1.61*** 1.38***

Std. Error 0.089 0.072

Variables Wife approval or FP Not sure Approves Occupation of husband Agri. Self-employed Professional/Services Occupation of wife Agri. Self-employed Professional/Services Discuss FP with partner At least once

Exp(P)
0.95 2.00***

Std. Error 0.112 0.072

1.75*** 1.13** 1.44***

0.076 0.062

0.91 1.11* 0.94 1.51***

0.079 0.064

0.071 0.154

0.068 1.49*** 0.99 1.28*** 1.00 0.029*** 0.065 0.009 0.018 0.018 0.233

1.39*** 1.55***

0.069 Age of marriage 0.077 Children ever born Current age

0.98

0.064 Constant

0.85* 5.53***

0.093 0.069

*p<0.10; **p<0.05; ***p<0.001. -2Loglikelihood = 8606.850; Nagelkerke ^ = 0.426

With regard to family planning, husband's approval of family planning increases the chances of ever use of contraceptives among women as compared to those who lack their husband's approval. The odds of contraceptive use are also higher among women who approve the use of family planning as compared to those who do not. Husband-wife communication also has a significant impact on ever use of contraceptives. Women who have discussed family planning with their partner have 1.49 times higher odds of ever using contraceptives than those who have never done so. Odds of contraceptive use also increase among women who have had more children. Women with more children have 1.28 times greater odds of ever use of contraceptives than those with fewer children. Three variables, the desire for more children, age at marriage, and current age are found to be statistically significant. Women who have the desire for more children have 0.98 times less chance of using contraceptives compared to those who lack any desire for additional children. A similar trend is observed among women who marry later in life. No difference is evident regarding the chances of contraceptive use among women in the various age groups surveyed. The final analysis considers the question of whether Yemeni women ever had abortions or miscarriages. Women were asked to report the number of abortions or miscarriages they had experienced in their lifetime. In addition to social and economic variables, the model focuses on husband and wife approval of contraceptive use, husband-wife communication concerning contraceptive use, and several discrepancy variables (male child disparity, female children disparity, and total children disparity). The disparity measures represent

INTERNATIONAL SOCIAL SCIENCE REVIEW

37

the difference between actual number of children (male/female) and ideal number of children. A logistic regression on the use of abortion is presented in Table 4. Table 4: Logistic regression on the use of abortion
Variables Region Mountain Plateau and Desert Place of residence Urban Source of drinking water Piped water Have electricity Yes Education of husband Some education Education of wife Some education Desire for more children Yes Husband approval of FP Not sure Approves Exp(p) Std. Error 0.101 0.083 Variables Occupation of husband Agri. Self-employed Professional/Services Occupation of wife Agri. Self-employed Professional/Services Discuss FP with partner At least once Age of marriage Children ever born 1.08 1.01 1.09 0.074 Ever use of contraception Yes 0.085 Current age 0.075 Disparity; male children 1.06*** 0.98 0.006 0.016 0.017 0.021 0.252 1.11 0.071 Exp(P) Std. Error 0.085 0.071 0.077 0.158

1.08 1.16 1.34***

1.06 1.02

0.087

1.05 1.38**

0.84**

0.069

1.14* 0.95** 1.14***

0.074 0.010 0.027

1.15**

0.078

Disparity: female children 1.02* 1.06 .084 0.100 0.084 Disparity: Total children Constant 0.95** 0.085***

Wife approval of FP Not sure 0.84 0.124 Approves 1.01 0.083 *p<0.10;**p<0.05;p<0.001 -2Loglikelihood=7102.172; Nagelkerke R^=0.127

Unlike the contraceptive use model, few variables are found to be significant in explaining the use of abortion among Yemeni women. Social and economic variables remain statistically significant, however. Women in urban areas have 1.34 times greater chance of having abortions compared to their rural counterparts. Women living in electrified households have 1.44 times higher odds of having an abortion than women residing in non-electrified households. Women employed in professional and service jobs have 1.38 times higher odds of having an abortion tban women who do not work. In contrast, the occupation status of the husband does not have any significant impact on Yemeni women having an abortion. Similar to the contraceptive use model, discussing family planning with one's partner is found to be significant in having an abortion. Women who had at least one discussion with their partner have 1.14 times higher odds of having an abortion than those who have never discussed family planning with their partners. Marrying at a later age decreases the odds of having an abortion, but as children ever bom increases, so do the odds of having an abortion. An increase in a woman's age also increases her chances of having an abortion. Interestingly, women who reported a disparity in

38

VOLUME 81, NUMBERS I &2

number of female children have higher odds of having an abortion than those who did not. Chances for an abortion decrease among women who reported a discrepancy in male number of children but it was not significant. A decrease in odds for an abortion is also observed among women who reported a discrepancy in total number of children.

Summary and Conclusion

Although the issue of women's reproductive health has aroused intemational concem in recent years, particularly in developing countries, the theoretical approaches used to explain levels of reproductive health are few and far between. While one might assume that understanding the fertility-controlling behavior of women is a significant factor in promoting improved reproductive health, many countries fail to do so. This study suggests that three reproductive components (age at marriage, use of contraceptives, and use of abortion) can help one understand the fertility behavior of women in Yemen. Assuming that controlling fertility behavior is only one ofthe many agents that provide for better reproductive health, these three factors take into account the major components involved in the reproductive process. The results of this study provide an opportunity to revisit some widely held assumptions about "Islamic doctrine" that are deemed incompatible with the concept of population control. While this study addresses the importance of understanding fertility-controlling factors, its limitations need to be recognized. First, it suffers from the non-availability of several theoretically important variables in the Yemen data set. It is restricted to available variables in the data set to measure the components of reproductive health. Tbis is reflected in the R-squared values reported in the analysis. Another limitation of this study is that the authors did not use any weights to account for the variation in the socioeconomic levels of the population living in North and South Yemen. These limitations notwithstanding, results from this study correspond with general accepted notions found in existing demographic literature concerning age at marriage, contraceptive use, and abortion. Consequently, this study has several policy implications. Fertility-controlling behavior is considered an elitist phenomenon in Yemen. Women who are living under the best social and economic conditions are more likely to adopt norms and values associated with small families and embrace family planning. For example, educated women are more likely to marry later and they are more likely to use contraceptives. Fertility-controlling behavior is also highest among women living in urban areas and those who live in households with better economic conditions (i.e., having electricity and use of pipe water). Husband-wife communication coneeming family planning and husband's approval of family planning are also found to be significant factors that contribute to contraceptive use in Yemen. These can be viewed as a welcoming gesture to the adaptability of birth control and a breakthrough from the barriers outlined by religious doctrine. One can argue that contrary to the belief among social and demographic researchers that Islam is a major hindrance to the practice of birth control and the idea of small family size, religious doctrines do not appear to influence at least a portion of Yemen's population. Diffusion of these ideas into the rural population is the next major challenge the govemment of Yemen faces in its efforts to limit that country's population growth. This challenge can be met successfully through policies that emphasize the benefits of family planning. Intervention programs such as Infonnation, Education and Communication (IEC) programs have experienced much success in limiting population growth in many developing countries. IEC programs emphasize education campaigns that provide information about all aspects of fertility control through various channels of communication. IEC programs

INTERNATIONAL SOCIAL SCIENCE REVIEW

39

may be one way to spread this message to the rural population. These programs are more effective in societies such as Yemen where the persistent influence of traditional norms and dominance of patriarchal beliefs exist."' Another major component that needs further attention is the political commitment towards strengthening and spreading the message of the use of family planning. Many countries in the Middle East have lowered their fertility levels significantly and are now moving towards the next stage of demographic transition. In the case of Yemen, one observes that despite the dominance and practice of traditional beliefs, knowledge of contraceptives is widespread. Yet, such knowledge is not reflected in the prevalence of contraceptive use. Narrowing the gap between knowledge of contraceptives and their use can be achieved through cooperation between religious and political leaders. Many countries in the region, such as Egypt and han, have undertaken a strong commitment to adopt policy changes to limit population growth through the support of both political and religious leaders."" Given the existing poor infrastructural conditions in Yemen, however, any future progress in fertility control can only be realized with the aid of intemational agencies.

ENDNOTES
'The ICPD was held in Cairo, Egypt from September 5-13, 2004. This was the third intemational population conference organized by the Population Division of the United Nations Department for Economic and Social Information and Policy Analysis and the United Nations Fund for Population Activities (UNFPA). More than 10,000 registered participants from 180 countries attended the conference. Participants included government officials, members from UN specialized agencies, and non-governmental organizations. They took part in negotiations to finalize a Program of Action regarding population and development for the next twenty years which emphasizes the importance of introducing developmental programs to meet the needs of individual men and women. ^United Nations, Report of the International Conference on Population and Development, 1995 (New York: United Nations, 1995), 5. ^Sandra D. Lane, "From Population Control to Reproductive Health: An Emerging Policy Agenda," Social Science and Medicine 39:9 (November 1994):1304. "Philippe Fargues, "The Decline of Arab Fertility," Population 44:1 (September 1989): 173-74; Hoda Rashad, "Demographic Transition in Arab Countries: A New Perspective," Journal of Population Research 17:1 (May 2000):83-85. ^Thomas R. Malthus, An Essay on the Principle ofPopulation: A View ofIts Past and Present Effects on Human Happiness with an Inquiry into Our Projects Respecting the Future Removal or Mitigation of the Evils Which It Occasions, 7th ed. (London: Reeves and Turner, 1872). 'Charles Hirschman, "Premarital Socioeconomic Roles and the Timing of Family Formation," Demography 22:1 (February 1985):52; Anju Malhotra and Amy Ong Tsui, "Marriage Timing in Sri Lanka: The Role of Modern Norms and Ideas," Journal of Marriage and the Family 58:2 (May 1996):488-89. Social and economic characteristics of the population include education level, income, occupation, and religion. 'Paula E. Hollerbach, "Fertility Decision-Making Process: A Critical Essay," in Determinants of Fertility in Developing Countries, eds. Rodolfo A. Bulatao and Ronald D. Lee (New York: Academic Press, 1983), 362. 'Frank L. Mott and Susan H. Mott, "Household Fertility Decisions in West Africa: A Comparison of Male Female Survey Results," Studies in Family Planning 16:2 (MarchApril 1985):98.

40

VOLUME 81, NUMBERS 1 & 2

'Alex C. Ezeh, "Gender Differences in Reproductive Orientation in Ghana: A New Approach to Understanding Fertility and Family Planning Issues in sub-Saharan Africa," in Demographic and Health Surveys World Conference: Proceedings, eds. Institute for Research Development (IRD) and Macro International (MI) (Columbia, MD: IRD/MI, 1991), 29. '"Vijayan K. Pillai and Guang-zhen Wang, Women s Reproductive Rights in Developing Countries (London: Ashgate Publishers, 1999), 186. "United Nations, Report of the International Conference on Population and Development, 1995, 5. 'Tillai and Wang, Women s Reproductive Rights in Developing Countries, 117-37. "Population Reference Bureau, World Population Data Sheet, 2002 (Washington, D.C.: Population Reference Bureau, 2002), 2. For Yemen's current fertility rate, see United Nations Development Program, Human Development Report, 2003 (New York: Oxford University Press, 2003), 252. '"Central Statistical Organization (CSO) and Macro International, Inc. (MI), Yemen Demographic and Maternal and Child Health Survey, 1997 (Calverton, MD: CSO and MI, 1998),151. "Population Reference Bureau, World Population Data Sheet, 2002, 2. "United Nations Development Program, Human Development Report, 2002, 236. "HDI is a sutnmary measure of human development. It measures the average achievements in a country in three basic dimensions of human development: a long and healthy life, as measured by life expectancy at birth; knowledge, as measured by the adult literacy rate; and, a decent standard of living, as measured by GDP per capita. United Nations Development Program, Human Development Report, 2002, 341. '*CSO and MI, Yemen Demographic and Maternal and Child Health Survey, 1997, 16. "Central Intelligence Agency, The World Fact Book, http://www.cia.gov/cia/publications/factbook/geos/ym.html#People (accessed December 18, 2003), 15. ^"CSO and MI, Yemen Demographic and Maternal and Child Health Survey, 1997, 75. ^'Ibid., 23. This rise in age of marriage has occurred in spite ofthe government's failed effort in 1998 to raise the minimum age of marriage to eighteen. "Susheela Singh and Renee Samara, "Early Marriage Among Women in Developing Countries," International Family Planning Perspectives 22:4 (December 1996):148. "Eltigani E. Eltigani, "Childbearing in Five Arab Countries," Studies in Family Planning 32:1 (March 2001): 19. ^'CSO and MI, Yemen Demographic and Maternal and Child Health Survey, 1997, 47. "Anne Helene Gauthier and Jan Hatzius, "Family Benefits and Fertility: An Econometric Analysis," Pcpw/afen Studies 51:3 (November 1997):299. ^'Paula E. Hollerbach, "Fertility Decision-Making Process: A Critical Essay," in Determinants of Fertility in Developing Countries, eds., Bulatao and Lee, 368. "Ezeh, "Gender Differences in Reproductive Orientation in Ghana," in IRD and MI, Demographic and Health Surveys World Conference: Proceedings, 15. ^"John Cleland and German Rodriguez, "The Effect of Parental Education on Marital Fertility in Developing Countries," Population Studies 42:3 (November 1988): 419. ^'Ruth Dixon-Mueller, Population Policy and Women s Rights (Westport, CT: Praeger, 1993), 138; Robert E. Lightboume and Alphonse L. MacDonald, Family Size Preferences, World Fertility Survey Comparative Studies No. 14 (Voorburg, The Netherlands: Intemationai Statistical Institute, 1982), 52.

INTERNATIONAL SOCIAL SCIENCE REVIEW

41

^"Susheela Singh, J.B. Casterline, and J.G. Cleland, "The Proximate Determinants of Fertility: Sub-national Variations," Population Studies 39:1 (March 1985): 114. ^'Hollerbach, "Fertility Decision-Making Process," in Determinants of Fertility in Developing Countries, eds. Bulatao and Lee, 362-63, 370-73. "Linda J. Beckman, "Communication, Power, and the Influence of Social Networks on Couple Decisions on Fertility," in Determinants of Fertility in Developing Countries, eds., Bulatao and Lee, 415-16; Terence H. Hull, "Cultural Influences on Fertility Decision Styles," in Determinants of Fertility in Developing Countries, eds., Bulatao and Lee, 38690; Mott and Mott, "Household Fertility Decisions in West Africa," 98; Ashraf Lasee and Stan Becker, "Husband-wife Communication about Family Planning and Contraceptive Use in Kenya," International Family Planning Perspectives 23:1 (March 1997): 19-20. "Ezeh, "Gender Differences in Reproductive Orientation in Ghana," in IRD and MI, Demographic and Health Surveys World Conference: Proceedings, 29. ^"Donna Lee Bowen, "Abortion, Islam, and the 1994 Cairo Population Conference," International Journal of Middle East Studies 29:2 (May 1997): 179-81. ''Ibid., 164. "^Malcolm Potts and Saba W. Masho, "Sterilization, Contraception, and Abortion: Global Issues for Women," Sexual and Marital Therapy 10:2 (August 1995):145. "Radheshyam Bairagi, "Effects of Sex Preference on Contraceptive Use, Abortion and Fertility in Matlab, Bangladesh," International Family Planning Perspectives 27:3 (September 2001): 137; Akinrinola Bankole, Susheela Singh, and Taylor Hass, "Characteristics of Women Who Obtain Induced Abortion: A Worldwide View," International Family Planning Perspectives 25:2 (June 1999):68; Stanley K. Henshaw, Susheela Singh, and Taylar Haas, "Recent Trends in Abortion Rates Worldwide," International Family Planning Perspectives 25:1 (March 1999): 44. ^'Eugenia Georges, "Abortion Policy and Practice in Greece," Social Science and Medicine 42:4 (February 1996): 509-10, 515; Brooke R. Johnson, Mihai Horga, and Laurentia Andronache, "Women's Perspective on Abortion in Romania," Social Science and Medicine 42:4 (February 1996):528. ^'Baochang Gu and Krishna Roy, "Sex Ratio at Birth in China with Reference to Other Areas in East Asia: What We Know," Asia Pacific Population Journal 10:3 (September 1995):41; S. Sudha and S. Irudaya Rajan, "Female Demographic Disadvantage in India, 1981-1991: Sex Selective Abortions and Female Infanticide," Development and Change 30:3 (July 1999):586-87. ""Bairagi, "Effects of Sex Preference on Contraceptive Use, Abortion and Fertility in Matlab, Bangladesh," 141-42. "'Bankole, Singh, and Hass, "Characteristics of Women Who Obtain Induced Abortion," 76. "^CSO and MI, Yemen Demographic and Maternal and Child Health Survey, 1997, 8. "Tred Arnold, Minja Kim Choe, and T.K. Roy, "Son Preference, the Family-building Process and Child Mortality in India," Population Studies 52:3 (November 1998):309; Petra Lofstedt, Luo Shusheng, and Annika Johansson, "Abortion Patterns and Reported Sex Ratios at Birth in Rural Yunnan, China," Reproductive Health Matters 12:24 (November 2004):91. "OLS regression, or ordinary least square regression, assumes that the independent variables are linearly associated with the outcome (or dependent) variable. "'In logistic regression, the dependent (or outcome) variable is a dichotomous variable (that is, only two categories, such as Yes and No). In OLS regression, the dependent variable is a continuous variable.

42

VOLUME 81, NUMBERS 1 & 2

""United Nations Fund for Population Activities, Developing Information, Education and Communication Strategies for Population Programs, Technical Paper Number 1 (New York: United Nations Fund for Population Activities, 1993). "Homa Hoodfar and Samad Assadpour, "The Politics of Population Policy in the Islamic Republic of Iran," Studies in Family Planning 31:1 (March 2000):20; Muhammad Faour, "Fertility Policy and Family Planning in Arab Countries," Studies in Family Planning 20:5 (September/October 1989):256.