TRANSITIONS TO ADULTHOOD

akistan currently has one of the largest cohorts ofyoung people in its history, with approximately 25million people between the ages of 15 and 24.Through the decisions they make and the opportu-nities they are offered, this group will play a crucialrole in the social, political, and economic develop-ment and stability of the country. Young people inthis age group face a number of critical life deci-sions as they negotiate the transition to adulthood:choices about leaving school, becoming employed,taking on greater responsibility, choosing a spouse,and starting a family.

Until recently, however, little was known aboutthe details of the lives of Pakistani youth. PopulationCouncil investigators, as part of the organization’sresearch into transitions to adulthood around theworld, sought to fill this knowledge gap. Theresearchers conducted the largest nationally repre-sentative survey ever to focus on this age group ofPakistanis. A total of 6,585 households in 254 com-munities were interviewed, including 4,530 adults(parents, where possible) and 8,074 young people.For the first time, Pakistani young people were askeddirectly about their lives, rather than having adultsspeak for them. The investigation yielded informa-tion about the state of education, work, and mar-riage and childbearing, among other insights.

“This survey’s findings should be translatedinto a social plan aimed at resolving health, edu-cation, and other problems that youth face,” statesPakistan’s Finance Minister, Shaukat Aziz, in apreface to a report of the survey’s findings. Thereport, Adolescents and Youth in Pakistan2001–02: A Nationally Representative Survey,was published in July 2003.

Education

The need to set up high-quality, well-functioningschools for children of both sexes, but particularlyfor females in rural areas, was one of the foremostfindings of the survey. Parents in Pakistan preferto send their children to single-sex schools.However, the number of schools available tofemales at each level falls far short of the numberof schools that are accessible to males, particular-ly in rural areas.

Roughly 50 percent of all females between 15and 24 have ever enrolled in school. Furthermore,those who do attend are more likely to drop out atan earlier level than their male counterparts. Thispattern of low enrollment for females is magnifiedamong the poorest Pakistani youth. “There is evi-dence that school enrollment and attainment hasincreased for females in the last five years,” saysPopulation Council deputy program managerMinhaj ul Haque, principal investigator for the sur-vey in Pakistan. “However, the gains are small andthe gender gap remains huge.”

Almost all males and females report ambi-tions for achieving higher educational levels thantheir parents attained, feeling that they should beeducated to either the secondary or university level.“While we found that educational aspirations arehigh, actual education attainment levels are muchlower. Poverty, lack of access, and poor school qual-ity all contribute to this gap,” says PopulationCouncil director of social science research CynthiaLloyd, a lead researcher.

October 2003 Volume 9, Number 3

Broad Survey of Pakistani Youth Completed

IN THIS ISSUE

• Transitions to Adulthood

• Quality of Care

• Biomedical Research

• Urban Studies

• Employment and Marriage

• Reference Works

continued on page 8

Improving family

planning services

provided at health

facilities can signifi-

cantly increase

contraceptive use

and continuation

rates.see page 2

P

mproving family planning services provided athealth facilities can significantly increase con-traceptive use and continuation rates, accord-ing to a recent study completed by PopulationCouncil researchers and their collaborators.“This is the first rigorous analysis that estab-lishes a link between quality of care and con-traceptive use,” write the authors of the study.

Why investigate quality?

Although high-quality care is a worthy end initself, family planning programs in developingcountries have often been justified and evaluat-ed solely in terms of their contribution to fertil-ity decline. Managers of family planning pro-grams have had little incentive to improvequality of services in the absence of empiricalevidence that better quality contributes toincreased contraceptive use or lower fertility.

At the same time, it seems intuitively likelythat increased contraceptive choice, enhancedtraining for health care providers, andimproved provider–client interactions in familyplanning facilities would result in more womenbeing satisfied with their care and meetingtheir reproductive goals. This hypothesis is sup-ported by some evidence but merits a more rig-orous exploration.

To this end, Population Councilresearchers Saumya RamaRao, MarilouCostello, and Heidi Jones collaborated withinvestigators from the Ateneo de DavaoUniversity in the Philippines. The researcherslooked at 80 health facilities in the provinces ofDavao del Norte and Compostela Valley, thePhilippines. They interviewed 1,728 familyplanning users who had obtained services atthese facilities between April and December1997. More than 80 percent of the respondentswere interviewed within six months of receivingcare. Interviews took place between September1997 and January 1998.

Known as the Davao project, the investiga-tion is one of four field studies being undertak-en by the Population Council under the ImpactStudies Program. The program is designed to

document the feasibility of improving quality ofcare and the effect of improved quality onwomen’s reproductive behavior. It is directed byAnrudh Jain, Population Council senior direc-tor of policy and regional programs.

Rating quality of care

The respondents were asked about the type offamily planning method they selected and aboutother characteristics, such as education level.They were also asked several questions regardingfive aspects of the care they received: needs

assessment, provision of information, methodchoice presentation, interactions betweenprovider and client, and follow-up care arrange-ments. The researchers assigned a quality of carescore on the basis of clients’ answers to questionsabout these facets of their care. Respondents whoreceived care near the mean level of quality weredeemed to have obtained medium-quality care,and those who received care that fell outside ofthis range were said to have gotten either low- orhigh-quality care. Twenty-seven percent ofrespondents received low-quality care, 37 percentreceived medium-quality care, and 36 percentreceived high-quality care.

Subsequently, the clients were reinter-viewed between May and August 1999 to obtaininformation on their contraceptive and repro-ductive behavior since the first round of inter-

views. By collecting information at two pointsin time, the researchers were able to assess theeffect of quality of services on subsequent con-traceptive use.

At the time of follow-up, 75 percent ofwomen said they currently used a contraceptivemethod, over two-thirds of them a modernmethod. Results from a cross-tabulation ofquality and contraceptive use at follow-up indi-cated that use of a modern method was greaterat the highest level of care than at the lowestlevel. Continuation of a modern method steadi-ly increased as the level of quality increased.This trend continued to be statistically signifi-cant even after adjusting for other variables,such as respondents’ education and income.

“This is a noteworthy result,” the authorswrite, “because previous analyses have indicat-ed that the effect of quality of care tends todiminish with the addition of socioeconomiccontrols,” such as education, employment, andwealth.

Many ways of improving quality of care—such as training providers in interview tech-niques that show respect for the client—costvery little to implement and can have a sub-stantial influence on clients’ subsequent choic-es. Research findings, for example, have shownrepeatedly that fearing and experiencing sideeffects are the main reasons women discontin-ue contraceptive use. “Our results suggest thatproviders can allay these legitimate fears if theyare trained in ways of presenting informationabout contraceptives and responding to clients’concerns,” says RamaRao.

“Clients at family planning and reproduc-tive health clinics deserve to receive high-quali-ty care,” says Jain. “This study provides addi-tional justification for improving services.” ■

SOURCERamaRao, Saumya, Marlina Lacuesta, Marilou Costello,Blesilda Pangolibay, and Heidi Jones. 2003. “The linkbetween quality of care and contraceptive use,”International Family Planning Perspectives 29(2): 76–83.

OUTSIDE FUNDINGThe Rockefeller Foundation and the United StatesAgency for International Development

2 P O P U L A T I O N B R I E F S 9 ( 3 ) S E P T E M B E R 2 0 0 3

Improved Care Increases Contraceptive Use

QUALITY OF CARE

I

Many ways of improving

quality of care cost very

little to implement and

can have a substantial

influence on clients’

subsequent choices.

onducting basic biomedical research, such asilluminating the events in cells at a molecularlevel, is a painstaking endeavor that can takedecades to produce major results. But knowledgegarnered from this type of study is crucial to theformulation of new drugs and the developmentof successful strategies for tackling health prob-lems. For more than 15 years, PopulationCouncil biomedical researcher James F. Catteralland his colleagues have been studying thegenetic mechanisms of action of male sex hor-mones, or androgens. Catterall is the director ofthe reproductive physiology and immunologyprogram at the Council’s Center for BiomedicalResearch. His lab has devised ingenious ways ofgleaning information about how androgens reg-ulate the activity of genes and why they affectcertain tissues and not others.

Scientists in the Catterall lab are studyingthe effects of androgen in the kidney, ratherthan in the reproductive system. “We expectandrogens to use the same mechanism ofaction in the kidney as they use in the repro-ductive system,” says Catterall.

By using kidney cells, the research team isable to simplify its studies. For example, germcells, which exist only in the reproductive sys-tem, undergo meiosis, the type of cell divisionthat results in sperm and eggs. At various pointsin this complex process, cells can have either thenormal amount of DNA, twice the normalamount of DNA, or half the normal amount ofDNA. The ever-varying amount of genetic mater-ial present in these cells complicates the analysisof gene regulation. Cells in the kidney, in con-trast, always have the normal amount of DNA;they never undergo meiosis. Catterall and hiscolleagues study the gene for the kidney andro-gen-regulated protein, known as the Kap gene.

The importance of androgens

Androgens, testosterone in particular, are essen-tial for male sexual function. Testosterone con-trols sex drive and the production of sperm,among many other functions. Much of theresearch conducted at the Center for

Biomedical Research is geared toward gaininga more complete understanding of male repro-ductive physiology and developing new malecontraceptives.

Genes make the proteins needed for vari-ous cellular tasks. All functional genes have asection called a “promoter.” The promoter pre-cedes the part of the gene that contains thecode, or recipe, for the gene’s protein.“Essentially, the promoter is a message for thecell’s protein-making apparatus that says ‘starthere,’ ” says Dianne O. Hardy, a scientist inCatterall’s lab.

Catterall and his colleagues wanted tostudy the Kap gene promoter to determine whatparts of it were involved in the regulation of the

gene by androgen. To do this, they created ahybrid gene in the laboratory. They took part ofthe promoter from the Kap gene and attachedit to the genetic code for another protein. Thenthey genetically engineered mice to carry thishybrid gene along with the normal Kap gene.

In these mice, the researchers could com-pare the activity of the hybrid gene to that of thenormal gene when androgen levels were manip-ulated experimentally. They were able to tell thedifference between the activities of the two genesby comparing the amounts of the two differentproteins they produce. The protein-coding sectionof the hybrid gene is known as the “reporter”because its activity in the cell provides informa-tion about the functioning of the promoter.

Catterall and his team removed a sectionof the hybrid gene’s promoter known as the L1

repeat. When they compared the hybrid gene’sactivity to that of the true gene, they found thatthe reporter gene no longer responded toandrogen. This surprised the researchersbecause the L1 repeat was previously thought tobe unnecessary for proper gene function. Nowthey believe that the L1 sequence is required forKap expression and its regulation by testos-terone. Catterall and his colleagues are con-ducting research to further quantify the role ofthe L1 repeat in the Kap gene.

In vivo or in vitro?

Most of the Catterall lab’s research has beendone in live animals, a practice known as invivo research. But this process can be time con-suming and costly. Recently, however, Hardyidentified a line of opossum kidney cells that arean appropriate model for conducting researchin culture dishes, or in vitro. This will allow thelab to use fewer animals in its research.

In the future, the investigators hope todetermine how androgen exerts its influence insome tissues and not in others. At least twothings may play a role in the specificity ofandrogen action. Variations in the promotersections of androgen-responsive genes probablyplay a role. Another factor may be the action ofco-regulator substances that are present insome tissues and not others. Tissue-specificcomplexes made from these substances maymodulate hormone action. ■

SOURCESHardy, Dianne O., En-Mei Niu, and James F. Catterall.2001. “Kap promoter analysis in vivo: A regulatoryrole for a truncated L1 repeat,” Molecular and CellularEndocrinology 181:57–67.

Ding, Yueming, Robin L. Davisson, Dianne O. Hardy,Li-Ji Zhu, David C. Merrill, James F. Catterall, and CurtD. Sigmund. 1997. “The kidney androgen-regulatedprotein promoter confers renal proximal tubule cell-specific and highly androgen-responsive expressionon the human angiotensinogen gene in transgenicmice,” Journal of Biological Chemistry 272(44):28142–28148.

OUTSIDE FUNDINGThe Andrew W. Mellon Foundation and the NationalInstitutes of Health

P O P U L A T I O N B R I E F S 9 ( 3 ) S E P T E M B E R 2 0 0 3 3

Unlocking the Mechanism of Androgen Action

BIOMEDICAL RESEARCH

“We expect androgens to

use the same mecha-

nism of action in the

kidney as they use in the

reproductive system.”

C

istorically, developing countries have beenlargely rural. As a result, demographers have focused on life cycle events—marriage,fertility, health, and schooling—in mainlyrural contexts. In the next 30 years, however,most of the world’s population growth willoccur in the cities and towns of Africa, Asia,and Latin America. This trend will transformthe developing world and generate unprece-dented challenges.

Recognizing the need for a better under-standing of issues related to urban populationgrowth, the National Research Council formedthe Panel on Urban Population Dynamics. Thepanel was chaired by Population Councildemographer Mark R. Montgomery andRichard Stren of the University of Toronto.Thirteen other scholars participated. The mem-bers reviewed existing literature and conductednew analyses. A report of their findings waspublished by National Academies Press.

Rapid changes

According to the panel, the world is in the midstof a fundamental economic restructuring, withless developed countries urbanizing and indus-trializing rapidly. The speed and scale of thesechanges pose risks to the environment andhealth. For example, expanding squatter settle-ments and shanty towns exacerbate urban congestion and hinder the provision of basicinfrastructure and amenities. There are benefitsto urbanization, though. Unlike rural areas,cities have a concentration of diverse social andeconomic resources, which, when properlymanaged, can become sources of innovationand advances in productivity.

One challenge to exploiting theseresources springs from a recent trend in whichnational governments and ministries havedecentralized the delivery of services related tohealth, family planning, and poverty allevia-tion. Responsibility for these tasks and for rev-enue raising has been transferred to local gov-ernments, few of which are equipped to takethem on.

Demographers are currently unable toprovide much evidence-based guidance forurban policymakers. Most of the available dataexamines simple rural/urban dichotomies,ignoring the diversity of life within and amongcities. Not only are there large and small cities,but these locales are populated by both richand poor people. Some of the poor live withinwealthier neighborhoods, while others are segregated in slums. Each of these settingsvaries with regard to health, fertility, and manyother factors. Adequate population data thatare comparable among and within cities, aswell as between urban and rural areas, areclearly needed.

Findings

By plumbing the available data, the panelfound that large urban areas enjoy a markedadvantage over smaller cities and rural areasin the provision of piped water, flush toilets,and electricity. For example, 31 percent of peo-ple in cities smaller than 100,000 lack theseamenities, while only 2 percent of people incities larger than 5 million lack them. Whenthey examined access to these services on thebasis of wealth, the researchers found thatrural residents still fare worse. In sub-SaharanAfrica, for example, 89 percent of rural vil-lagers lack these amenities, compared with 63percent of the urban poor and 34 percent ofbetter-off urban residents.

Perhaps because of the greater access toservices found in cities, urban dwellers havegenerally been thought to be healthier thanrural residents. Since the mid-1980s, however,

researchers have questioned this urban healthadvantage. Where urban poverty is spatiallyconcentrated—in slums—health risks canexceed those seen in rural areas. For example,one study showed that infant mortality is high-er in a Dhaka slum (134 deaths per 1000births) than in rural Bangladesh (93 deathsper 1000 births).

“The urban advantage in health is not amyth—but is only a partial truth,” saysMontgomery. “Where it exists, it is an advan-tage that has been constructed from politicalwill and from the marshaling of massive infra-structural and other economic investments.”

Urban governance

Solutions to urban problems are increasinglybeing sought at the city level as national gov-ernments decentralize basic service delivery.The panel identified many governance chal-lenges that will confront cities in the develop-ing world in the coming years. Cities will haveto increase their capacity to provide services,often with limited financial resources. Theywill have to cope with the diversity inherent inurban settings and deal with increasing urbanviolence and crime. Finally, they will have toovercome the difficulties of providing servicesin sprawling urban areas.

By 2030, more than 80 percent of the pop-ulation of North America, Europe, Oceania,and Latin America and more than 50 percentof the population of Asia and Africa will be liv-ing in urban areas. “Until demographers devel-op an understanding of all facets of the urban-ization process, their work will continue to beof marginal relevance to those charged withthe design of better urban policies,” concludesthe panel. ■

SOURCEMontgomery, Mark R., Richard Stren, Barney Cohen,and Holly E. Reed (eds.). 2003. Cities Transformed:Demographic Change and Its Implications in theDeveloping World. A report of the National ResearchCouncil Panel on Urban Population Dynamics.Washington, DC: National Academies Press.

4 P O P U L A T I O N B R I E F S 9 ( 3 ) O C T O B E R 2 0 0 3

Transformation in World’s Cities Explored

URBAN STUDIES

H

“The urban advantage

in health is not

a myth—but is only

a partial truth.”

rends in work and marriage have shifted dra-matically in Egypt, particularly since the1960s. Women are getting married later thanever and, although work opportunities havestagnated recently, women are working outsidethe home more than they did historically.Learning about the relationship between workand marriage may be crucial for understand-ing a number of other phenomena related togender roles, including trends in educationand childbearing. Population Council demog-rapher Sajeda Amin collaborated with Cairo-based researcher Nagah H. Al-Bassusi toexplore how working women in Egypt viewmarriage and work.

Amin and Al-Bassusi analyzed nationaldata published by the United Nations on long-term marriage trends and by Egypt’s CentralAgency for Public Mobilization and Statistics(CAPMAS) on labor force trends in 1988 and1998. The Population Council developed a set ofquestions about young people that were incor-porated into the 1998 survey administered byCAPMAS and also conducted a qualitative studyof young female wage workers. The CAPMASsurveys were nationally representative. The 1988survey reached 28,286 individuals, 2,709 ofwhom were women between the ages of 15 and24. The 1998 survey reached 23,997 individuals,2,438 of whom were women between 15 and 24.

The researchers found that, in 1988, 22percent of 15–19-year-old women and 57 per-cent of 20–24-year-old women were married.By 1998, those figures had declined to 11 per-cent and 44 percent respectively. (Exploringlonger-term trends, demographers have deter-mined that the decline in the proportions whomarried at young ages began between 1966and 1976.)

Concurrently, the CAPMAS data showedthat the rate of employment has not increased,while educational attainment has. In 1988, 27percent of women aged 15–24 were in school,and 29 percent of them were employed. In1998, those figures were 38 percent and 26 per-cent, respectively. An increase in women work-ing has remained elusive despite the imple-

mentation of economic policies, such as invest-ing in the textile export industry, that observersbelieved would boost young women’s employ-ment. Women who do work, however, are work-ing longer hours than they did in the past.

Changes in marriage expectations

Several analyses of marriage in Egypt havesuggested that the number of material goodsobtained by young couples in preparation formarriage has increased in recent years.Moreover, newly married couples are morelikely to want to live in their own householdafter marriage, mandating additional setupcosts, rather than accepting the less expensiveoption of living with extended family. These

rising aspirations may have been driven bylabor migration of young Egyptian men to thePersian Gulf region. This migration has led toan increase in income that allowed suchexpensive tastes to develop despite the lack ofeconomic opportunities locally.

Engagements at a relatively young agehave remained common, but the length ofengagements has increased in order to providetime for the accumulation of goods now seenby many young couples in Egypt as necessaryfor marriage. Women’s employment is one wayof meeting costs and building a dowry. “Thesociety appears willing to accommodate a lot ofwaiting and bargaining to meet these goals,”says Amin.

Working women’s views

The qualitative study of young female wageworkers conducted by the Population Councilbetween 1998 and 2000 took place in threelocations in northern Egypt: an urban area, aninvestment zone on the coast, and a rural vil-lage. The researchers conducted multiple in-depth interviews with a total of 27 randomlyselected women in these locations between theages of 15 and 29. All of the women had expe-rience working in formal, full-time jobs insales and services, garment manufacturing,and small factories.

The women reported overwhelmingly thata primary reason they took a job was to pre-pare for marriage. Although arranged mar-riages are still the norm in Egypt, the womeninterviewed reported being actively involved inthe process of finding a husband and exercisedsome control, either direct or indirect, in thedecision. For example, one woman said, “I wasengaged to my cousin about three yearsago…. In fact, I did not love him. I did nottreat him the way he would like,” and theengagement was eventually called off.

Whether engaged or not, all of the respon-dents spoke of saving for marriage with theexpectation of carrying a substantial trousseau(gehaz) into the new home. One respondentpaid for her transportation from her salary, butsaved the rest for her gehaz. Another respon-dent, who was recently married, contributed3,000 out of the 8,000 pounds required for hermarriage. In addition to working, manywomen and their families go into debt in orderto obtain the money needed for marriage.“These women are not defying marriage byworking,” says Amin. “They see work as a wayof facilitating marriage.” ■

SOURCEAmin, Sajeda and Nagah H. Al-Bassusi. 2003. “Wagework and marriage: Perspectives of Egyptian workingwomen.” Policy Research Division Working Paper no.171. New York: Population Council.

OUTSIDE FUNDINGThe International Development Research Centre ofCanada, the Rockefeller Foundation, and the UnitedStates Agency for International Development

P O P U L A T I O N B R I E F S 9 ( 3 ) O C T O B E R 2 0 0 3 5

Egyptian Working Women’s Perceptions of Marriage

“These women are not

defying marriage.

They see work as a

way of facilitating

marriage.”

EMPLOYMENT AND MARRIAGE

T

he newly published Encyclopedia ofPopulation provides a comprehensiveappraisal of the field of population studies.The reference work was badly needed, as thelast encyclopedia of population was publishedmore than two decades ago in 1982. “In the1980s, population issues seemed to many peo-ple to connote little else but rapid populationgrowth and measures to curtail it,” write theeditors, Paul Demeny and Geoffrey McNicoll,in their preface. “Today, population growth isone concern among many.” Both editors havelong associations with the Population Council.Demeny, who holds the position ofDistinguished Scholar, is founder and editor ofthe Council’s journal Population andDevelopment Review. McNicoll is a seniorassociate at the Council. Both have writtenextensively on population and developmentissues.

The Encyclopedia of Population isdirected both to professionals in the populationsciences reading outside their immediate areasof expertise and to other social scientists, col-lege students, advanced high school students,and the educated lay reader. “An effort is madeto avoid material and jargon that wouldrequire specialized knowledge,” write the edi-tors, “but without losing significant detailthrough undue simplification.” The two-vol-ume set includes 336 short articles written by278 authors. The contributors are experts froma wide range of disciplinary backgrounds:anthropology, biology, demography, economics,geography, history, law, literature, philosophy,political science, public health, and sociology.More than one-third of them are from outsidethe United States.

Expanding the boundaries

Along with the standard demographic entriesand biographies of persons notable in the field,

topics covered in the encyclopedia help todelineate a broadened scope of populationstudies. Among these are: AIDS, aging of popu-lation, animal ecology, childlessness, climatechange and population, emerging infectiousdiseases, environmental ethics, feminist per-spectives on population issues, human extinc-tion, and population in literature. “If [thisencyclopedia] has an ambition beyond theutilitarian it is to push out the boundaries ofthe subject.”

Practical information

The editors have not neglected the core of thefield, demography. Subjects related to this, too,are treated in a reader-friendly fashion. In herarticle on population dynamics, for example,Heather Booth of the Australian NationalUniversity, Canberra, provides a basic introduc-tion to the topic. She describes populationgrowth and decline, population age structure,and population momentum and aging, avoid-ing complicated mathematics.

Other demographic topics that are eachexplored in several articles are: applied demog-raphy, demographic techniques, economicdemography, fertility, historical demography,

mortality and health, political demography,population statistics and data collection, pre-historic demography, reproduction and birthcontrol, and urban demography.

Controversial issues

The editors also plumb controversial issues.The ethical concerns raised by genetic testingand new reproductive technologies are dis-cussed, for example. The debate over animalrights is described, as are questions of environ-mental ethics and euthanasia. “Not a few top-ics in population studies are contentious, eitherin terms of research findings or, more basically,in terms of their political and ethical premisesor implications,” write the editors.“Unsurprisingly, the various authors writing onmatters related to such topics may often takediffering positions. We have not sought to sup-press those differences, but rather to ensure arough overall degree of balance among thearticles.”

“A test of such a work,” conclude Demenyand McNicoll, “is the extent to which it repaysbrowsing and offers the reader serendipitousdiscoveries and insights.” The encyclopedia isavailable from Macmillan Reference USA. Aword-searchable electronic version is planned,to be accessible through Gale eBooks andnetLibrary. ■

SOURCEDemeny, Paul and Geoffrey McNicoll (eds.). 2003.Encyclopedia of Population. New York: MacmillanReference USA.

6 P O P U L A T I O N B R I E F S 9 ( 3 ) O C T O B E R 2 0 0 3

New Population Encyclopedia Offers Thorough Review,Reflects Expanded Scope of Field

T

“If this encyclopedia

has an ambition

beyond the utilitarian

it is to push out

the boundaries of

the subject.”

REFERENCE WORK

All issues of Population Briefs are available on the Population Council’sWeb site: http://www.popcouncil.org/publications/popbriefs/default.htm

P O P U L A T I O N B R I E F S 9 ( 3 ) O C T O B E R 2 0 0 3 7

Biomedical Research

Contraceptive development and productsChen, Y.M., N.P.Y. Lee, D.D. Mruk, W.M. Lee, and C.Y. Cheng.“Fer kinase/FerT and adherens junction dynamics in thetestis: An in vitro and in vivo study,” Biology of Reproduction69(2): 656–672.

Lau, A.S.N. and D.D. Mruk. “Rab8B GTPase and junctiondynamics in the testis,” Endocrinology 144(4): 1549–1563.

Lee, N.P.Y., D.D. Mruk, W.M. Lee, and C.Y. Cheng. “Is the cad-herin/catenin complex a functional unit of cell–cell actin-based adherens junctions in the rat testis?” Biology ofReproduction 68(2): 489–508.

Lui, W.Y., W.M. Lee, and C.Y. Cheng. “Sertoli–germ celladherens junction dynamics in the testis are regulated byRhoB GTPase via the ROCK/LIMK signaling pathway,”Biology of Reproduction 68(6): 2189–2206.

Mruk, D.D., M.K.Y. Siu, A.M. Conway, N.P.Y. Lee, A.S.N. Lau, andC.Y. Cheng. “Role of tissue inhibitor of metalloproteases-1 in junc-tion dynamics in the testis,” Journal of Andrology 24(2): 510–523.

Saleh, S.I., S.H. Khidr, S.M. Ahmed, T.M. Jackanicz, and H.A.Nash. “Estradiol–progesterone interaction during the prepa-ration of vaginal rings,” Journal of Pharmaceutical Sciences92(2): 258–265.

Segal, Sheldon J. “Modern methods of contraception,” in Paul

Demeny and Geoffrey McNicoll (eds.), Encyclopedia ofPopulation. New York: Macmillan Reference USA, pp. 170–174.

Siu, M.K.Y., W.M. Lee, and C.Y. Cheng. “The interplay of colla-gen IV, tumor necrosis factor-a, gelatinase B (matrix metallo-protease-9), and tissue inhibitor of metalloproteases-1 in thebasal lamina regulates Sertoli cell-tight junction dynamics inthe rat testis,” Endocrinology 144(1): 371–387.

Siu, M.K.Y., D.D. Mruk, W.M. Lee, and C.Y. Cheng. “Adheringjunction dynamics in the testis are regulated by an interplayof b 1-integrin and focal adhesion complex-associated pro-teins,” Endocrinology 144(5): 2141–2163.

Reproductive health product developmentYlänen, K., T. Laatikainen, P. Lähteenmäki, and A.J. Moo-Young.“Subdermal progestin implant (Nestorone®) in the treatment ofendometriosis: Clinical response to various doses,” ActaObstetricia et Gynecologica Scandinavica 82(2): 167–172.

Reproductive physiology

Akingbemi, B.T., R.S. Ge, C.S. Rosenfeld, L.G. Newton, D.O. Hardy,J.F. Catterall, D.B. Lubahn, K.S. Korach, and M.P. Hardy. “Estrogenreceptor-a gene deficiency enhances androgen biosynthesis inthe mouse Leydig cell,” Endocrinology 144(1): 84–93.

Bernard, D.J. “SMAD expression in the testis predicts age-and cell-specific responses to activin and TGFb,” Journal ofAndrology 24(2): 201–203.

Gao, H.B., M.H. Tong, Y.Q. Hu, H.Y. You, Q.S. Guo, R.S. Ge, andM.P. Hardy. “Mechanisms of glucocorticoid-induced Leydigcell apoptosis,” Molecular and Cellular Endocrinology199(1–2): 153–163.

Lee, N.P.Y. and C.Y. Cheng. “Regulation of Sertoli cell tightjunction dynamics in the rat testis via the nitric oxide syn-thase/soluble guanylate cyclase/3’,5’-cyclic guanosinemonophosphate/protein kinase G signaling pathway: An invitro study,” Endocrinology 144(7): 3114–3129.

Lui,W.Y., W.M. Lee, and C.Y. Cheng. “Rho GTPases and sper-matogenesis,” Biochimica et Biophysica Acta 1593(2–3): 121–129.

———. “TGF-bs: Their role in testicular function and Sertolicell tight junction dynamics,” International Journal ofAndrology 26(3): 147–160.

———. “Transforming growth factor b3 regulates thedynamics of Sertoli cell tight junctions via the p38 mitogen-activated protein kinase pathway,” Biology of Reproduction68(5): 1597–1612.

Lui, W.Y., D.D. Mruk, W.M. Lee, and C.Y. Cheng. “Adherensjunction dynamics in the testis and spermatogenesis,”Journal of Andrology 24(1): 1–14.

———. “Sertoli cell tight junction dynamics: Their regulationduring spermatogenesis,” Biology of Reproduction 68(4):1087–1097.

Lui, W.Y., D.C.H. Wong, D.D. Mruk, and C.Y. Cheng. “TGF-b3regulates the blood–testis barrier dynamics via the p38 mito-gen activated protein (MAP) kinase pathway: An in vivostudy,” Endocrinology 144(4): 1139–1142.

Morris, D.J., A.S. Brem, R.S. Ge, P.H. Jellinck, R.R. Sakai, andM.P. Hardy. “The functional roles of 11 b-HSD1: Vascular tis-sue, testis and brain,” Molecular and Cellular Endocrinology203(1–2): 1–12.

Walch, L., E. Clavarino, and P.L. Morris. “Prostaglandin (PG)FP and EP1 receptors mediate PGF2a and PGE2 regulation ofinterleukin-1b expression in Leydig cell progenitors,”Endocrinology 144(4): 1284–1291.

Building Research Capacity andTools/Capacity Building

Developing or adapting tools for reproductive health research

Hewett, Paul C., Annabel S. Erulkar, and Barbara S. Mensch.“The feasibility of computer-assisted survey interviewing inAfrica: Experience from two rural districts in Kenya.” PolicyResearch Division Working Paper no. 168. New York:Population Council.

Gender and Family DynamicsFamily dynamicsMensch, Barbara S., Barbara L. Ibrahim, Susan Lee, andOmaima El-Gibaly. “Gender role attitudes among Egyptianadolescents,” Studies in Family Planning 34(1): 8–18.

HIV/AIDSBasic science of infectionKetas, T.J., I. Frank, P.J. Klasse, B.M. Sullivan, J.P. Gardener, C. Spenlehauer, M. Nesin, W.C. Olson, J.P. Moore, and M. Pope.“Human immunodeficiency virus type 1 attachment, coreceptor,and fusion inhibitors are active against both direct and transinfection of primary cells,” Journal of Virology 77(4): 2762–2767.

Ketas, T., P.J. Klasse, C. Spenlehauer, M. Nesin, I. Frank, M. Pope, J.M. Strizki, G.R. Reyes, B.M. Baroudy, and J.P.Moore. “Entry inhibitors SCH-C, RANTES, and T-20 block HIVtype 1 replication in multiple cell types,” AIDS Research andHuman Retroviruses 19(3): 177–186.

Steinman, R.M., A. Granelli-Piperno, M. Pope, C. Trumpfheller,R. Ignatius, G. Arrode, P. Racz, and K. Tenner-Racz. “Theinteraction of immunodeficiency viruses with dendritic cells,”in A. Steinkasserer (ed.), Dendritic Cells and Virus Infection,vol. 276. New York: Springer-Verlag, pp. 1–30.

Veazey R.S., R.J. Shattock, M. Pope, J.C. Kirijan, J. Jones, Q. Hu, T. Ketas, P.A. Marx, P.J. Klasse, D.R. Burton, and J.P.Moore. “Prevention of virus transmission to macaque mon-keys by a vaginally applied monoclonal antibody to HIV-1gp120,” Nature Medicine 9(3): 343–346.

PreventionBraunstein, Sarah and Janneke van de Wijgert. “Culturalnorms and behavior regarding vaginal lubrication during sex:Implications for the acceptability of vaginal microbicides forthe prevention of HIV/STIs.” Robert H. Ebert Program onCritical Issues in Reproductive Health publication series.New York: Population Council.

Population and Social Science Research

JournalPopulation and Development Review 29(2)

Child health and survivalBhargava, Alok, Howarth E. Bouis, Kelly Hallman, and BilqisA. Hoque. “Coliforms in the water and hemoglobin concen-tration are predictors of gastrointestinal morbidity ofBangladeshi children ages 1–10 years,” American Journal ofHuman Biology 15(2): 209–219.

Policy developmentDemeny, Paul. “Population policy dilemmas in Europe at thedawn of the twenty-first century,” Population andDevelopment Review 29(1): 1–28.

Quality of Services/Quality of Care

TrainingRamaRao, Saumya, Marlina Lacuesta, Marilou Costello,Blesilda Pangolibay, and Heidi Jones. “The link betweenquality of care and contraceptive use,” International FamilyPlanning Perspectives 29(2): 76–83.

Reproductive Health

JournalStudies in Family Planning 34(2)

ContraceptionJain, Anrudh. “Religion, state and population growth,” inDaniel C. Maguire (ed.), Sacred Rights: The Case forContraception and Abortion in World Religions. Oxford:Oxford University Press, pp. 237–254.

Reducing unsafe abortionLara, Diana, Libby Klein, Sandra G. García, and Davida

Becker. “Abortion in Mexico,” report. Mexico City: PopulationCouncil (available in English and Spanish).

Reproductive tract infections and sexually transmitted infectionsJejeebhoy, Shireen and Michael Koenig. “The social contextof gynaecological morbidity: Correlates, consequences andhealth seeking behaviour,” in Shireen Jejeebhoy, MichaelKoenig, and Christopher Elias (eds.), Reproductive TractInfections and Other Gynaecological Disorders: AMultidisciplinary Research Approach. Cambridge: CambridgeUniversity Press, pp. 30–81.

Jejeebhoy, Shireen, Michael Koenig, and Christopher Elias(eds.). Reproductive Tract Infections and OtherGynaecological Disorders: A Multidisciplinary ResearchApproach. Cambridge: Cambridge University Press.

———. “Community interaction in studies of gynaecologicalmorbidity: Experiences in Egypt, India and Uganda,” in Shireen

Jejeebhoy, Michael Koenig, and Christopher Elias (eds.),Reproductive Tract Infections and Other GynaecologicalDisorders: A Multidisciplinary Research Approach. Cambridge:Cambridge University Press, pp. 140–147.

———. “Introduction and overview,” in Shireen Jejeebhoy,Michael Koenig, and Christopher Elias (eds.), ReproductiveTract Infections and Other Gynaecological Disorders: AMultidisciplinary Research Approach. Cambridge: CambridgeUniversity Press, pp. 1–10.

Safe motherhood/postpartum careMiller, Suellen, Nancy L. Sloan, Beverly Winikoff, Ana Langer,and Fariyal Fikree. “Where is the ‘E’ in MCH? The need for anevidence-based approach in safe motherhood,” Journal ofMidwifery & Women’s Health 48(1): 10–18.

Philip, Neena, Caitlin Shannon, and Beverly Winikoff.“Misoprostol and teratogenicity: Reviewing the evidence—Report of a meeting.” Robert H. Ebert Program on CriticalIssues in Reproductive Health publication series. New York:Population Council.

Segal, Sheldon J. “Spontaneous abortion,” in Paul Demeny

and Geoffrey McNicoll (eds.), Encyclopedia of Population.New York: Macmillan Reference USA, pp. 913–914.

Transition to Adulthood

Experimental programsRamaRao, Saumya and Nafissatou J. Diop. “Serving the repro-ductive health needs of adolescents in Senegal: Analysis ofcosts,” Frontiers project report. Washington, DC: PopulationCouncil.

Other Council PublicationsDemeny, Paul and Geoffrey McNicoll (eds.). Encyclopedia ofPopulation. New York: Macmillan Reference USA.

Population Briefs 9(2)

RECENT PUBLICATIONS

Publications are by Population Council staff members and consultants. Year of publication is 2003 unless otherwise noted. Names in boldface are staff members.

Transitions to Adulthoodcontinued from page 1

Time use and work

Young males and young females in Pakistan,particularly those who are not in school, spendtheir time very differently. While most youngmen eventually enter the paid labor force out-side the home, less than 40 percent of youngwomen have entered the workforce by age 24.Females are most likely to work inside the homeon domestic chores. These work arrangementsreflect very different mobility patterns, withmales being much freer than females to leavethe home unaccompanied. But, “these youngwomen are not idle,” states Zeba Sathar,Population Council country director in Pakistanand a lead investigator on the survey. “We foundthat at every age between 15 and 24, womenwork longer hours than men.” (See graph.)

Recently, however, there has been a slightrise in paid work among females aged 15 to 19in comparison to the cohort born five years ear-lier. Most young people, men and women, workin agriculture. Other types of work are segregat-ed by gender, with females engaged in stitching,embroidery, and knitting (largely based athome) while young men work in factories, areself-employed, or perform skilled labor. Youngpeople’s attitudes about gender roles remaintraditional, with well-defined lines between thedomains of males and females.

Marriage and childbearing

The gap between the onset of puberty and thetime of marriage for females and males is grow-ing as a result of an increasing age at marriage.For females, however, there is little substantive,

skills-enhancing activity to fill this growing gap.Females in rural areas continue to marry muchearlier than those in urban areas. A rural ado-lescent female is more than twice as likely asher urban peer to be married before age 20 (58percent versus 27 percent).

The birth of a child tends to follow fairlyquickly upon marriage. Worryingly, “survey dataindicate that females between the ages of 15 and19 are receiving less antenatal care and are lesslikely to have a medically trained attendant attheir first births than were females between theages of 20 and 24,” says Council program asso-ciate Judith Diers, a researcher on the study.Thus, not only are younger women facing thedangers associated with early childbirth, buttheir risks are further elevated by less access toprofessional care before and during the birth.

The survey’s findings will likely informPakistan’s emerging national youth policy. Inresponse to insights gleaned from the investiga-tion, the Population Council plans to continuein-depth research into primary schooling oppor-tunities in the country’s rural communities.“Although students at these schools are not yetadolescents, these establishments are of theutmost importance for ensuring positive andhealthy transitions to adulthood among futuregenerations,” says Barbara Ibrahim, Councilregional director for West Asia and North Africa.

Economic growth and prosperity “are notautomatic; they will depend on whetherPakistan succeeds in providing better education,minimizing the gender gap, and creating jobopportunities for today’s adolescents and youthin the country,” emphasizes Finance Minister

Aziz. Young people are no doubt the mostimportant resource for the country’s future, henotes. “But the government alone can’t do it—we need the world of NGOs, we need the world ofcivil society, we need the world of philanthropyto help us achieve this goal.” ■

SOURCESathar, Zeba A., Cynthia B. Lloyd, Minhaj ul Haque,Judith A. Diers, Azeema Faizunnissa, Monica Grant,and Munawar Sultana. 2003. Adolescents and Youth inPakistan 2001–02: A Nationally Representative Survey.Islamabad, Pakistan: Population Council.

OUTSIDE FUNDINGDepartment for International Development (UK), theRockefeller Foundation, UNICEF/Pakistan, and theUnited Nations Population Fund

To order Adolescents and Youth in Pakistan 2001–02: A Nationally Representative Survey, contact KhalidMehmood (khalid@pcpak.org or Information Officer,Population Council, House # 7, Street 62, F-6/3,Islamabad - 44000, Pakistan).

A PDF of the report can be downloaded at www.popcouncil.org/pdfs/ayp0102.pdf. Please note thisreport is over 8MB in size.

8 P O P U L A T I O N B R I E F S 9 ( 3 ) O C T O B E R 2 0 0 3

Males Females Males Females0

2

4

6

8

10

Hour

s pe

r day

Domestic choresUnpaid workPaid work15–19 20–24

Domestic, paid, and unpaid work (hours per day)

6.1

4.5

8.4

7.0

October 2003 Vol. 9, No. 3

Population Briefs is a research newsletter of the PopulationCouncil. The Council is an international, nonprofit, non-governmental organization that seeks to improve the well-being and reproductive health of current and future genera-tions around the world and to help achieve a humane, equi-table, and sustainable balance between people andresources. The Council conducts biomedical, social science,and public health research and helps build research capaci-ties in developing countries. Established in 1952, the Councilis governed by an international board of trustees. Its NewYork headquarters supports a global network of regional andcountry offices.

Writer/EditorGina Duclayan

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