The Sociocultural Environment The Demographic Aspect

The South Asian nations are characterized by high birthrates, rapidly declining overall death rates, and consequently high natural increases to their already large population bases. For example, Bangladesh, at current rates, will double its population in 25 years, Pakistan in 24, and India in 32 years. The immediate reality is that in spite of much lowered crude death rates in the 1980s, infant mortality rates are very high: 112 per 1,000 live births in Nepal, about 120 in Pakistan, and 138 in Bangladesh. A large proportion - nearly 40 percent - of the population of South Asia is composed of children under 15 years of age. Maternal and child health must therefore consume a large part of the national health budgets. Large families, especially of the poor, lead to a high incidence of protein-energy malnutrition (PEM). Migration to urban areas, and life in overcrowded houses and hutments mean constant exposure to pathogens.

Social Realities

In South Asia, irrespective of religious beliefs, most of which are expressed in Hinduism, there is a strong concept of social groupings or castes. The most important aspect of this system that concerns us here is that the lowest caste groups ("scheduled castes") constitute about 15 percent of India's population. They have not only been socially disadvantaged but also tend to be the poorest. They have traditional occupations such as sweeping, cleaning of human waste, skinning animals, and leather working, and are spatially segregated in the villages and cities. Although they are not ethnically different from the majority population, the hamlets of these predominantly landless workers are located separately from the main villages, and their densely populated clusters of huts are found on the outskirts of cities along major roads and railway lines. Living conditions in their settlements are extremely unhygienic because they lack waste disposal systems. Proximity to urban dumps, and pools of stagnant water in construction pits create ideal conditions for a very high density of flies and mosquitoes in their settlements.

Tribal cultural groups, collectively termed "scheduled tribes," who make up about 3 percent of India's population, live mostly in forested, agriculturally marginal areas of the eastern states, the northeastern part of peninsular India, and the degraded forests in Madhya Pradesh, Maharashtra, Rajasthan, and Gujarat. Many of these groups practice jhumming, or slash-and-burn agriculture, but others have migrated to cities and mining areas in search of employment. Because virtually all of their traditional habitat has been isolated, health programs have rarely been extended effectively to them.

Differential gender valuation is common in South Asia. Male children are valued more than females. This tendency is reflected in the actual share of food and health care that is available to female children, who may get a less nutritious diet. When sick, the males are more likely than females to receive medical attention. In general, it would appear that female morbidity is underreported.

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