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It is evident that the sexual and reproductive health of adolescents has emerged as an issue of great concern in Asia. This is based on two demographic trends that exist in the region: the widening gap between sexual maturity and age at marriage, and the continuing prevalence of adolescent marriage and low contraceptive use during adolescence.

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Fourteen countries in Asia have total fertility rates at or below replacement level. This is more pronounced in China, Japan, the Republic of Korea, Singapore and Thailand. The implications are far-reaching and profound as they affect the age structure of the population, giving rise to population ageing, labour force shortages, increased elderly dependency ratios and feminization of the aged population. Evidence from European countries suggests that although fertility may rebound, in most countries it is highly unlikely that fertility will recover sufficiently to reach replacement level in the near future. Mortality reduction will continue to be an overriding policy goal, which would further enhance the ageing process. Therefore, the greatest challenge will be to pension systems, old-age care systems, and health systems or health insurance. This paper first examines the fertility transition in five low-fertility countries. It then discusses the policy measures that these countries have adopted in response to low fertility and population ageing. The paper concludes with the policy implications for healthcare, social care, income security and caregiving facility, and the scope for further study.

SummaryThis examination of the effect of birth spacing on infant and child mortality in rural Nepal is based on data from the Nepal Fertility Survey 1976 carried out by the Nepal Family Planning and Maternal Child Health Project in collaboration with the World Fertility Survey. The study confirms that the higher risk of infant death to first-born children is mainly due to the higher proportions of younger women having first births, rather than due to their being first order births per se. The effect of maternal age on infant and child mortality is largely associated with birth interval. Previous birth interval, therefore, stands out as the most important factor affecting infant mortality; the next most important factor is the survival of the preceding child.