Publication Date

1979

Introduction/Abstract

INTRODUCTION

Taiwan's place among the population hierarchy remains dwarfed by the shadow of China's nearly billion people. Yet Taiwan's population exceeds 17 minion and as such cis larger than that of most African, (e.g., Ghana, Kenya, Uganda), most Latin American (e.g., Chile, Cuba, Ecuador, Guatemela, Venezuala), and many Asian countries. Indeed, its exceptional family planning efforts, begun in 1964 on an island-wide basis, have been instrumental in lowering its natural increase rate from 30 per 1,000 in 1963 to 19 by 1973. This drop from 3% to less than 2% in a decade has been a remarkable achievement. The island, however, remains faced with the perplexing reality that in spite of intensive educational and service inputs, the crude birth rate has been stalled at 23 per 1,000 since 1973 (rising to 25.9 in 1976 and down again to 23.8 in 1977).

The present three-year Family Planning Promotion Plan, which is part of the ongoing National Six-Year Economic Development Plan, calls for a lowering of the population increase rate to 1.7% by 1981. Such an achievement seems a difficult task with the rapidly increasing numbers of younger women who are entering marriagable ages. In addition to its efforts to shift emphasis to promoting later marriage, earlier use of contraception, and birth spacing among younger women, the government also has begun to consider relaxing present legal restrictions relating to induced abortion, including review of the present Cr"imina1 Law Code, and establishment of an Eugenic Protection Law.

The existing bibliography on the closely-evaluated Taiwan family planning program is extensive (Chinese Center for International Training in Family Planning, 1974) but relatively little study has been done on induced abortion to pave the way for change, presumably because of its officia1 illegality in spite of widespread availability. This survey assesses the ethical orientations about induced abortion of the several hundred field workers who provide family planning education and services to the people of Taiwan. These workers represent the major link between the public health administration and the people the government serves and their attitude toward abortion seems critical to future population planning. The study also reviews their knowledge about abortion availability, practice, and referrals. In addition it explores the relationship of their basic beliefs about the value assessments of human life to their ethical judgments about induced abortion. These beliefs and value assessments are studied to provide some better understanding of how they may affect the value judgments a worker may make about an ethical mode of behavior regarding a woman having an abortion under a particular circumstance.

The actual survey was preceeded by more than a year of exploratory interviews, research review, consultation with experts, and pretesting of research instruments. It took place in late 1973 and covered 399 workers at 19 county and city health bureaus around the island. Only 14 of the 413 family planning workers did not attend the interview sessions scheduled at their county/city health bureaus: an impressive response rate (97%) considering that the interviewing was done during the typhoon season. Those unable, to attend (due to weather conditions or sickness) were not found to differ significantly from those attending. The 399 respondents represented virtually all geographic areas: from remote rural ones (including salt flats and mountainous areas) to semi -rural and suburban towns as well as highly-urbanized districts in large cities such as Kaohsiung, Taichung, Tainan and Keelung.

The research questionnaire which took the workers from two and a half to three hours to complete is described below:

Part 1: Ethical judgments about the IUD and the pill, sterilization, and induced abortion (74 items taking l-l-~ hours to complete).

Part 2: Basic beliefs about human life and value assessments of human life (11 questions taking 20-30 minutes).

Part 3: Judgments about fertility-related areas (32 items on spacing, two-child norm, sex preference, etc.).

Part 4: Vital data (24 questions), religion (14 questions), and experience with abortion (11 questions) (Part 3 and 4 administered together taking 30-40 minutes).

The ethical judgment scales were patterned after ones developed for use with U.S. public health professionals (Knutson, 1972) but their major thrust was toward the cognitive framework of the Taiwan field workers and the Taiwan social and cultural setting. The questions on beliefs and value assessments about human life relied heavily on a previous inventory developed by Knutson and tested in the U.S., India, Thailand, and Taiwan in an exploratory English form in the late 1960's (1972, 1973) which was modified slightly to fit the Taiwan cultural melieu.

The analysis involves two approaches. The first is use of the responses to the ethical judgment items to describe the nature and extent of the circumstances under which the field workers indicate that induced abortion should or should not be done and to provide scores to indicate comparative favorab"ility to induced abortion. This involves a descriptive review including the use of Guttman-type scales to provide a cumulative ordered sequence of these ethical judgment positions in terms of their acceptability. The second includes: (a) reviewing individual basic beliefs and ideal value assessments about human life in terms of each1s associational and directional relationship to the abortion judgment scores of the workers (based on a 25-item Likert-like scale) and whether they ever referred for abortion; (b) determining the percent of variance in the scale scores accounted for by individual basic beliefs and selected demographic variables.

The analysis is followed by a discussion of practical implications of the findings for population planning in Taiwan and suggestions for further research.

The author thanks the Population Council and the staff of the Taiwan Provincial Health Department's Institute of Family Planning for their support of this study. In addition, he expresses his appreciation to the many field workers who cooperated in the survey. He also acknowledges the help of Ching-ching Chen (Cernada) in fielding the survey and Professors Andie Knutson, William Griffiths, Thomas Crawford, and Harold Gustafson, then faculty at the University of California at Berkeley and Ronald Freedman at the University of Michigan who provided valuable direction as thesis advisors.

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