Infant mortality in Third World countries is still a major health problem; overall, there has been progress over the past three decade, but it is unevenly distributed. Some Third World countries have achieved significant declines in infant mortality, while others have not. The expectation – rising from the historical experience of industrialized countries – that infant mortality will decline concurrently with the process of economic development has not, in general, been borne out. This paper applies a “political economy of health” perspective to infant mortality and seeks to account for discrepancies between economic progress and progress against infant mortality. It traces out a four-fold comparison – between countries with high/low economic development and countries with high/low infant mortality – for testing hypotheses in the political economy of health.

Characteristics of community contexts important to child survival in Third World countries are reviewed. The type of economic production and stratification system, women's position, medical care and public health services, and cultural practices constrain and provide resources to individuals living within a community. Child survival viewed within the community context expands upon structural forces affecting mortality differentials.

Maternal sociodemographics, knowledge about oral rehydration, and specific health practices were found to interact with access to primary care system variables in predicting the use of oral rehydration in two areas of rural Guinea. Extremely limited primary health care resources were related to very low levels of usage even with a national effort to increase oral rehydration therapy. The study used a stratified sampling design to compare the differential effects of town, village, health care system availability and ethnic factors in oral rehydration solution use.

The study of wives' roles in fertility decision-making among 97 caste-Hindu women from West Central Nepal reveals wide variation on four issues: (1) Are fertility decisions conscious? (2) Who makes fertility decisions? (3) Do ideal family size and composition affect fertility decisions? and (4) Are economic, social, cultural or health factors the major motives in fertility decisions? Findings suggest a greater level of variation in and complexity of fertility decisions than appreciated by existing theory. This paper concludes that fertility decisions are highly individualistic and are based more on personal characteristics and life experiences than they are on generalized distinctions between societal types.

Infant Mortality in Nepal is among the highest in the world. Since the 1950s a number of studies have examined the causes of infant mortality in Nepal. This study attempts to identify the causes of infant mortality using a comprehensive approach. In other words, this study incorporates biological, socio-economic, behavioral, psychological, environmental, and health care factors to provide a thorough understanding of the underlying causes of infant mortality.

Prior research on the presence of medical pluralism and factors affecting utilization patterns within such societies/systems have been able to provide only variable oriented explanations. This paper draws on differentiation theory to provide a theoretical framework for understanding the context of medical pluralism in the developing countries. For the purpose, the South Asian country of Nepal is selected as a basic example. It is inferred that the arguments/theory presented in the paper will be applicable to other third world societies which have medical pluralism as well. This paper suggests that differentiation in these third world societies has not resulted in the formation of a single formal health care complex as in most developed countries. For example, in Nepal three overlapping and competing health care systems (folk, traditional, modern) have evolved producing a pattern we call “incomplete differentiation” in which there are no clearly demarcated boundaries separating the responsibilities of each health care system. Furthermore, in this incompletely differentiated system, modern medicine faces stiff competition with the folk/traditional health care systems over cultural legitimation.

The People's Republic of China originally developed a unique health services system that embodies decentralization, continuity with traditional medicine, integration with the local political structure, and mass participation. In order to provide health services for over one billion people. China concentrated on training barefoot doctors, assistant doctors, midwives, and public health workers. Also, training programs attempted to integrate Chinese traditional medicine with Western medicine. However, economic reforms initiated during the 1980s currently are transforming the health care system. The rural cooperative medical service is being replaced by private hospitals and clinics and health insurance systems. In the future, China will have to balance increased specialization and technology with the delivery of health services to a largely rural population. This will be a difficult task for a nation in the process of economic reform.

Therapeutic healing symbols should be recognized as being embedded in and arising from a cultural context, which both specialists and nonspecialists then draw upon in treating the sick. The symbolic aspects of material features of medical systems have been discussed in reference to biomedicine, but little discussion has been devoted to these symbolic dimensions of traditional medical systems. Ethnographic data from an Andean hamlet in Northern Peru provides evidence that the symbolic content of remedies is rooted in the collective experience of the people and can be shared across all types of healing encounters. The three symbolic qualities of materia medica identified are blackness, topicality and liquidity, [index words: symbolic healing, ethnomedicine, medical anthropology, Peru, Andes]

Based on interviews with neurologists and medical personnel throughout Indonesia, the paper reports on the medical and cultural situation of epilepsy in a developing country. After briefly reviewing the context of Indonesian medical care, the paper examines the indigenous perspectives of epilepsy with particular attention the “underutilization” of western medical care. Contributing factors discussed include cultural beliefs, perception of stigma, and cost and accessibility of medical care. This is followed by a discussion of two grassroots initiatives to modify the image and treatment of epilepsy.

Using data from a sample survey undertaken in 1982, this study examines the perceptions and attitudes of 1000 women in Accra toward mental disorders. The majority of the women in the sample perceive the causes of mental disorders to be stress-related, though some serious mental disorders are still thought to be of supernatural origin. The implications of such perceptions for an effective integration of mental health care into primary health services are discussed.

While there is much descriptive information on the structural features of the Caribbean family, little data exists on mental health outcomes that may be associated with these structures. Using a sample of 654 adults from urban Guyana, this study explores the extent to which family structure is related to psychological distress. The analyses indicate that female heads of household report more depressive symptoms than women in simple nuclear settings. Sociodemographic and psychosocial factors are more consistently related to mental health than family structure.