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Book reviews

The New Politics of Population: Con- flict and Consensus in Family Plan- ning J. L. Finkle and C. A. McIntosh

(eds) Oxford University Press Oxford Sup- plement to Population and Develop- ment Review, 20 (1994) f10.99 hardback ISBN 0195210883

Whilst highly apposite to the 1994 International Conference on Popula- tion and Development (ICPD) this collection of articles derives from a Rockefeller Foundation-sponsored seminar held in February 1990. The focus is contexted within the well- documented recent history of the growing international consensus in favour of ‘population control’. The editors define their starting point as the belief in ‘a major shift of emph- asis (in which) the old politics of population have been replaced by the politics of family planning’ (p.3). The articles are divided into four sections; overviews and frameworks for analysis; the political environ- ment of policies and programmes to influence family planning; case studies of the politics of policy formu- lation and implementation; and trans- national actors and family planning policy. The common thread moving through all of the articles is the ex- ploration of the ways in which ideas of fertility limitation and family plan- ning are articulated and developed into policies within political and socio-cultural contexts.

The two articles in the overviews and frameworks section are a little bland but may provide some useful structuring for the non-specialist. Warwick’s contribution on the poli- tics of research on fertility control would have been more logically placed with the overviews rather than in the later case studies section. Warwick’s main focus upon question- ing the demographic-developmental

rationale for family planning seems not entirely appropriate given the greater emphasis today given to human rights, maternal and child health and women’s status rationales.

The volume really comes to life in the articles which explore the under- lying themes in relation to particular cultural, national and transnational contexts. Two articles focus on Sub- Saharan Africa; Kokole on the poli- tics of fertility and Mazrui on Islamic doctrine. Both articles highlight the complications arising from ethnic di- versity and conflict. Mazrui notes that in its competitive tendency and universalist rivalry, Islam was coun- ter to the non-monopolistic orien- tation of traditional African creeds but found common ground in sup- porting high fertility. He links the culture of procreation and the cul- ture of war in which virility represents valour in the sexual privileges of the warrior. The introduction of Islam entailed a clash of Arab and African cultures, in which Islam used racial intermarriage as a strategy for making new ethnic alliances and establishing long-term expansion and consoli- dation.

Cabrerar provides a superb over- view of the development of popu- lation policy in Mexico. Assessing the current situation he concludes that the impact of population policy upon attaining social and economic change has been impeded by the lack of integration of population variables into social and economic program- mes. Aramburu’s careful analysis of population policies in Latin America concludes that a population policy may not be essential in bringing ab- out a fertility decline but ‘can do much to ease the pain of the demo- graphic transition’ (p.177).

One of the major themes running through a number of the articles is the way in which ideas/policies/ techniques pertaining to family plan-

ning are handled by specific institu- tional systems, be they the govern- ments of India and China, the Vati- can or the feminist movement. Echoing the African chapters, Pai Panandiker and Umashankar ex- plain the main barriers to the success of the family planning programme in India as being the sub-continents’ ethnic diversity in conjunction with the electoral politics of the federal democratic system. The contrasting family planning situation in China is primarily ascribed to the overriding- ly powerful centralized planning of its political and institutional struc- ture. White explores the implications of China’s recent market reforms for its continued strict control of popu- lation described in terms of estab- lishing a compromise and then more recently seeking to define clearly and enforce rigorously the limits of that compromise. Similarly Keely discus- ses the Vatican approach to family planning in relation to internal de- bate concerning doctrinal develop- ment (change) and restatement of its authority (stasis). Within a climate of social change both the communist government of China and the Vati- can of Pope John Paul are putting priority upon the re-establishment of their basic power structures. Thus their response to family planning matters is partly shaped by the way in which their handling of such policies/teachings may have a re- flexive impact upon the core insti- tutions themselves.

Dixon-Mueller and Germain dis- cuss the feminist movement’s evolv- ing response towards family planning as an increasingly significant trans- national actor. Their Brazilian and Philippines’ case studies also high- light the varied impact of the Papacy upon fertility-regulating behaviour. Whilst sharing an essential common ideological core, different feminists hold and have held widely diverging

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Book reviews

positions on many matters including family planning. Some groups were traditionally hostile to the ‘family planning movement’ discerning in its demographic targets infringements of women’s reproductive rights. How- ever, as Crane notes in her article on abortion in order for prochoice groups (including the women’s move- ment) to advance their cause it is pol- itically necessary for them to reconcile past differences with new allies. In the 1990s there is a widespread awareness that there is an at least potential underlying convergence of demographic-developmental, human rights, maternal and child health and women’s status rationales for family planning. Whether or not such convergence is achieved in practice depends upon the precise ways in which programmes are implemented (regarding quality of care issues) and whether ‘population’ variables are meaningfully addressed in related social and economic poli- cies. This volume makes a useful and stimulating contribution towards the appreciation of the crucial importance of the national, transnational and cultural policies of family planning.

Nicholas Ford University of Exeter

Medical Statistics on Personal Com- puters, 2nd edn R. A, Brown and J. Swanson Beck BMJ Publications London (1994) ISBN 0727907719 paperback

Anyone who, like me, has to wrestle with the perennial problems of teaching statistics at an introductory level is always on the look-out for good pedagogic material. In ad- dition, having been encouraged to work in a PC-based environment, rather than the ‘mainframe-based’ environment that I have used for 15 years, I am especially interested in any book that offers appropriate guid- ance. The sub-title of this book, ‘A Guide to the Appropriate Use of Statistical Packages’ actually conveys better the real subject matter, since the ‘Personal Computers’ in the title is something of a red herring. What the book succeeds in doing is offer-

ing a good guide to some aspects of medical statistics, illustrating their use with some examples and, in most (but by no means all) cases, giving an indication of how to implement such techniques using one of two packages, MINITAB and STAT- GRAPHICS.

Any book that mentions ‘Personal Computers’ is likely to find that the technology has moved on by the date of publication, and this is no excep- tion! I suspect that many of us teaching statistics are now working in a ‘Windows’ environment; cer- tainly, MINITAB is now available for Windows, as is SPSS (which I have been using myself). Such en- vironments are mentioned in an Appendix but I would look to a third edition of the book to integrate this fully into the text.

One of the strengths of the book is the emphasis it places on graphical display; the use of plots in explora- tory data analysis and in regression figures prominently, for example. From a research point of view, and certainly from a geographical point of view, it would have been useful to ‘flag’, even if no more than that, recent developments in statistical computing that allow the user to move fluently between different ‘views’ of one’s data; for example, to show a tabulation of data in one window, a scatter diagram in another, and maybe a map in a third. The most exciting developments in this field seek to link these different views, so that observations highlight- ed in one view are simultaneously highlighted in others.

The book has good substantive chapters on such topics as: analysis of variance; distribution-free methods; correlation and regression; and cate- gorical data. However, there is noth- ing on logistic regression or the use of odds ratios, which I found surpris- ing. Some concepts are, curiously, taken for granted; for example, we encounter ‘Poisson variability’, on p. 4 before we have even been intro- duced to descriptive measures of central tendency and dispersion! The chapter on survival analysis is especially welcome, but rather fizzles out towards the end; we learn that a MINITAB ‘macro’ is actually re-

quired to do the analysis but rather than helpfully supplying this here, we are advised to consult a ‘local statistical guru’. Plenty of examples and applications are given through- out, but it is a pity that the back- ground to most of these is not ex- plained; they appear out of thin air, with no real context to motivate them. In addition, why was a decision not taken to perhaps include them on disk or to invite the reader to access them electronically?

These points aside, the book con- tains generally very clear expo- sitions, with excellent diagrams. The chapter on sample size and power was a strong one, the dangers of multiple comparisons were properly highlighted, and the use of confi- dence intervals rather than p-values was emphasized. Overall, the book provides a good basis for more ad- vanced treatments.

Tony Gatreli University of Lancaster

The Politics of Health Policy: the US Reforms, 198&1994 V. Navarro Blackwell Cambridge Massachusetts (1994) 231 pp

The recent demise of President Clin- ton’s health care reform plan drew attention once again to the difficulty of changing the USA’s massive health care system. Since the enact- ment of Medicare and Medicaid in the 196Os, no President or Congress has achieved significant health care reform, and health services and costs continue to expand without direction or limit. In such a context, under- standing the politics of health policy is critically important, both as a guide to reform efforts and a window on the barriers to reform. The Poli- tics of Health Policy offers a unique perspective on health care reform in the USA during the 1980s and 1990s. Written by Vicente Navarro, long- time critic of the health system, it is an insider’s view of health politics from outside the health mainstream. Navarro’s efforts to promote a national health program (NHP) form the basis for this penetrating analysis

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