TRANSITIONS, TRANSFORMATIONS, AND THE CHANGING CONTEXT OF INCLUSION
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the growth rate of the population in the region has declined (UN 2011a). People with HIV/AIDS face higher risk of death and are stigmatized and excluded from a number of domains. Their children are at greater risk of orphanhood, and the impacts of the disease permeate their families, as discussed in chapter 5. Developing countries and populations are not the only ones excluded from the huge progress in mortality decline. Eastern Europe has experienced reductions in life expectancy since the late 1980s. Despite having recorded some recovery since the late 1990s, Moldova, the Russian Federation, and Ukraine currently have the lowest life expectancies among developed countries (below 70 years), driven mainly by very high rates of male mortality. Brainerd and Cutler (2005) mark out a “mortality belt” in Eastern Europe, where men die much earlier than women and their male counterparts in other Organisation for Economic Co-operation and Development (OECD) countries. They attribute this pattern to two main factors: alcohol use, especially as it relates to external causes of death (homicide, suicide, and accidents), and stress associated with a poor outlook for the future. In addition to fertility patterns, far-reaching demographic changes have led to new family formations and living arrangements. For instance, delayed marriage and childbearing have played a role in the fertility transition. Women are also increasingly having children outside of wedlock, and couples are cohabiting rather than marrying more than before, leading to a decline in marriage. The norm of a two-parent heterosexual family is under question, especially in some OECD countries and parts of Latin America. In developing countries, urbanization, modern social mores, and migration have meant that extended families are increasingly moving to a nuclear model. Table 4.2 shows the recent decline in the proportion of extended and joint families (accompanied by an increase in single, semi-single, and nuclear families) in Bangladesh, often considered a “traditional” country. These new family formations have important social consequences at the individual, household, community, and national levels. Split families in China are aberrant enough to warrant serious policy concern. Nuclear families allow women greater freedom and control over their own lives, but they also impose a greater burden of caregiving on them, especially in countries where informal arrangements dominate the provision of care. Outward migration is also known to have profound effects on family life. A thread of the literature from Kerala, India, and Sri Lanka focuses on the impact on the mental health of both men