The key data items to note are: a) 47.7% of the total population are under 15 years of age (59% under 20 years of age), b) only 8.6% of the population are over 55 years of age, and c) 74.1% of all females are under 30 years of age. These data pregnant women, show that children, the main target groups and young people. for The health biological (fecundity) of this young population is also highly apparent. care are potential Though it would seem that health care problems of the elderly would be minor, it is not quite the case here as in many developing countries because of the much higher than normal incidences of specific chronic diseases i.e. diabetes and hypertension (discussed later). Other key vital statistics for the Marshall Islands in 1976 are Summarized below (Source: TTPI Five Year Comprehensive Health Plan, April 1, 1980) Crude birth rate 31.1 Crude death rate 4.2 Infant mortality rate = 17. 9 * Maternal mortality rate = 27.0 (1974-1976) R. Natural Increase = 26.9 *Infant mortality would probably be in the upper 20's to low 30's if there were better reporting. Also a child is historically considered a _ live birth only after his first birthday. In general the Marshall Islands do not compare badly with many developing countries in “infant mortality" yet it still is significant. natural increase" is quite planning are obvious. considerably. is though. The implications for family Unfortunately the level of family planning services delivered has been low. among males high The "rate of low to Perception of need for family planning services non-existent, though women's perceptions differ The need for better integration of family planning into ongoing maternal and child health services needs to be done, as well as the development of a concerted culturally sensitive educational campaign. The geographical distribution of the population demographic factor to consider in health care delivery. is also a key (See Table 3) In 1977 it was estimated that 57% of the total population resided either in the “district center" (Majuro - 10,087 or 39%) or in the “subdistrict center" (Ebeye - 18% or 4,577). Arno atoll classifies as an “intermediate zone”, and had 1,199 inhabitants or 5% of the population (it lies just 35 miles by water from Majuro); while the remainder of the atolls or “outer islands" contained 38% of the population or a total of 9,594. The map on the next page gives the last known totals of inhabitants by atoll as well as water distances from Majuro. 3