The distribution of rural health care over large parts of Asia does little to protect women and children from organic, parasitic and infectious disease. The worldwide reduction of epidemic diseases has, however, made it more likely that some children will survive into adulthood. Children are essential for sacramental and economic reasons for the family and, in patrilineal societies, for the wellbeing of women who gain real acceptance in their husband's family only with the birth of a child. In both the Philippines and India, families with larger landholdings and houses better than the average, in both rural and urban areas, have more children than those less well off. The preponderance of tubal ligation as the means of birth control in Shanghai is seen as continued inequality between women and men in bearing responsibility for contraception; cadres report that men insist on women undergoing surgery because of their uneasiness about vasectomy.