India's National Family Health Survey provides new information on maternal and child health and AIDS awareness

Teams surveyed a sample of 88,562 households, drawn from 99% of the population of India in 24 states plus the National Capital Territory of Delhi, between April 1992 and September 1993 to collect a basic set of information on all 500,492 household members, with more details on the 89,777 women in the households who had ever been married and were aged 13-49 years. This National Family Health Survey (NFHS) collected information from the women on a range of health topics including child immunization, women's knowledge of AIDS, services and facilities use during pregnancy and childbirth, infant feeding and treatment for diarrhea, and infant, child, and maternal mortality. Levels of infant and child mortality declined in India, but 8% of all children still die before their first birthday and 11% die before reaching age 5. As for maternal mortality, there are an estimated 420 maternal deaths per 100,000 live births annually. That rate implies that at least 100,000 Indian women die each year due to causes related to pregnancy and childbirth. Survey results indicate the need to strengthen vaccination programs and teach women about proper infant feeding practices. They also highlight the need to increase antenatal care and other medical services. In all of these areas, the NFHS results indicate wide variation among India's regions and states. Furthermore, a general lack of AIDS awareness suggests that the government's AIDS awareness campaign, relying primarily upon electronic media, has not yet reached the majority of India's population.     

Validation of the Childbirth Attitudes Questionnaire in Greek and psychosocial characteristics of pregnant women with fear of childbirth

BackgroundFear of childbirth has been found to be a factor that influences women's decision about their choice of delivery. The investigation of psychological factors that relate to fear of childbirth as well as the validation of the Childbirth Attitudes Questionnaire (CAQ) can help identify pregnant women with high fear of childbirth.AimThis study aimed to (a) translate and validate the Childbirth Attitude Questionnaire in Greek and (b) explore how fear of childbirth was related to childbirth self-efficacy, state anxiety, depression, neuroticism, self-esteem and optimism.Methods145 nulliparous pregnant women, in late pregnancy, attending routine antenatal visit in a private maternity clinic participated. All participants completed the CAQ (fear of childbirth) and other self-report questionnaires that measured childbirth self-efficacy, self-esteem, optimism, neuroticism, state anxiety and depressive symptomatology. Factor structure was investigated using principal axis factoring. Cronbach's α was used to measure internal consistency reliability. Pearson's correlation coefficients were calculated between all study variables, followed by multiple linear regression.FindingsThe factor analysis suggested the existence of one-factor structure. Construct validity was confirmed by computing correlations between the CAQ and childbirth self-efficacy, self-esteem and optimism. Multivariate analysis showed that childbirth self-efficacy, self-esteem and optimism were negatively and significantly associated with fear of childbirth.Conclusion and implications for practiceThe Greek version of the CAQ is a reliable and valid measure. The clinical use of CAQ may enable midwives and other health care professionals to identify pregnant women with low childbirth confidence and to provide information and support.     

A meta-synthesis of the perspectives and experiences of healthcare professionals on the humanisation of childbirth using a meta-ethnographic approach

ProblemThe humanisation of childbirth has been identified as a practice of care focusing on the physical, psychological, and emotional wellbeing of women. Healthcare professionals (HCPs) are expected to understand and embed humanised practice when supporting women in childbirth.AimThe aim of this paper is to present a meta-synthesis of the experiences and perspectives of HCPs who undertake care for women at the time of birth regarding the humanisation of childbirth.MethodsA systematic search of the electronic databases CINAHL, Medline, PsycINFO, and SocINDEX were conducted in July 2020. Qualitative studies exploring HCPs’ experiences and perspectives of humanisation in childbirth were eligible. Studies were synthesised using a meta-ethnographic approach.FindingsFourteen studies involving 197 participants were included. Two themes were identified: ‘Women at the centre’ and ‘Professional dissonance’. Two line of argument synthesis were identified: ‘invisible boundaries’ and ‘unconscious undermining’.DiscussionHCPs recognised that women required positive interactions which met both their emotional and physical needs. Human touch supported bonding between HCPs and women. HCPs understood humanisation as the reduction of unnecessary intervention and/or technology but had difficulties enacting this and often used disempowering language when discussing women’s choices. The management of pain and the presence of a companion were considered important by HCPs.ConclusionThis synthesis revealed that HCPs do understand the humanisation of childbirth but have difficulties in enacting it in practice. Women classified as high risk were identified as having specific needs such as increased emotional support. Further research is required for women classified as high risk who may require technology and/or interventions to maintain a safe birth.     

Paperbark and pinard: A historical account of maternity care in one remote Australian Aboriginal town

Background and aimMaternity care in remote areas of the Australian Northern Territory is restricted to antenatal and postnatal care only, with women routinely evacuated to give birth in hospital. Using one remote Aboriginal community as a case study, our aim with this research was to document and explore the major changes to the provision of remote maternity care over the period spanning pre-European colonisation to 1996.MethodsOur research methods included historical ethnographic fieldwork (2007–2013); interviews with Aboriginal women, Aboriginal health workers, religious and non-religious non-Aboriginal health workers and past residents; and archival review of historical documents.FindingsWe identified four distinct eras of maternity care. Maternity care staffed by nuns who were trained in nursing and midwifery serviced childbirth in the local community. Support for community childbirth was incrementally withdrawn over a period, until the government eventually assumed responsibility for all health care.ConclusionsThe introduction of Western maternity care colonised Aboriginal birth practices and midwifery practice. Historical population statistics suggest that access to local Western maternity care may have contributed to a significant population increase. Despite population growth and higher demand for maternity services, local maternity services declined significantly. The rationale for removing childbirth services from the community was never explicitly addressed in any known written policy directive. Declining maternity services led to the de-skilling of many Aboriginal health workers and the significant community loss of future career pathways for Aboriginal midwives. This has contributed to the current status quo, with very few female Aboriginal health workers actively providing remote maternity care.     

中国大陆、中国台湾地区和日本人口问题之探讨及其对策

日本、中国大陆和中国台湾地区均处于低生育率水平,但各自所处发展阶段和面临的人口问题迥异,应对战略不尽相同:中国台湾地区地狭人稠,人口减少未必是坏事,应以稳定生育率为首要,鼓励适龄结婚,带动生育率回升,放宽移民政策,移入高素质人才,提升竞争力;日本总人口已经负增长,应鼓励生育,改革教育,坚持能力主义;中国大陆人口面临结构和数量双重压力,应以调整人口结构和控制人口数量并重为首要任务,提升人力素质。     

State-Level 2010 Census Coverage Rates for Young Children

The Census Bureau’s demographic analysis (DA) shows that the net undercount rate for children aged 0–4 was 4.6 percent in the 2010 U.S. Decennial Census while adults (age 18 and older) had a net overcount rate of 0.7 percent. For the population aged 0–4, DA estimates are seen as more accurate than the U.S. Decennial Census because the estimates for this young population rely heavily on highly accurate birth certificate data. Given the relatively high net undercount rate for young children, it would be useful to examine census coverage rates for this population in subnational geographic units. In this study, the 2010 U.S. Decennial Census counts of children aged 0–4 are compared to the corresponding figures from the Census Bureau’s Vintage 2010 Population Estimates in each state. Differences between the 2010 U.S. Decennial Census count and the Vintage 2010 Population Estimates for the population aged 0–4 range from an estimated net undercount of 10.2 percent in Arizona to an estimated net overcount of 2.1 percent in North Dakota. Larger states tended to have higher net undercounts than smaller states. The ten largest states account for about 70 percent of the national net undercount of the population aged 0–4. Of all the factors examined here, the relative size of the Blacks Alone or in Combination plus Hispanics population is most highly correlated with the estimated net undercount of the population aged 0–4. Other measures that were highly correlated with net undercount rates for the population aged 0–4 were linguistic isolation, percent of adults without a high school degree, and the unemployment rate. In general, characteristics of people are more highly correlated with the net undercount rates of young children than the characteristics of housing units.     

Pro-natalist population policies in Czechoslovakia

Summary Given the high rate of women's employment and the lack of labour reserves, other than the natural replacement of the population, pro-natalist population policy in Czechoslovakia should be seen as a response to an anticipated shortage of labour. The rapid post-war decline in the birth rate has been caused by the greatly increased opportunity structure for women in education and employment, and by other policies favouring lower natality - rapid urbanization, inadequate provision of housing, insufficient investment in consumers' goods and services, low wages and relatively free availability of abortion. To reverse this undesirable population trend, the Czechoslovak government has adopted a more restrictive attitude towards abortion, lengthened paid maternity leave, increased family allowances and single grants given at childbirth and introduced the so-called maternity allowance, which is a direct monthly payment given by the state to mothers who wish to stay at home to raise a second or subsequent child, until the child is two years old. The time so spent counts towards the mother's retirement pension and other kinds of seniority, and her job is held open for her. These measures have contributed to the recent increase in the Czechoslovak birth rate, but more time is needed for the assessment of the long-term effectiveness of these measures.     

Rumour of angels and heavenly midwives: anthropology of transpersonal events and childbirth

Some contemporary women can experience non-ordinary states of consciousness when childbearing. The purpose of this paper is to bring a ‘transpersonal’ frame to these non-ordinary states of consciousness (hereafter: NOSC). Transpersonal psychology is an interdisciplinary movement in Western science that studies ‘religious’, ‘peak’ or ‘healing’ experiences in different cultures and social contexts. Between 2001 and 2006 in Auckland, New Zealand, while engaged in anthropological fieldwork, I collected stories from mothers, fathers, and midwives who had participated in transpersonal events during childbirth.I will compare the local women's NOSC with ethnographic accounts of spirit-possession and its relationship to indigenous midwifery then revisit and reconstruct the witch-hunts of Medieval Europe from this perspective. Midwives are encouraged to learn to identify and support women's NOSC during labour and birth as many women find strength and wisdom by passing through these states in labour. The subject is also critical to men, whether they are present with women and birth as fathers or health professionals. The hoped for result of this inquiry is to revalorise NOSC among birth-giving mothers, and to educate birth attendants in this field.     

适应新形势的要求 深化计划生育宣传教育工作

吉林省人口与计划生育工作进入新的发展时期,在宣传教育工作中仍存在一些问题和困难。开展计生宣教"五好"竞赛活动是促进婚育观念转变的有效途径。     

Predictors of women’s positive childbirth pain experience: Findings from an Icelandic national study

Background

Pain in childbirth has been identified as one of the major components in the childbirth experience and an important topic that needs to be addressed during pregnancy, birth and the after-birth period.

Women’s Short-Term Employment Trajectories Following Birth: Patterns,Determinants, and Variations by Race/Ethnicity and Nativity

Despite a large literature documenting the impact of childbearing on women’s wages, less understanding exists of the actual employment trajectories that mothers take and the circumstances surrounding different paths. We use sequence analysis to chart the entire employment trajectory for a diverse sample of U.S. women by race/ethnicity and nativity in the first year following childbirth. Using data from the 1996–2008 panels of the Survey of Income and Program Participation and sample selection models, we find that women employed before childbirth show a high degree of labor market continuity. However, a notable share of them (24 %) took less stable paths by dropping out or scaling back work. In addition, mothers’ attachment to the labor force is simultaneously supported by personal endowments and family resources yet constrained by economic hardship and job characteristics. Moreover, mothers’ employment patterns differ by race/ethnicity and nativity. Nonwhite women (blacks, Hispanics, and Asians) who were employed before childbirth exhibited greater labor market continuation than white women. For immigrant women, those with a shorter length of residence were more likely to curtail employment than native-born women, but those with longer duration of residence show greater labor force attachment. We discuss the implications of these findings for income inequality and public policy.     

Fresh impetus to family planning programmes planned in India. APPN interviews Mr. B. Shankaranand Union Minister for Health and Family Welfare,India

Mr. B. Shankaranand, Union Minister for Health and Family Welfare in India, speaking on new policy measures planned to give family planning a major boost, stated that programs related to population and family welfare should be interwoven with the minimum needs program so that the message of the small family norm becomes attractive to acceptors. The new incentive measures, outlined by Shankaranand, are based on the understanding that the existing infrastructure for service delivery must be fully utilized. The new package of incentives places equal emphasis on state level campaigns which will be suitably dovetailed with services and supplies. Monetary rewards in the form of community assets will be given to organized and identifiable groups actively engaged in the implementation of the Family Welfare Program. Cash awards will be given to the best performing states. A new incentive scheme will be introduced for industrial labor groups in the organized sector. Innovative publicity campaigns in selected areas will be conducted. Reorganization of the service delivery outreach system will include establishing health posts staffed by nurse midwives and health workers in urban slums and congested areas. A scheme is in preparation to issue green cards to acceptors of terminal methods after 2 children. The card holders will be entitled to priority attention and preferential treatment in schemes where such practices are feasible. Currently, there are 5000 Primary Health Centers and 50,000 subcenters offering integrated health services. Family planning statistics provide supportive evidence of programmatic response to the achievement of longterm goals of population stabilization. During the 1st 10 months of the current financial year 2,800,000 sterilizations were performed, a 43% higher achievement rate than the corresponding period last year. The number is likely to rise to 4,000,000 by the end of this financial year. Similarly, the number of IUD acceptors is 760,000, 35% higher than last year. Another encouraging sign has been the formulation of a National Health Policy.     

Economic analysis of same-sex marriage

This article applies the neoclassical microeconomic analysis of marriage as developed by Nobel laureate economist Gary Becker to same-sex marriage. The objective is to demonstrate that the economic analysis of marriage supports allowing same-sex marriage, and that same-sex marriages would strengthen the incentive to marry, increase the efficiency of marriage markets, provide for more children to be raised in two-parent optimum environments, and benefit states economically overall. The article concludes with an overview of the economic impact of same-sex marriages on states based on the analysis, data and fiscal information currently available from researchers and economists in the field.     

Midwives’ practices and knowledge about fear of childbirth and postpartum posttraumatic stress disorder

BackgroundWomen suffering from fear of childbirth and postpartum posttraumatic stress disorder are often not recognised by health care professionals.AimTo evaluate practices, knowledge and the attitudes of midwives towards women with fear of childbirth and postpartum posttraumatic stress disorder.MethodsA cross-sectional study was performed amongst midwives who work in community practices and hospitals in the Netherlands with the use of a questionnaire purposefully designed for this research aim.Findings257 midwives participated in the study, of whom 217 completed all items in the questionnaire. Midwives were better equipped to answer knowledge questions concerning fear of childbirth than posttraumatic stress disorder (regarding symptomatology, risk factors, consequences and treatment). When tending to women with fear of childbirth or (suspected) postpartum posttraumatic stress disorder, most midwives referred to another caregiver (e.g. psychologist). Most midwives expressed a positive and compassionate attitude towards women with fear of childbirth and postpartum posttraumatic stress disorder.DiscussionThe majority of midwives are well informed with respect to fear of childbirth, but knowledge of important aspects of postpartum posttraumatic stress disorder is often lacking. Midwives report no crucial issues related to their attitudes towards women with fear of childbirth and posttraumatic stress disorder. Most midwives provide adequate organisation of care and support.ConclusionMidwives should acquire more in depth knowledge of fear of childbirth and postpartum posttraumatic stress disorder. This can be achieved by including the two conditions in the program of midwifery education.     

Spirituality and spiritual care in and around childbirth

BackgroundEmerging evidence points to childbirth as a spiritually felt meaningful occasion. Although growing literature and development of guidelines charge the midwife to provide spiritual care felt spiritual experiences are not addressed. There is need to revisit contemporary approaches to spiritual care in midwifery lest something of significance becomes lost in policy rhetoric.AimThe aim of this discussion paper is to bring to the surface what is meant by spiritual care and spiritual experiences, to increase awareness about spirituality in childbirth and midwifery and move beyond the constraints of structured defined protocols.MethodsThe authors’ own studies and other's research that focuses on the complex contextual experiences of childbirth related to spirituality are discussed in relation to the growing interest in spiritual care assessments and guidelines.FindingsThere is a growing presence in the literature about how spirituality is a concern to the wellbeing of human beings. Although spirituality remains on the peripheral of current discourse about childbirth. Spiritual care guidelines are now being developed. However spiritual care guidelines do not appear to acknowledge the lived-experience of childbirth as spiritually meaningful.ConclusionIntroduction of spiritual care guidelines into midwifery practice do not address the spiritual meaningful significance of childbirth. If childbirth spirituality is relegated to a spiritual care tick box culture this would be a travesty. The depth of spirituality that inheres uniquely in the experience of childbirth would remain silenced and hidden. Spiritual experiences are felt and beckon sensitive and tactful practice beyond words and formulaic questions.     

计划生育法制建设与生殖健康——兼论生殖健康理念的国际比较

我国的婚育制度为计划生育与生殖健康建立了良好的发展环境,我国相关法律规范中体现了《国际人口与发展大会》对生殖健康的要求,为生殖健康事业的发展提供了有力的法律保障和广阔的发展空间。     

The association between mistreatment of women during childbirth and postnatal maternal and child health care: Findings from “Birth in Brazil”

BackgroundThe mistreatment of women during pregnancy, childbirth, and the puerperium is a global public health problem besides being a violation of human rights. However, research exploring the consequences of mistreatment of women and newborns is scarce.QuestionTo shed light on this issue, we investigated the association between the mistreatment of women during childbirth and the subsequent use of postnatal health services by women and their newborns.MethodsWe used data from the study “Birth in Brazil”, a national hospital-based survey of puerperal women and their newborns, carried out in 2011/2012. This analysis involved 19,644 women. Mistreatment was a latent variable composed of seven indicators. We assessed the attendance of women and newborns to a review consultation following birth, and the timing of this appointment. We applied multigroup structural equation modeling (based on childbirth payment source) and considered separate analysis for women (vaginal births and0 caesarean-sections) and newborns.FindingsWe found a causal association between mistreatment during childbirth and decreased and/or delayed use of postnatal health services, for both women and their newborns. These results also revealed that women who use the public sector are affected more than those who pay for private healthcare.ConclusionMistreatment during childbirth has broader implications than “maternal mental health”, and it would be useful to understand that experience of care has vast implications for families. In Brazil, the mistreatment must be mitigated via the implementation of public policy. This is part of the path to dignified and respectful childbirth care for all women.     

A longitudinal analysis of family migration and the gender gap in earnings in the united states and great britain

This article uses longitudinal data for the United States and Great Britain to examine the impact of residential mobility and childbirth on the earnings of women, their family earnings, and the related division of earnings by gender. This project is the _ rst to compare explicitly the impact of childbirth and family migration on women’s earnings, and it extends prior cross-sectional and longitudinal studies on isolated countries by providing a direct contrast between two major industrialized nations, using comparable measures. The results indicate that families respond in similar ways in both countries to migration and childbirth. In response to both migration and childbirth, women’s earnings fall at the time of the event and recover slowly afterward, but the magnitude of the impact is roughly twice as large for childbirth as for migration. However, migration but not the birth of a child is also associated with a significant increase in total family earnings because of increased husbands’ earnings. As a result, the effect of migration on the relative earnings of wives to husbands is similar to the effect of childbirth. These results suggest that family migration should be given consideration in the literature on the gender earnings gap.