The informal health sector and health care-seeking behaviour of mothers in urban Dhaka slums

Infant and child mortality in Bangladesh has declined in recent years but early death rates remain high among Bangladesh’s urban poor, even in comparison to rates in rural Bangladesh. Although they live close to the country’s leading public hospitals and private health clinics, the urban poor continue to rely heavily on services and advice provided by the informal health sector. This paper examines the use of the informal health sector by urban poor children’s main caregivers, their mothers, and the key role performed by pharmacists in treating these children. It explores the nature of the relationship between the mothers and the health providers and the implications for the broader health system. The study combines in-depth interviews with survey data.     

Maternity and child health care in urban China

In China the effort to develop maternal and child health (MCH) care has been ongoing. Initially, attention was directed primarily to promulgating a modern method of delivery in an effort neonatal tetanus and puerperal fever. The next stage was the systematic management of MCH care. Pregnant women and puerperants were given a series of checkups and guidance from conception until the 42nd day after delivery. The purpose was to prevent and treat complications. In some cities, perinatal care has developed to the point of health care management of the health of both mother and child. This extensive health care system includes preconception and pregnancy care, puerperant care, and neonatal care. Premarital checks have become the rule in the urban areas. MCH care organizations at the grassroots level and community health workers take responsibility for advising newly married couples about health care. In addition, some medical colleges and their affiliated hospitals provide consultation services for these couples. The Shanghai Railway Medical College uses a computer to make projections on multigenic genetic diseases. It provides information on incidence risk of the next generation to help couples make their childbearing decisions. The majority of pregnant women get their 1st prenatal check prior to the 12th week of pregnancy, followed by 9 re-examinations to screen out high risk factors. Difficult labor, infections, obstetric trauma, postpartum hemorrhage, and fetal distress are prevented at childbirth. Newborns are scored with Apgar comments; those with low marks are specially protected. In some cities, an investigation system has been established to deal with perinatal deaths. Perinatal care is managed at 3 levels: community MCH centers and MCH departments of hospitals, clinics, and industrial enterprises form the 1st level of care; MCH centers of city districts and hospitals at the district level make up the 2nd level of care; and MCH institutes or hospitals at provincial or city levels, hospitals attached to medical colleges, and hospitals under government ministries form the 3rd level of care.     

Factors associated with child mortality in Pakistan and implications for the national health programs

"This study attempts to establish the levels of infant and child mortality in Pakistan using an indirect estimation technique to analyze data from the 1984-85 Pakistan Contraceptive Prevalence Survey....[Results indicate] that children's survival chances have hardly improved in recent years.... Suggestions are offered on ways to improve the effectiveness of rural health programs."     

Emerging issues in urban ecology: implications for research,social justice,human health,and well-being

Urbanization affects landscape structure and the overall human condition in numerous ways. Green spaces include vegetated land cover (e.g., urban forests, trees, riparian zones, parks) which play a distinctive role in urban ecology. This article reviews emergent literature on the linkages between urban green spaces, social justice, and human health. We explore this subject in the context of landscape structure, ecosystem services, and distributional equity as it relates to various health outcomes. Finally, we conclude by identifying gaps in the scholarship and potential areas of future research.     

The impact of child care on fertility in urban Thailand

Women’s labor force participation in Thailand, particularly in the modem sector, recently has increased in conjunction with rapid declines in fertility. This paper examines whether a relationship exists between child care considerations and fertility decision making among Bangkok women. Although the two-child family has become the norm in recent years, and although most respondents said that ideally they would like to have two children, a high proportion of women surveyed said they planned to only have one child. Women’s work status and type of employment is found to strongly affect the likelihood of having a second birth: those who work at jobs that not only are low-paying but are located in a formal setting are least likely to have a second child. The type of child care for the first child also has an impact: those whose first child is in a less preferred situation are less likely to have a second. Variables measuring the need for and type of child care are found to have greater consequences for fertility than do usual measures of socioeconomic status.     

Climatic conditions and infant care: implications for child nutrition in rural Ethiopia

Population and Environment - We examine the relationships between climatic conditions, breastfeeding behavior, and maternal time use in Ethiopia. Infant feeding practices are important predictors...     

The labor force implications of expanding the child care industry

This paper examines the labor force implications of increased social investment in the child care industry. We have two main conclusions to report. First, expanding the child care industry will remove a major barrier to employment for a sizable number of women. This includes women in middle and upper income families who desire to work for personal fulfillment and to improve their families' lifestyles. But even more so, it includes women in low-income and single-parent families who need to work to maintain a minimal and dignified standard of living and who might otherwise remain dependent on welfare benefits for their own and their families' subsistence. Second, expanding the child care industry will help employers cope with a range of personnel problems they will increasingly face as the U.S. undergoes a major transition in the 1990's from being a labor surplus economy to being a labor shortage economy.     

Maternal and child health care: a key step for family planning

The Maternal-Child Health Division of the Qinghai Provincial Health Department, the United Nations Children's Fund, and the United Nations Fund for Population Activities are collaborating on a model maternal-child health care project set up in the province's pastoral area. The project encompasses perinatal services in Minhe and Huangyuan counties, development of maternal-child health services at the grassroots level in Hainan Prefecture, and educational classes on child care for national minorities. The population has doubled in this vast but sparsely populated part of China since the founding of the People's Republic, and this rapid population growth has had negative repercussions for animal husbandry. To address this problem, 26 maternal-child health centers have been established in provincial pastoral areas of Qinghai and there are 20 full-time workers. Modern midwifery services are available to 67% of the population; as a result, mortality has dropped to 50/1000.     

An alternative sampling strategy for obtaining child health data in a reproductive health survey

Retrospective demographic surveys typically collect substantial information about child health. This information is often collected for all children born during a specified period. For women with several young children, the interview can become quite long. To shorten the interview, some surveys have asked child health questions only for the last child born. However, data on the last birth may be biased because last children have a younger age distribution and have longer subsequent birth intervals than does the average child. In this paper, we propose an alternative approach to collecting child health data - that child health questions be asked only for a child chosen randomly from among the respondent's children younger than age five. This alternative has the advantage of keeping the interview shorter but does not lead to biased information.Abbreviations DHS Demographic and Health Surveys     

The environmental problems in urban communities and the protection of the environment in Korea

Korea's urban environmental problems, specifically air and water pollution, government environmental policies, and the role of nongovernmental organizations (NGOs) in protecting the environment are described and discussed. Korea's rapid industrialization and urbanization between 1961 and 1985 led to an increased volume of waste and air pollution. Automobiles increased in number from 29,234 in 1961 to 1,113,430 in 1985. In the same period, the number of factories with at least five employees rose from 15,204 to 44,037. The volume of chemical materials and agricultural chemicals dramatically increased. Household wastes in urban areas increased from 26,831 tons per day in 1978 to 61,072 tons per day in 1985. Industrial waste rose from 13,130 to 33,349 tons per day in 1985. Respiratory diseases are precipitated by exposure to sulphur dioxide, which is produced during cooking and heating with coal briquets; to nitrogen dioxide from automobile exhaust; and to carbon monoxide from coal briquets. Indoor air pollution from particles such as radon, asbestos, cigarette smoke, fungus, and bacteria also impacts on health. Tolerance limits have been reached or surpassed in many cities, particularly in Seoul. Air pollution is worse during the winter. The poor are particularly affected because of the continued use of coal briquets for heating. Industry contributes to water pollution. The volume of industrial waste water quadrupled between 1980 and 1990. In Seoul, however, population size directly contributes to 64.3% of water pollution, and the remaining 35.2% is from factories. Although livestock contributes to only 0.5% of water pollution, livestock drainage contributes to 36.3% of chemical materials in polluted water. Biological oxygen demand has also exceeded tolerance limits. Water reservoirs contain toxic chemicals such as lead, copper, mercury, arsenic, phenol, phosphorus, and nitrogen, which take a longer time to affect health. The Anti-Pollution Law of 1963 and the Environmental Protection Law of 1977 were adopted, but public participation was problematic, and funding for assessment was limited. NGOs have been active in environmental programs since democratization in 1987.     

Federal financing of child care: Alternative approaches and economic implications

This paper surveys alternative approaches to financing child care at the federal level and discusses their economic implications with respect to female labor force participation, fertility, child care demand and supply, and poverty. The current system of federal support for child care is seen to consist of a series of overlapping programs that tend to create inefficiencies and inequities in the distribution of child care benefits. Four basic principles of an ideal child care system are outlined, and a general two-tiered system of support is proposed that would satisfy these four principles. The two-tiered system is centered on a refundable tax credit considerably more progressive than the current child care tax credit. A simulation analysis indicates that the proposed refundable tax credit would not cost much more than many of the more popular child care bills currently being debated in Congress.     

The effect of female education on marital matches and child health in Bangladesh

This paper examines the effects of female education on marriage outcomes by exploiting the exogenous variation generated by the Female Secondary School Stipend Program in Bangladesh, which made secondary education free for rural girls. Our findings show that an additional year of female education leads to an increase in 0.72 years of husband’s education and that better educated women pair with spouses who have better occupations and are closer in age to their own, suggesting assortative mating. Those educated women appear to experience greater autonomy in making decisions on receiving their own health care and visiting their family. Furthermore, educated women have lower fertility and use more maternal health care, and their children have better health outcomes than those of less-educated women. Overall, our results suggest that the marriage market is one of the channels through which women’s education affects their life outcomes.     

The effects of child health on marital status and family structure

The purpose of this paper is to provide evidence on the effect of child health on marital stability and family structure in an economic framework. We use the 1988 National Health Interview Survey's Child Health Supplement, with a sample of about 9,000 families, to test whether having an unhealthy child decreases the mother's chance of being married and whether it increases her chance of living in an extended family. Using two different measures of child health, we find that having an unhealthy child decreases the mother's likelihood of being married. Our results imply that children in poor health are more likely to face obstacles beyond their illness because they also are more likely to suffer the consequences of poverty and the poor schooling outcomes that result from being raised in a female-headed household. The only mitigating factor is that unhealthy white children are more likely than their healthy counterparts to be living in an extended family.     

The inequality of maternal health care in urban sub-Saharan Africa in the 1990s

Numerous studies document the disadvantage in child health of the urban poor in African cities. This study uses Demographic and Health Survey data from 23 countries in sub-Saharan Africa to examine whether the urban poor experience comparable disadvantages in maternal health care. The results show that, although on average the urban poor receive better antenatal and delivery care than rural residents, the care of the urban poor is worse than that of the urban non-poor. This suggests that the urban bias in the allocation of health services in Africa does not benefit the urban poor as much as the non-poor. Multilevel analyses reveal significant variations in maternal health in urban areas across countries of sub-Saharan Africa. The dis-advantage of the urban poor is more pronounced in countries where maternal health care is relatively good. In these countries the urban poor tend to be even worse off than rural residents, suggesting that the urban poor have benefited least from improvements in maternal health care.     

Role of women in schooling and child labour decision: the case of urban boys in India

This paper uses household level data from National Sample Survey Organization (NSSO) of India, the 55th round (1999–2000), to show that for urban male children there exists significant wage incentive for schooling, though school dropout rate and child labour incidence are not so small. The parents’ level of education plays an important role in reducing this tendency; thus establishing the linkage between social and human capital outcomes in the family. We also look at the incidence of harmful and manual occupations among the child labour. Mother’s education now appears as a very important factor in curbing these incidences; supporting earlier findings that women’s empowerment (one important indicator of which would be female educational level) is indeed instrumental in increasing parental awareness.     

Sibling rivalry and the gender gap: evidence from child health outcomes in Ghana

When capital and labor markets are imperfect, choice sets narrow, and parents must choose how to ration available funds and time between their children. One consequence is that children become rivals for household resources. In economies with pro-male bias, such rivalries can yield gains to having relatively more sisters than brothers. Using a rich household survey from Ghana, we find that on average if children had all sisters (and no brothers) they would do roughly 25-40% better on measured health indicators than if they had all brothers (and no sisters). The effects are as large as typical quantity-quality trade-offs, and they do not differ significantly by gender. Received: 22 May 1996 / Accepted: 13 July 1998     

Deepwater Horizon oil spill exposure and child health: a longitudinal analysis

Population and Environment - The BP Deepwater Horizon oil spill (DHOS) created widespread concern about threats to health among residents of the Louisiana Gulf Coast. This study uses data from the...     

Investigating important interactions between water and food security for child health in Burkina Faso

Failures in either water systems or food systems, or a combination of system failures, could provide the underlying explanation for continued high levels of malnutrition in many regions. We focus on child health and offer the first spatially explicit analysis of the interaction between water source and food insecurity on children’s health in Burkina Faso, an African nation that continues to struggle with poor children’s health. We combine data from the 2010 Demographic and Health Survey, a small USAID water quality survey collected from community wells, and remotely sensed imagery. Results suggest that, in a few cases, reliable and clean water sources are positively correlated to children’s linear growth and weight gain, although in many regions, the interaction with community-level food production is critical to understanding health outcomes. The results also suggest that maternal health and nutrition during pregnancy and breastfeeding are foundational to the healthy development of young children. In all, the findings provide evidence of the importance of multi-sectoral interventions targeted at improving children’s health.