Effects of the physical accessibility of maternal health services on their use in rural Haiti

An analysis of data from the 2000 Demographic and Health Survey shows that little use is made of antenatal and delivery-care services in rural Haiti. After adjusting for individual-level factors, poor road conditions significantly reduce the likelihood of timely receipt of antenatal care and of four or more antenatal care visits, while the availability of a health centre within 5 kilometres significantly increases the odds of each outcome. The odds of being attended at delivery by trained medical personnel and of institutional delivery are significantly reduced by mountainous terrain and distance from the nearest hospital, and are increased if a health worker providing antenatal care is present in the neighbourhood. Neighbourhood poverty reduces the likelihood of safe delivery care. The findings suggest that improving the use made of maternal healthcare services would require, among other things, improvement of the availability of services and road conditions, and the reduction of poverty.     

Effects of the physical accessibility of maternal health services on their use in rural Haiti

An analysis of data from the 2000 Demographic and Health Survey shows that little use is made of antenatal and delivery-care services in rural Haiti. After adjusting for individual-level factors, poor road conditions significantly reduce the likelihood of timely receipt of antenatal care and of four or more antenatal care visits, while the availability of a health centre within 5 kilometres significantly increases the odds of each outcome. The odds of being attended at delivery by trained medical personnel and of institutional delivery are significantly reduced by mountainous terrain and distance from the nearest hospital, and are increased if a health worker providing antenatal care is present in the neighbourhood. Neighbourhood poverty reduces the likelihood of safe delivery care. The findings suggest that improving the use made of maternal healthcare services would require, among other things, improvement of the availability of services and road conditions, and the reduction of poverty.     

Financing rural health services in Kenya

The paper analyzes household expenditure on medical care and the willingness to contribute towards service improvements at government health facilities. The analysis is based on survey data from two rural districts in Kenya situated approximately four hundred miles apart. The main finding is that medical care expenditure rises as household income increases, but the probability of willingness to pay fees for service improvement at government clinics declines with income. Income is an important determinant of the willingness to participate in a hypothetical government insurance scheme, with the probability of participation falling as income rises. These results should be interpreted with caution because of the potential for incorrect reporting of the willingness to pay for services that have an element of a social good. The policy implications of the results are briefly discussed.     

Son preference, use of maternal health care, and infant mortality in rural China, 1989-2000

This study assesses the effects of socio-economic conditions and the interaction between son preference and China's one-child family planning policy on the use of maternal health care services and their effects on infant mortality in rural China, using nationally representative data from the 2001 National Family Planning and Reproductive Health Survey. The results show that while the use of maternal health care services has continued to increase over time, large gaps still exist in the use of these services and in infant survival by mother's education, community income, and parity. Further improvements in the reproductive health of all women and in infant survival will require effective reduction of the obstacles to the use of maternal health care among those women in rural China who are less educated, poor, and of higher parity.     

Determinants of out-migration in rural China: effects of payments for ecosystem services

Rural-to-urban migration has been a hallmark of economic development in China and other developing countries and can have profound socio-economic and ecological implications. This study seeks to understand the impacts on this migration of two large payments for ecosystem services (PES) programs implemented by the Chinese Government: the Conversion of Cropland to Forest Program (CCFP) and the Ecological Welfare Forest Program (EWFP). The primary goal of these PES programs is environmental conservation with poverty alleviation as the secondary goal. We use a full model of the factors affecting rural out-migration at the individual, household, and community levels to investigate how these PES programs have influenced out-migration in a mountainous rural area of Anhui, China. Results show that the CCFP facilitates out-migration, while the EWFP overall discourages it, thereby somewhat offsetting the effects of the CCFP. Out-migration is also shown to be affected by a number of other individual, household, and community characteristics. The results are useful for designing concurrent PES programs in the future aiming at both environmental conservation and livelihood improvement in not only China but also other developing countries.     

Birth-interval dynamics in rural Bangladesh and maternal weight

This article reports on the results of a study conducted in rural Bangladesh on the influence of maternal weight on the components of birth intervals, including gestation and intrauterine mortality, the duration of postpartum amenorrhea, and the duration of waiting time to conception (the menstrual interval). When biological factors (including maternal age, parity, and supplementation practices) and behavioral variables, including religion, education, and occupation, were controlled, maternal weight was found to be related to the risk of intrauterine mortality and to the probability of resuming menses in the postpartum period. The implications of these findings for policies and programs in developing countries are discussed.     

Family size and maternal health: evidence from the One-Child policy in China

In this paper, we examine the impact of family size on maternal health outcomes by exploiting the tremendous change in family size under the One-Child policy in China. Using data from the China Health and Nutrition Survey 1993–2006, we find that mothers with fewer children have a higher calorie intake and a lower probability of being underweight and having low blood pressure; meanwhile, they have a higher probability of being overweight. This would occur if a smaller family size increases the food consumption of mothers, leading underweight women to attain a normal weight and normal weight women becoming overweight. Robust tests are performed to provide evidence on the hypothesis that the tradeoff between children’s quantity and mother’s “quality” is through a budget constraint mechanism, that is, having more children decreases the resource allocated to mothers and affects their health outcomes.     

Effects of early maternal employment on maternal health and well-being

This study uses data from the National Institute of Child Health and Human Development Study on Early Child Care to examine the effects of maternal employment on maternal mental and overall health, self-reported parenting stress, and parenting quality. These outcomes are measured when children are 6?months old. Among mothers of 6-month-old infants, maternal work hours are positively associated with depressive symptoms and parenting stress and negatively associated with self-rated overall health. However, maternal employment is not associated with quality of parenting at 6?months, based on trained assessors’ observations of maternal sensitivity.     

Fertility of rural China: effects of local family planning and health programs

The rationing of births in China after the 1979 announcement of the one-child family policy has been held responsible for the rapid decrease in Chinese fertility, whereas other observers have noted that parallel fertility declines occurred with voluntary behavior in other East and Southeast Asian countries. This paper assesses the joint contribution of local family planning and health programs, individual characteristics of women, and the development of their communities, as explanatory variables for Chinese fertility in rural areas of three provinces in 1985. Given the explicit quantitative reproductive goals of the government, an ordered Probit model for cumulative fertility is estimated for women age 15–34 and 35–49.The authors appreciate the comments on and corrections of our paper by John Ermisch and the programming assistance of Paul McGuire. The financial support of the Rockefeller Foundation is acknowledged.     

Elderly parent health and the migration decisions of adult children: Evidence from rural China

Recent research has shown that participation in migrant labor markets has led to substantial increases in income for families in rural China. This article addresses the question of how participation is affected by elderly parent health. We find that younger adults are less likely to work as migrants when a parent is ill. Poor health of an elderly parent has less impact on the probability of employment as a migrant when an adult child has siblings who may be available to provide care. We also highlight the potential importance of including information on nonresident family members when studying how parent illness and elder care requirements influence the labor supply decisions of adult children.     

Taxes versus services: Municipal service provision in growing rural communities

Planners and administrators in North American rural communities proximate to cities have struggled over the last decade to cope with expanding populations. Amongst the questions posed by this population growth, those associated with the municipal provision of services are considered to be of paramount importance by many commentators. This article examines conventional wisdom on the service-provision implications of rural population growth in light of evidence gained through surveys of rural residents in an urbanizing region of Southern Ontario, Canada. A trade-off game is used to produce budget-constrained community preferences on priorities of municipal service provision; preferences are shown to be more complex in their relationship to residents' characteristics, such as length of residence, than is often suggested in the literature. Moreover, when asked to indicate their preference concerning the broad trade-off between service levels and taxes, 41 percent preferred the status quo and 40 percent opted for increased services and taxes, whilst only 10 percent preferred to save on taxes by sacrificing service quality. It is suggested that policy makers consider carefully the design limitations of survey instruments prior to phrasing policy on service provision. In situations like those created by Proposition 13 in California and Proposition 2 1/2 in Massachusetts, the implications of budget cuts became apparent to residents only as services seriously deteriorated or disappeared altogether. By conducting a trade-off game or some suitable alternative, the implications of tax changes for service provision became apparent to residents without the changes having to occur in reality.We gratefully acknowledge the financial support of the Social Science and Humanities Research Council of Canada (Research Grant No. 410-80-0442) and the Ontario Ministry of Agriculture and Food (Program 40).     

Nepal: Integrated health services project

The Integrated Health Services Project, part of Nepal's current 5-year development plan, will aim at minimal health services to the maximum number of people. The project plans to provide for basic health needs through home visits by village health workers. The object is to stem high mortality particularly of mothers and infants through home nutrition, immunization, and teaching oral rehydration techniques, and induce a decline in fertility with conventional devices and ad hoc sterilization camps. The health aides will number 1/3000-5000 people who will visit villages with materials and a 12-point health message. 1 implement is an armband to measure the circumference of children's arms to diagnose nutritional status.     

The effects of maternal smoking on infant health

Maternal smoking has serious consequences for the developing fetus and infant, including a higher probability that the infant will be born prematurely and at low birth weight, will require admission to neonatal intensive care, and die during infancy. Data from Alabama birth certificates for births occurring between 1988 and 1991 were analyzed using log linear methods to calculate relative risks of adverse pregnancy outcomes and infant death. Smoking by mothers during pregnancy is associated with an elevated risk of infant death, low birth weight, and prematurity, controlling for mother's educational attainment, age, marital status, race, and trimester prenatal care was initiated. Smoking was also associated with a higher rate of admission to neonatal intensive care and to deaths from SIDS and respiratory causes. Reducing maternal smoking can contribute to a reduction of premature and low weight births and infant deaths. Because of the difficulty of stopping smoking, efforts need to be directed at preventing younger women from beginning to smoke.An earlier version of this paper was presented at the Southern Demographic Association annual meeting in New Orleans in October 1993.     

Use of the intra-uterine contraceptive device in rural West Pakistan

This paper presents selected aspects of experience with the intra-uterine contraceptive device (IUD) in rural West Pakistan. There were 1,162 IUD cases analyzed with respect to retention or non-retention. Retention rates were estimated, using life table methods, to be between 55 and 75 percent at one year; the smaller figure was obtained when theIUD was considered to be in situ only until the last examination, when it was observed to be in place. The latter or larger figure was obtained when the IUD was considered to be in situ unless known to be out.The extent of follow-up greatly affects estimates of the length of time the IUD remains in situ. Retention also varies with the type of I UD employed; exclusive use of Loop 3, which has the best retention record of those used,may be expected to yield higher retention rates by as much as 5 to 10 percent for one year. A number of other factors were examined that might explain non-retention. The objective variables that were examined in this experience, such as age, previous contraception, and husband's illiteracy, were on the whole rather poor predictors of IUD retention. Expulsion and other medical complications appear to account for most discontinuance of use of the IUD.     

Comparing two survey methods for estimating maternal and perinatal mortality in rural Cambodia

PURPOSE: We need solid estimates of maternal mortality rates (MMR) to monitor the impact of maternal care programs. Cambodian health authorities and WHO report the MMR in Cambodia at 450 per 100,000 live births. The figure is drawn from surveys where information is obtained by interviewing respondents about the survival of all their adult sisters (sisterhood method). The estimate is statistically imprecise, 95% confidence intervals ranging from 260 to 620/100,000. The MMR estimate is also uncertain due to under-reporting; where 80-90% of women deliver at home maternal fatalities may go undetected especially where mortality is highest, in remote rural areas. The aim of this study was to attain more reliable MMR estimates by using survey methods other than the sisterhood method prior to an intervention targeting obstetric rural emergencies. PROCEDURES: The study was carried out in rural Northwestern Cambodia where access to health services is poor and poverty, endemic diseases, and land mines are endemic. Two survey methods were applied in two separate sectors: a community-based survey gathering data from public sources and a household survey gathering data direct from primary sources. FINDINGS: There was no statistically significant difference between the two survey results for maternal deaths, both types of survey reported mortality rates around the public figure. The household survey reported a significantly higher perinatal mortality rate as compared to the community-based survey, 8.6% versus 5.0%. Also the household survey gave qualitative data important for a better understanding of the many problems faced by mothers giving birth in the remote villages. There are detection failures in both surveys; the failure rate may be as high as 30-40%. PRINCIPLE CONCLUSION: Both survey methods are inaccurate, therefore inappropriate for evaluation of short-term changes of mortality rates. Surveys based on primary informants yield qualitative information about mothers' hardships important for the design of future maternal care interventions.     

The spread of health services and fertility Transition

We use detailed measures of social change over time, increased availability of various health services, and couples' fertility behaviors to document the independent effects of health services on fertility limitation. Our investigation focuses on a setting in rural Nepal that experienced a transition from virtually no use of birth control in 1945 to the widespread use of birth control by 1995 to limit fertility. Changes in the availability of many different dimensions of health services provide the means to evaluate their independent influences on contraceptive use to limit childbearing. Findings show that family planning as well as maternal and child health services have independent effects on the rate of ending childbearing. For example, the provision of child immunization services increases the rate of contraceptive use to limit fertility independently of family planning services. Additionally, new Geographic Information System (GIS)-based measures also allow us to test many alternative models of the spatial distribution of services. These tests reveal that complex, geographically defined measures of all health service providers outperform more simple measures. These results provide new information about the consequences of maternal and child health services and the importance of these services in shaping fertility transitions.     

Mental health concerns of gay and bisexual men seeking mental health services

Little data exist about the mental health needs of gay and bisexual men. This is due to limitations of existing studies such as small and nonrepresentative samples, failure to assess sexual orientation, and concerns about stigmatization, possibly causing sexual minority individuals to be reluctant to disclose their sexual orientation to researchers. Fenway Community Health is a large urban health center that serves the LGBT community. The large number of gay and bisexual men who present for mental health treatment allows for a unique opportunity to gain insight into mental health, prevention, and intervention needs for this group. The current study is a review of the mental health information from all of the gay and bisexual men who reported that they were HIV-negative during their mental health intake over a six-month period at Fenway Community Health (January to June 2000; N = 92). The most frequent presenting problems were depression, anxiety, and relationship issues. Additionally, presenting problems included current or past abuse, substance abuse, finance and employment, recent loss, and family issues. The most frequent diagnoses were depression, anxiety disorders, and adjustment disorders. These findings support the notion that presenting problems and mental health concerns among gay and bisexual men are similar to those frequently reported by individuals in other mental health facilities, however, specific psychosocial stressors are unique to this population.     

The impact of grandparental proximity on maternal childcare in China

This paper investigates the impact of the proximity of grandparents' residence on mother's childcare involvement in contemporary China. Drawing on data from the 1991 China Health and Nutrition Survey, we find that the presence of grandparents in the household significantly reduces a mother's involvement in childcare. Nearby residence of grandparents also decreases mothers' childcare involvement, but only in the case of paternal grandparents not maternal grandparents. These findings suggest the importance of grandparents as childcare substitutes and the strong legacy of a patrilineal culture. Our results point to the importance of taking into account kinship ties that extend beyond the household boundary.     

农村社会保障的若干问题

农村社会保障制度发展滞后是社会主义中国的最大缺憾 ;农村社会保障的根本特点不容扭曲 ,其内涵有必要明确 ;现行“农村社会养老保险”和农村合作医疗要改革要改进 ;农村农民的失业风险产生并加剧 ;农村社会保障资金的来源渠道要开拓 ;农村要建立有利于计划生育的社会保障体系     

Integrating reproductive health services into family planning programs

A recent Population Council publication, Reproductive Health Approach to Family Planning, discusses integration of reproductive health into family planning programs in a series of edited presentations that Council staff and colleagues gave at a 1994 meeting of the US Agency for International Development (USAID) cooperating agencies. The presentations reflect the Council's view that family planning programs ought to help individuals achieve their own reproductive goals in a healthful manner. The report discusses four areas of reproductive health: reproductive tract infections (RTIs), including sexually transmitted diseases; prevention and treatment of unsafe abortion; pregnancy, labor, and delivery care; and postpartum care. Christopher Elias (Senior Associate, Programs Division) argued that family planning programs ought to provide services that target RTIs, given that these illnesses afflict a significant proportion of reproductive-age women. The family planning community has an ethical responsibility to provide services to women who experience an unwanted pregnancy. They must have access to high-quality postabortion care, including family planning services. Professional midwives are ideally suited to serve as integrated reproductive health workers trained to combat the five major maternal killers: hemorrhage, sepsis, pregnancy-induced hypertension, obstructed labor, and unsafe abortion. This was demonstrated in a highly successful Life-Saving Skills for Midwives program undertaken in Ghana, Nigeria, and Uganda, and soon to start in Vietnam in conjunction with the Council's Safe Motherhood research program. Family planning services should be viewed as part of a comprehensive set of health services needed by postpartum women, which include appropriate contraception, maternal health checks, well-baby care, and information about breastfeeding, infant care, and nutrition. Family planning programs should incorporate breastfeeding counseling into their services. When programs aim to help individuals meet their own reproductive goals in a healthful manner, this implies that services will not increase clients' risk of morbidity.