Type of Health Facility and Utilization of Antenatal Care Services Among Ghanaian Women

This study examined if differences exist in the number and timing of antenatal care (ANC) visits for users of public and private health care facilities in Ghana. Also, the study explored if such variations could be attributed to health-provider factors or the selective socioeconomic characteristics of the users. Data were drawn from the recently collected Ghana Demographic and Health Survey and from a representative sample of t 2135 women who attended antenatal care in a health facility 6 months preceding the survey. Random-effects Poisson and logit models were employed for analysis. Results showed statistically significant differences between users of private and public health facilities for number of ANC visits, but not for the timing of such visits. Although some health-provider factors were significantly associated with ANC visits, these factors did not explain why users of private health facilities had significantly higher number of ANC visits than users of public health facilities. Differences in ANC visits for both private and public health facilities were rather explained by the selective socioeconomic characteristics of the users, especially as wealthy and educated women patronized private health care than poorer and uneducated women. The study concludes that Ghanaian women attending private health facilities may not have improved access to antenatal care compared to those attending public health facilities, and adds to the emerging body of literature that questions private health care in sub-Saharan Africa as more effective than public health care.     

Tracking Poverty Reduction in Bhutan: Income Deprivation Alongside Deprivation in Other Sources of Happiness

This paper analyses poverty reduction in Bhutan between two points in time—2003 and 2007—from a multidimensional perspective. The measures estimated include consumption expenditure as well as other indicators which are directly (when possible) or indirectly associated to valuable functionings, namely, health, education, access to electricity, safe water, improved sanitation, enough room per person in dwelling, access to roads and land ownership. Interestingly, most of these indicators have been identified as sources of happiness in the 2007 Gross National Happiness Survey. Twelve different measures are estimated with a variety of values for the different parameters involved for robustness analysis. Also, estimates are bootstrapped creating 95 % confidence intervals. We find that over the study period there was an unambiguous reduction in multidimensional poverty regardless of the indicators’ weights, deprivation cutoffs and identification criterion of the poor. This reduction was mainly led by a reduction in the proportion of the poor which was accompanied by a reduction in the intensity of poverty among those who were less intensively poor, although not among those who were more intensively poor. Rather than accomplishing this poverty reduction by improving achievements in one or two indicators, there were significant reductions in several deprivations, especially in access to roads, electricity, water, sanitation, and education. We also find that when income alone is used to target the poor, inclusion errors are marginal but exclusion errors are sizeable. Despite Bhutan’s significant progress, challenges remain as poverty is still high in rural areas. A multidimensional measure in the lines proposed in this paper can prove useful for monitoring poverty reduction, prioritizing groups and evaluating upon investment.     

Is the Pro-Poor Premium Exemption Policy of Ghana’s NHIS Reducing Disparities Among the Elderly?

Under the act that established the National Health Insurance Scheme (NHIS), persons 70 years of age or above are automatically enrolled in the scheme and therefore can access health services free at the point of use. This suggests that the elderly who are unable to afford the premiums of private health insurance can enrol in the NHIS thereby eliminating the possibility of disparities in health insurance coverage. Notwithstanding, few studies have examined health insurance coverage among the elderly in Ghana. The lack of studies on the elderly in Ghana may be due to limited data on this important demographic group. Using data from the Study on Global Ageing and Health and applying logit models, this paper investigates whether the pro-poor exemption policy is eliminating disparities among the elderly aged 70 years and older. The results show that disparities in insurance coverage among the elderly are based on respondents’ socio-economic circumstances, mainly their wealth status. The study underscores the need for eliminating health access disparities among the elderly and suggests that the current premium exemptions alone may not be the solution to eliminating disparities in health insurance coverage among the elderly.     

World population beyond six billion

This world report reviews population growth pre-1900, population change during 1900-50 and 1950-2000, causes and effects of population change and projections to 2050. World population grew from 2 billion in 1900 to almost 6 billion in 2000. Population showed more rapid growth in the 17th and 18th centuries. Better hygiene and public sanitation in the 19th century led to expanded life expectancies and quicker growth, primarily in developed countries. Demographic transition in the 19th and 20th centuries was the result of shifts from high to low mortality and fertility. The pace of change varies with culture, level of economic development, and other factors. Not all countries follow the same path of change. The reproductive revolution in the mid-20th century and modern contraception led to greater individual control of fertility and the potential for rapid fertility decline. Political and cultural barriers that limit access affect the pace of decline. Population change is also affected by migration. Migration has the largest effect on the distribution of population. Bongaarts explains differences in fertility by the proportion in unions, contraceptive prevalence, infertility, and abortion. Educational status has a strong impact on adoption of family planning. Poverty is associated with multiple risks. In 2050, population could reach 10.7 billion or remain low at 7.3 billion.     

The Sustainable Development Goal on Water and Sanitation: Learning from the Millennium Development Goals

Social Indicators Research - Target 7c of the Millennium Development Goals (MDG 7c) aimed to halve the population that had no sustainable access to water and basic sanitation before 2015. According...     

Improvements in Life Expectancy: 1960–1995 an Exploratory Analysis

Human history observed significant changes in life expectancy over the last three and half decades (1960–1995). This study attempts to explore the determinant factors behind improvements in life expectancy in most of the countries in the Post World War II period. In this context the study estimates a double logarithmic convergence type model where the dependent variable is relative change of life over the period and the explanatory variables are initial per capita real gross domestic product, initial per capita calorie intake as percentage of requirement, adult literacy rate at the initial point of time, and initial physician per thousand of population. The study estimates different variants of the basic model. Female population has been treated separately. All estimates have been offered for three broad income groups low, middle and high. An attempt is also made to take into account the effects of some public health measures such as access to safe drinking water and access to sanitation.     

Measuring Access to Continuing Professional Education among the Health Workers in Ghana: Constructing an Index

To measure the levels of access to continuing professional education (CPE) among the health workers, an index (continuing professional education access index: CEAI) was constructed. The CEAI is composed of six indicators: (i) availability of CPE; (ii) distribution of CPE; (iii) informational access; (iv) geographical access; (v) economic access; and (vi) preparedness to release staff. When developing the equation of the CEAI, these six component indicators were weighted in accordance with the order of importance reported by the earlier studies. To test its validity, the CEAI was applied to the CPE status in three regions of Ghana. The results of this application revealed that there was greater discrepancies in the CEAI values according to the type of health facilities. The type of health facilities with the greatest CEAI (= 0.609) implying the best access to CPE was clinics while training/research institutes resulted in the lowest CEAI (= 0.447). Regional variation among the three regions was not significant. A simple linear regression between CEAI and adjusted number of CPE opportunities per health worker produced an extremely high conformity in the model (R² = 0.960). This may indicate the validity of the proposed CEAI model to the large extent.     

Gender inequalities and demographic behavior

A summary was provided of the central findings about gender inequalities in Egypt, India, Ghana, and Kenya published by the Population Council in 1994. These countries exhibited gender inequalities in different ways: the legal, economic, and educational systems; family planning and reproductive health services; and the health care system. All countries had in common a high incidence of widowhood. Widowhood was linked with high levels of insecurity, which were linked with high fertility. Children thus became insurance in old age. In Ghana, women's insecurity was threatened through high levels of marital instability and polygyny. In Egypt, insecurity was translated into economic vulnerability because of legal discrimination against women when family systems were disrupted. In India and all four countries, insecurity was reflective of limited access to education, an impediment to economic autonomy. In all four countries, women's status was inferior due to limited control over reproductive decision making about childbearing limits and contraception. In India, the cultural devaluation of girls contributed to higher fertility to satisfy the desire for sons. In India and Egypt, family planning programs were dominated by male-run organizations that were more concerned about demographic objectives than reproductive health. The universal inequality was the burden women carry for contraception. Family planning programs have ignored the local realities of reproductive behavior, family structures, and gender relations. The assumption that husbands and wives have similar fertility goals or that fathers fully share the costs of children is mistaken in countries such as Ghana. Consequently, fertility has declined less than 13% in Ghana, but fertility has declined by over 30% in Kenya. Family planning programs must be aware of gender issues.     

Academic Buildings and Their Influence on Students’ Wellbeing in Higher Education Institutions

The purpose of this study is to explore the perception of students about aspects of academic building that affect their wellbeing. The study adopts focus group discussion using semi structured interview guide to elicit their responses. Six different groups of students participated in the study. Interviews were recorded using digital audio recorder and were later transcribed to text. The qualitative data obtained was analysed through content analysis. Six key themes that emerged from the analysis are: comfort; health and safety; access and quality of facilities; space provision and adequacy; participation and inclusiveness; interaction. These six items are considered as parameters that are important to students’ wellbeing in relation to academic buildings. The most emphasised aspects of academic building that are essential to meeting students need include thermal conditions, internet access, furniture, duration of access, availability of refreshment facilities, availability of discussion room and availability of personal workstation. This implies that facilities managers in higher education institutions should give adequate attention to these identified aspects of academic buildings as they can potentially affect students output.     

Big Microdata for Population Research

This article describes an explosion in the availability of individual-level population data. By 2018, demographic researchers will have access to over 2 billion records of accessible microdata from over 100 countries, dating from 1703 to the present. Another 2 to 4 billion records will be available through restricted-access data enclaves. These new resources represent a new kind of data that will enable transformative research on demographic and economic change and the spatial organization of society.     

Environment,Access to Health Care,and Other Factors Affecting Infant and Child Survival Among the African and Coloured Populations of South Africa, 1989–94

Some maintain that environmental factors are unimportant for infant and child survival once mother's education and other characteristics have been taken into account. However, an analysis of survival of African and Coloured children based on the 1994 October Household Survey supports the importance of environmental factors in relatively high mortality populations. Among African households, the source of domestic water is important, but for Coloured households, almost all of which have safe water, the type of sanitation is important. If safe drinking water is available, the type of sanitation influences survival; if safe drinking water is not available, sanitation seems to matter little.     

Inequality in South Africa: Findings from the 1994 October Household Survey

This paper argues that inequality and relative deprivation are the main problems to be addressed in the country, based on the denial of access to facilities and equal opportunities by the previous apartheid government. It focuses on the stark contrasts in living conditions and life-styles between blacks and whites, males and females, urban and non-urban people, the employed and the unemployed, and those doing formal versus those doing informal work. It is based on the findings of the 1994 October Household Survey (OHS) of South Africa's Central Statistical Service. The findings show that Africans, who constitute 76% of the population, are more likely to be affected by inequality and relative deprivation. As many as 64% of Africans of all ages, and 70% of Africans aged between 0 and 15 years, live in non-urban areas. Africans are more likely than other population groups to live in shacks in urban areas and in traditional dwellings in non-urban areas, and to have less access to domestic infrastructure such as water, sanitation and electricity. They have also received less education, and are therefore less able to compete with others for jobs in the formal economy. The informal economy consists mainly of service and trade businesses, with little scope for new employment creation. The UNDP's Human Development Index is much lower for Africans, compared to whites. On the basis of the findings, it is argued that large-scale development programmes are required to overcome the inequalities of the past. If this does not happen, there is a danger that there will be insufficient high-level skills in the country to sustain economic growth.     

Infant mortality decline in Malaysia, 1946–1975: The roles of changes in variables and changes in the structure of relationships

This analysis has identified several factors contributing to the dramatic decline in infant mortality since World War II in Malaysia, as well as one factor that prevented the infant mortality rate from declining even more rapidly. Our main findings are the following: On average, mothers' education more than doubled over the study period, contributing to the decline in their infants' mortality. In addition, the beneficial effect of mothers' education on infant survival appears to have become stronger over the study period. Hence, further advances in education should lead to further improvements in infants' survival prospects. Another analysis of these data (Peterson et al. 1985) found that education is somewhat more influential in affecting child mortality in low-mortality, high-income areas than in the opposite type of areas. Therefore, socioeconomic development may have complemented, instead of substituted for, the the beneficial effect of mothers' education in promoting infant and child survival in Malaysia. Improvements in water and sanitation also contributed to the infant mortality decline, especially for babies who did not breastfeed. However, unlike education, these influences have become less important over time, especially for babies who are not breastfed. Hence, further improvements in water and sanitation, a goal of Malaysia's Rural Environmental Sanitation Programme, may have smaller relative effects on infant mortality than did previous improvements. Targeting such improvements on areas where women breastfeed little or not at all, however, will increase their effectiveness in promoting infant survival. The substantial reductions in breastfeeding that have taken place since World War II have kept the infant mortality rate in Malaysia from declining as rapidly as it would have otherwise. We estimate that, in our sample, the detrimental effects on infant survival of the decline in breastfeeding have more than offset the beneficial effects of improvements in water and sanitation. Unlike some other researchers (e.g., Palloni 1981), we find that changes in fertility levels and in the timing and spacing of births have had negligible effect in explaining the decline in infant mortality within the samples we have considered. We have excluded births to older women from our analysis, however; this exclusion may have led to an understatement of the influence of changes in the age pattern of childbearing.(ABSTRACT TRUNCATED AT 400 WORDS)     

Socio-Economic Inequalities in Happiness in China and U.S.

Our paper studies the determinants of happiness in China and U.S. and provides a better understanding of the issue of inequalities in happiness beyond income inequality. Based on the two waves of nation-wide survey data on happiness collected by World Values Survey in 1995 and 2007, Probit and ordinary least square methods are used to estimate effects of various factors on happiness. Our findings show that socio-economic inequalities increase inequalities in happiness in China. The poor are the least happy even though the income effect flats out at the high end. Individuals with below high school education attainment are less happy than those with more education. Agricultural workers are the most unhappy and are becoming even more unhappy over time. However, in U.S., there is no systematic difference in happiness across income and education groups and between agricultural and non-agricultural workers. In both countries health is a major factor contributing to happiness. Our study implies that adequate provision of national health care services should be an effective way to improve social welfare. Besides, since the probability of being happy for agricultural workers is still considerably less after controlling for income in China, policies to improve their welfare should not be limited to enhancing current income.     

Health conditions in rural and urban areas of developing countries

The poor quality and meagre supply of data prohibit conclusions as to the relationship of health status to rural-urban residence in underdeveloped countries. Demographic indicators of health, specifically infant mortality and average life expectancy, do not seem to vary systematically according to rural-urban residence in the less developed countries ofAsia, Africa and Latin America. Further differences between rural and urban areas in availability of health services and facilities do not always conform with apparent differences between the areas in health status. However, nutritional standards, housing conditions, and sanitation, water supply and other pertinent environmental circumstances account to some extent for differences observed in health status between rural and urban inhabitants of these countries.     

Polygynists and Their Wives in Sub-Saharan Africa: An Analysis of Five Demographic and Health Surveys

Differential polygyny in Ghana, Kenya, Senegal, Uganda, and Zambia is investigated using individual-level Demographic and Health Surveys data. As well as contrasting polygynists' first wives with women in monogamous unions, the analysis distinguishes higher-order wives from first wives. This permits study of the determinants of the prevalence and intensity of polygyny respectively. Polygyny and other aspects of marriage interlock in very similar ways in all five countries. Individuals' experience of polygyny tends to reflect their luck in the marriage market rather than their socio-economic characteristics. While polygyny is less prevalent in urban areas, other socio-economic factors are important only in Kenya and Zambia, the two countries where less than 25 per cent of married women are in polygynous unions. The prevalence and intensity of polygyny are negatively associated. Thus, any drop in the prevalence of polygyny in Africa may be accompanied by a rise in the number of wives per polygynist.     

Community based approaches in water supply and sanitation programme — An Indian experience

With the onset of the International Drinking Water Supply and Sanitation Decade (IDWSSD), 1981–1990, global policies and strategies were evolved for the effective planning, implementation and monitoring of water supply and sanitation programmes. In the introduction of IDWSSD policies in water supply programmes, socio-economic aspects have been given equal importance to the hardware aspects. The responsible water bodies and donor countries realised the need for an integrated approach in the water supply sector ultimately. Socio-economic Units in Kerala was conceptually formulated during 1984–85 in order to meet the guidelines under IDWSSD. In 1984 both the governments of the Netherlands and Denmark launched a joint mission to develop a systamatic frame work for the implementation of three Socio-Economic Units and a Co-ordinating office to work jointly with the Kerala Authority (KWA). The three units are located in the North, Central and Southern parts of Kerala State. Each units covered a project area which consists of 600000 population. The activities are mainly concentrated in 73 panchayaths, where the 11 bilateral water supply schemes are under implementation. The activities includes community education, community mobilization, inter-sectoral and intra-departmental co-ordination and collaboration, human resources development and institutional development including appropriate training programmes, establishment of viable and realistic management information systems etc. The major thrust of the programme interventions are on developing micro-level planning and implementation systems and procedures at the ward level. The results of these experiments would be available by the end of 1990.     

Multidimensional Human Opportunity Index

One fact that emerges from the evaluation of the Millennium Development Goals is that not all countries met all the goals and there are significant complementaries among failing on specific goals. This paper proposes the Multidimensional Human Opportunity Index (MHOI) that focuses on the complementaries among access to multiple services. We focus on access to services for children, with the aim of capturing equality in opportunity for children from diverse socio-economic backgrounds. This index builds on the Human Opportunity Index of the World Bank that measures children’s access to a basic service, such as access to clean water. However, the MHOI differs from the parent index in that we measure joint access to multiple services or access to a bundle of services. We apply the MHOI on two Himalayan states of South Asia, Nepal and Bhutan, and show that although each basic service is available to a large proportion of the population, only two-thirds in Bhutan and one half in Nepal have access to the bundle of basic services in 2011–2012.     

Population and environment in the twenty-first century

In the past 50 years global population grew by 3.7 billion. There is a large unmet need for family planning and wherever women have been given the means and the information to decide if or when to have the next child, then family size has fallen, often rapidly. However, since the UN 1994 Cairo conference on population and development, support for international family has collapsed and fertility declines in many of the poorest countries have stalled. Amongst some of the most vulnerable groups family size has risen. The investment made in voluntary family planning will largely determine whether, in the next 50 years, the global population grows to something less than 8 billion or to over 10. The trajectory taking us to the higher figure could jeopardize any possibility of transitioning the global economy to a biological sustainability. Much precious time has been lost. Almost all the additional growth in population will take place in the world’s poorest countries, and it is imperative that the international community act to improve access to family planning in those countries, within a human rights frame framework.     

Child Spacing in the Philippines: The Effect of Current Characteristics and Rural Development

In this study the effects of characteristics current at the beginning of the birth interval on the time elapsing before the next birth are examined. The child-spacing process is viewed as affected by time-varying and fixed characteristics of the community, household, and individual. In the model on which the empirical research is based sociological and economic antecedents are used. The study is based on data from two panels of the Bicol Multipurpose Survey collected in 1978 and 1983. These furnish detailed histories of pregnancy and contraception, together with an extensive set of socio-economic data. Detailed information on services and facilities available in each of the 100 sample communities is also available. Because of the large rural development programme introduced in various sub-areas of the Bicol region, substantial changes in the rural infrastructure and in availability of health and family planning facilities and services occurred between 1976 and 1980, the period on which the analysis is focused. Our results clearly show that current characteristics at the individual, household, and community levels have significant and interpretable effects on the lengths of birth intervals.