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.     

Sensitivity of Livelihood Strategy to Livelihood Capital: An Empirical Investigation Using Nationally Representative Survey Data from Rural China

Research on the association between rural households’ livelihood capitals and livelihood strategies has long been of interest in geography, management, economics, ecology and other disciplines. However, the existing micro-empirical studies are mostly small-scale surveys of rural households; there are much fewer large-scale investigations at the national level. Meanwhile, few empirical studies have analyzed the sensitivity of rural households’ livelihood strategies to various types of livelihood capitals in different types of villages, from the perspective of village type. This study uses survey data from 8031 rural households in 226 villages from 27 provinces (cities) of China; the villages were divided into three types: plain villages, hilly villages and mountainous villages. The livelihood capitals and livelihood strategies of rural households in different types of villages were examined, and ordinal logistic regression models were construed to explore the sensitivity of rural households’ livelihood strategies to various types of livelihood capitals in different types of villages. The results revealed that: (1) the sample of rural households had similar livelihood asset structures and livelihood strategy selections across the different types of villages. Among them, human capital was the most important livelihood asset for rural households, while rural households had the lowest dependence on natural capital; off-farm work was the main livelihood strategy for rural households, followed by on-farm work, while the proportion of households engaged in part-time work was the smallest. (2) Rural households’ livelihood strategies had different sensitivities to various types of livelihood capitals, and there were also differences in the sensitivities among different types of villages. For the total sample, as well as the hill and mountain village sub-samples, human and financial capitals had significant positive impacts on livelihood strategy, while nature and social capitals had significant negative impacts on livelihood strategy; physical capital had no significant impact on livelihood strategy. For the plain village sub-sample, human and physical capitals had significant positive impacts on livelihood strategy, while nature capital had a significant negative impact on livelihood strategy; financial and social capitals had no significant impacts on livelihood strategy. This study enhances our understanding of the characteristics of rural households’ livelihood capital structures and livelihood strategy selections as well as the sensitivity of rural households’ livelihood strategies to various types of livelihood capitals among different types of villages in China. These findings provide reference for the formulation of policies related to the improvement of rural households’ livelihoods in different types of villages.

     

Rainfall variations and child mortality in the Sahel: results from a comparative event history analysis in Burkina Faso and Mali

Over the last 40 years, the Sahel has seen a long-term downward trend in rainfall. The importance of ecological variables as factors affecting child survival in rural subsistence societies has already been emphasized, but little empirical evidence has been gathered to support this. This paper presents a comparative event history analysis aimed at understanding how rainfall variations may influence child mortality in two neighbouring countries, Burkina Faso and Mali. These countries are similar in terms of population dynamics, economy, livelihood, child mortality and rainfall conditions (i.e. strong south–north decreasing rainfall gradient). Individual data for both countries came from two detailed nationally representative retrospective surveys conducted in 2000. Rainfall data for the 1960–1998 time period were obtained from the Climatic Research Unit. This study shows that child survival in each country is related to specific patterns of rainfall variation across livelihood regions, highlighting the complex nature of environmental causality of child mortality.     

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.     

Maternal education and child health: Is there a strong causal relationship?

Using data from the first round of Demographic and Health Surveys for 22 developing countries, we examine the effect of maternal education on three markers of child health: infant mortality, children s height-for-age, and immunization status. In contrast to other studies, we argue that although there is a strong correlation between maternal education and markers of child health, a causal relationship is far from established. Education acts as a proxy for the socioeconomic status of the family and geographic area of residence. Introducing controls for husband’s education and access to piped water and toilet attenuate the impact of maternal education on infant mortality and children’s height-for-age. This effect is further reduced by controlling for area of residence through the use of fixed-effects models. In the final model. maternal education has a statistically significant impact on infant mortality and height-forage in only a handful of countries. In contrast. maternal education remains statistically significant for chidren’s immunization status in about one-half of the countries even after individual-level and community-level controls are introduced.     

The labour division of Italian couples after a birth: assessing the effect of unobserved heterogeneity

The results of previous studies on the effect of childbearing on both parents’ paid and unpaid work suffer from the difficulty related to the specification of latent variables that influence the relationship between reproductive behaviour of the couple and working activity. The aim of this study is to estimate the effect of transition to parenthood on the partners’ division of labour by accounting for latent variables, such as the bargaining process between partners and endogenous fertility decisions. In particular, this is the first time that our specific estimation strategy has been applied to determine the impact of childbearing on the division of household labour between partners taking into account the reverse causality effect between labour and fertility decisions. We use longitudinal data on married or cohabiting Italian couples provided by the Italian panel survey of the Generation and Gender Program. Our results are consistent with previous studies, and show that the birth of a child affects a woman’s unpaid labour strongly and positively and her paid labour negatively, while men’s work is mostly unaffected. Moreover, when partners hold traditional attitudes regarding gender roles and the family, the female partner is even more strongly affected by childbearing in terms of total amount of labour (paid plus unpaid). However, our sensitivity analysis shows that these results appear only when our correction strategy for the misspecification of latent variables is applied.

     

Bidirectional longitudinal associations of parent and child health following the BP Deepwater Horizon oil spill

This study (1) assessed whether parent health mediated associations between exposures to the 2010 BP Deepwater Horizon oil spill (BP-DHOS) and child health, and whether child health mediated associations between BP-DHOS exposures and parent health; and (2) assessed bidirectional longitudinal associations between parent health and child health following the BP-DHOS. The study used three waves of panel data (2014, 2016, and 2018) from South Louisiana communities highly impacted by the BP-DHOS. Parents with children (aged 4–18 at the time of the interview) were interviewed based on a probability sample of households. Focal measures included economic and physical BP-DHOS exposures, self-reported parent health, and parent-reported child health. Health measures were gathered at three time points. The analyses included mediation analysis and estimating and comparing effect sizes of longitudinal cross-lagged effects between parent health and child health. Results showed that parent health partly mediated associations between BP-DHOS exposures and child health, and that child health partly mediated associations between BP-DHOS exposures and parent health. Paths from prior waves of parent health to subsequent waves of child health were positive and statistically significant as were paths from prior waves of child health to subsequent waves of parent health. The differences in size of the child-to-parent health effects and the parent-to-child health effects were not statistically significant. This study’s results extend evidence for the post-disaster effect of parent health on child health and the effects of child health on parent health. These findings support the contention that harm to the health of one’s family member following disasters operates as a form of resource loss deleterious to one’s health.

     

A Four-Country Study on the Relationship Between Parental Educational Homogamy and Children’s Health from Infancy to Adolescence

This study explores the relationship between parental educational similarity—educational concordance (homogamy) or discordance (heterogamy)—and children’s health outcomes. Its contribution is threefold. First and foremost, I use longitudinal data on children’s health outcomes tracking children from age 1 to 15, thus being able to assess whether the relationship changes at key life-course and developmental stages of children. This is an important addition to the relevant literature, where the focus is solely on outcomes at birth. Second, I look at different health outcomes, namely height-for-age (HFA) and BMI-for-age (BFA) z-scores, alongside their dichotomized counterparts, stunting and thinness. Third, I conduct the same set of analyses in Ethiopia, India, Peru, and Vietnam, thus providing multi-context evidence from countries at different levels of development and with different socio-economic characteristics and gender dynamics. Results reveal important heterogeneity across contexts. In Ethiopia and India, parental educational homogamy is associated with worse health outcomes in infancy and childhood, while associations are positive in Peru and, foremost, Vietnam. Complementary estimates from matching techniques show that these associations tend to fade after age 1, except in Vietnam, where the positive relationship persists through adolescence, thus supporting the homogamy-benefit hypothesis not only at birth, but also across the early life course. Insights from this study contribute to the inequality debate on the intergenerational transmission of advantage and disadvantage and shed additional light on the relationship between early-life conditions and later-life outcomes in critical periods of children’s lives.

     

Estimating Diversity Effects in the Neighborhood: On the Role of Ethnic Diversity and Out-group Size and their Associations with Neighborhood Cohesion and Fear of Crime

This study considers and simultaneously tests the role of ethnic diversity and out-group size in relation to individuals’ perceptions of neighborhood cohesion and fear of crime among natives in Dutch neighborhoods. We challenge the way the impact of diversity has been studied previously and propose an alternative measure to examine diversity effects. This results in a better understanding of how and why the ethnic composition of a neighborhood may impact levels of cohesion and fear, and thereby contributes to the literature on the societal effects of ethnic diversity. In addition, attention is paid to the association between cohesion and fear and whether neighborhood cohesion mediates the relationship between ethnic diversity and fear of crime. We apply multilevel equation modeling techniques to analyze the different relationships and use data of the Dutch Safety Monitor (N?=?71,760) in combination with detailed register data. Our study is one of the first to detect a diversity effect on cohesion based on the modified diversity measure. We do not find support for the hypothesized diversity effect on fear of crime. Lastly, out-group size turned out to decrease cohesion and increase fear.

     

Household income and child survival in Egypt

This article uses household-level economic and fertility survey data to examine the relationship between household income and child survival in Egypt. Income has little effect on infant mortality but is inversely related to mortality in early childhood. The relationship persists with other associated socioeconomic variables controlled. The mechanisms underlying the income effects are not evident from this analysis: income differentials in sources of household drinking water, type of toilet facilities, and maternal demographic characteristics do not explain the net impact of income on child mortality. The absence of effects on child survival of the size of the place of residence and the relatively weak effects of maternal schooling are also notable.     

Mothers’ Sexual Identity and Children’s Health

Sexual minority women face a plethora of structural, socioeconomic, and interpersonal disadvantages and stressors. Research has established negative associations between women’s sexual minority identities and both their own health and their infants’ birth outcomes. Yet a separate body of scholarship has documented similarities in the development and well-being of children living with same-sex couples relative to those living with similarly situated different-sex couples. This study sought to reconcile these literatures by examining the association between maternal sexual identity and child health at ages 5–18 using a US sample from the full population of children of sexual minority women, including those who identify as mostly heterosexual, bisexual, or lesbian, regardless of partner sex or gender. Analyses using data from the National Longitudinal Study of Adolescent to Adult Health (N?=?8978) followed women longitudinally and examined several measures of their children’s health, including general health and specific developmental and physical health conditions. Analyses found that children of mostly heterosexual and bisexual women experienced health disadvantages relative to children of heterosexual women, whereas the few children of lesbian women in our sample evidenced a mixture of advantages and disadvantages. These findings underscore that to understand sexual orientation disparities and the intergenerational transmission of health, it is important to incorporate broad measurement of sexual orientation that can capture variation in family forms and in sexual minority identities.

     

Transgender Identities,Pressures, and Social Policy: A Study Carried Out in Spain

ABSTRACT

This article draws on a qualitative research project concerning the relationship between trans people’s mental health and wellbeing, pressures, social policy, and heteronormative gender norms in Spain. Drawing on interviews carried out with trans people from all regions and generations, we use an ecological framework to illustrate how a socially entrenched heteronormativity pressures trans people to comply with gender norms that impact negatively their mental health and wellbeing. The article argues that the legal changes in Spain are not enough in themselves to bring about social change, but, rather, Spanish social policy makers also need to challenge gender categorization and work toward transforming public discourses on gender issues if trans people are to gain full social recognition and equal social rights.     

The experiences of pregnant women attending a specialist service and using methamphetamine

BackgroundPregnant women attending the Specialist Drug and Alcohol Service in Perth use methamphetamine as their primary drug of choice. This is the only tertiary service for pregnant and postnatal women with complex Alcohol and Other Drug Use in Western Australia. It is a midwifery-led multidisciplinary team. Many of the women struggle with addiction, polysubstance use, co-occurring mental health, family and domestic violence, complex trauma and fear of Child Protection and infant removal. Therefore, the aim of this study was to understand the impact of methamphetamine use of pregnant women attending the service and explore and highlight the potential barriers to engagement and follow-up.MethodsA qualitative study informed by phenomenological methods was undertaken using semi-structured interviews with 20 women with methamphetamine use attending the service in order to explore and understand the experience of using methamphetamine in pregnancy and the postpartum period. A thematic analysis was undertaken with data from the women in the study (n = 20) to identify key themes.ResultsKey themes that emerged from the women’s experiences detail their resilience and experience with methamphetamine and the impact that methamphetamine has on their life. A key concern for women regarding methamphetamine use and engagement with specialist services was the welfare of their child(ren). Agencies charged with child protection was a barrier to treatment because women feared disclosure of methamphetamine use would result in loss of child custody. Themes highlighted the multiple layers of adversities, and trauma from childhood to adulthood including, co-occurring drug use, mental health and life histories of trauma (abuse, violence, and neglect; intergenerational trauma; intergenerational drug and alcohol use, and child removal), the omnipresence of methamphetamine, and the impact on pregnancy and mothering.ConclusionWe conclude that understanding the experiences of women and the impact methamphetamine use has on their life is paramount to providing effective and appropriate care to support pregnant women in a trauma-informed and woman-centred approach. Poor engagement in pregnancy care for women with methamphetamine use has significant impacts on mother and infant.     

Maternal Smoking and Infant Low Birth Weight: Exploring the Biological Mechanism Through the Mother’s Pre-pregnancy Weight Status

Maternal smoking has been found to adversely affect birth outcomes, such as increasing the odds of having low birth weight infants. However, the mechanisms explaining how a mother’s smoking is linked to a child’s low birth weight status are underexplored. This study merged two nationally representative datasets in the United States (US)—the National Longitudinal Survey of Youth 1979 (NLSY79) and the NLSY79 Child and Young Adult (NLSYCYA)—to examine whether maternal weight status before pregnancy serves as a biological mechanism. We applied a recently developed mediation analysis technique to a data sample of 6550 mother–child pairs, and we compared the estimated coefficients across nested probability models. We found that maternal body mass index (BMI) (in kg/m²), a widely used measure of weight status, reduces the odds of delivering a low birth weight infant, and this mechanism explains about 10.2% of the adverse impact of maternal smoking on having a low birth weight child. Moreover, when categorizing maternal pre-pregnancy BMI into four weight statuses (i.e., underweight, normal weight, overweight, and obese), we found that, in contrast to mothers with normal weight status, underweight mothers are 70% more likely to have a low birth weight child. Our findings suggest that maternal weight status plays a role in understanding how maternal smoking affects low birth weight outcome, indicating that maintaining a proper weight status for women who plan to give birth may be a possible policy to promote infant health.

     

A Proactive Approach to Aging Well for Women Over 45

ABSTRACT

This paper reports on an exploratory two-group, pre- and posttest design study, which employed data triangulation with a convenience sample (n = 120) of women over 45 years aged between 45 and 83 years, living and/or working within the South East Sydney and Illawarra areas of New South Wales. Sixty-nine women recorded the Health Check Log (HCL) (33 were health professionals) to assess and monitor their health over 12 months. The majority found the HCL greatly assisted in monitoring and maintaining their health, and the analyses of the SF-36 health survey suggest that women 45 years and over may benefit by regular use of the HCL.     

Family Structure and Self-Rated Health in Adolescence and Young Adulthood

While the relationship between family structure and child well-being is well-established, little is known about the specific impact of family structure on health in adolescence and young adulthood. Using data on 12,737 respondents from Waves I and III of Add Health, we examine the association between family structure (two biological/adoptive, stepfather, and single mother families at Wave I) and self-rated health in adolescence (Wave I) and young adulthood (Wave III). We build on previous literature by investigating whether the relationship between family structure and self-rated health is mediated by demographic background, socioeconomic status, parent–child relationships, external social support, and health characteristics and behaviors, and whether the influence of these factors endures into adulthood. Overall, we find that self-rated health is reduced for respondents who lived in stepfather or single mother families during adolescence, although this effect is attenuated in young adulthood. Family structure effects at both waves are explained by socioeconomic status, social support and competence, and health characteristics and behaviors. We find little evidence that demographic background or mother–child relationships mediate the relationship between family structure and self-rated health. By young adulthood, effects of most adolescent predictors are attenuated, but health assessments are largely influenced by changes in health characteristics and behaviors, and in family type.

Drought and disproportionate disease: an investigation of gendered vulnerabilities to HIV/AIDS in less-developed nations

Environmental change and climate-related disasters are an under-examined factor impacting women’s health, globally. Drawing on ecofeminist theory, we conduct analyses examining if the HIV burden among women is higher in nations that experience suffering from droughts. Specifically, we posit that droughts, which typically impact more people and for greater lengths of time than other climate-related disasters, have a unique impact on women’s vulnerability to HIV/AIDS. We use a cross-national dataset of less-developed countries and ordinary least squares (OLS) regression to explore and compare relationships between suffering from drought and total HIV prevalence and suffering from drought and women’s proportion of HIV cases. Overall, the results demonstrate that while droughts have an inconsistent impact on total HIV prevalence, suffering from drought significantly increases the proportion of HIV cases among women in comparison to men, net of the impact of common economic, social, cultural, and political predictors. The findings suggest that suffering from drought differentially impacts women’s health in less-developed countries, where a number of mechanisms, such as transactional sex or displacement, likely underlie the associations identified.

     

Quality Assessment of the Oncology Health Service in a Public Hospital

Quality assessment is a crucial issue in the strategic management of the public health sector. The objective of this study is to investigate the patients’ perception of the health system quality and explore the relationships between doctors and long-term cancer patients. The data under study have been collected during a survey conducted with long-term cancer patients who follow an oncological therapy in a Public Hospital. In the study, exploratory factorial analysis is developed and two structural equation models are proposed. The first model describes the service quality as perceived by the patients, which is influenced by four important factors, namely tangible aspects, reliability, empathy (doctor–patient human relations) and hospital organization. The second model describes the relationship between doctors and long-term cancer patients, which is influenced by three factors, that is reliability, empathy and hospital organization. The discussion highlights the contribution that the results of the study may make to the investigation of the possible strategies for improving health care service quality.

     

Domestic Outsourcing in an Ultra-Low Fertility Context: Employing Live-in Domestic Help and Fertility in Hong Kong

The fertility rate in Hong Kong has been very low for decades. Because work–family conflict is one of the major barriers for married couples in actualizing their fertility ideals, domestic outsourcing that relieves women from the burden of domestic labor may help reduce the gap between ideal and actual fertility. Hiring live-in domestic helpers, who co-reside with the hiring families and work on a full-time basis, is gaining popularity in Hong Kong. However, past studies neither inside nor outside of East Asia have examined how employing live-in helpers affects fertility. This study investigates the relationship between live-in helpers and fertility by analyzing retrospective event-history data we collected from a representative survey of married couples in Hong Kong (n?=?1697). Our results show that married couples employing live-in helpers tend to have more children than couples not employing live-in helpers. Specifically, the practice is associated with higher odds of first childbirth and of second childbirth, with no evidence of a positive effect beyond bearing a second child. The findings have implications for other East Asian societies, which share similar backgrounds of ultra-low fertility rates, rising female labor force participation rates, rigid gender inequalities in domestic labor, and demanding work cultures.

     

Is the Relationship between Socioeconomic Status and Health Stronger for Older Children in Developing Countries?

Recent research on the relationship between child health and income in developed countries reveals a positive gradient that is more pronounced for older children, suggesting that the impact of income upon health accumulates. This article examines whether the same is true in a developing country. Using data from the Indonesian Family Life Survey on children aged 0 to 14 years, we find that although low income adversely affects health, its impact does not differ by age. This finding is robust to the use of both subjective and objective health measures, controlling for selective mortality, the use of alternative measures of households’ resources, and the inclusion of indicators of health at birth and parental health. One explanation for the constancy of the health-income relationship that we explore is the dominant role played by acute illness in determining the general health status of children in a developing-country context compared with the more central role played by chronic conditions in developed countries.