Traditional birth attendant training and local birthing practices in India

Training birth attendants (TBAs) provide essential maternal and infant health care services during delivery and ongoing community care in developing countries. Despite inadequate evidence of relevance and effectiveness of TBA training programmes, there has been a policy shift since the 1990s in that many donor agencies funding TBA training programmes redirected funds to providing skilled attendants during delivery. This study aimed to assess the ways in which a TBA training programme in India has been successful in disseminating evidence-based knowledge on birthing practices. TBAs practicing within 16 villages targeted by training programme initiatives were administered with structured questionnaires. The post training birthing practices of trained (24) and untrained (14) TBAs was compared and birthing practices adopted by women assisted by trained (16) and untrained (9) TBAs was analysed. Positive post training practices were hand washing, use of a clean blade for cutting the cord, immediate breastfeeding and weighing of babies. Nevertheless, the training could be further improved with up to date and evidence-based information and more comprehensive instructions. The findings suggest an integration of local and evidence-based knowledge is needed to improve the training. Raising community awareness of public health measures related to maternal and child health is also recommended.     

‘Like waking up in a Franz Kafka novel’: Service users' experiences of the child protection system when domestic violence and acrimonious separations are involved

The challenges that arise in respect of child abuse reports made in the context of domestic violence and/or acrimonious separation have been the subject of recent academic discussion. This paper adds a service user perspective to the debate and reports on the findings from a study conducted in the Republic of Ireland. In addition to the previously established evidence about such cases, it demonstrates the level of powerlessness and frustration experienced by families who found it difficult to have their needs heard or met. It also illustrates the very detrimental emotional impact on children and parents who frequently encountered indifference as well as insensitive and gendered responses from child protection staff. The findings indicate that mainstream statutory child protection services do not have the capacity to deal with these complex cases, and advocates the adoption of alternative approaches. Importantly, the study demonstrates the necessity to pay attention to the views of service users in developing an appropriate response.     

Informal caregiving for elders in Sweden: an analysis of current policy developments

In Sweden, care of elderly people is a public responsibility. There are comprehensive public policies and programs providing health care, social services, pensions, and other forms of social insurance. Even so, families are still the major providers of care for older people. In the 1990s, the family was "rediscovered" regarding eldercare in Sweden. New policies and legislative changes were promoted to support family caregivers. The development of services and support for caregivers at the municipal level has been stimulated through the use of national grants. As a result, family caregivers have received more recognition and are now more visible. However, the "Swedish model" of publicly financed services and universal care has difficulty addressing caregivers. Reductions in institutional care and cutbacks in public services have had negative repercussions for caregivers and may explain why research shows that family caregiving is expanding. At the same time, a growing "caregivers movement" is lobbying local and national governments to provide more easily accessible, flexible, and tailored support. In 2009, the Swedish Parliament passed a new law that states: "Municipalities are obliged to offer support to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities." The question is whether the new legislation represents a paradigm shift from a welfare system focused on the individual to a more family-oriented system. If so, what are the driving forces, motives, and consequences of this development for the different stakeholders? This will be the starting point for a policy analysis of current developments in family caregiving of elderly people in Sweden.     

Building an expanded learning time and opportunities school: principals' perspectives

Four principals from New York City, Los Angeles, and Houston share their schools' journeys of how they expanded learning time and opportunities to best meet their students' academic and developmental needs.     

The Effects of Post-marital Childbearing on Divorce and Remarriage: An Application of Hazards Models with Time-dependent Covariates

In this paper we examine the effects of having a baby during a period of separation on the probability of divorce, and the impact of bearing a child while divorced on the likelihood of remarriage in the United States. Among whites, neither a first nor a second birth during separation had any significant effect on the probability of divorce. Among blacks, either a first or second birth significantly increased the chance of divorce. The function of post-marital childbearing among black women as an incentive to obtaining divorces (presumably to allow them to establish new unions formally) is important, because a large proportion remain separated indefinitely. Whereas the occurrence of both first and second births during divorce significantly increased the probability of remarriage among whites, only a second birth did so among blacks. Further analysis suggests that while the legitimization of births was an important factor among whites, there was little evidence of a comparable effect among blacks.     

Understanding intimate partner violence against women in the rural South

Most U.S. intimate partner violence (IPV) research to date has been limited to women residing in urban areas, with the small body of research focusing on rural populations being primarily qualitative. In this case-control study of Southern rural women, while many factors are consistent with those found in urban settings, unlike findings elsewhere, IPV risk appears to increase with age, and race showed no increased risk. Furthermore, in rural areas where guns are more acceptable than in other parts of the United States, partners of IPV victims are considerably more likely to carry weapons than partners of nonabused women. Given the geographic limitations to police and medical response to severe IPV in a rural setting, an improved understanding of IPV risk among this population can aid health care providers in ascertaining risk before it escalates further.