Is Asian ethnicity an independent risk factor for severe perineal trauma in childbirth? A systematic review of the literature

ObjectiveTo undertake a systematic review of the literature to determine whether Asian ethnicity is an independent risk factor for severe perineal trauma in childbirth.MethodOvid Medline, CINAHL, and Cochrane databases published in English were used to identify appropriate research articles from 2000 to 2010, using relevant terms in a variety of combinations. All articles included in this systematic review were assessed using the Critical Appraisal Skills Programme (CASP) ‘making sense of evidence’ tools.FindingsAsian ethnicity does not appear to be a risk factor for severe perineal trauma for women living in Asia. In contrast, studies conducted in some Western countries have identified Asian ethnicity as a risk factor for severe perineal trauma. It is unknown why (in some situations) Asian women are more vulnerable to this birth complication. The lack of an international standard definition for the term Asian further undermines clarification of this issue. Nevertheless, there is an urgent need to explore why Asian women are reported to be significantly at risk for severe perineal trauma in some Western countries.ConclusionCurrent research on this topic is confusing and conflicting. Further research is urgently required to explore why Asian women are at risk for severe perineal trauma in some birth settings.     

Divorced Fathers’ Proximity and Children’s Long-Run Outcomes: Evidence From Norwegian Registry Data

This study examines the link between divorced nonresident fathers’ proximity and children’s long-run outcomes, using high-quality data from Norwegian population registers. We follow (from birth to young adulthood) each of 15,992 children born into married households in Norway in the years 1975–1979 whose parents divorced during his or her childhood. We observe the proximity of the child to his or her father in each year following the divorce and link proximity to educational and economic outcomes for the child in young adulthood, controlling for a wide range of observable characteristics of the parents and the child. Our results show that closer proximity to the father following a divorce has, on average, a modest negative association with offspring’s outcomes in young adulthood. The negative associations are stronger among children of highly educated fathers. Complementary Norwegian survey data show that highly educated fathers report more post-divorce conflict with their ex-wives as well as more contact with their children (measured in terms of the number of nights that the child spends at the father’s house). Consequently, the father’s relocation to a more distant location following the divorce may shelter the child from disruptions in the structure of the child’s life as they split time between households and/or from post-divorce interparental conflict.     

Home birth and the National Australian Maternity Services Review: too hot to handle?

Background

In February 2009 the Improving Maternity Services in Australia – The Report of the Maternity Services Review (MSR) was released, with the personal stories of women making up 407 of the more than 900 submissions received. A significant proportion (53%) of the women were said to have had personal experience with homebirth. Little information is provided on what was said about homebirth in these submissions and the decision by the MSR not to include homebirth in the funding and insurance reforms being proposed is at odds with the apparent demand for this option of care.

Method

Data for this study comprised 832 submissions to the MSR that are publicly available on the Commonwealth of Australia Department of Health and Aging website. All 832 submissions were downloaded, coded and then entered into NVivo. Content analysis was used to analyse the data that related to homebirth.

Findings

450 of the submissions were from consumers of maternity services (54%). Four hundred and seventy (60%) of the submissions mentioned homebirth. Overall there were 715 references to home birth in the submissions. The submissions mentioning homebirth most commonly discussed the ‘Benefits’ and ‘Barriers’ in accessing this option of care. Benefits to the baby, mother and family were described, along with the benefits obtained from having a midwife at the birth, receiving continuity of care and having a good birth experience. Barriers were described as not having access to a midwife, no funding, no insurance and lack of clinical privileging for midwives.

Conclusion

Many positive recommendations have come from the MSR, however the decision to exclude homebirth from these reforms is perplexing considering the large number of submissions describing the benefits of and barriers to homebirth in Australia. A concerning number of submissions discuss having had or having considered an unattended birth at home due to these barriers. Overall there is the belief that not enabling access to funded, insured homebirth in Australia is a violation of human rights. It appears that homebirth was considered by the MSR as ‘too hot to handle’ and by dismissing it as a minority issue the government sought to avoided dealing with homebirth as a ‘sensitive and controversial issue.’     

Minority stress in same-sex male relationships: when does it impact relationship satisfaction?

The minority stress model (Meyer, 2003) has been proposed to explain higher rates of psychopathology in lesbian, gay, and bisexual individuals. However, studies of minority stress have rarely taken into account the interface between minority stress and same-sex relationship processes. In the current study, 142 gay men in romantic relationships completed an online survey assessing minority stress constructs, relationship features, and relationship satisfaction. Minority stress was not directly related to relationship satisfaction, while commitment, trust, and support from one's partner were related to relationship satisfaction. Significant moderation effects emerged between discrimination and trust and between internalized heterosexism and commitment, indicating that trust was related to satisfaction for those who had experienced frequent discrimination, while commitment was related to satisfaction for those low in internalized heterosexism.     

Yearning, learning, and conceding: reasons men and women change their childbearing intentions

People's childbearing intentions change over the course of their reproductive lives. These changes have been conceptualized as occurring in response to the realization that an individual is unlikely to achieve his or her intended fertility, because of constraints such as the "biological clock" or lack of a partner. In this article, we find that changes to child-bearing plans are influenced by a much wider range of factors than this. People change their plans in response to the wishes of their partners, in response to social norms, as the result of repartnering, and as the result of learning about the costs and benefits of parenthood; there are also differences between the factors that influence men's and women's decision-making. In a departure from existing studies in this area, we use a flexible analytical framework that enables us to analyze increases in planned fertility separately from decreases. This allows us to uncover several complexities of the decision-making process that would otherwise be hidden, and leads us to conclude that the determinants of increases in planned fertility are not simply equal and opposite to the determinants of decreases.     

Suburban queer: reading Grease

This article examines how nontraditional representations of gender can complicate received social norms, and it examines, in particular, how pre-adolescent suburban youth reconfigure social codes within popular film in order to identify positive queer aesthetics. While several studies have documented the function of classic and mainstream film in the tradition of queer reading, there has been comparatively less analysis devoted to the ways that filmic representations themselves might contribute to theoretical debates regarding sexual identity. As a case in point, this essay analyzes the 1978 musical Grease in order to suggest ways that critics might navigate between strict social constructionist and essentialist theories of sexual identity in order to identify avenues for queer identification within non-queer contexts.     

The problems of eligibility and endogenous confounders when assessing the mortality impact of a nationwide disease-prevention programme: the case of insecticide-treated nets in Togo

Evaluation of the mortality impact of nationwide disease-prevention efforts is complicated by potential endogeneity: programme recipients may have unobserved characteristics that simultaneously make them both more likely to become recipients and more likely to survive as a result of other health practices. This population-based study assesses the mortality impact of a nationwide programme that distributed insecticide-treated nets (ITNs) to mothers of children aged 9-59 months in Togo. By comparing mortality rates before and after the programme according to households' eligibility status, we demonstrate that a one-time programme that restricts eligibility to households with a surviving child excludes some households with a high risk of child mortality. We then apply simultaneous estimation models to untangle the mortality impact of ITNs from the effects of unobserved confounders and show that among eligible households, living in a household with ITNs significantly reduces mortality for children aged 20-59 months, even after controlling for endogeneity.     

Comparison of household-survey estimates with projections of mortality and orphan numbers in sub-Saharan Africa in the era of HIV/AIDS

The United Nations publishes estimates of HIV prevalence, AIDS mortality, and orphan numbers for all countries of the world. It is important to assess the validity of these model-based estimates since they underpin much policy concerned with care and prevention. Household surveys that ask questions about the survival of children's parents (orphanhood) offer an independent source of data with which these estimates can be compared. Survey estimates of maternal and paternal orphans are significantly lower than model estimates for 40 surveys in 36 countries of sub-Saharan Africa (p < 0.001, p = 0.002). This is probably because adult mortality from causes other than AIDS is lower than assumed in the models, although under-reporting of orphanhood in surveys may also play a role. Reducing adult mortality from causes other than AIDS brings the model estimates into close agreement with the surveys. This suggests that the fraction of orphans attributable to AIDS is greater than estimated previously.     

Do conditional cash transfers influence migration? A study using experimental data from the Mexican progresa program

Prior research on Mexican migration has shown that social networks and economic incentives play an important role in determining migration outcomes. We use experimental data from PROGRESA, Mexico's primary poverty-reduction program, to evaluate the effects of conditional cash transfers on migration both domestically and to the United States. Our study complements a growing body of literature aimed at overcoming longstanding hurdles to the establishment of causal validity in empirical studies of migration. Analysis based on the data collected before and after the program's onset shows that conditional transfers reduce U.S. migration but not domestic migration. The data also enable us to explore the role of existing family and community migration networks. The results show that migration networks strongly influence migration, but that the effect of conditional transfers on migration is apparently not mediated by existing migration network structures. Our results suggest that conditional transfers may be helpful in managing rural out-migration, particularly to the United States.