GEOGRAPHICAL PERSPECTIVES ON SAFE MOTHERHOOD IN THE HILL COUNTRY OF SRI LANKA: A CASE STUDY OF THE DORAGALA TEA PLANTATION IN PUSSELLAWA

ABSTRACT

In comparison with other South Asian countries, Sri Lanka maintains well-developed health care systems. Nonetheless, limited health care services are provided to mothers and children in the hill country. This research raises a series of questions concerning current challenges for safe motherhood, such as health care services already present, spatial distribution of health care professionals, and health policy in the hill counties of Sri Lanka. The authors argue that to understand the existing infrastructure of health care systems and future challenges to provision of health care services, it is important to depict the spatial location of health care units and to recognize the complexity of interactions between these units and the social, economic, and health environment. Such assessment provides a human geography approach that investigates health care systems in spatial dimensions. This study uses the geographical techniques of Geographic Information Systems and Global Positioning Systems to answer the fundamental questions of “what is where,” “why is it there,” and “why do we care.” The questions underline the importance of spatial methodology in assessment of safe motherhood and the importance of accurate and precise knowledge about the status of maternal health.     

Maternal Health Policies in Countries in Transition: Poland and Kyrgyzstan, 1990–2006

ABSTRACT

Starting with the initiation of democratic and market economic transitions, unsupportive policies concerning women's reproductive health were implemented in Kyrgyzstan and Poland in the period 1990–2006. These policies were expressed by (1) political decisions limiting available funding to support medical practices protecting women's reproductive health, (2) diminishing or restricted dissemination of knowledge about family planning, and (3) the implementation of new contraception and abortion policies. Could these changes be perceived as combat between democratic liberalism, cosmopolitanism, and tolerance versus traditionalism, insularism, and fundamentalism? We use analyses of policies concerning women's reproductive and maternal health to manifest rivalry between economic crisis and the push toward modernity and between traditionalism and liberalism. We demonstrate that the return to traditional gender roles and gender policies, and their practical application expressed in maternal health policies, illustrates cultural backlash toward diffusing Western liberalism in countries in political and economic transition.     

Safe Motherhood in the Context of Nepal

ABSTRACT

Nepal ranks low on the Human Development Index and has a high maternal mortality rate. Various factors contribute to the high rate of maternal mortality and include a shortage of health care professionals, limited access to basic maternal health care, poverty, illiteracy, women's low social status, a poorly developed transportation system, a limited communication system, political conflict, and a diverse population. Interviews with pregnant women, observational data, and national statistics provide the basis for suggestions provided by the author. These include upgrading and opening new maternal care facilities, integrating midwives into local health services, providing education on women's health needs during pregnancy, and improving public awareness of the availability of maternal care services.     

PUBLIC–PRIVATE PARTNERSHIPS FOR MATERNAL HEALTH IN AFRICA: CHALLENGES AND PROSPECTS

ABSTRACT

The concept of public and private partnerships raises growing interest and hope from international development agencies, governments, and communities as an alternative strategy in social welfare delivery. Conceptualized as a strategy to build and capitalize on the tangible and intangible assets and resources endogenous to social organizations and communities, individually and collectively, this article embraces an asset-based approach to analyze the potency of such a framework in enhancing maternal health care delivery in developing countries such as Senegal and Mali. These countries face growing retrenchment of the state from social service delivery and scarcity of human and financial resources, which call for innovative approaches and sustainable solutions in addressing pervasive deficits in health service delivery. Drawing from empirical field research conducted in Senegal and Mali, this article examines the trend toward public–private partnerships and its gender impacts and critically analyzes the challenges and opportunities it offers conceptually and practically to address and improve equity in health care delivery, particularly safe motherhood and maternal health care delivery in developing countries.     

Population pressure and fertility in pre-transition Thailand

Before the demographic transition in Thailand, fertility was high, but not uniformly so. As in other pre-transition settings, Thai fertility responded to pressures and opportunities created by socioeconomic structure and land availability. Drawing upon provincial data from the 1947 and 1960 censuses of Thailand, we find a strong 'frontier effect' on Thai fertility in the 1950s. Fertility was higher in sparsely settled frontier provinces and lower in provinces with higher population density relative to cultivatable land. This finding is robust and holds up with controls for agricultural employment, land quality, and the sex ratio (an indicator of sex-selective migration). The effect of population pressure lowers the likelihood of marriage and of marital fertility. The findings from Thailand are consistent with the research of Easterlin on the nineteenth century United States and with other pre-transition societies. We suggest how demographic transition theory might be broadened to include fertility dynamics in pre-transition societies.     

Health and Cultural Determinants of Voluntary HIV Testing and Counseling Among Middle-Aged and Older Latina Women

The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people with HIV/AIDS is over age 50. This study describes the correlates of HIV Voluntary Counseling and Testing (VCT) using structural equation modeling techniques for a sample of 135 middle-aged and middle-aged and older Latinas in South Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to be the strongest predictor of VCT (odds ratio [OR] = 6. 38), followed by having a clinic as a regular source of healthcare (OR = 3.88). Social work implications are provided.     

俄狄浦斯神话的社会与政治隐喻——象征主义视角下的神话意义阐释

以"象征主义"的阅读态度解读俄狄浦斯神话,其叙事主题是以宿命式的故事情节展现表达了父子之间的敌对与冲突状况。这种冲突的根源也是神话叙事所隐含的社会与政治意蕴在于父系社会与母系社会代表的两种社会价值原则之间的斗争。在故事的主要显性冲突与次要隐性融合的复合叙事中,神话隐示了两种社会价值原则和谐共存的可能性及由此而生的人类理想社会的蓝图。     

The relationship between maternal depression and child outcomes in a child welfare sample: implications for treatment and policy

Maternal depression is an extremely important parenting variable in relation to child general health. This investigation addressed the issue of maternal depression as it relates to the lives of children seen by child welfare authorities. Maternal depression was investigated in the context of the increasing rate of children coming to the attention of the London and Middlesex Children's Aid Society. A variety of child outcomes including those of particular relevance to child welfare, specifically disorders of attachment and neglect and physical abuse, school‐related variables, conduct disorder and psychological distress, were investigated. The relative contribution of maternal depression along with measures of socioeconomic status and social isolation to childhood risk was examined. Results indicated that the rate of maternal depression doubled during the years 1995–2001. Maternal depression was related to children entering care through wardship. Additional poor child outcomes such as attention deficit disorder, conduct disorder and emotional adjustment were also related to maternal depression. The findings are discussed in terms of treatment and policies that can lower the risk to children through effective intervention with depressed mothers.