Does early childbearing and a sterilization-focused family planning programme in India fuel population growth?

Recent stagnation in the reduction of infant mortality in India can arguably be attributed to early child bearing practices and the lack of progress in lengthening birth intervals. Meanwhile, family planning efforts have been particularly successful in the southern states such as Andhra Pradesh, although family limitation is almost exclusively by means of sterilisation at increasingly younger ages. This paper examines the population impact of the unprecedented convergence of early childbearing trajectories in India and quantifies the potential implications stemming from the neglect of strategies that encourage delaying and spacing of births. The effects of adopting a ‘later, longer and fewer’ family planning strategy are compared with the continuation of fertility concentrated in the younger age groups. Results from the cohort component population projections suggest that a policy encouraging later marriage and birth spacing would achieve a future total population which is about 52 million less in 2050 than if the current early fertility trajectory is continued.census, family planning, fertility, India, National Family Health Surveys, population policies, population projections, Sample Registration Systems, sterilisation

Care Needs and Caregivers: Associations and Effects of Living Arrangements on Caregiving to Older Adults in India

As the ageing phenomenon continues in India, we explore the care needs of older adults and identify caregivers for specific care needs across living arrangements. Using the United Nations Population Fund (UNFPA) conducted Building Knowledge Base on Population Ageing in India (BKPAI 2011) data comprising 9850 older adults, we employed statistical methods to analyze the data, find associations and used binary logistic regression to model the adjusted and unadjusted effects of living arrangements on caregiving to older adults for specific care needs. Care-requiring situations considered were acute sickness, sickness requiring hospitalization, chronic morbidity, functional disability represented by ADL and IADL limitations, and locomotor disability. Results indicate that living arrangements of older adults were significantly associated with health, functional status and disability as well as caregiving patterns. Our results suggest that co-residence with children and all others was beneficial to older adults in obtaining care from a family caregiver for their hospitalization and chronic morbidity needs while living with spouse or living with a partner was advantageous for older adults in receiving care for their ADL limitations and during hospitalizations. Mean number of children was also significantly associated with the availability of a caregiver during hospitalization, locomotor disability, chronic morbidity and acute sickness. The study also highlights a little known phenomenon, that there was familial help available to older adults who lived alone. Notably, non-family sources of caregiving were steadily becoming visible (as high as 8–10 % of the caregiving component) especially among older adults living alone

Occurrence of Pregnancies among HIV Infected Indian Women

This is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India (N = 560), were analysed. Directly standardized overall and parity-specific pregnancy rates were compared among HIV infected women before and after coming to know about their HIV status. The age- and parity-standardized pregnancy rates and age-standardized parity-specific pregnancy rates were statistically significantly lower after knowing about HIV status as compared to before the HIV status was known. Analysis of parity-specific rates suggested lower likelihood of HIV infected women to progress to higher parity. The clear behavioural impact of HIV on fertility observed should be taken into account while estimating HIV infected pregnant women in the country. Ensuring access to information and services for PMTCT to HIV infected couples is essential to support informed reproductive decision making among them

"In a situation of rescuing life"

Background: Diabetes mellitus is an emerging public health problem in Tanzania. For the community and the health system to respond adequately to this problem, it is important that we understand the meanings given to its symptoms, and the care-seeking practices of individuals. Methods: To explore collective views on the meanings given to diabetes symptoms, we conducted nine focus group discussions with adult diabetes patients and members of the general community. To gain a better understanding of how the meanings in the community inform the care-seeking practices of individuals, 19 in-depth interviews were conducted with diabetes patients. The data were analyzed using principles of grounded theory and applying cultural schema theory as a deductive framework. Results: In the communities and among the patients, knowledge and awareness of diabetes are limited. Both people with diabetes and community members referred to their prevailing cultural meaning systems and schemas for infectious diseases to interpret and assign meaning to the emerging symptoms. Diabetes patients reported that they had initially used anti-malarial medicines because they believed their symptoms—like headache, fever, and tiredness—were suggestive of malaria. Schemas for body image informed the meaning given to diabetes symptoms similar to those of HIV, like severe weight loss. Confusion among members of the community about the diabetes symptoms instigated tension, causing patients to be mistrusted and stigmatized. The process of meaning-giving and the diagnosis of the diabetes symptoms was challenging for both patients and health care professionals. Diabetes patients reported being initially misdiagnosed and treated for other conditions by medical professionals. The inability to assign meaning to the symptoms and determine their etiologies informed the decision made by some patients to consult traditional healers, and to associate their symptoms with witchcraft causes. Conclusion: The meanings given to diabetes symptoms and the care-seeking practices described in the study are shaped by the prevailing cultural schemas for infectious diseases and their treatments. Efforts to educate people about the symptoms of diabetes and to encourage them to seek out appropriate care should build on the prevailing cultural meaning system and schemas for diseases, health and illness

Welbevinden: wat vinden ouderen er zelf van?

Subjectief welbevinden kan worden omschreven als iemands waardering van zijn of haar eigen leven. Meer inzicht in het subjectieve welbevinden van ouderen is belangrijk omdat dit samengaat met een betere ervaren en objectieve gezondheid. In onderzoek over welbevinden van ouderen wordt maar weinig aandacht besteed aan de mening van ouderen zelf

Teachers’ personal experiences of sexual initiation motivating their sexuality education messages in secondary schools in Kampala, Uganda

Little is known about how teachers’ personal sexual experiences influence their motivations and practices when teaching sexuality education. Cultural schema theory was used to explore teachers’ personal experience of the onset of sexual activity and explain how sexuality education teaching is influenced by such experiences. In-depth interviews were conducted with 40 secondary school teachers in Kampala, Uganda. The interviews were transcribed verbatim and analysed using principles of grounded theory. Findings show that while teachers’ personal experience of sexual initiation did not directly align with the content of their messages, due to the centrality and evocative function of these schemas these experiences strengthened teachers’ motivation to teach sexuality education because they enabled them to empathise with students. The study concludes that teachers’ personal experiences of sexual initiation provide intrinsic motivation for teaching sexuality education. The inclusion of dialogues and activities which encourage self-reflexivity in teacher education and training may improve the delivery of sex, sexuality and relationships education

The Changing Nature of Home-Based Care for Older Adults in Goa’s Emigrant Households:Implications for Policy and Practice.

In developing countries such as India, the consequences of aging within underdeveloped social security systems coupled with traditional expectations on filial provision of care mean that families continue to remain primary caregivers for dependent older parents. Concerns abound regarding the increasing costs of healthcare, inadequate access to geriatric care, competing time constraints, and difficulties experienced by filial caregivers that could necessitate caregiver support to alleviate burden and provide respite. These concerns are further exemplified in emigration contexts in India where the emigration of the adult child alters traditional filial intergenerational care arrangements. Housed within strong notions of filial piety and a sociocultural reluctance to accept institutional care, this chapter focuses on Goa’s emigrant households where adult children emigration involves leaving behind older parents. We identify, describe, and reflect on the emergence of adaptive intergenerational care arrangements including the emergence of chaperoned provision of care for older parents through engagement of formal home-based older adult care services. While this could potentially offer respite to primary caregivers, it could also end up increasing family involvement in care and significantly impact family caregivers’ financial situation, lead to time constraints, and affect employability. In juxtaposing policy and practice, we abridge that while notions of filial responsibility are being redefined by processes such as modernization and emigration, the preference for home-based care prevails and is interestingly and increasingly becoming visible through adaptive intergenerational care arrangements that are effectuated through filially orchestrated home-based formal care services – an emerging area with regulatory as well as policy implications for both caregivers and care recipients

The Changing Nature of Home-Based Care for Older Adults in Goa’s Emigrant Households:Implications for Policy and Practice.

In developing countries such as India, the consequences of aging within underdeveloped social security systems coupled with traditional expectations on filial provision of care mean that families continue to remain primary caregivers for dependent older parents. Concerns abound regarding the increasing costs of healthcare, inadequate access to geriatric care, competing time constraints, and difficulties experienced by filial caregivers that could necessitate caregiver support to alleviate burden and provide respite. These concerns are further exemplified in emigration contexts in India where the emigration of the adult child alters traditional filial intergenerational care arrangements. Housed within strong notions of filial piety and a sociocultural reluctance to accept institutional care, this chapter focuses on Goa’s emigrant households where adult children emigration involves leaving behind older parents. We identify, describe, and reflect on the emergence of adaptive intergenerational care arrangements including the emergence of chaperoned provision of care for older parents through engagement of formal home-based older adult care services. While this could potentially offer respite to primary caregivers, it could also end up increasing family involvement in care and significantly impact family caregivers’ financial situation, lead to time constraints, and affect employability. In juxtaposing policy and practice, we abridge that while notions of filial responsibility are being redefined by processes such as modernization and emigration, the preference for home-based care prevails and is interestingly and increasingly becoming visible through adaptive intergenerational care arrangements that are effectuated through filially orchestrated home-based formal care services – an emerging area with regulatory as well as policy implications for both caregivers and care recipients

High prevalence of unwanted pregnancies and induced abortions among HIV-infected women from Western India:need to emphasize dual method use?

This study examines the prevalence, reasons, and predictors of unwanted pregnancies and induced abortions among ever married HIV-infected women attending a care facility in Maharashtra, Western India, and discusses its programmatic and policy implications. Retrospectively collected data of pregnancies conceived after the diagnosis of HIV were analyzed using descriptive and logistic regression techniques. Among the 622 women interviewed, 113 women had 158 pregnancies with known outcomes after HIV diagnosis. Among these pregnancies, 80 (51%) were unwanted and 79 (50%) were voluntarily terminated. Fear of transmitting HIV to the child was a frequently mentioned reason for an unwanted pregnancy (71.8%) and induced abortion (59.5%). Women from urban areas [OR 2.43 (95% CI 1.23-4.79)] and with two or more live births before HIV diagnosis [OR 3.33 (95% CI 1.36-8.20)] were significantly more likely to report an unwanted pregnancy. Women with two or more live births before HIV diagnosis [OR 3.16 (95% CI 1.20-8.35)], who did not know that HIV transmission to the baby can be prevented [OR 3.29 (95% CI 1.48-7.34)] and with an unwanted pregnancy [OR 4.82 (95% CI 2.33-10.00)], were significantly more likely to terminate the pregnancy. Despite increased coverage of antiretroviral treatment, effective provision of reproductive healthcare services to HIV-infected women remains challenging. A high prevalence of unwanted pregnancies and induced abortions and a low level of knowledge about prevention of mother to child transmission (PMTCT) underscore the need for preconception counseling and provision of comprehensive family planning services to HIV-infected women. Enrolling all HIV-infected pregnant women, irrespective of their decision to continue with their pregnancy, in the PMTCT program and discussing with HIV-infected women and their partners at HIV diagnosis a full array of contraceptive methods and not just consistent use of condoms might be helpful in reducing unwanted pregnancies.</p