You Have the Right to Remain Powerless: Deprivation of Agency by Law Enforcement and the Legal and Carceral Systems

(Excerpt) The charges against Philadelphia Police Officer Phillip Nordo read like an episode of The Shield. The grand jury presentment, should you have the stomach for it, is closer to Law & Order: Special Victims Unit. For over twenty years, Officer Nordo groomed, sexually assaulted, and used crime reward funds to pay off vulnerable men in Philadelphia. Whether in his transport van, prison visiting rooms, or police interrogation rooms, he regularly exploited his unfettered access to and absolute control over vulnerable individuals. Though he was not convited until 2022, the communities he stalked and preyed upon knew exactly what Nordo was doing in the decades leading up to his arrest. Living in the streets where Nordo flexed his considerable power, these Philadelphians had nowhere to run, and no one to whom to report the bad detective. They could not call the other officers who took turns leaving Nordo alone with suspects for long stretches of time. Nor could they rely on the Internal Affairs Division, who corroborated rape allegations against Nordo and then kept him on payroll for another decade. And they certainly could not turn to Philadelphia prosecutors, who had quietly put Nordo on a “no call list.” This Article is not about Phillip Nordo. This Article is about the outright excision of agency that our legal system exacts on vulnerable communities. At every stage, our legal system strips already marginalized communities of power, particularly communities of color. Mass incarceration, a mechanism to uphold white supremacy, has further corroded individual and collective autonomy in these communities. This Article examines the ways in which law enforcement, the legal system, and the carceral state remove agency from individuals. In the final section, this Article suggests measures to immediately empower incarcerated individuals who have been stripped of their agency by our system

Approaches to understanding and measuring women’s empowerment and its relationship with women’s and children’s dietary diversity in sub-Saharan Africa.

Background Women’s empowerment has been identified as a key component of development policies since in many cases, there are existing and widening gender gaps in wellbeing including in access to improved nutrition especially in low-and-middle- income countries (LMICs). In addition, in many LMICs especially in those found in sub-Sahara Africa (SSA), there are existing gender-based barriers including norms, attitudes, and patriarchal societies that undermine the opportunities given to women. While there are many interventions, programmes, and field experiments that aim to redress these gender gaps in many LMICs, there is the need to understand and examine the concept and role of women’s empowerment in access to welfare-improving inputs including improved dietary diversity for themselves and their children. Study objective To add to this growing literature, this thesis sought to examine the concept of women’s empowerment and its relationship with women’s and children’s dietary diversity using a mixed-methods approach of qualitative focus group discussions (FGDs) and in-depth interviews (IDIs), and quantitative secondary data. Methods Studies 1 and 2 - For the qualitative studies, 89 married participants (64 women of reproductive age and 25 men) who were cohabiting with their spouses were recruited in Southeastern Nigeria in April, 2019. Of this number of women, 38 participated in IDIs while the rest took part in 2 FGDs of 13 participants each. The 25 men participated in 2 FGDs of 12 and 13 men respectively. In the IDIs, participants were grouped into two based on their primary economic activity. One group engaged only in farming and the other engaged in other economic activities (mainly hairdressing and food vending) in addition to farming. For the FGDs, men and women participants were recruited using a form of snowball sampling strategy from the IDIs participants and were also grouped according to their primary economic activity; namely farming only, or food trading as well as farming. Study 1 reports findings from the IDIs and FGDs concerning the concept of empowerment and, in particular, women’s empowerment using domains contained in two quantitative measures and one qualitative guideline. These measures were respectively; the Women’s Empowerment in Agriculture Index (WEAI), the Survey-based Women's emPowERment (SWPER) index for women's empowerment in Africa, and the Food and Agriculture Organization guide to measuring women’s empowerment and social protection. Men were recruited to permit gauging their perception of empowerment and women’s empowerment. Study 2 used IDIs to explore women’s consumption of food items contained in the Minimum Dietary Diversity for women of reproductive age (MDD-W) measure and assessed important household dynamics that could influence food consumption decision-making. Analyses for the IDIs and FGDs were done in excel and NVivo and followed the principle of constant comparison. Studies 3 and 4: – Study 3 used secondary quantitative data from the Demographic and Health Surveys (conducted on 14,688 respondents) and Study 4 used the Feed the Future (on 10,041 respondents in the FTF) baseline studies. Data was extracted from each of the DHS and FTF for five sub-Sahara Africa countries (Mozambique, Rwanda, Malawi, Uganda, and Zambia). Study 3 explored the relationship between women’s empowerment measured by the SWPER index (which contains three domains of empowerment; attitude towards violence, autonomy (social independence), and decision-making) and children’s dietary diversity measured by using the Infant and Young Children Dietary Diversity Score (IYCDDS). IYCDDS was the outcome of interest and was examined as a continuous and count variable while the seven food groups contained in it were treated as dichotomous variables (i.e. consumed or not consumed). Analyses were restricted to children between 6 and 23 months in line with the IYCDDS guidelines. The three domains of the SWPER index were examined as the key independent variables and other important demographic, economic, and geographic covariates were specified as controls. Interaction effects between the three SWPER domains of empowerment, gender of index child and wealth index were also explored to determine if women’s empowerment has differential effects on IYCDDS for boys and girls, and based on women’s socioeconomic status. Study 4 examined the relationship between women’s empowerment and women’s dietary diversity using the FTF dataset. Empowerment was measured using the WEAI index which contains 10 indicators of empowerment within 5 broader domains of empowerment. The 10 indicators and the aggregate empowerment score were treated as key independent variables while Women’s Dietary Diversity Score (WDDS) was treated as the outcome of interest. The WDDS was examined as a continuous and count variable and the food groups contained in the WDDs were also treated as dichotomous outcome variables. Analyses were restricted for women of reproductive age in line with the WDDS guidelines and those that engaged in agriculture in line with the WEAI index, and important demographic, economic, and geographic variables were specified as controls. Ordinary least squares (OLS) regression verified with marginal effects from Poisson regression analyses were used for the continuous outcome variables and linear probability models (LPMs) verified with marginal effects from logistic regression analyses for the dichotomous outcome variables. Analyses of the two quantitative datasets were appropriately weighted and cluster-adjusted, and significance was established at 95% and 99% confidence intervals. Findings Study 1 findings suggest that local understanding of women’s empowerment dynamics does not always resonate with external definitions and ideologies. Contextual factors play a significant role in determining the extent of positive effects of empowerment. It was challenging to identify a direct translation of “empowerment” into the local language with the same meaning when back-translated to English. Different local terminologies elicited different responses from participants with a gender divide where men pushed back on one particular local terminology. This suggests that terminologies used in presenting empowerment interventions might impact on their acceptance and success and make this a challenging term to use in cross-cultural and cross-country research. Study 2 findings suggest that the consumption of nutrient-rich food groups, especially certain legumes, nuts and seed, flesh protein, and eggs, would benefit from improved women’s economic empowerment, and the consumption of fruits and vegetables might benefit from improved agricultural practices in addition to economic empowerment. By contrast, staple food-items including grains and root-tubers that are consumed by all women irrespective of their income-earning status would not benefit so much. Dietary diversity is influenced by food production and purchase, where factors including seasonal variation in food production and prices are important determinants. Economic empowerment improved women’s autonomy in food purchase and consumption. However, limited income restricted women from exhibiting full autonomy in consumption decisions and access. Study 3 findings suggest that there were significant associations between women’s autonomy and improved child’s diet diversity in analyses pooled across five countries, and that Uganda and Zambia might account for these significant associations. There were no significant associations between the three domains of empowerment and improved IYCDDS in Mozambique, Rwanda and Malawi. Results from Uganda suggested a differential impact for boys and girls where women’s improved autonomy was protective for a female child’s dietary diversity. Only Mozambique exhibited a significant positive association in the interaction between the domains of empowerment and wealth index. Findings suggest that women in poorer households who viewed violence as disempowering might practice improved dietary consumption for their children. Findings also suggest that legumes, dairy and dairy products, and other vitamin A-rich fruits and vegetables account for the association between improved autonomy and IYCDDS in the pooled analysis and that Uganda and Zambia might account for these significant associations. These findings suggest that improvement in women’s autonomy might confer the most dietary benefit for infant and young children through improved consumption of dairy and dairy products, grains and fruits and vegetables. However, these significant associations were only found in two (Uganda and Zambia) out of the five countries examined further suggesting that the benefits from improved autonomy on improved food consumption for infant and young children differs, and this difference in benefits also differ across countries. Study 4 – Four empowerment indicators (autonomy, input in production decisions, empowerment in public speaking, and working less that 10.5 hours in a day) out of the 10 indicators used in the WEAI were positively and significantly associated with improved WDDS and food consumption in the pooled and disaggregated regression analyses. There were different significant associations between the four indicators of empowerment and women’s food consumption in three out of the five countries examined (no significant associations were found in Malawi and Zambia). Autonomy and input in production decisions were significantly associated with improved WDDS and findings suggest that Uganda and Rwanda might account for these associations. Autonomy in production was associated with the likelihood of consumption of grains and root-tubers, dairy and dairy products, flesh proteins and vitamin A-rich vegetables and fruits in Uganda. In Rwanda, input in production decisions was associated with the consumption of other fruits and vegetables including vitamin A-rich produce. Empowerment in public speaking was significantly associated with improved WDDS and consumption of other fruits and vegetables in the pooled analyses and Mozambique and Rwanda might account for these significant associations. In Mozambique, empowerment in public speaking was associated the consumption of other vitamin A-rich fruits and vegetables and in Rwanda, empowerment in public speaking was associated with the consumption of grains/tubers, flesh protein, vitamin A-rich leafy greens, and other fruits and vegetables. Non-excessive workload (i.e. working for less than 10.5 hours in 24 hours) was significantly but negatively associated with improved WDDS and Mozambique accounted for this association, where women who worked below 10.5 hours in a 24- hour cycle were less likely to consume flesh proteins. The differential performance of the four indicators in the WEAI index further suggests that different empowerment strategies might confer different benefits towards consumption of different food items and these benefits might vary across countries. In summary, this thesis found that local knowledge, perceptions and norms play a significant role in women’s empowerment discourse and this will impact on how women’s empowerment is conceptualised and how different empowerment measures perform. In addition, conceptualizing women’s empowerment ought to be done in a manner that recognizes the multifaceted linkages between the different domains of empowerment and how they dictate women’s participation in rural economic activities. Economic empowerment might be beneficial for the consumption of nutrient-dense food items including flesh proteins that are expensive for women to purchase, while autonomy, including in having input in production, might be beneficial for the consumption of nutrition-vital dairy and dairy products, fruits and vegetables for women and children. Leadership empowerment through empowerment in public speaking might be important for the consumption of grains and tubers and legumes in addition to nutrition-vital fruits and vegetables for women. However, these benefits might differ across different SSA countries. Conclusion Interpretation of the qualitative findings should be done with caution due to the limitations inherent in the study design including its limited generalisability. However, the qualitative studies contribute to a very limited area of knowledge and are the first to qualitatively examine two known measures of women’s empowerment, and household-level dynamics between women’s empowerment and food consumption. The quantitative studies are prone to limitations including recall bias of women’s and children’s food consumption and other retrospective data that rely on the memory of past events, however, the quantitative studies advance knowledge in the measurement and analyses of women’s empowerment using two different but somewhat complementary measures of empowerment across multiple countries in two regions of sub-Sahara Africa. This enables a comparison of the performance of the two indexes in determining women’s and children’s dietary diversity. This study provides a few key contributions to knowledge. Firstly, women’s empowerment needs are diverse and largely context-specific: hence, local understanding of empowerment concepts and terms remains an important determinant of the rate of acceptance and successes of women’s empowerment interventions in developing countries. Secondly, economic empowerment in the form of income earning improves women’s consumption of certain food items including flesh proteins and some legumes, nuts and seeds, which are usually nutrient-rich and more expensive however, limited economic prospects for women still limit women from expressing full empowerment in food consumption. Thirdly, women’s autonomy including in production is important for improving dietary diversity for women and children through the consumption of important products especially dairy, and vitamin A-rich fruits and vegetables. However, these benefits differ across countries examined. In addition, while empowerment in public speaking improved women’s dietary diversity, it appears that women might have to work excessively to improve their dietary diversity since non-excessive workload reduced women’s dietary diversity and consumption of flesh proteins. An overall observation is that an explanation of the variation in effect of women’s empowerment measures in different country contexts, perhaps lies in the difficulty of measuring women’s empowerment in a non-context-specific way

Perinatal suicidal ideation and behaviour: psychiatry and adversity

Pregnant women are at increased risk for suicidal ideation and behaviours (SIB) compared to the general population. To date, studies have focused on the psychiatric correlates of SIB with lesser attention given to the associated contextual risk factors, particularly in low- and middle-income countries. We investigated the prevalence and associated psychiatric and socio-economic contextual factors for SIB among pregnant women living in low resource communities in South Africa. Three hundred seventy-six pregnant women were evaluated using a range of tools to collect data on socio-economic and demographic factors, social support, life events, interpersonal violence and mental health diagnoses. We examined the significant risk factors for SIB using univariate, bivariate and logistic regression analyses (p ≤ 0.05). The 1-month prevalence of SIB was 18%. SIB was associated with psychiatric illness, notably major depressive episode (MDE) and any anxiety disorder. However, 67% of pregnant women with SIB had no MDE diagnosis, and 65% had no anxiety disorder, while 54% had neither MDE nor anxiety disorder diagnoses. Factors associated with SIB included lower socio-economic status, food insecurity, interpersonal violence, multiparousity, and lifetime suicide attempt. These findings focus attention on the importance of socio-economic and contextual factors in the aetiology of SIB and lend support to the idea that suicide risk should be assessed independently of depression and anxiety among pregnant women

Male-female differences in households' resource allocation and decision to seek healthcare in south-eastern Nigeria: Results from a mixed methods study

The final publication is available at Elsevier via http://dx.doi.org/10.1016/j.socscimed.2018.03.033 © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/Ability to influence household decision-making has been shown to increase with improved social capital and power and is linked to better access to household financial resources and other services outside the household including healthcare. To examine the male-female differences in household custody of financial resources, decision-making, and type of healthcare utilised, we used a mixed methods approach of cross-sectional household surveys and focus-group discussions (FGDs). Data was collected between 10 January–28 February 2011. We analyzed a sample of 411 households and a sub-sample of 223 households with a currently married head. We conducted six single-sex FGDs in 3 communities (1 urban, 2 rural) among a random sub-sample of participants in the survey. We performed univariate, bivariate, and logistic regression analyses with a 95% confidence interval. For the qualitative data, we performed thematic analysis where broad themes relevant to the research objective were abstracted. In all households and in those with a married head, sick male members were less likely to forgo healthcare (aORall0.87, 95% CI 0.80–0.90; aORmarried0.52, 95% CI 0.18–0.83) and more likely to utilise formal healthcare relative to female sick members (aORall3.36, 95% CI 3.20–3.87; aORmarried19.50, 95% CI 9.62–39.52). Formal healthcare providers are medically trained while informal providers are untrained vendors that dispense medications for profit. There were more reports of sole custody of household resources among men within households with married heads. Joint decision-making on healthcare expenditure improved women's access to healthcare but is not reflective of unhindered access to household financial resources. Qualitatively, women spoke of seeking permission from male household head before expenditure was incurred, while male heads spoke of concealing household financial resources from their spouse. Gender constructs and male-female differences have important effects on household resource allocation and healthcare utilisation

Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective

Out-of-pocket (OOP) payments have severe consequences for health care access and utilisation and are especially catastrophic for the poor. Although women comprise the majority of the poor in Nigeria and globally, the implications of OOP payments for health care access from a gender perspective have received little attention. This study seeks to fill this gap by using a combination of quantitative and qualitative analysis to investigate the gendered impact of OOPs on healthcare utilisation in south-eastern Nigeria. 411 households were surveyed and six single-sex Focus Group Discussions conducted. This study confirmed the socioeconomic and demographic vulnerability of female-headed households (FHHs), which contributed to gender-based inter-household differences in healthcare access, cost burden, choices of healthcare providers, methods of funding healthcare and coping strategies. FHHs had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs) with affordability as a reason for not seeking care. There is also a high utilisation of patent medicine vendors (PMVs) by both households (PMVs are drug vendors that are unregulated, likely to offer very low-quality treatment and do not have trained personnel). OOP payment was predominantly the means of healthcare payment for both households, and households spoke of the difficulties associated with repaying health-related debt with implications for the medical poverty trap. It is recommended that the removal of user fees, introduction of prepayment schemes, and regulating PMVs be considered to improve access and provide protection against debt for FHHs and MHHs. The vulnerability of widows is of special concern and efforts to improve their healthcare access and broader efforts to empower should be encouraged for them and other poor households

ASSESSMENT OF HEALTH INFORMATION LITERACY OF NIGERIANS ON THE PREVENTIVE MEASURES OF COVID 19 PANDEMIC: A CROSS SECTIONAL ONLINE SURVEY

The study assessed the health information literacy level of Nigerian on the preventive measures and management of COVID 19 pandemic using online cross sectional survey. The research design adopted for the study is descriptive survey research design. Nigerians between the age of 15 and above made up the population of the study. Online survey using Google form was conducted between using social media platforms. To assess the health information literacy level of Nigerians on the preventive measures of COVID-19; a 25 objective questions constructed by the researcher called “COVID-19 Health Related Information Literacy Assessment Scale” was used. Data collected was analyzed using frequency distribution table and percentage. The null hypotheses one was tested using Mann Whitney U, while the hypothesis two was tested using Kruskal Wallis Test at 0.05 significance level. The computation and analysis of the data collected was performed with the aid of SPSS version 23. The study revealed that, the major sources of information for COVID-19 related health information among Nigerians are social media (facebook, twitter, whatsapp etc.), friends and family, radio programmes. the COVID-19 health literacy level of Nigerians is moderate. Though many scored high in the scale used, most of the respondents are incorrect in most of the advance questions such as recommended meter for social distancing, most appropriate way to wear face shield, contracting COVID-19 through books, spoons, plates among others touched by infected person, and even what to do after coughing or sneezing during COVID-19 among other technical and advance questions. Gender was not a significant factor in the COVID-19 Health Information Literacy Level of Nigerians on the preventive measures of COVID 19 pandemic; while there was a significant difference in the health information literacy level of Nigerians on the preventive measures of COVID 19 pandemic according to educational level, as Nigerians with higher level of education had higher COVID-19 Health Information Literacy level than those with lower educational level. The study recommended among other things that, Federal government should adopt more proactive measures of education Nigerians on the advanced ways to prevent and manage COVID-19. Also, in order to reach wider audience with little or no cost the government should mandate churches and mosques to devote few minutes for enlightening and educating their members on the global best practice in the prevention and management of COVID-1

Predictors of alcohol and other drug use among pregnant women in a peri-urban South African setting

Background: Alcohol and other drugs (AOD) use among pregnant women have been associated with adverse health outcomes for mother and child, during and after pregnancy. Factors associated with AOD use among women include age, poverty, unemployment, and interpersonal conflict. Few studies have looked at demographic, economic, and psychosocial factors as predictors of AOD use among pregnant women in low-income, peri-urban settings. The study aimed to determine the association between these risk factors and alcohol and drug use among pregnant women in Hanover Park, Cape Town. Methods: The study was undertaken at a Midwife Obstetric Unit providing primary-level maternity services in a resource-scarce area of South Africa. 376 adult women attending the unit were recruited and a multi-tool questionnaire administered. Demographic, socioeconomic and life events data were collected. The Expanded Mini-International Neuropsychiatric Interview Version 5.0.0 was used to assess alcohol abuse and other drugs use, depression, anxiety, and suicidal ideation. Descriptive and bivariate analyses were conducted to examine the associations between predictor variables. Non-parametric tests, Wilcoxon sum of rank test, Fisher Exact and two sample T test and multicollinearity tests were performed. Logistic regression was conducted to identify associations between the outcome of interest and key predictors. A probability value of p ≤ 0.05 was selected. Results: Of the total number of pregnant women sampled, 18 % reported current AOD use. Of these, 18 % were currently experiencing a major depressive episode, 19 % had a current anxiety diagnosis, and 22 % expressed suicidal ideation. Depression, anxiety, suicidality, food insecurity, interpersonal violence, relationship dynamics, and past mental health problems were predictors of AOD use. Conclusions: This study has confirmed the vulnerability of pregnant women in low-income, peri-urban settings to alcohol abuse and other drugs use. Further, the association between diagnosed depression and anxiety, suicidality, and AOD use among these women may reflect how complex environmental factors support the coexistence of multiple mental health problems. These problems place mothers and their infants at high risk for poor health and development outcomes. The results have implications for planning appropriate interventions

Placement, support, and retention of health professionals: national, cross-sectional findings from medical and dental community service officers in South Africa

Background: In South Africa, community service following medical training serves as a mechanism for equitable distribution of health professionals and their professional development. Community service officers are required to contribute a year towards serving in a public health facility while receiving supervision and remuneration. Although the South African community service programme has been in effect since 1998, little is known about how placement and practical support occur, or how community service may impact future retention of health professionals. Methods: National, cross-sectional data were collected from community service officers who served during 2009 using a structured self-report questionnaire. A Supervision Satisfaction Scale (SSS) was created by summing scores of five questions rated on a three-point Likert scale (orientation, clinical advising, ongoing mentorship, accessibility of clinic leadership, and handling of community service officers’ concerns). Research endpoints were guided by community service programmatic goals and analysed as dichotomous outcomes. Bivariate and multivariate logistical regressions were conducted using Stata 12. Results: The sample population comprised 685 doctors and dentists (response rate 44%). Rural placement was more likely among unmarried, male, and black practitioners. Rates of self-reported professional development were high (470 out of 539 responses; 87%). Participants with higher scores on the SSS were more likely to report professional development. Although few participants planned to continue work in rural, underserved communities (n = 171 out of 657 responses, 25%), those serving in a rural facility during the community service year had higher intentions of continuing rural work. Those reporting professional development during the community service year were twice as likely to report intentions to remain in rural, underserved communities. Conclusions: Despite challenges in equitable distribution of practitioners, participant satisfaction with the compulsory community service programme appears to be high among those who responded to a 2009 questionnaire. These data offer a starting point for designing programmes and policies that better meet the health needs of the South African population through more appropriate human resource management. An emphasis on professional development and supervision is crucial if South Africa is to build practitioner skills, equitably distribute health professionals, and retain the medical workforce in rural, underserved areas