National estimates for maternal mortality: an analysis based on the WHO systematic review of maternal mortality and morbidity

BACKGROUND: Despite the worldwide commitment to improving maternal health, measuring, monitoring and comparing maternal mortality estimates remain a challenge. Due to lack of data, international agencies have to rely on mathematical models to assess its global burden. In order to assist in mapping the burden of reproductive ill-health, we conducted a systematic review of incidence/prevalence of maternal mortality and morbidity. METHODS: We followed the standard methodology for systematic reviews. This manuscript presents nationally representative estimates of maternal mortality derived from the systematic review. Using regression models, relationships between study-specific and country-specific variables with the maternal mortality estimates are explored in order to assist further modelling to predict maternal mortality. RESULTS: Maternal mortality estimates included 141 countries and represent 78.1% of the live births worldwide. As expected, large variability between countries, and within regions and subregions, is identified. Analysis of variability according to study characteristics did not yield useful results given the high correlation with each other, with development status and region. A regression model including selected country-specific variables was able to explain 90% of the variability of the maternal mortality estimates. Among all country-specific variables selected for the analysis, three had the strongest relationships with maternal mortality: proportion of deliveries assisted by a skilled birth attendant, infant mortality rate and health expenditure per capita. CONCLUSION: With the exception of developed countries, variability of national maternal mortality estimates is large even within subregions. It seems more appropriate to study such variation through differentials in other national and subnational characteristics. Other than region, study of country-specific variables suggests infant mortality rate, skilled birth attendant at delivery and health expenditure per capita are key variables to predict maternal mortality at national level

How to teach fully illiterate adults to read.

About 750 million adults (15%) worldwide lack any literacy skills, most because they lack adequate learning opportunities (UNESCO, 2016). In this chapter, we discuss how to teach to read to such people. We first examine scientific evidence suggesting that literacy acquisition does not radically differ as a function of age of acquisition. We then discuss the data relevant for designing effective methods aimed at teaching literacy to fully illiterate adults. We argue that the available adult data confirm those relative to teaching methods and learning processes that have been gathered on literacy acquisition by children. On the basis of those works we propose principles that should underlie any method aiming at rapidly developing basic literacy skills. Lastly, we present evidence (Kolinsky, Leite, Carvalho, Franco, & Morais, submitted) suggesting that implementing these principles does indeed allow teaching illiterate adults to decode words and pseudo-words in a very short period of time

Higher education and unemployment in Europe : an analysis of the academic subject and national effects

This paper examines the impact of an academic degree and field of study on short and long-term unemployment across Europe (EU15). Labour Force Survey (LFS) data on over half a million individuals are utilised for that purpose. The harmonized LFS classification of level of education and field of study overcomes past problems of comparability across Europe. The study analyses (i) the effect of an academic degree at a European level, (ii) the specific effect of 14 academic subjects and (iii) country specific effects. The results indicate that an academic degree is more effective on reducing the likelihood of short-term than long-term unemployment. This general pattern even though it is observed for most of the academic subjects its levels show significant variation across disciplines and countries

The translation of articles from the United Nations Convention on the Rights of the Child into education legislation:the narrowing of Article 12 as a consequence of translation

This paper is concerned with the inclusion, exclusion and reshaping of articles within the United Nations Convention on the Rights of the Child (CRC) as they are translated into English education legislation. The CRC comprises 54 articles aimed at outlining rights and freedoms for children and was ratified by the United Kingdom (UK) government in 1991. The paper builds on a previous publication by the authors which highlighted how the mobilisation of articles within the CRC into professional practice undergoes multiple translations. This paper takes an in‐depth and critical look at the first stage of the translation process in which articles are mobilised from the CRC into national legislation. Specifically, the paper presents findings from a documentary analysis which explored the translation of principles pertaining to Article 12 of the CRC into English Education Regulations, Acts and Statutory Guidance for schools. Findings demonstrate that the reshaping of the article within education legislation strongly reflects the government's priorities and agendas. The study raises new insights into the need to establish processes to ensure the full mobilisation of Article 12 and questions whether specific principles pertaining to the article could or should be incorporated into national legislative systems.Output Status: Forthcoming/Available Onlin

Interacting regional-scale regime shifts for biodiversity and ecosystem services

Current trajectories of global change may lead to regime shifts at regional scales, driving coupled human–environment systems to highly degraded states in terms of biodiversity, ecosystem services, and human well-being. For business-as-usual socioeconomic development pathways, regime shifts are projected to occur within the next several decades, to be difficult to reverse, and to have regional- to global-scale impacts on human society. We provide an overview of ecosystem, socioeconomic, and biophysical mechanisms mediating regime shifts and illustrate how these interact at regional scales by aggregation, synergy, and spreading processes. We give detailed examples of interactions for terrestrial ecosystems of central South America and for marine and coastal ecosystems of Southeast Asia. This analysis suggests that degradation of biodiversity and ecosystem services over the twenty-first century could be far greater than was previously predicted. We identify key policy and management opportunities at regional to global scales to avoid these shifts

Greening Capitalism? A Marxist Critique of Carbon Markets

Climate change is increasingly being recognized as a serious threat to dominant modes of social organization, inspiring suggestions that capitalism itself needs to be transformed if we are to ‘decarbonize’ the global economy. Since the Kyoto Protocol in 1997, carbon markets have emerged as the main politico-economic tools in global efforts to address climate change. Newell and Paterson (2010) have recently claimed that the embrace of carbon markets by financial and political elites constitutes a possible first step towards the transformation of current modes of capitalist organization into a new form of greener, more sustainable ‘climate capitalism.’ In this paper, we argue that the institutionalization of carbon markets does not, in fact, represent a move towards the radical transformation of capitalism, but is better understood as the most recent expression of ongoing trends of ecological commodification and expropriation, driving familiar processes of uneven and crisis-prone development. In this paper, we review four critical Marxist concepts: metabolic rift (Foster, 1999), capitalism as world ecology (Moore, 2011a), uneven development and accumulation through dispossession (Harvey, 2003, 2006), and sub-imperialism (Marini, 1972, 1977), developing a framework for a Marxist analysis of carbon markets. Our analysis shows that carbon markets form part of a longer historical development of global capitalism and its relation to nature. Carbon markets, we argue, serve as creative new modes of accumulation, but are unlikely to transform capitalist dynamics in ways that might foster a more sustainable global economy. Our analysis also elucidates, in particular, the role that carbon markets play in exacerbating uneven development within the Global South, as elites in emerging economies leverage carbon market financing to pursue new strategies of sub-imperial expansion. </jats:p

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Continued inequities in coverage, low quality of care, and high out-of-pocket expenses for health services threaten attainment of Millennium Development Goals 4 and 5 in many sub-Saharan African countries. Existing health systems largely rely on input-based supply mechanisms that have a poor track record meeting the reproductive health needs of low-income and underserved segments of national populations. As a result, there is increased interest in and experimentation with results-based mechanisms like supply-side performance incentives to providers and demand-side vouchers that place purchasing power in the hands of low-income consumers to improve uptake of facility services and reduce the burden of out-of-pocket expenditures. This paper describes a reproductive health voucher program that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the program to include public sector facilities. Methods: Data presented here describes the results of interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher program in southwestern Uganda. Interviews were transcribed and organized thematically, barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the program by involving public sector facilities were investigated. Results: The findings show that access to sexual and reproductive health services in southwestern Uganda is constrained by both facility and individual level factors which can be addressed by inclusion of the public facilities in the program. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher program with other services is likely to address some of the barriers. The public sector facilities were also seen as being well positioned to provide voucher services because of their countrywide reach, enhanced infrastructure, and referral networks. The voucher program also has the potential to address public sector constraints such as understaffing and supply shortages.Conclusions: Accrediting public facilities has the potential to increase voucher program coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening linkages between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilization of resources to support the sustainability of the programs. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher program

Designing a package of sexual and reproductive health and HIV outreach services to meet the heterogeneous preferences of young people in Malawi: results from a discrete choice experiment.

BACKGROUND: This article examines young people's preferences for integrated family planning (FP) and HIV services in rural Malawi. Different hypothetical configurations for outreach services are presented using a Discrete Choice Experiment (DCE). Responses are analysed using Random Parameters Logit and Generalised Mixed Logit (GMXL) models in preference space and a GMXL model parameterised in willingness-to-pay space. Simulations are used to estimate the proportion of respondents expected to choose different service packages as elements are varied individually and in combination. RESULTS: Responses were collected from 537 young people aged 15-24. Results show that when considering attending an outreach service to access family planning young people value confidentiality and the availability of HIV services including HIV counselling and testing (HCT) and HIV treatment, though significant observable and unobservable heterogeneity is present. Female respondents and those aged 20-24 were less concerned with service confidentiality compared to male respondents and those aged 15-19; respondents who were in a relationship at the time of the survey valued confidentiality more than those who reported being single. The addition of sports and recreation for young people may also be an attractive feature of a youth-friendly service; however, preferences for this attribute vary according to respondent gender. Results of the simulation modelling indicate that the most preferred service package is one that offers confidential services, both HCT and HIV treatment and sports for youth, with up to 32% of respondents expected to choose this service over a service where clients may have concerns over confidentiality, only HCT is available and there are no additional activities for young people. Estimates of willingness-to-pay for service attributes indicate that respondents were willing to pay up to USD$1.76 for confidentiality, USD$0.65 for a service offering both HCT and HIV treatment and USD$0.26 for a service including sports for youth. CONCLUSIONS: Young people were able to complete a complex DCE and appeared to trade between the different characteristics used to describe the outreach services. These findings may offer important insight to policy makers designing youth friendly SRH outreach services and providers aiming to improve the acceptability and uptake of FP services