Fertility, socioeconomic status, and the position of women in a Javanese village

Over recent years, and particularly during the period spanning World Population Year and International Women's Year, there has been growing attention to the relation between the status of women and fertility. A central assumption, based on research findings in several countries, is that the provision of education and improved socioeconomic standing in general results in a better position of women and smaller family size. In Java, however, evidence from recent demographic surveys indicates that there is a positive association between fertility and various measures of socioeconomic status, including educational level. The present study investigates the relations among fertility, socioeconomic status, and the position of women in a village in the Yogyakarta region of central Java. Using data collected in a multi-stage survey and supplemented by participant observation, the research provides further evidence of a direct relation between socioeconomic status and fertility, and also indicates that higher socioeconomic status implies a different, but not necessarily better, position of women in many important dimensions of daily life. The study examines the causes of the observed fertility differentials, considering both voluntary and involuntary factors, and describes important social class differences in the sociocultural context of childbearing. It illustrates the need for any policy measures to take account of the complex nature of the relation between women's roles and their fertility in contrasting socioeconomic groups

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

The impact of women's social position on fertility in developing countries

This paper examines ideas about possible ways in which the extent of women's autonomy, women's economic dependency, and other aspects of their position vis-à-vis men influence fertility in Third World populations. Women's position or “status” seems likely to be related to the supply of children because of its links with age at marriage. Women's position may also affect the demand for children and the costs of fertility regulation, though some connections suggested in the literature are implausible. The paper ends with suggestions for future research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45660/1/11206_2005_Article_BF01124382.pd

Breast-feeding and health professionals: A study in hospitals in Indonesia

This paper presents findings on knowledge, attitudes, and practices regarding breast-feeding management in the modern health sector in Indonesia. The methodology applied was a survey which was carried out in teaching hospitals in major cities throughout Indonesia. The results showed that although the perinatal health care providers' attitudes toward breast-feeding were very positive, there were many areas in which knowledge was incomplete and in which wide variation existed or incorrect advice given to breast-feeding mothers. The content of advice on breast-feeding was not always sound. Many thought that a wide range of illness were a contraindication to breast-feeding, nearly one in five thought that breast-feeding should follow a fixed schedule rather than the baby's needs, and only 54% thought that breast-feeding should be initiated immediately after delivery. Most of the providers did not seem to have the knowledge to cope with the common problem of insufficient breast-milk supply syndrome. Similarly, although support for the concept of rooming-in was strong, about one-third of respondents did not think the mother and infant should be together for the full 24 hr implied by true rooming-in. Fears about the possibility of increased risk of infection with rooming-in were expressed. These and other misconceptions about rooming-in imply that a consistent, well-designed training program needs to be carried out in the modern health sector which will provide the necessary information to health care providers about this important aspect of early infant care.breast-feeding health professionals hospitals Indonesia

Por y para mujeres: motivando su participación en el desarrollo de materiales para la atención en salud reproductiva

Los estudios en este número de Calidad/Quality/Qualité describen tres esfuerzos para involucrar a las mujeres en el desarrollo de materiales de atención de salud reproductiva en diferentes escenarios del mundo en desarrollo. En El Cairo, un colectivo de salud de mujeres elaboró un libro comprehensivo de consulta para mujeres; en Perú, un grupo de mujeres, con una gran participación de su audiencia analfabeta, desarrolló una serie de materiales ilustrados para la enseñanza; y en el Pacífico del Sur, un grupo de producción integrado por mujeres, produjó tres videos motivacionales y para la enseñanza, desarrollados como respuesta a las necesidades expresadas por las mujeres. A pesar del contraste en las características de las audiencias a las que se dirigieron, del proceso de desarrollo, y del medio utilizado para enviar los mensajes de salud, todos los proyectos se caracterizaron por la participación activa de las mujeres en todos los niveles y en todas las etapas de desarrollo. Las autoras cuentan la historia de su proyecto, comentan la diferencia que hizo la participación de las mujeres, y reflexionan sobre las implicaciones para las actividades futuras. En cada caso, la participación de las mujeres se ha convertido en un legado que comprende más que sólo un conjunto de materiales de información efectivos y bien usados—ha impulsado la movilización de las mujeres que participaron y las ha capacitado para ayudarse a sí mismas. The studies in this issue of Quality/Calidad/Qualité describe three efforts to involve women in the development of reproductive health care materials in different settings in the developing world. In Cairo, a women\u27s health collective produced a comprehensive reference book for women; in Peru, a woman\u27s group, with the extensive involvement of their nonliterate audience, developed a series of illustrated teaching materials; and in the South Pacific, an all-woman production crew produced three motivation and teaching videos developed in response to the expressed needs of Pacific Island women. Despite contrasts in the characteristics of the intended audiences, the development process, and the medium employed to deliver health messages, the projects are all characterized by the active involvement of women at all levels and in all stages of development. The authors tell the story of their project, comment on how involving women made a difference, and reflect on implications for future activities. In each case, women\u27s involvement has resulted in a legacy of more than just a set of effective and well-utilized information materials—it has mobilized the women involved and enabled them to help themselves

By and for women: Involving women in the development of reproductive health care materials

The studies in this issue of Quality/Calidad/Qualité describe three efforts to involve women in the development of reproductive health care materials in different settings in the developing world. In Cairo, a women\u27s health collective produced a comprehensive reference book for women; in Peru, a woman\u27s group, with the extensive involvement of their nonliterate audience, developed a series of illustrated teaching materials; and in the South Pacific, an all-woman production crew produced three motivation and teaching videos developed in response to the expressed needs of Pacific Island women. Despite contrasts in the characteristics of the intended audiences, the development process, and the medium employed to deliver health messages, the projects are all characterized by the active involvement of women at all levels and in all stages of development. The authors tell the story of their project, comment on how involving women made a difference, and reflect on implications for future activities. In each case, women\u27s involvement has resulted in a legacy of more than just a set of effective and well-utilized information materials—it has mobilized the women involved and enabled them to help themselves