Evaluation of the Population and Poverty Research Initiative (PopPov)

Since 2005, the William and Flora Hewlett Foundation, with collaboration and co-funding from research councils in the United Kingdom, the Netherlands, France, and Norway and from the World Bank, has invested in a portfolio of social science research on the relationship between population dynamics and micro- and macroeconomic outcomes. It is known as the Population and Poverty Research Initiative (PopPov), and its geographic focus is on subSaharan Africa (SSA). The starting premises that led to the development of PopPov were that evidence showing that population dynamics could affect economic outcomes might increase the interest of ministers of finance in funding population policies and that they might be most convinced by rigorous research done by respected economists. The core aim of the program has been to build (or, in some cases, rebuild) and advance the field of economic demography, orienting the work toward research that would be relevant for policy and would increase recognition by economic policymakers of the value of lowering the rate of population growth and investing in family planning (FP). The program also aimed to strengthen the capacity of researchers in SSA. The PopPov initiative tried to achieve these aims through four main components: (1) grants to support research on PopPov core topics of interest, (2) fellowships to support graduate students preparing their doctoral dissertations, (3) conferences and workshops to support the development of networking opportunities, and (4) other dissemination activities. PopPov has funded 56 doctoral fellows and, together with its partners, has supported 61 research projects. Seven international conferences and additional workshops have been held, and there have been several other dissemination activities. The Population Reference Bureau (PRB) and the Center for Global Development (CGD) have been the secretariats for PopPov. Since 2008, the Institute of International Education (IIE) has administered the fellowship program.In November 2012, to help guide its decisions about both the substance and means of future investments, the foundation issued a request for proposals (RFP) for an evaluation of PopPov. The RAND Corporation was selected to conduct the evaluation

Pregnancy Termination in Matlab, Bangladesh: Trends and Correlates of Use of Safer and Less-Safe Methods

CONTEXT: Menstrual regulation (MR), a relatively safe form of pregnancy termination, is legal in Bangladesh during the early stages of pregnancy. However, little is known about the factors associated with whether women who terminate pregnancies choose this method or a less-safe one. METHODS: Data from the Matlab Demographic Surveillance System on 122,691 pregnancies-5,221 (4.3%) of which were terminated-were used to examine trends between 1989 and 2008 in termination and in use of safer methods (MR or dilation and curettage) and less-safe (all other) methods of pregnancy termination. Logistic and multinomial logistic regressions were used to assess factors associated with whether women terminate pregnancies and whether they use safer methods. RESULTS: Sixty-seven percent of pregnancy terminations were by safer methods and 33% by less-safe means. The proportion of pregnancies that were terminated increased between 1989 and 2008; this increase was entirely due to increased use of safer methods. Women younger than 18 and those 25 or older were more likely than women aged 20-24 to terminate their pregnancies (odds ratios ranged from 1.5 among women aged 16-17 or 25-29 to 26.1 among those aged 45 or older). Among women who terminated their pregnancies, those aged 25-44 were more likely than those aged 20-24 to use a safer method. Compared with women who had no formal education, those with some education were more likely to terminate their pregnancies and to do so using safer methods. CONCLUSION: A growing proportion of pregnancies in Matlab are terminated, and these terminations are increasingly done using safer methods

How long after a miscarriage should women wait before becoming pregnant again? Multivariate analysis of cohort data from Matlab, Bangladesh

ObjectiveTo determine the optimum interpregnancy interval (IPI) following a miscarriage.DesignMultivariate analysis of population-based, prospective data from a demographic surveillance system.SettingPregnancies in Matlab, Bangladesh, between 1977 and 2008.Participants9214 women with 10 453 pregnancies that ended in a miscarriage and were followed by another pregnancy outcome.Main outcome measuresOutcome of pregnancy following the miscarriage was singleton live birth, stillbirth, miscarriage or induced abortion. For pregnancies that ended in live birth: early neonatal, late neonatal and postneonatal mortality.ResultsCompared with IPIs of 6–12 months, pregnancies that were conceived ≤3 months after a miscarriage were more likely to result in a live birth and less likely to result in a miscarriage (adjusted relative risk ratio (RRR) 0.70, 95% CI 0.57 to 0.86) or induced abortion (0.50, 0.29 to 0.89). Induced abortions were significantly more likely following IPIs of 18–24 months (2.36, 1.48 to 3.76), 36–48 months (2.73, 1.50 to 4.94), and >48 months (3.32, 1.68 to 2.95), and miscarriages were more likely following IPIs of 12–17 months (1.25, 1.01 to 1.56) and >48 months (1.90, 1.40 to 2.58). No significant effects of IPI duration are seen on the risks of a stillbirth. However, IPIs≤3 months following a miscarriage are associated with significantly higher late neonatal mortality for the infant born at the end of the IPI (adjusted hazard ratio (HR) 1.74, 1.06 to 2.84), and IPIs of 12–18 months are associated with a significantly lower unadjusted risk of postneonatal mortality (0.54, 0.30 to 0.96).ConclusionsThe shorter the IPI following a miscarriage, the more likely the subsequent pregnancy is to result in a live birth. However, very short IPIs may not be advisable following miscarriages in poor countries like Bangladesh because they are associated with a higher risk of mortality for the infants born after them

Pregnancy Termination in Matlab, Bangladesh: Maternal Mortality Risks Associated with Menstrual Regulation and Abortion

CONTEXT: In Bangladesh, both menstrual regulation (MR), which is thought to be a relatively safe method, and abortion, which in this setting is often performed using unsafe methods, are used to terminate pregnancies (known or suspected). However, little is known about changes over time in the use of these methods or their relative mortality risks. METHODS: Data from the Demographic Surveillance System in Matlab, Bangladesh, on 110,152 pregnancy outcomes between 1989 and 2008 were used to assess changes in mortality risks associated with MR (and a small number of dilation and curettage procedures), abortion and live birth. Tabulation and logistic regression analyses were used to compare outcomes in two areas of Matlab--the comparison area, which receives standard government health and family planning services, and the Maternal and Child Health-Family Planning (MCH-FP) area, which receives enhanced health and family planning services. RESULTS: In Matlab as a whole, the proportion of pregnancies ending in MR increased from 1.9% in 1989-1999 to 4.2% in 2000-2008, while the proportion ending in abortion decreased from 1.6% to 1.1%. The odds of mortality from MR were 4.1 times those from live birth in 1989-1999, but were no longer elevated in 2000-2008. The odds of mortality from abortion were 12.0 and 4.9 times those of live birth in 1989-1999 and 2000-2008, respectively. Reduction in mortality risk was greater in the MCH-FP area than the comparison area (90% vs. 75%). CONCLUSION: MR is no longer associated with higher mortality risk than live birth in Bangladesh, but abortion is

The impact of breastfeeding patterns on regional differences in infant mortality in Germany, 1910

This paper examines the impact of breastfeeding practices on the large regional differences in infant mortality in Germany around 1910. Breastfeeding is strongly negatively associated with infant mortality and remains so after controlling for public health measures and for demographic, economic, and social factors that also affect infant mortality. But it contributes much less to regional differences in infant mortality than do access to medical care, percentage illegitimate and marital fertility. Breastfeeding is less important than these other factors because it affects fewer causes of death and has a smaller impact on cause-specific infant mortality rates. L'auteur étudie l'impact des pratiques d'allaitement sur les grandes différences régionales de mortalité infantile observées en Allemagne aux alentours de 1910. Il existe une association fortement négative entre l'allaitement et la mortalité infantile, même quand on contrôle les facteurs démographiques, économiques, sociaux et de politique sanitaire, qui, eux aussi, affectent la mortalité infantile. Mais les différences régionales de mortalité infantile s'expliquent nettement moins par l'allaitement que par l'accessibilité des soins médicaux, le taux d'illégitimité des naissances et la fécondité légitime. L'allaitement est un facteur de moindre importance que ceux-ci parce qu'il n'a d'impact que sur un petit nombre de causes de décès, et un faible impact sur les taux de mortalité infantile par cause.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42730/1/10680_2005_Article_BF01796777.pd

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

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

The Impact of Wives' Earnings Inequality among Married-Couple Households in Malaysia

Using data from the First and Second Malaysian Family Life Surveys, the authors analyze the effects of wives' earnings on household earnings inequality in Malaysia in 1976 and 1988.women's employment, household earnings inequality, married women, Malaysia