Sexual and reproductive health in local mining contexts in Colombia

Background. Research on the relationship between mining and sexual and reproductive health (SRH) is limited, almost exclusively concerned on the HIV spread in mining contexts. Colombia, like other Latin American and Caribbean countries, experienced an unprecedented mining boom since the mid-2000’s with insufficient evidence on its effects on SRH. This dissertation study examined the relationship between the gold-mining boom and fertility—as a comprehensive measure for SRH, in Colombian municipalities, between 2001 and 2015. Methods. I conducted a longitudinal ecological study using a multilevel model of change. I used data of gold-mining production and births of each of the 1112 municipalities of Colombia—excluding ten municipalities created after 2001. For the independent variable, I constructed the time-varying categorical variable Stages of gold-mining boom (SGMB). This variable represented the municipal status regarding a gold-mining boom at each year, by defining categories of pre-boom, boom—rapid increase (boom-up) and rapid decline (boom-down)—, and post-boom. For the dependent variable, I calculated general fertility rates (GFR), age-specific fertility rates (ASFR), and total fertility rates (TFR). I performed multilevel regression models of change to test the association between the stages of gold-mining boom and fertility change, controlling for socioeconomic confounders. I conducted a sensitivity analysis by including only the municipalities with acceptable live birth coverage by 2005 (N=191). Results. The results indicated a positive longitudinal association between the gold-mining boom and fertility, in Colombian municipalities, between 2001 and 2015. Fertility (GFR and TFR) increased in the boom-down and post-boom periods. Among different age-groups, fertility (ASFR) increased in the periods of boom-up (age group 10-14), boom-down (age groups in the range 15-25, and 35-39), and post-boom (age group 15-19). The sensitivity analysis indicated the results were robust. Conclusions. The rapid fertility change (including of adolescent fertility) observed in the short period of the boom stages suggests that SRH is deeply impacted in gold-mining boom contexts. This study provides a baseline for further global research on this critical but neglected topic of public health significance. New investigations must consider the gender dynamics triggered by a mining boom, which may configure contexts of unbalanced gendered power relations