Fertility and union dissolution in Brazil: an example of multi-process modelling using the Demographic and Health Survey calendar data

This study examines the union and conception histories of Brazilian women aged 15-49 using the 1996 Demographic and Health Survey’s calendar data. The aim of the paper is twofold: firstly to explore the use of union histories in the DHS calendar data, which have not yet been used for union dynamics studies and secondly to secondly to analyse the relationship between union instability and fertility in Brazil which has been long understudied. Using the example of Brazil it investigates the potential strengths and biases of this data source. In particular it analyses the impact of union dissolution on fertility in Brazil using multiprocess event history analysis techniques as developed by Lillard (1993). This type of methodology has been widely used for the analyses of developed countries data. However, it has not been explored for developing countries mainly due to the lack of data. The paper will demonstrate the positive effect of union instability on fertility.aml, Brazil, calendar data, DHS, fertility, multiprocess model, union dissolution

Fertility and union dissolution in Brazil: an example of multi-process modelling using the Demographic and Health Survey calendar data.

This study examines the union and conception histories of Brazilian women aged 15-49 using the 1996 Demographic and Health Survey’s calendar data. The aim of the paper is twofold: firstly to explore the use of union histories in the DHS calendar data, which have not yet been used for union dynamics studies and secondly to secondly to analyse the relationship between union instability and fertility in Brazil which has been long understudied. Using the example of Brazil it investigates the potential strengths and biases of this data source. In particular it analyses the impact of union dissolution on fertility in Brazil using multiprocess event history analysis techniques as developed by Lillard (1993). This type of methodology has been widely used for the analyses of developed countries data. However, it has not been explored for developing countries mainly due to the lack of data. The paper will demonstrate the positive effect of union instability on fertility.

The commodity chain of the household: from survey design to policy and practice

Data collection and analysis and policy formulation all require a social unit to be defined, generally called the household. Multidisciplinary evidence shows that households as defined by survey practitioners often bear little resemblance to lived socio-economic units. This study examines how a shared language, the 'household', can generate misunderstandings because different groups with distinctive understandings of the term 'household' are often unaware that others may be using ‘household’ differently. Results from 4 interlinked and iterative methods are presented: review of household survey documentation (1950s-present); ethnographic ground-truthing fieldwork; in-depth key informant interviews; and modelling. Results show that whereas data collectors have a clear idea of what a `household` is, data users are often unaware of the nuances of the constraints imposed by data collection. This has implications for policy planning and practice. What interviewees consider when they think of their household can differ systematically from data collectors' definitions

Gender-based violence and reproductive health in five Indian states

Gender-based violence is a multi-faceted public health problem with numerous consequences for an individual’s physical and mental health and wellbeing. This collection develops a comprehensive public health approach for working with gender-based violence, paying specific attention to international budgets, policies and practice and drawing on a wide selection of empirical studies

Rising overmedicalisation of births in India: a demand or supply phenomenon?

Rising overmedicalisation of childbearing in low income countries is seen as a worrying trend as resources are scarce and could create a further risk for mother and child’s health. Here, Tiziana Leone summarises her recent paper which explores the driving forces behind the phenomenon in India

Demand and supply factors affecting the rising overmedicalization of birth in India

Objective To understand the interaction between health systems and individual factors in determining the probability of a cesarean delivery in India. Methods In a retrospective study, data from the 2007–2008 District Level Household and Facility Survey was used to determine the risk of cesarean delivery in six states (Punjab, Delhi, Maharashtra, Andhra Pradesh, Kerala, and Tamil Nadu). Multilevel modeling was used to account for district and community effects. Results After controlling for key risk factors, the analysis showed that cesareans were more likely at private than public institutions (P < 0.001). In terms of demand, higher education levels rather than wealth seemed to increase the likelihood of a cesarean delivery. District-level effects were significant in almost all states (P < 0.001), demonstrating the need to control for health system factors. Conclusion Supply factors might contribute more to the rise in cesarean delivery than does demand. Further research is needed to understand whether the quest for increased institutional deliveries in a country with high maternal mortality might be compromised by pressures for overmedicalization

The effect of social participation on the subjective and objective health status of the over-fifties: evidence from SHARE

Increasing social participation among older individuals to increase health and wellbeing has become a distinct policy goal of many national governments and the European Commission. However, to date the evidence on how social participation affects health, both subjective and objective, remains limited, especially since most studies do not account for the reciprocal relationship. The aim of this study is to analyse how changes in social participation affect both the subjective and objective health of older Europeans as well as how changes in health status affect social participation. Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the results suggest that both the uptake as well as the continuation of social activities increase the chances of improvements in subjective as well as objective health. Furthermore, improvements in self-rated health as well as grip strength significantly increase the chances of taking up new activities as well as continuing with existing ones. Country effect is not as strong as expected and the benefits could be homogeneous across different cultures once we control for socio-economic status. Overall, the results stress the need for taking into account the reciprocal relationship between social participation and health. The paper highlights the importance of focusing on both uptake and continuation of social participation when devising policy aimed at improving healthy ageing

The effect of social participation on the subjective and objective health status of the over-fifties: evidence from SHARE

Increasing social participation among older individuals to increase health and wellbeing has become a distinct policy goal of many national governments and the European Commission. However, to date the evidence on how social participation affects health, both subjective and objective, remains limited, especially since most studies do not account for the reciprocal relationship. The aim of this study is to analyse how changes in social participation affect both the subjective and objective health of older Europeans as well as how changes in health status affect social participation. Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the results suggest that both the uptake as well as the continuation of social activities increase the chances of improvements in subjective as well as objective health. Furthermore, improvements in self-rated health as well as grip strength significantly increase the chances of taking up new activities as well as continuing with existing ones. Country effect is not as strong as expected and the benefits could be homogeneous across different cultures once we control for socio-economic status. Overall, the results stress the need for taking into account the reciprocal relationship between social participation and health. The paper highlights the importance of focusing on both uptake and continuation of social participation when devising policy aimed at improving healthy ageing

Service utilization patterns for childbirth and neonatal mortality in the occupied Palestinian territory during conflict

BACKGROUND: The global incidence of man-made crises has increased in the last decade. Evidence on deviations in service uptake during conflict is needed to better understand the link between conflict and adverse neonatal outcomes. We assessed the association between conflict intensity in the occupied Palestinian territory (oPt) at time of birth and (i) utilization patterns for childbirth across different providers; and (ii) neonatal mortality. METHODS: We combined data on conflict intensity with four demographic and health surveys (2004, 2006, 2010 and 2014) that included nationally representative samples of women of childbearing age. Our exposure variable was casualties per 100 000 population in defined sub-regions of the oPt. Our outcome specifications were a binary variable for neonatal deaths and a categorical variable for childbirth location. We used multivariate logistic and multinomial regressions to assess the associations. RESULTS: High conflict intensity was associated with fewer childbirths in the private sector (RR=0.97, P=0.04), and non-governmental organizations (RR=0.95, P=0.03) compared to public facilities. Conflict intensity was not associated with higher neonatal mortality beyond 2004. CONCLUSIONS: Policy implications include better preparedness in the public sector for childbirth during conflict and exploring reasons for the slow decline in neonatal mortality in the territory beyond conflict at time of birth

Timing and determinants of age at menarche in low-income and middle-income countries

Introduction: Understanding the timing and determinants of age at menarche is key to determining potential linkages between onset of puberty and health outcomes from a lifecourse perspective. Yet, we have little information in low- and middle-income countries (LMICs) mainly due to lack of data. The aim of this study is to analyse trends in the timing and the determinants of menarche in LMICs. Methods: Using 16 World Fertility Surveys and 28 Demographic and Health Surveys (DHS) from 27 countries, we analyse cohort trends and use fixed-effects models for DHS surveys to investigate socio-demographic and regional effects in the timing of age at menarche. Results: Trends of the mean age at menarche across time within and between countries show a declining or stalling path. Results of the determinants modelling show the relationship with wealth changes over time although not consistently across countries. We see a shift from poorer women having earlier menarche in earlier surveys to richer women having earlier menarche in later surveys in Indonesia, the Philippines and Yemen, whilst in Egypt the reverse pattern is evident. Conclusions: There is a considerable gap in both literature and data on menarche. We see a trend which is declining rapidly (from 14.66 to 12.86 years for the 1932 and 2002 cohorts respectively), possibly at a faster pace than high income countries and with a strong link to socio-economic status. This study calls for menarche questions to be included in more nationally-representative surveys and greater use of existing data because of its impact on life-course health in fast ageing settings. Further studies will need to investigate further the use of the age at menarche as an indicator of global health