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Childhood vaccinations and demographic transition: Long-term evidence from India
No full textChildhood vaccines can increase population growth in the short term by improving the survival rates of young children. Over the long run, reductions in child mortality rates are associated with lower demand for children and fertility rates (known as “demographic transition”). Vaccines can potentially aid demographic transition by lowering child mortality and improving future health, schooling, and labor market outcomes of vaccinated mothers, but these long-term demographic benefits remain untested. In this study, we examine the demographic effects of India’s national childhood vaccination program (the Universal Immunization Programme or UIP). We combine data on the district-wise rollout of UIP during 1985–1990 with fertility preference data of 625,000 adult women from the National Family Health Survey of India 2015–2016. We include women who were born five years before and after the rollout period (1980–1995) and were cohabiting with a partner at the time of the survey. We divide these 20-36-year-old women into two groups: those who were exposed to UIP at birth (treatment group) and those who were born before the program (control group). After controlling for individual- and household-level factors and age and district fixed effects, treatment group women are 2% less likely to have at least one child and want 2% fewer children in their lifetime as compared with the control group. The results are robust to variations in study periods and samples, alternative regression model specifications, and falsification test. The negative effect on at least one childbirth is larger for more educated and richer women, while the effect on the desired number of children is larger for uneducated and poorer women
Developing and testing a chatbot to integrate HIV education into family planning clinic waiting areas in Lusaka, Zambia
No full textBackground: To maximize protection against both unintended pregnancy and HIV, it is important that family planning (FP) services integrate HIV counseling, both to support method choice and identify potential HIV services of interest, such as pre-exposure prophylaxis (PrEP). However, FP providers often lack sufficient time and knowledge to address HIV vulnerability with clients. To potentially offload some of the initial HIV counseling burden from FP providers, we developed and tested a chatbot that provided information about HIV and dual protection to FP clients in waiting areas of FP clinics in Lusaka, Zambia. Chatbot Development: We drafted a scripted conversation and tested it in English in formative workshops with Zambian women between the ages of 15 and 49 years. After translating the content to Bemba and Nyanja, we conducted a second round of workshops to validate the translations, before uploading the content into the chatbot platform. Chatbot User Test: Thirty volunteers tested the chatbot in 3 Lusaka FP clinics, completing an exit survey to provide feedback. A large majority (83%) said they learned new HIV information from the chatbot. Twenty (67%) learned about PrEP for the first time through the chat. Most (96%) reported discussing HIV with the provider, after engaging with the chatbot. In response to an open-ended question, several testers volunteered that they wanted to learn more about PrEP. Conclusions: Pre-consultation waiting-area time is an underutilized opportunity to impart HIV information to FP clients, thereby preparing them to discuss their dual HIV and pregnancy prevention needs when they see their providers. FP clients expressed particular interest in learning more about PrEP, underscoring the importance of integrating HIV into FP services
People\u27s care seeking journey for a chronic illness in rural India: Implications for policy and practice
No full textDrawing on interviews conducted in 2019–2020, across twenty villages in India, this paper unpacks how people with chronic illness navigate complex care-seeking terrain. We show how the act of seeking care involves navigating through personal, family, social, economic, cultural, and most importantly, difficult health systems spaces—and entails making difficult social, moral, and financial choices. We show how the absence of reliable and accessible points of first contact for primary care results in people running from pillar to post, taking wrong turns, and becoming disappointed, frustrated, and, sometimes, impoverished. We reveal the complex individual and social dynamics of hope and misplaced and misguided expectations, as well as social obligations and their performance that animate the act of navigating care in rural India. We shine light on how a health system with weak primary care and poor regulation amplifies the medical, social, and financial consequences of an otherwise manageable chronic illness, and how these consequences are the worst for those with the least social, network and economic capital. Crucially we highlight the problematic normalisation of the absence of reliable primary care services for chronic illness in India, in rural India specifically. We signpost implications for research, and for policy and practice in India and similar health system contexts, i.e. those with weak primary care and poor regulation of the private sector. | We argue that in India, having in place accessible, good quality, and trustworthy sources of advice and care for chronic illness at the first point of call, for all, is critical. We contend that this first point of call should be quality, public primary care services. We conclude that if such arrangements are in place in public services, people will use them
2022 Pakistan floods: Population estimates and vulnerabilities of people affected by floods in Pakistan
Get PDFGendered effects of COVID-19 school closures: Kenya case study
Get PDFThis brief summarizes a case study that assessed the gendered impact of COVID-19 school closures in Kenya. COVID-19 school closures escalated education inequalities especially for girls and young people in rural areas. These closures exacerbated adolescent mental health issues, food and economic insecurity, and experiences of violence. COVID-19 response programs implemented by both the Government of Kenya and non-state actors were not able to fully mitigate the impacts of school closures for adolescents, teachers, or schools. Continued efforts to understand the implications of school closures and to support vulnerable students are needed
The importance of reclassification to understanding urban growth: A demographic decomposition of the United States, 1990–2010
No full textAn improved understanding of reclassification as a sociodemographic component of urban growth is important for urban planning and sustainable development. However, empirical assessments of the effect of reclassification on urban population dynamics are lacking, especially in countries in the later stage of the urban transition. Using recently available data on spatial reclassification of rural and urban land areas and population, and adopting multiregional demographic methods, we explicitly examine the effects of reclassification, natural growth and rural–urban migration on urban growth in the United States for the intercensal periods of 1990–2000 and 2000–2010. Results suggest that reclassification played a significant role in U.S. urban population change but its magnitude depends on assumptions about the timing of reclassification. The net effect of reclassification on urban change is the largest when reclassification is assumed to occur at the end, and the smallest when assumed to occur at the beginning, of the decennial census periods. While the impact of natural growth on U.S. urban population change is relatively stable, there is significant uncertainty in the effects of reclassification and rural–urban migration. Additionally, international migration is a key source of urban growth in the United States. We find that the places reclassified from rural to urban or from urban to rural experienced the largest changes in population sizes and age composition
Meeting men’s mental health needs during COVID-19 and beyond: A global health imperative
No full textDetermining a trusting environment for maternity care: A framework based on perspectives of women, communities, service providers, and managers in peri-urban Kenya
No full textTrust in health service providers and facilities is integral to health systems accountability. Understanding determinants of trust, a relational construct, in maternity settings necessitates exploring hierarchical perspectives of users, providers, and influencers in the care environment. We used a theoretically driven qualitative approach to explore trust determinants in a maternity setting across patient-provider, inter-provider, and community-policymaker interactions and relationships in peri-urban Kenya. Focus groups (n = 8, N = 70) with women who recently gave birth (WRB), pregnant women, and male partners, and in-depth-interviews (n = 33) with WRB, health care providers and managers, and community health workers (CHWs) were conducted in 2013, soon after the national government\u27s March 2013 introduction of a policy mandate for “Free Maternity Care.” We used thematic coding, memo writing, and cross-perspective triangulation to develop a multi-faceted trust determinants framework. We found that determinants of trust in a maternity setting can be broadly classified into six types of factors, where each type of factor represents a cluster of determinants that may each positively or negatively influence trust: patient, provider, health facility, community, accountability, and structural. Patient factors are prior experiences, perceived risks and harms, childbirth outcomes, and maternal health literacy. Provider factors are empathy and respect, responsiveness, and perceived capability of providers. Health facility factors are “good services” as perceived by patients, physical environment, process navigability, provider collaboration and oversight, discrimination, and corruption. Community factors are facility reputation and history, information channels, and maternal health literacy. Accountability factors are alignment of actions with expectations, adaptations to policy changes, and voice and feedback. Structural factors are institutional hierarchies and policies in the form of professional codes. Trust determinants are complex, nuanced and reflect power dynamics across relationships. Findings offer insight into socio-political maternity norms and demand a more equitable care interface between users and providers
Necesidades y atención en salud sexual y reproductiva de mujeres migrantes en México: Un estudio desde Ciudad Juárez—Volumen 3
No full textEl estudio retoma las voces de personas encargadas de los albergues y que brindan servicios de salud en los albergues de Ciudad Juárez, México. Explora sus puntos de vista sobre las necesidades de salud sexual y reproductiva de las mujeres migrantes extranjeras durante el tránsito por esta ciudad, y sobre las necesidades de los albergues para brindar atención. El volumen 1 y 2 del estudio, retoma las voces de las mujeres migrantes en estos temas.
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Elevating the voices of migrant shelter coordinators and healthcare service providers in the shelters of Ciduad Juárez, México, this study explores their viewpoint on the various sexual and reproductive health needs of foreign migrant women in-transit through the country. The report also presents the shelters need to provide care to this population. Volumes 1 and 2 of the study explore migrant women\u27s viewpoints
Unit costs of a community-based girl-centered HIV prevention program: A case study of Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe program
No full textObjective: We compare the unit costs of providing Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) interventions to adolescent girls and young women (AGYW) reached across two sites, an urban (Nyalenda A Ward) and peri-urban (Kolwa East Ward) setting, in Kisumu County of Kenya. Design: Micro-costing, using the average cost concept during project initiation and early implementation. Methods: Adopting the implementer\u27s (provider\u27s) perspective, we computed and classified costs in the following categories for each sub-implementing partner: medical and professional staff, administrative and support staff, materials and supplies, building space and utilities, equipment, establishment, and miscellaneous. These costs were summed across sub-implementing partners in a site to obtain the site-level total costs. These are then divided by the total number of AGYW reached in each site to obtain the unit costs. Data were collected from July to September 2017. Results: The unit costs in the peri-urban area were about 1.9 times of those in the urban area. It cost about US129 (or 327 International Dollars) in the peri-urban area. Conclusion: First, it was generally more expensive to deliver DREAMS interventions in the peri-urban setting as compared with the urban setting. Second, the difference in unit costs was mainly driven by the building space and utilities. Strategies to lower intervention costs are needed in the peri-urban setting, such as using existing infrastructure (either governmental or nongovernmental) or other innovative ways to deliver the services