Public Health Commons^™

Trends And Transitions In Children's Coresidence With Older Adults In Beijing Municipality, Zachary Zimmer, Xianghua Fang, Toshiko Kaneda, Zhe Tang, Julia Kwong

Poverty, Gender, and Youth

The reduction in family size in China and concurrent social and economic change are raising concerns that traditional sources of support may be eroding. This Population Council working paper paper examines a) whether rates of coresidence between older adults and their adult children in the Beijing municipality of China have been declining, and b) the determinants of coresidence and coresidence transitions. Results suggest that family support structures for the elderly, when they are facilitated through coresidence, remain basically intact, particularly for those who require the greatest amount of support. Further assessment is required to elucidate the effects of availability, need, …

Population Aging And The Rising Cost Of Public Pensions [Arabic], John Bongaarts

Poverty, Gender, and Youth

Rapid population aging is raising concerns about the sustainability of public pension systems in high-income countries. The first part of this study identifies the four factors that determine trends in public pension expenditures: population aging, pension benefit levels, the mean age at retirement, and the labor force participation rate. The second part presents projections to 2050 of the impact of demographic trends on public pension expenditures in the absence of changes in pension benefits, labor force participation, and age at retirement. These projections demonstrate that current trends are unsustainable, because without reforms population aging will produce an unprecedented and harmful …

Urban Poverty And Health In Developing Countries: Household And Neighborhood Effects, Mark R. Montgomery, Paul C. Hewett

Poverty, Gender, and Youth

In the United States and other high-income countries, where most people live in cities, there is intense scholarly and program interest in the effects of household and neighborhood living standards on health. This paper investigates whether in these cities the health of women and young children is influenced by both household and neighborhood standards of living. To judge from our results, it appears that as a rule, poor urban households do not tend to live in uniformly poor communities; indeed, about one in ten of a poor household’s neighbors is relatively affluent, belonging to the upper quartile of the urban …

Formal And Informal Abortion Services In Rajasthan, India: Results Of A Situation Analysis, Sandhya Barge, Hillary J. Bracken, Batya Elul, Nayan Kumar, Wajahat U. Khan, Shalini Verma, Carol Camlin

Reproductive Health

As part of a Population Council program of research on unwanted pregnancy and induced abortion in Rajasthan, the Population Council and the Centre for Operations Research and Training conducted a situation analysis of abortion services in both the formal and informal sectors in six districts. This report offers insights into the availability and organization of abortion services in the sampled areas in Rajasthan. The report also documents a vast array of informal providers who offer services for delayed menstruation or unwanted pregnancy. Informal providers appear particularly accessible to women because they are far more prevalent in rural areas than formal …

Willingness To Pay Surveys For Setting Prices For Reproductive Health Products And Services: A User's Manual, Karen G. Fleischman Foreit, James R. Foreit

Reproductive Health

Social programs need to balance volume (coverage) and revenue (sustainability). The law of demand says that we cannot get both coverage and sustainability at the same time—as prices go up, demand will come down. Client loss with increasing prices is inevitable, except in those cases where starting prices are so low or demand is so high that demand is insensitive to price changes. Willingness to pay surveys allow program managers to simulate price-related changes in demand without actually changing prices, giving them a way to make pricing decisions based on empirical information. In making pricing decisions, managers of social programs …

Integration Of Reproductive Health Services For Men In Health And Family Welfare Centers In Bangladesh, Ubaidur Rob, Sharif M.I. Hossain, M.E. Khan, Ahmed Al-Sabir, Mohammed Ahsanul Alam

Reproductive Health

Since the mid-1970s, the Bangladesh national family planning program primarily focused on motivating women to use modern contraceptive methods and encouraging them to seek services from clinics. In addition, female field workers were recruited to deliver contraceptive methods at homes. The program design facilitated women’s access to information and medical care through clinics and home visits. In the process, however, the medical needs of males were marginalized. Men generally seek services from pharmacies, private practitioners, and district hospitals, and often ignore preventive steps and postpone seeking medical care for chronic health conditions. In cases of acute illness, they often resort …

Community Involvement In Reproductive Health: Findings From Research In Karnataka, India, Foundation For Research In Health Systems

Reproductive Health

In 1996, the government of India decided to provide a package of reproductive and child health services through the existing family welfare program, adopting a community needs assessment approach (CNAA). To implement this approach, the government abolished its practice of setting contraceptive targets centrally and introduced a decentralized planning strategy whereby health workers assessed the reproductive health needs of women in their respective areas and prepared local plans to meet those needs. They also involved community leaders to promote community participation in the reproductive and child health program. Since 1998, several evaluation studies have assessed the impact of CNAA on …

A Multi-Sectoral Approach To Providing Reproductive Health Information And Services To Young People In Western Kenya: The Kenya Adolescent Reproductive Health Project, Ian Askew, Jane Chege, Carolyne Njue, Samson Radeny

Reproductive Health

Informing adolescents about appropriate and acceptable behaviors, and ways to protect themselves against unwanted and unprotected sex, has proved problematic in Kenya. Education programs for in- and out-of-school adolescents are lacking, there is controversy about providing services to sexually active adolescents, and a pervasive concern that sexuality education and contraceptive services leads to promiscuity. Unbiased and accurate information and services are needed if adolescents are to delay becoming sexually active, to resist pressures to engage in nonconsensual sex, and to protect themselves against unwanted pregnancies and infections if they do have sex. Moreover, strategies for providing such information and services …

Determining An Effective And Replicable Communication-Based Mechanisms For Improving Young Couples' Access To And Use Of Reproductive Health Information And Services In Nepal—An Operations Research Study, Center For Research On Environment Health And Population Activities (Crehpa)

Reproductive Health

This operations research study sought to determine an effective communication-based model for increasing the involvement of community-based groups in improving access to and use of reproductive health services and information by young married couples. The study employed a quasi-experimental design with two experimental and two nonequivalent control groups in the Udaypur district of Nepal. As stated in this report, this OR study clearly demonstrates the effectiveness of communication-based models such as the formation and reactivation of Youth Communication Action Groups and Mother’s groups, basic and refresher training, group interaction and mobilization, and social events in creating an enabling environment for …

Testing A Community-Based Distribution Approach To Reproductive Health Service Delivery In Senegal (A Study Of Community Agents In Kébémer), Diouratie Sanogo, Mady Cisse, Adama Ndoye, Laty G. Ndoye, Ousmane Faye, Balla Mbacke Mboup

Reproductive Health

The Division of Reproductive Health (DSR) of the Senegal Ministry of Health and Social Action, in partnership with the Population Council’s FRONTIERS in Reproductive Health program and Management Sciences for Health (MSH), conducted a study to test and compare three ways of providing reproductive health services to rural communities in the Kébémer district of Senegal in terms of their effectiveness, cost, and cost-effectiveness. FRONTIERS and MSH collaborated with the DSR to design the interventions, MSH supported the DSR in implementing the interventions, and FRONTIERS undertook the evaluation. This study, funded by USAID, responded to the recommendations of a 1999 workshop, …

New Findings From Intervention Research: Youth Reproductive Health And Hiv Prevention, Family Health International

Reproductive Health

On September 9, 2003, FRONTIERS/Population Council, Horizons/Population Council, and YouthNet/Family Health International co-sponsored a technical meeting in Washington, DC, “New Findings from Intervention Research: Youth Reproductive Health and HIV Prevention.” Approximately 150 HIV/AIDS, reproductive health, and youth development experts from a diversity of organizations and backgrounds participated. The purpose of the meeting was to disseminate newly available research findings on how to change youth reproductive health/HIV knowledge, attitudes, and behaviors in developing countries. The meeting also sought to stimulate discussion on lessons learned, best practices, and recommendations for future youth programs and research. This meeting report summarizes the presentations and …

Promoting Young People's Sexual And Reproductive Health: Stigma, Discrimination And Human Rights, Kate Wood, Peter Aggleton

Reproductive Health

Sponsored jointly by the DFID-supported Safe Passages to Adulthood program, John Snow International, YouthNet/Family Health International, and the Population Council, the international knowledge synthesis meeting on Promoting Young People’s Sexual and Reproductive Health: Stigma, Discrimination and Human Rights took place in Brighton, England, June 5–7, 2003. Participants from a wide variety of countries were invited to describe their experiences of working to challenge stigma and discrimination and promote human rights as they relate to young people’s sexual and reproductive health. The meeting brought together program leaders from a variety of countries to discuss stigma, discrimination, and human rights in relation …

Understanding Induced Abortion: Findings From A Programme Of Research In Rajasthan, India, Population Council

Reproductive Health

In India, abortion has been legal for over 30 years, following the enactment of the Medical Termination of Pregnancy (MTP) Act in 1971. While the MTP Act permits abortion for a broad range of social and medical reasons, it also includes provisions regarding delivery of services that have proved to constrain access to safe and legal abortion for the great majority of women in India. Due in part to these constraints, up to 90 percent of the six million induced abortions estimated to occur annually in India are illegal—provided in uncertified settings and/or by uncertified providers. Many are unsafe and …

Unwanted Pregnancy And Induced Abortion In Rajasthan, India: A Qualitative Exploration, Batya Elul, Hillary J. Bracken, Shalini Verma, Rajani Ved, Rajesh Singhi, Karin Lockwood

Reproductive Health

As part of a Population Council program of research on unwanted pregnancy and induced abortion in Rajasthan, the Council and Ibtada conducted a qualitative exploration of attitudes and behaviors regarding unwanted pregnancy and induced abortion in Alwar district. The study was intended to lay the groundwork for two quantitative studies on abortion undertaken subsequently in six districts of Rajasthan. The qualitative exploration shows that women, particularly those who are poor, turn to largely untrained community-level providers for abortion services. Additionally, women use home remedies in an often unsuccessful attempt to terminate unwanted pregnancies. Women with greater financial means obtain surgical …

Unwanted Pregnancy And Induced Abortion: Data From Men And Women In Rajasthan, India, Batya Elul, Sandhya Barge, Shalini Verma, Nayan Kumar, Hillary J. Bracken, Hemlata Sadhwani

Reproductive Health

This report is the result of a collaborative project between the Population Council and the Centre for Operations Research and Training, conducted as part of a Council program of research on unwanted pregnancy and induced abortion in Rajasthan, India. Designed as a complement to service-delivery activities being undertaken in Rajasthan by the Indian nongovernmental reproductive health service provider Parivar Seva Sanstha, the program of research aimed to provide a multifaceted picture of the on-the-ground realities related to unwanted pregnancy and abortion in six districts of Rajasthan. Detailed pregnancy histories yielded data on levels of unwanted pregnancy and induced abortion in …

Safe Motherhood Demonstration Project, Western Province: Final Report, Charlotte E. Warren, Wilson Liambila

Reproductive Health

Since March 2000, the Population Council and the University of Nairobi have been assisting the Kenya Ministry of Health to implement Safe Motherhood activities in Western Kenya. The purpose of this project was to increase utilization of quality maternal services in the selected districts and, in an effort to improve pregnancy outcomes, focused on improving quality of antenatal care, essential obstetric care, clean and safe delivery, postpartum care, postabortion care, and management issues at all levels. In addition, the project focused on strengthening referral practices and addressing factors responsible for delays by pregnant women in making decisions on when, where, …

Making Motherhood Safer In Egypt, Karima Khalil, Farzaneh Roudi-Fahimi

Reproductive Health

Fewer Egyptian women die of maternal causes today than they did 10 or 15 years ago, due in large part to the national safe motherhood program. Nevertheless, maternal mortality is still relatively high, and the country faces challenges in reducing it further. Many of these challenges involve addressing the delays women face when they need essential obstetric care. In Egypt and other countries, most maternal deaths could be avoided if women had timely access to high-quality emergency obstetric services. Although Egypt’s level of maternal mortality is relatively high by international standards, recent evidence suggests that a woman’s lifetime risk of …

Predictors That Affect The Caregiver's Health Status And The Role Of Social Support On The Caregiver's Health Status, Hong Wang

All-Inclusive List of Electronic Theses and Dissertations

This study examines whether the caregiver's self-rated health status is affected by the caregiver's demographic characteristics (age, education level, and income), caregiver's stressor (the number of ADL and IADL), mediating variables of the caregiver's appraisal (willingness to help non-family members, level satisfaction with life, and financial burden), of and mediating variable of social support (information and/or advice from other family members or friends). Data were drawn from Chronic Illness and Caregiving, a national telephone survey conducted by Harris Interactive Inc. on behalf of The Robert Wood Johnson Foundation, Johns Hopkins University, and Partnership for Solutions. The sample size of caregivers …

Sibling Death In Childhood: An Evaluation Of The Literature Regarding Inclusion Of Minority Cultures, 1990–2002, Joyce Kay L. Cherry

Community & Environmental Health Theses & Dissertations

This evaluation seeks to determine the extent to which the professional literature concerning bereaved children in the United States includes African American, Hispanic American, and Asian American children whose siblings have died in childhood.

A literature search identifies 58 articles, published between 1990 and 2002, concerning children under age 19 living in the United States whose siblings have died. Articles are sorted by time frame and classified by type. There are 31 descriptive articles consisting of five literature reviews, five commentaries, five case studies, and 16 narratives; there are 27 research articles. Analysis determines the extent to which race, culture, …

Long-Term Care: Informed By Research, Francis G. Caro

Gerontology Institute Publications

Health services research has contributed to health policy and service developments that have led to major improvements in the quality of long-term care in the United States. This policy brief highlights a few areas in which publicly and privately funded research has informed the long-term care field.

Seniors Count Follow-Up Study, Nina M. Silverstein, Heather Connors, May Jawad

Gerontology Institute Publications

Seniors Count is an ongoing outreach initiative under the direction of Boston Mayor Thomas M. Menino with the leadership and support of Joyce Williams, Boston's Commissioner on Affairs of the Elderly. The program's purpose is to "identify and reach out to those members of the city's elderly population who live in private housing arrangements and help provide them with the information and services they [may] need" (Boston Commission on Affairs of the Elderly, 2002). Since the program's inception in 1999, it has reached over 5,500 community-dwelling elders in the City of Boston (Boston Commission on Affairs of the Elderly, 2002). …

Evidence-Based Development Of Health And Family Planning Programs In Bangladesh And Ghana, James F. Phillips, Tanya C. Jones, Frank K. Nyonator, Shruti Ravikumar

Poverty, Gender, and Youth

This paper describes two initiatives that have used experimental studies to guide the development of community-based health and family planning programs. In Bangladesh and Ghana, factorial experiments were implemented in stages. An exploratory phase developed a service system for community-based health care; an experimental phase assessed the demographic impact of the system; a replication phase examined the transferability of the experimental program to a non-research setting; and a scaling-up phase facilitated the extension of the new system to the national health care program. All stages were guided by research, with questions, mechanisms, and outcomes shifting as the process developed. Large-scale …

Determinants Of Old-Age Mortality In Taiwan, Zachary Zimmer, Linda G. Martin, Hui-Sheng Lin

Poverty, Gender, and Youth

Relationships among socio-demographic characteristics, general assessments of health, and old-age mortality are well established in developed countries. There is also an increasing focus on the connection between early-life experiences and latelife health. This paper tests these and other associations using representative survey data from Taiwan on the population aged 60 and older in 1989, 1993, and 1996 that have been linked to data on deaths between 1989 and 1999 from a national death registry. The study also explores the possible influence of Taiwan’s Universal Health Insurance Program, instituted in 1995, and whether or not the survival of some groups of …

Estimating Mean Lifetime, John Bongaarts, Griffith Feeney

Poverty, Gender, and Youth

The life expectancy implied by current age-specific mortality rates is calculated with life table methods that are among the oldest and most fundamental tools of demography. We demonstrate that these conventional estimates of period life expectancy are affected by an undesirable “tempo effect.” The tempo effect is positive when the mean age at death is rising and negative when the mean age is declining. Estimates of the effect for females in three countries with high and rising life expectancy range from 1.6 years in the United States and Sweden to 2.4 years in France for the period 1980-95.

Completing The Fertility Transition In The Developing World: The Role Of Educational Differences And Fertility Preferences, John Bongaarts

Poverty, Gender, and Youth

This study summarizes patterns of educational differentials in wanted and unwanted fertility at different stages of the fertility transition based on data from DHS surveys in 57 less developed countries. As the transition proceeds, educational differentials in wanted fertility tend to decline and differentials in unwanted fertility tend to rise. An assessment of fertility patterns in more and less developed countries with low fertility concludes that these differentials are likely to remain substantial when less developed countries reach the end of their transitions. This finding implies that the educational composition of the population remains a key predictor of overall fertility …

The Ghana Community-Based Health Planning And Services Initiative: Fostering Evidence-Based Organizational Change And Development In A Resource-Constrained Setting, Frank K. Nyonator, John Koku Awoonor-Williams, James F. Phillips, Tanya C. Jones, Robert A. Miller

Poverty, Gender, and Youth

Research projects demonstrating ways to improve health services often fail to have an impact on what national health programs actually do. An approach to evidence-based policy development has been launched in Ghana that bridges the gap between research and program implementation. The Community-based Health Planning and Services (CHPS) initiative employs strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteers, resources, and cultural institutions to support community-based primary health care. Over the 1999 to 2002 period, 100 out of the 110 districts in Ghana adopted a CHPS initiative. This paper reviews features of the initiative …

Primary Schooling In Sub-Saharan Africa: Recent Trends And Current Challenges, Cynthia B. Lloyd, Paul C. Hewett

Poverty, Gender, and Youth

At the dawn of the twenty-first century we estimate that more than 37 million young adolescents aged 10-14 in sub-Saharan Africa will not complete primary school. Our estimates are based on data from nationally representative Demographic and Health Surveys from 26 countries, collectively representing 83 percent of the sub-Saharan youth population. This number is nearly twice the entire population of children aged 10-14 in the United States, virtually all of whom will complete primary school. Reducing the number of uneducated African youth is a primary objective of the United Nations as laid out in the Millennium Development Goal for education, …

The Feasibility Of Computer-Assisted Survey Interviewing In Africa: Experience From Two Rural Districts In Kenya, Paul C. Hewett, Annabel Erulkar, Barbara Mensch

Poverty, Gender, and Youth

This paper explores the use of an audio computer-assisted self-interviewing (audio-CASI) methodology in a household survey of adolescents in two districts of Kenya. Computer software was developed as part of a research project comparing audio-CASI with traditional methods of interviewing about sensitive behaviors, including sexual initiation, risky sexual behavior, coerced sex, and drug and alcohol use. The paper describes the experience of carrying out a household-based study using computers and explores the technical challenges faced by the data collection teams. Few problems emerged with the computer hardware and software, despite the difficult interviewing conditions. The adolescent respondents easily adapted to …

Condom Use And Abstinence Among Unmarried Young People In Zimbabwe: Which Strategy, Whose Agenda?, Ravai Marindo, Steve Pearson, John B. Casterline

Poverty, Gender, and Youth

This paper compares the views about abstinence and condom use expressed by young people in Zimbabwe in focus-group discussions with the views underlying national policies and religious and traditional beliefs. Young people’s decisions to adopt one or the other of these risk-reduction strategies may not necessarily indicate genuine individual choices, but rather their deference to adults’ interests as they understand those interests. Policymakers and traditional and Christian leaders promote abstinence as the exclusive strategy for all young people, whereas nongovernmental organizations and the private sector promote condom use. Evidence from the focus-group discussions indicates that adolescents are aware of this …

Wage Work And Marriage: Perspectives Of Egyptian Working Women [Arabic], Sajeda Amin, Nagah Hassan Al Bassusi

Poverty, Gender, and Youth

This paper explores young working women’s perceptions of marriage and work in contemporary Egypt at a time when an increase in age at marriage was evident from national survey data. Data from two nationally representative labor surveys, the Labor Force Sample Survey of 1988 and the Egypt Labor Market Survey of 1998, show that working conditions and employment opportunities declined significantly for young women even as their educational attainment increased. Indepth interviews were conducted with young women working in a range of salaried jobs in three locations: a rural village in Mansoura, a periurban district near Cairo, and in the …