A New Measure of Fertility Replacement Level in the Presence of Positive Net Immigration.

In most more developed countries, the total fertility rate (TFR) is below 2.1 and net immigration is positive. This paper proposes and calculates for 22 populations for 2011-15 a 'Current Migration Replacement TFR' which in combination with the mortality and absolute net migration for that period generates a stationary population equal in size to the mid-period population. The results show the Current Migration Replacement TFR ranges widely from 0.60 for Singapore to 2.05 for Slovakia. That the Current Migration Replacement TFR is below the 2011-15 TFR in 14 of the 22 countries shows that, when considered in combination with current migration and mortality, in most of the countries the current 'below 2.1' TFR is coherent with population increase, not population decline, over the long run. For New Zealand, Australia, Norway, Sweden and the UK continued current fertility in combination with constant mortality and constant absolute net migration is coherent with more than doubling of the current population size. The value of this measure for illustrating the interconnected population size implications of sub-replacement fertility and immigration, for sub-categorisation of 'post-transitional' populations by population growth prospects, and for guiding population policy is discussed.

Climate-Related Displacement and Antenatal Care Service Utilization in Rural Bangladesh.

CONTEXT: Extreme weather events cause large-scale population displacement in Bangladesh. It is important to know how household displacement due to such events might affect women's antenatal care (ANC) service utilization. METHODS: In 2017, a cross-sectional household survey was conducted in 25 rural villages in either displacement prone or non-displacement prone areas of Bangladesh. Data were collected from 611 respondents (a woman or her husband) who reported having had a live birth in the past three years; of those, 289 had experienced household displacement due to an extreme weather event. Logistic regression analyses were conducted to examine the relationship between experience of household displacement and women's ANC service utilization during their last pregnancy resulting in a live birth. RESULTS: Eighty-three percent of women had received at least one ANC visit during their last pregnancy resulting in a live birth; of those, 31% received at least four visits with a trained provider. Women from households that had been displaced three or more times were less likely than those from nondisplaced households to have received an ANC visit and at least four visits with a trained provider (odds ratios, 0.3 and 0.4, respectively). Receiving at least four visits with a trained provider was also associated with having previous children (0.3-0.4), age at pregnancy (2.5-3.9), husband's occupation (2.2 for "other") and joint parental decision-making about ANC visits (1.8). CONCLUSIONS: Strengthening family planning services and extending eligibility for Bangladesh's Maternity Allowance benefits in the areas prone to floods and riverbank erosion are recommended to improve ANC service utilization.

RESUMEN Contexto: Los eventos climáticos extremos causan desplazamientos de población a gran escala en Bangladesh. Es importante conocer cómo el desplazamiento de hogares debido a tales eventos podría afectar la utilización que las mujeres hacen de los servicios de atención prenatal (APN). Métodos: En 2017, se condujo una encuesta transversal de hogares en 25 pueblos rurales de Bangladesh tanto en áreas propensas al desplazamiento como en áreas no propensas al mismo. Se recolectaron datos de 611 personas entrevistadas (mujeres o sus cónyuges) que reportaron haber tenido un nacido vivo en los tres años previos; de ellas, 289 habían experimentado desplazamiento del hogar debido a un evento climático extremo. Se llevaron a cabo análisis de regresión logística para examinar la relación entre la experiencia del desplazamiento del hogar y la utilización de servicios de APN por las mujeres durante su último embarazo que resultó en un nacido vivo. Resultados: Ochenta y tres por ciento de las mujeres habían tenido al menos una visita de APN durante su último embarazo que resultó en un nacido vivo; de ellas, 31% tuvo al menos cuatro visitas con un proveedor de servicios capacitado. Las mujeres de hogares que habían sido desplazados tres o más veces tuvieron menos probabilidad que las mujeres de hogares no desplazados de haber tenido una visita de APN y al menos cuatro visitas con un proveedor de servicios capacitado (razón de probabilidades, 0.3 y 0.4, respectivamente). Tener hijos previamente (0.3­0.4), edad al embarazo (2.5­3.9), ocupación del cónyuge (2.2 para "otro") y toma de decisiones parentales conjunta sobre visitas de APN (1.8) también estuvieron asociados con el hecho de tener al menos cuatro visitas con un proveedor de servicios capacitado. Conclusiones: Se recomienda fortalecer los servicios de planificación familiar y extender la elegibilidad para los beneficios de la Prestación por Maternidad del Gobierno de Bangladesh en las áreas propensas a inundaciones y erosión de las riberas de los ríos para mejorar la utilización de servicios de APN.

RÉSUMÉ Contexte: Les phénomènes météorologiques extrêmes sont la cause de déplacements de population à grande échelle au Bangladesh. Il importe de documenter l'effet éventuel de ce déplacement des ménages sur le recours des femmes aux prestations de soins prénatals (SPN). Méthodes: En 2017, une enquête transversale auprès des ménages a été menée dans 25 villages bangladais situés dans des zones sujettes ou non au déplacement. Les données ont été collectées auprès de 611 répondants (les femmes ou leur mari) ayant déclaré avoir eu une naissance vivante au cours des trois dernières années. Parmi ces répondants, 289 avaient connu un déplacement du ménage dû à un phénomène météorologique extrême. La relation entre le vécu de ce déplacement et le recours des femmes aux prestations SPN durant leur dernière grossesse ayant abouti sur une naissance vivante a été examinée par analyses de régression logistique. Résultats: Quatre-vingt-trois pour cent des femmes avaient obtenu au moins une consultation SPN durant leur dernière grossesse ayant abouti sur une naissance vivante; parmi elles, 31% en avaient obtenu au moins quatre avec un prestataire qualifé. Les femmes des ménages déplacés trois fois ou davantage étaient moins susceptibles que celles des ménages non déplacés d'avoir obtenu une consultation SPN et au moins quatre consultations avec un prestataire qualifié (RC, 0,3 et 0,4, respectivement). L'expérience antérieure de la maternité (0,3­0,4), l'âge au moment de la grossesse (2,5­3,9), l'activité professionnelle du mari (2,2 pour « autre ¼) et la prise de décision parentale conjointe concernant les consultations SPN (1,8) se sont aussi avérés associés à l'obtention d'au moins quatre consultations avec un prestataire qualifié. Conclusions: Le renforcement des services de planification familiale et l'admissibilité accrue aux prestations de maternité du gouvernement bangladais dans les zones vulnérables aux inondations et à l'érosion des rives sont recommandés pour améliorer le recours aux prestations SPN.

The effects of household's climate-related displacement on delivery and postnatal care service utilization in rural Bangladesh.

Exposure to extreme climate events causes population displacement and adversely affects the health of mothers and children in multiple ways. This paper investigates the effects of displacement on whether a child is delivered at a health center, as opposed to at home, and on postnatal care service utilization in Bangladesh. Using cross-sectional survey data from 599 mothers who gave birth in the three years prior to the date of interview, including 278 from households which had previously been displaced and 231 from households which had not been displaced, we use multivariate logistic regression to identify the factors associated with maternal healthcare service utilization. The results show that displaced households' mothers are only about a quarter as likely to deliver at a health center as mothers from non-displaced households. The use of health center-based delivery decreases as the numbers of past displacements increases. Higher number of previous children, lower use of antenatal care during pregnancy, lower household income, and lack of access to radio/television also significantly reduce a mother's likelihood of delivery at a health center. Displaced mothers are also substantially less likely to use postnatal care services for their neonates, especially those supplied by trained providers. Use of health facilities for delivery, use of antenatal care services, and previous number of children are other important predictors of postnatal care service utilization for neonates. In light of these findings, relocation of local health facilities with basic and emergency care provisions to areas in which the displaced have resettled, reinforcement of Family Planning services, and extension of coverage of the Maternity Allowance benefits in the displacement-prone mainland riverine areas are recommended policy responses.

Parents' healthcare-seeking behavior for their children among the climate-related displaced population of rural Bangladesh.

In Bangladesh climate change has contributed to a massive displacement of people. This study examines the effects of climate-related displacement, socioeconomic status, availability of healthcare providers and disease-related attributes on the healthcare-seeking behaviors of parents for their children. Using cross-sectional survey data from the parents of 1003 children aged under 15 who were ill in the four weeks prior to the interview, collected from 600 randomly-selected households in climate displacement-susceptible areas and 600 households in non-climate-displacement-susceptible areas in Bangladesh, we use multivariate logistic regression to identify the factors associated with parental healthcare-seeking behaviors. The results show that 15.5% of the children who had been ill receive either no care or curative care at home. Of those receiving care outside the home, only 22.1% are treated by trained providers. Climate-related displaced parents are significantly less likely to seek care or to use provider-prescribed care to manage children's illnesses. Areas lacking local healthcare providers, poorer households, females, child age and mild illness are also associated with a child being significantly less likely to be treated outside the home. The children of climate-related displaced parents are around half as likely as those of non-displaced parents to be treated by a trained provider. The local availability of medical doctors, cost of reaching a healthcare center, household income, type and severity of illness, child's age, and joint parental decision-making about care providers are also important predictors of the selection of trained healthcare providers for children. Thus, climate-related displacement affects the healthcare-seeking behaviors of parents for their children. Policy aimed at improving child health should address the socioeconomic disadvantage and access to healthcare of the displaced, the training of local untrained providers about Primary Health Care service provision, and the numbers of medical doctors in the displacement-prone areas.

LOCAL GOVERNMENT AND COMMUNITY LEADERS' PERSPECTIVES ON CHILD HEALTH AND MORTALITY AND INEQUITY ISSUES IN RURAL EASTERN INDONESIA.

Since 2001 a decentralization policy has increased the responsibility placed on local government for improving child health in Indonesia. This paper explores local government and community leaders' perspectives on child health in a rural district in Indonesia, using a qualitative approach. Focus group discussions were held in May 2013. The issues probed relate to health personnel skills and motivation, service availability, the influence of traditional beliefs, and health care and gender inequity. The participants identify weak leadership, inefficient health management and inadequate child health budgets as important issues. The lack of health staff in rural areas is seen as the reason for promoting the use of traditional birth attendants. Midwifery graduates and village midwives are perceived as lacking motivation to work in rural areas. Some local traditions are seen as detrimental to child health. Husbands provide little support to their wives. These results highlight the need for a harmonization and alignment of the efforts of local government agencies and local community leaders to address child health care and gender inequity issues.

A cost of living longer: Projections of the effects of prospective mortality improvement on economic support ratios for 14 advanced economies.

The economic implications of increasing life expectancy are important concerns for governments in developed countries. The aims of this study were as follows: (i) to forecast mortality for 14 developed countries from 2010 to 2050, using the Poisson Common Factor Model; (ii) to project the effects of the forecast mortality patterns on support ratios; and (iii) to calculate labour force participation increases which could offset these effects. The forecast gains in life expectancy correlate negatively with current fertility. Pre-2050 support ratios are projected to fall most in Japan and east-central and southern Europe, and least in Sweden and Australia. A post-2050 recovery is projected for most east-central and southern European countries. The increases in labour force participation needed to counterbalance the effects of mortality improvement are greatest for Japan, Poland, and the Czech Republic, and least for the USA, Canada, Netherlands, and Sweden. The policy implications are discussed.

The relationship between atmospheric lead emissions and aggressive crime: an ecological study.

BACKGROUND: Many populations have been exposed to environmental lead from paint, petrol, and mining and smelting operations. Lead is toxic to humans and there is emerging evidence linking childhood exposure with later life antisocial behaviors, including delinquency and crime. This study tested the hypothesis that childhood lead exposure in select Australian populations is related to subsequent aggressive criminal behaviors. METHODS: We conducted regression analyses at suburb, state and national levels using multiple analytic methods and data sources. At the suburb-level, we examined assault rates as a function of air lead concentrations 15-24 years earlier, reflecting the ubiquitous age-related peak in criminal activity. Mixed model analyses were conducted with and without socio-demographic covariates. The incidence of fraud was compared for discriminant validity. State and national analyses were conducted for convergent validity, utilizing deaths by assault as a function of petrol lead emissions. RESULTS: Suburb-level mixed model analyses showed air lead concentrations accounted for 29.8 % of the variance in assault rates 21 years later, after adjusting for socio-demographic covariates. State level analyses produced comparable results. Lead petrol emissions in the two most populous states accounted for 34.6 and 32.6 % of the variance in death by assault rates 18 years later. CONCLUSIONS: The strong positive relationship between childhood lead exposure and subsequent rates of aggressive crime has important implications for public health globally. Measures need to be taken to ameliorate exposure to lead and other environmental contaminants with known neurodevelopmental consequences.

INEQUITY ISSUES AND MOTHERS' PREGNANCY, DELIVERY AND EARLY-AGE SURVIVAL EXPERIENCES IN ENDE DISTRICT, INDONESIA.

Indonesia's infant mortality rates are among the highest in South-East Asia, and there are substantial variations between its sub-national regions. This qualitative study aims to explore early mortality-related health service provision and gender inequity issues based on mothers' pregnancy, delivery and early-age survival experience in Ende district, Nusa Tenggara Timur province. Thirty-two mothers aged 18-45 years with at least one birth in the previous five years were interviewed in depth in May 2013. The results show most mothers have little knowledge about the danger signs for a child's illness. Mothers with early-age deaths generally did not know the cause of death. Very few mothers had received adequate information on maternal and child health during their antenatal and postnatal visits to the health facility. Some mothers expressed a preference for using a traditional birth attendant, because of their ready availability and the more extensive range of support services they provide, compared with local midwives. Unprofessional attitudes displayed by midwives were reported by several mothers. As elsewhere in Indonesia, the power of health decision-making lies with the husband. Policies aimed at elevating mothers' roles in health care decision-making are discussed as measures that would help to improve early-age survival outcomes. Widening the public health insurance distribution, especially among poorer mothers, and equalizing the geographical distribution of midwives and health facilities are recommended to tackle geographical inequities and to increase early-age survival in Ende district.

Use of 'dual protection' and other combinations of contraceptive methods in Australia.

OBJECTIVE: To examine the demographic profiles of contraceptive users in Australia, paying particular attention to the use of condoms with other methods. METHOD: Data from a specific section on contraceptive use in the 2005 Wave 5 of the nationwide, longitudinal Household Income and Labour Dynamics in Australia (HILDA) were analysed. The section was restricted to 2,221 women aged 18-44; women were excluded if they were pregnant or subfecund, or if they or their partner had been sterilised. RESULTS: Two-thirds of respondents were using contraception, including more than 15% who indicated use of more than one method. The contraceptive pill (39%) was the most widely used method, followed by the condom (28%). Women using sex-related methods were more likely to be using more than one method. More than one-quarter of pill users (28%) were using condoms as well. The combination of pill and condom was significantly associated with age, being a student, and country of birth. Less than 3% of women reported using rhythm methods and of these two-thirds were using another method. CONCLUSIONS: Dual protection provided by the combination of the condom with the pill or other methods has become an important factor in the prevention of sexually transmitted infections and unwanted pregnancies, but continuing education on dual protection and better access to treatment is still necessary for both men and women, particularly among at-risk groups.