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1.
PLoS Med ; 18(9): e1003781, 2021 09.
Article in English | MEDLINE | ID: mdl-34529666

ABSTRACT

BACKGROUND: Approximately 40% of children 3 to 4 years of age in low- and middle-income countries have suboptimal development and growth. Women's empowerment may help provide inputs of nurturing care for early development and growth by building caregiver capacity and family support. We examined the associations between women's empowerment and child development, growth, early learning, and nutrition in sub-Saharan Africa (SSA). METHODS AND FINDINGS: We pooled data on married women (15 to 49 years) and their children (36 to 59 months) from Demographic and Health Surveys that collected data on child development (2011 to 2018) in 9 SSA countries (N = 21,434): Benin, Burundi, Cameroon, Chad, Congo, Rwanda, Senegal, Togo, and Uganda. We constructed a women's empowerment score using factor analysis and assigned women to country-specific quintile categories. The child outcomes included cognitive, socioemotional, literacy-numeracy, and physical development (Early Childhood Development Index), linear growth (height-for-age Z-score (HAZ) and stunting (HAZ <-2). Early learning outcomes were number of parental stimulation activities (range 0 to 6) and learning resources (range 0 to 4). The nutrition outcome was child dietary diversity score (DDS, range 0 to 7). We assessed the relationship between women's empowerment and child development, growth, early learning, and nutrition using multivariate generalized linear models. On average, households in our sample were large (8.5 ± 5.7 members) and primarily living in rural areas (71%). Women were 31 ± 6.6 years on average, 54% had no education, and 31% had completed primary education. Children were 47 ± 7 months old and 49% were female. About 23% of children had suboptimal cognitive development, 31% had suboptimal socioemotional development, and 90% had suboptimal literacy-numeracy development. Only 9% of children had suboptimal physical development, but 35% were stunted. Approximately 14% of mothers and 3% of fathers provided ≥4 stimulation activities. Relative to the lowest quintile category, children of women in the highest empowerment quintile category were less likely to have suboptimal cognitive development (relative risk (RR) 0.89; 95% confidence interval (CI) 0.80, 0.99), had higher HAZ (mean difference (MD) 0.09; 95% CI 0.02, 0.16), lower risk of stunting (RR 0.93; 95% CI 0.87, 1.00), higher DDS (MD 0.17; 95% CI 0.06, 0.29), had 0.07 (95% CI 0.01, 0.13) additional learning resources, and received 0.16 (95% CI 0.06, 0.25) additional stimulation activities from their mothers and 0.23 (95% CI 0.17 to 0.29) additional activities from their fathers. We found no evidence that women's empowerment was associated with socioemotional, literacy-numeracy, or physical development. Study limitations include the possibility of reverse causality and suboptimal assessments of the outcomes and exposure. CONCLUSIONS: Women's empowerment was positively associated with early child cognitive development, child growth, early learning, and nutrition outcomes in SSA. Efforts to improve child development and growth should consider women's empowerment as a potential strategy.


Subject(s)
Child Development , Child Health , Empowerment , Gender Role , Maternal Behavior , Mothers/psychology , Adolescent , Adult , Africa South of the Sahara , Age Factors , Child Behavior , Child Nutritional Physiological Phenomena , Child, Preschool , Cognition , Cross-Sectional Studies , Female , Humans , Learning , Male , Middle Aged , Nutritional Status , Socioeconomic Factors , Spouses/psychology , Young Adult
2.
J Biosoc Sci ; 52(1): 14-26, 2020 01.
Article in English | MEDLINE | ID: mdl-31140390

ABSTRACT

Unintended pregnancy and sexually transmitted infections (STIs) pose a huge public health problem in the United States. Efforts towards reducing unintended pregnancies have previously focused on women, but the role of men in family planning and preventing unwanted pregnancy is becoming clearer. The primary objective of the study was to fully examine the utilization of family planning services by men in the US, and to determine whether factors such as race, health insurance type and number of sexual partners influenced their utilization and receipt of family planning services and STI-related health services. Data were from the 2006-2010 National Survey on Family Growth (NSFG) study conducted in the US. The study sample comprised 7686 men aged 14-44 who ever had sex with women, and who had had at least one sexual partner in the 12 months before the survey. The receipt of family planning and STI-related health services by this group of men was estimated. The results showed that non-Hispanic Black men were more likely to receive family planning and STI-related services than Hispanic and non-Hispanic White males. Given that non-Hispanic Black men are disproportionately affected by STIs and are a high-risk group, the finding that this group received more family planning and STI services is a positive step towards reducing the disproportionately high prevalence of STIs in men in this under-privileged population.


Subject(s)
Black or African American/statistics & numerical data , Family Planning Services , Hispanic or Latino/statistics & numerical data , Patient Acceptance of Health Care/ethnology , Sexual Partners , Sexually Transmitted Diseases/ethnology , White People/statistics & numerical data , Adolescent , Adult , Humans , Male , Prevalence , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & control , Surveys and Questionnaires , United States/epidemiology , United States/ethnology , Young Adult
3.
J Biosoc Sci ; 51(4): 534-548, 2019 07.
Article in English | MEDLINE | ID: mdl-30501648

ABSTRACT

Acute respiratory infection (ARI) is a major cause of mortality among children under the age of five in developing countries. This paper examines Demographic and Health Survey (DHS) data on maternal recall of episodes of ARI in the contrasting settings of Bangladesh and Nigeria, where about 11.1% and 3.3% of under-5 children, respectively, are reported to have symptoms of ARI. The surveys found that about 25.6% of married Bangladeshi women and 15.4% of married Nigerian women reported experiencing spousal violence in the past year. To test the proposition that women's experience of intimate partner violence (IPV) is associated with adversity in their children, the study examined the relationship between spousal violence in the past year and childhood ARI in the past 2 weeks among children under the age of five in Bangladesh and Nigeria. Data were taken from a nationally representative sample of mothers aged 15-49 years obtained from the 2007 Bangladesh DHS and 2008 Nigeria DHS. Random-effects multiple logistic regression models were estimated to assess the association of maternal exposure to IPV with the incidence of ARI in the past 2 weeks among under-5 children after controlling for the potentially confounding effects of maternal social and demographic characteristics. Results from Nigeria suggest that the odds of ARI incidence among children of mothers who were IPV victims were almost two times higher than among their counterparts whose mothers had not experienced IPV (OR = 1.78; 95% CI: 1.45-2.19; p <0.001). Similarly, the odds for the children of Bangladeshi IPV victims were elevated one and half times (OR = 1.61; 95% CI: 1.21-2.14; p <0.001). The findings suggest that under-5 children suffer indirect health consequences of gender-based violence.


Subject(s)
Intimate Partner Violence/statistics & numerical data , Respiratory Tract Infections/epidemiology , Adolescent , Adult , Bangladesh/epidemiology , Child, Preschool , Correlation of Data , Female , Health Surveys , Humans , Infant , Male , Middle Aged , Models, Statistical , Nigeria/epidemiology , Risk Factors , Young Adult
4.
Health Secur ; 16(S1): S18-S24, 2018.
Article in English | MEDLINE | ID: mdl-30480497

ABSTRACT

The Staged Development Tool (SDT) was created to help national public health institutes (NPHIs) assess their current capacity and develop roadmaps for achieving a higher level of functioning. This article discusses the current use of the SDT by national public health institutes to establish baseline capacity and inform strategic planning and its proposed use in a 3-step sequence for measuring the impact of capacity-building interventions over time. The article also includes descriptions of how national public health institutes have been using the SDT to assess their baseline capacity in management issues and core public health functions. The first use of the SDT by a national public health institute provides essential baseline information on their capacities and levels of functioning and plans for addressing gaps. By repeating the SDT after time for the plans to be implemented, the SDT can be used to evaluate changes in capacity and the effectiveness of the interventions made. Because the SDT is built to be complementary to existing assessments and public health strengthening tools and guidelines, implementing the SDT provides concrete, complementary information that can help countries achieve global health security goals and address current and future threats to public health.


Subject(s)
Academies and Institutes , Capacity Building , Planning Techniques , Public Health Administration , Strategic Planning , Capacity Building/standards , Global Health , Humans , International Agencies/organization & administration , Security Measures , Strategic Planning/standards
5.
Womens Health Issues ; 27(5): 551-558, 2017.
Article in English | MEDLINE | ID: mdl-28420558

ABSTRACT

BACKGROUND: Obstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured. OBJECTIVE: The objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending during the prenatal period among a national sample of 95,663 commercially-insured women at low risk for cesarean delivery. METHODS: We conducted secondary analyses of 2010-2011 inpatient, outpatient, and professional claims for health care services from the Health Care Cost Institute. Allowed charges were summed for the prenatal and childbirth periods. Ordinary least squares regressions tested associations between maternal health conditions and health care expenditures during pregnancy. RESULTS: Thirty-four percent of pregnant women had one or more comorbidities; 8% had two or more. Pregnant women with one or more comorbidities had significantly higher allowed charges than those without comorbidities (p < .001). Spending during the prenatal period was nearly three times higher for women with preexisting diabetes compared with women with no comorbid conditions. Average levels of prenatal period spending associated with maternal comorbidities were similar for women who had vaginal and cesarean deliveries. Patient characteristics accounted for 30% of the variance in prenatal period expenditures. CONCLUSIONS: The impact of maternal comorbidities, and in particular preexisting diabetes, on prenatal care expenditures should be taken into account as provider payment reforms, such as pay-for performance incentives and bundled payments for episodes of care, extend to maternal and child health-related services.


Subject(s)
Cesarean Section/economics , Delivery, Obstetric/economics , Health Care Costs , Prenatal Care/economics , Adolescent , Adult , Comorbidity , Delivery, Obstetric/methods , Diabetes Mellitus/epidemiology , Female , Humans , Parturition , Pregnancy , Pregnancy Complications , Pregnancy Outcome
8.
Am J Public Health ; 106(8): 1457-9, 2016 08.
Article in English | MEDLINE | ID: mdl-27310354

ABSTRACT

OBJECTIVES: To provide lifetime estimates of intimate partner victimization among pregnant adolescents and examine associations between victimization and health risk behaviors identified by the Centers for Disease Control and Prevention as leading causes of adolescent morbidity and mortality. METHODS: Participants (n = 1233) were predominantly Latina (58%) and non-Latina Black (34%) pregnant adolescents (aged 14-21 years) enrolled in a randomized controlled trial of group prenatal care in 14 clinical sites in New York City (2008-2012). They completed surveys to assess interpersonal victimization and risk behaviors: substance use, risky sexual behaviors, injuries or violence, unhealthy dietary behavior, and inadequate physical activity. RESULTS: Fifty-two percent reported intimate partner victimization, which was associated with nearly all health risk behaviors. CONCLUSIONS: Pregnant adolescents who experienced intimate partner victimization were significantly more likely to engage in health risk behaviors, which can have adverse health consequences. Expanded prevention programs tailored to specific needs of pregnant adolescents are needed. Health care providers and others who work with pregnant adolescents should consistently screen for and intervene in intimate partner victimization.


Subject(s)
Health Behavior , Pregnant Women , Spouse Abuse/ethnology , Adolescent , Black or African American/statistics & numerical data , Crime Victims/statistics & numerical data , Diet/ethnology , Exercise , Female , Hispanic or Latino/statistics & numerical data , Humans , New York City/epidemiology , Pregnancy , Risk Factors , Risk-Taking , Sexual Behavior/ethnology , Socioeconomic Factors , Substance-Related Disorders/ethnology , Young Adult
9.
Matern Child Health J ; 20(7): 1424-31, 2016 07.
Article in English | MEDLINE | ID: mdl-26992715

ABSTRACT

Objectives This longitudinal study examined the influence of Intimate Partner Violence (IPV) experience of pregnant women participating in the Domestic Violence Enhanced Home Visitation Program on the language and neurological development of infants and toddlers. Methods A total of 210 infants and toddlers born to women reporting low, moderate, and high levels of IPV were included in the analysis. Logistic regression analysis was used to determine the bivariate association between maternal IPV and risk of language and neurological delay of infants and toddlers and between covariates and language and neurological delay. Generalized estimating equation models with logit link was used to predict the risk of language and neurological delay of infants and toddlers as a result of maternal IPV. Results Infants and toddlers born to women exposed to moderate levels of IPV had increased odds of language delay compared to infants and toddlers of women who experienced low levels of violence (OR 5.31, 95 % CI 2.94, 9.50, p < 0.001). Infants and toddlers born to women who experienced moderate and high levels of IPV were at higher risk of neurological delay respectively, compared to infants and toddlers of women who experienced low levels of IPV (OR 5.42, 95 % CI 2.99, 9.82, p < 0.001 and OR 2.57, 95 % CI 1.11, 5.61, p = 0.026). Conclusions for Practice Maternal IPV is associated with increased risk of language and neurological delay of infants and toddlers. These findings have implications for health care for women and infants exposed to IPV. Clinicians including pediatricians working with pregnant women should screen for IPV throughout pregnancy to identify women and children at risk. Interventions to reduce maternal IPV and early intervention services for infants and toddlers exposed to IPV are necessary for optimal maternal and child health.


Subject(s)
Child Development , Child of Impaired Parents/psychology , Depression/epidemiology , Intimate Partner Violence/psychology , Language Development , Mothers/psychology , Pregnant Women/psychology , Adolescent , Child, Preschool , Depression/psychology , Ethnicity/statistics & numerical data , Female , Humans , Infant , Intimate Partner Violence/statistics & numerical data , Maternal Age , Multivariate Analysis , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/psychology , Regression Analysis , Rural Population , Stress, Psychological/complications , Stress, Psychological/epidemiology , United States/epidemiology , Urban Population , Young Adult
10.
Afr J Reprod Health ; 20(3): 108-117, 2016 Sep.
Article in English | MEDLINE | ID: mdl-29553200

ABSTRACT

Sub-Saharan Africa (SSA) has the highest maternal and under-5 mortality rates as well as low facility births, with a high percentage of births occurring in the absence of skilled personnel. We examine trends in health facility births in SSA by geographic areas (urban-rural) and regions; and also the correlation between health facility birth and neonatal mortality rate (NMR). Data come from Demographic and Health Surveys (27 countries), conducted between 1990 and 2014. Median health facility births, urban-rural gaps, and regional variations in health facility births between initial (1990) and latest (2014) surveys were calculated. The median health facility birth increased from 44% at initial survey to 57% at the latest survey. Rural areas had a higher percentage increase in health facility births between initial and latest surveys (16%) than urban areas (6%) with a 2% overall gap reduction between initial and latest surveys. Health facility births were inversely associated with NMR at initial (R2=0.20, p=0.019) and latest (R2=0.26, p=0.007) surveys. To achieve the Sustainable Development Goal target of reducing neonatal mortality, policies should particularly focus on bringing rural areas on par with urban areas.

11.
Pediatrics ; 132 Suppl 2: S134-9, 2013 Nov.
Article in English | MEDLINE | ID: mdl-24187115

ABSTRACT

OBJECTIVES: Intimate partner violence (IPV) during pregnancy affects 0.9% to 17% of women and affects maternal health significantly. The impact of IPV extends to the health of children, including an increased risk of complications during pregnancy and the neonatal period, mental health problems, and cognitive delays. Despite substantial sequelae, there is limited research substantiating best practices for engaging and retaining high-risk families in perinatal home visiting (HV) programs, which have been shown to improve infant development and reduce maltreatment. METHODS: The Domestic Violence Enhanced Home Visitation Program (DOVE) is a multistate longitudinal study testing the effectiveness of a structured IPV intervention integrated into health department perinatal HV programs. The DOVE intervention, based on an empowerment model, combined 2 evidence-based interventions: a 10-minute brochure-based IPV intervention and nurse home visitation. RESULTS: Across all sites, 689 referrals were received from participating health departments. A total of 339 abused pregnant women were eligible for randomization; 42 women refused, and 239 women were randomly assigned (124 DOVE; 115 usual care), resulting in a 71% recruitment rate. Retention rates from baseline included 93% at delivery, 80% at 3 months, 76% at 6 months, and 72% at 12 months. CONCLUSIONS: Challenges for HV programs include identifying and retaining abused pregnant women in their programs. DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs' federal government mandates for the appropriate identification and intervention of women and children exposed to IPV.


Subject(s)
Battered Women/psychology , Home Care Services , House Calls , Perinatal Care/methods , Pregnant Women/psychology , Spouse Abuse/psychology , Adult , Female , Follow-Up Studies , Humans , Longitudinal Studies , Patient Compliance/psychology , Pregnancy , Spouse Abuse/therapy , Young Adult
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