[Social services in the social security system of family support]. / Szociális ellátások a társadalombiztosítási családtámogatás rendszerében.

INTRODUCTION AND AIM: In my study, analysing the data available from the change of the regime to the present day, from among the social services, I examine the changes of the financial support relating to children and its parts which are currently financed from the budget of the National Health Insurance Fund of Hungary, with special emphasis on the Child Care Benefit and the Child Care Allowance and their modifications. DATA AND METHODS: Within the framework of our research, we analyze - through data from the National Health Insurance Fund of Hungary, the Hungarian Central Statistical Office, the Organisation for Economic Co-operation and Development (OECD) and the Hungarian State Treasury as well as on the basis of literature review - the social financial support and its changes, within the family policy system. RESULTS: Hungarian family policy is still driven by the attitude of staying at home for three years with the child. The long period spent at home with the children fundamentally affects the adjustment of mothers to the labour market which has a direct effect on the economic productivity. Even though according to the current regulations, mothers are allowed to work full-time besides receiving child care allowance after their child fills 6 months, part-time employment and telework is still in its infancy compared to the Western-European countries. Based on our research, high percentage of families go for the child care benefit directly after the birth of the child thus not participating in the labour market processes. Besides if they do participate, the percentage of employment on minimal wage is still very high which means that in 2016-2017 36% of families with two breadwinners and two children were forced to survive on subsistence income. CONCLUSION: In the examined period, we found that social and family policy changes unfortunately were not able to react sufficiently to the demographic challenges despite Hungary spending significantly more on family policy than other European and OECD countries. Orv Hetil. 2019; 160(Suppl 1): 43-48.

Contraceptive Coverage and the Affordable Care Act.

A major goal of the Patient Protection and Affordable Care Act is reducing healthcare spending by shifting the focus of healthcare toward preventive care. Preventive services, including all FDA-approved contraception, must be provided to patients without cost-sharing under the ACA. No-cost contraception has been shown to increase uptake of highly effective birth control methods and reduce unintended pregnancy and abortion; however, some institutions and corporations argue that providing contraceptive coverage infringes on their religious beliefs. The contraceptive coverage mandate is evolving due to legal challenges, but it has already demonstrated success in reducing costs and improving access to contraception.

Losing an only child: the one-child policy and elderly care in China.

China has had the one-child policy for more than 30 years. It reduced China's population growth within a short period of time and promoted economic development. However, it has also led to difficulties, and this paper focuses on those which pertain to ageing and losing one's only child. Approximately one million families have lost their only child in China. They suffer mentally and physically, and sometimes face social stigma and economic loss. What worries them most, however, is elderly care, which has become a severe crisis for the families who have lost their only children. This article draws upon several qualitative studies and 12 cases reported by the Chinese media in 2012 and 2013, and existing laws and policies for supporting those who have lost only children. It also analyses the current elderly care situation facing these families. The Chinese government has recognized the predicament and provides some help, which is increasing but is still not always adequate. To both sustain China's economic development and limit population growth, it is essential for the government to reform the one-child policy and provide a comprehensive support system for the families who have lost their only children, including financial relief and elderly care, and work to reduce stigma against these families.

Family planning in Guinea: a need for better public commitment.

OBJECTIVE: To describe the evolution of family planning (FP) in Guinea and to identify strengths, weaknesses, opportunities and threats of the current FP programme. METHODS: Descriptive study of the evolution of FP in Guinea between 1992 and 2010. First, national laws as well as health policies and strategic plans related to reproductive health and family planning were reviewed. Second, FP indicators were extracted from the Guinean Demographic and Health Surveys (1992, 1999 and 2005). Third, FP services, sources of supply and data on FP funding were analysed. RESULTS: Laws, policies and strategic plans in Guinea are supportive of FP programme and services. Public and private actors are not sufficiently coordinated. The general government expenditure on health has remained stable at 6-7% between 2005 and 2011 despite a doubling of total expenditures on health, and contraceptives are supplied by foreign aid. Modern contraceptive prevalence slightly increased from 1.5% in 1992 to 6.8% in 2005 among women aged 15-49. CONCLUSION: A stronger national engagement in favour of repositioning FP should result in improved government funding of the FP programme and the promotion of long-acting and permanent methods.

National and sub-national analysis of the health benefits and cost-effectiveness of strategies to reduce maternal mortality in Afghanistan.

BACKGROUND: Afghanistan has one of the highest rates of maternal mortality in the world. We assess the health outcomes and cost-effectiveness of strategies to improve the safety of pregnancy and childbirth in Afghanistan. METHODS: Using national and sub-national data, we adapted a previously validated model that simulates the natural history of pregnancy and pregnancy-related complications. We incorporated data on antenatal care, family planning, skilled birth attendance and information about access to transport, referral facilities and quality of care. We evaluated single interventions (e.g. family planning) and strategies that combined several interventions packaged as integrated services (transport, intrapartum care). Outcomes included pregnancy-related complications, maternal deaths, maternal mortality ratios, costs and cost-effectiveness ratios. FINDINGS: Model-projected reduction in maternal deaths between 1999-2002 and 2007-08 approximated 20%. Increasing family planning was the most effective individual intervention to further reduce maternal mortality; up to 1 in 3 pregnancy-related deaths could be prevented if contraception use approached 60%. Nevertheless, reductions in maternal mortality reached a threshold (∼30% to 40%) without strategies that assured women access to emergency obstetrical care. A stepwise approach that coupled improved family planning with incremental improvements in skilled attendance, transport, referral and appropriate intrapartum care and high-quality facilities prevented 3 of 4 maternal deaths. Such an approach would cost less than US$200 per year of life saved at the national level, well below Afghanistan's per capita gross domestic product (GDP), a common benchmark for cost-effectiveness. Similar results were noted sub-nationally. INTERPRETATION: Our findings reinforce the importance of early intensive efforts to increase family planning for spacing and limiting births and to provide control of fertility choices. While significant improvements in health delivery infrastructure will be required to meet Millennium Development Goal 5, a paced systematic effort that invests in scaling up capacity for integrated maternal health services as the total fertility rate declines appears feasible and cost-effective.

Foucault, fields of governability, and the population­family­economy nexus in China.

It was only in the early twentieth century that China discovered that it had a population, at least if a population is understood not as a simple number of people but instead in terms of such features as variable levels of health, birth and death rates, age, sex, dependency ratios, and so on­as an object with a distinct rationality and intrinsic dynamics that can be made the target of a specific kind of direct intervention. In 1900, such a developmentalist conception of the population simply did not exist in China; by the 1930s, it pervaded the entire social and political field from top to bottom. Through a reading of a series of foundational texts in population and family reformism in China, this paper argues that this birth of the Chinese population occurred as a result of a general transformation of practices of governing, one that necessarily also involved a reconceptualization of the family and a new logic of overall social rationalization; in short, the isolation of a population­family­economy nexus as a central field of modern governing. This process is captured by elaborating and extending Foucault's studies of the historical emergence of apparatuses (dispositifs) into a notion of fields of governability. Finally, this paper argues that the one-child policy, launched in the late 1970s, should be understood not in isolation from the imposition of the "family-responsibility system" in agriculture and market reforms in exactly that period, but as part­mutatis mutandis­of a return to a form of governing that was developed in the first half of the twentieth century.

Policy experiment in Russia: cash-for-babies and fertility change.

Population decline in modern day Russia is alarmingly steep: Russia loses approximately 750 thousand people each year. To combat population decline, the Russian government instituted aggressive pro-natalist policies. The paper evaluates the capacity of new policies to change women's reproductive behavior using a socio-institutionalist theoretical framework, which analyzes the gendered interaction between the states, the labor market, and family. The paper arrives to a disappointing conclusion that while efforts to improve fertility are quite aggressive, new policies do not challenge gendered hierarchies neither in public nor in private spheres, which will further depress fertility rates of Russian women.

Women, microcredit and family planning practices: a case study from rural Ghana.

This paper examines the influence of informal banking club participation on family planning practices in rural Ghana. Research from Asia suggests that family planning practices are improved by club participation. This study examines this thesis in an African context, using rural Ghana as a case study. A sample of 204 women (19 years and older) was drawn from Abokobi village, Ghana. Multivariate analyses of direct, mediating and moderating effects of women's demographic background characteristics, membership status and length, and women's empowerment status as predictors of family planning practices are assessed. Findings suggest that club membership and membership length is not associated with family planning practices; however, age, education level, number of children and empowerment status are.

Yearning, learning, and conceding: reasons men and women change their childbearing intentions.

People's childbearing intentions change over the course of their reproductive lives. These changes have been conceptualized as occurring in response to the realization that an individual is unlikely to achieve his or her intended fertility, because of constraints such as the "biological clock" or lack of a partner. In this article, we find that changes to child-bearing plans are influenced by a much wider range of factors than this. People change their plans in response to the wishes of their partners, in response to social norms, as the result of repartnering, and as the result of learning about the costs and benefits of parenthood; there are also differences between the factors that influence men's and women's decision-making. In a departure from existing studies in this area, we use a flexible analytical framework that enables us to analyze increases in planned fertility separately from decreases. This allows us to uncover several complexities of the decision-making process that would otherwise be hidden, and leads us to conclude that the determinants of increases in planned fertility are not simply equal and opposite to the determinants of decreases.

Family policies in OECD countries: a comparative analysis.

This article discusses the diversity of family policy models in 28 OECD countries in terms of the balance between their different objectives and the mix of instruments adopted to implement the policies. Cross-country policy differences are investigated by applying a principal component analysis to comprehensive country-level data from the OECD Family database covering variables such as parental leave conditions, childcare service provision, and financial support to families. The results find persistent differences in the family policy patterns embedded in different contexts of work-family "outcomes." Country classifications of family policy packages only partially corroborate categorizations in earlier studies, owing to considerable within-group heterogeneity and the presence of group outliers. The Nordic countries outdistance the others with comprehensive support to working parents with very young children. Anglo-Saxon countries provide much less support for working parents with very young children, and financial support is targeted on low-income and large families and focuses on preschool and early elementary education. Continental and Eastern European countries form a more heterogeneous group, while the support received by families in Southern Europe and in Asian countries is much lower in all its dimensions.

Estimating a dynamic model of sex selection in China.

High ratios of males to females in China, which have historically concerned researchers (Sen 1990), have increased in the wake of China's one-child policy, which began in 1979. Chinese policymakers are currently attempting to correct the imbalance in the sex ratio through initiatives that provide financial compensation to parents with daughters. Other scholars have advocated a relaxation of the one-child policy to allow more parents to have a son without engaging in sex selection. In this article, I present a model of fertility choice when parents have access to a sex-selection technology and face a mandated fertility limit. By exploiting variation in fines levied in China for unsanctioned births, I estimate the relative price of a son and daughter for mothers observed in China's census data (1982-2000). I find that a couple's first son is worth 1.42 years of income more than a first daughter, and the premium is highest among less-educated mothers and families engaged in agriculture. Simulations indicate that a subsidy of 1 year of income to families without a son would reduce the number of "missing girls" by 67% but impose an annual cost of 1.8% of Chinese gross domestic product (GDP). Alternatively, a three-child policy would reduce the number of "missing girls" by 56% but increase the fertility rate by 35%.

The unique role of U.S. foundations in international family planning and reproductive health.

This article reviews the unique historic and contemporary role of U.S. philanthropies in supporting international family planning and reproductive health (FPRH) programs, including how priorities are set, strategies developed, and activities funded. We then discuss the FPRH situation in sub-Saharan Africa today, where needs are the most urgent and where, increasingly, foundations are focusing their resources. We describe one case study exhibiting good philanthropic practice and conclude with thoughts about what the future holds for foundations in international FPRH. We find that as leaders in the field of FPRH, foundations have the ability to stay committed to their goals of championing the reproductive health and rights of individuals under dynamic circumstances. Although every policy environment offers opportunities and constraints, foundations, with their grantee partners, have a range of tools to foster and guide social change. As circumstances change, foundations have to be willing and able both to reassess where they provide added value and to take risks through innovative strategies.

China's below-replacement fertility: government policy or socioeconomic development?

The article challenges the notion that below-replacement fertility and its local variation in China are primarily attributable to the government's birth planning policy. Data from the 2000 census and provincial statistical yearbooks are used to compare fertility in Jiangsu and Zhejiang, two of the most developed provinces in China, to examine the relationship between socioeconomic development and low fertility. The article demonstrates that although low fertility in China was achieved under the government's restrictive one-child policy, structural changes brought about by socioeconomic development and ideational shifts accompanying the new wave of globalization played a key role in China's fertility reduction.

Health as a context for social and gender activism: female volunteer health workers in Iran.

Having reversed its pronatalist policies in 1988, the Islamic Republic of Iran implemented one of the most successful family planning programs in the developing world. This achievement, particularly in urban centers, is largely attributable to a large women-led volunteer health worker program for low-income urban neighborhoods. Research in three cities demonstrates that this successful program has had a host of unintended consequences. In a context where citizen mobilization and activism are highly restricted, volunteers have seized this new state-sanctioned space and successfully negotiated many of the familial, cultural, and state restrictions on women. They have expanded their mandate from one focused on health activism into one of social, if not political, activism, highlighting the ways in which citizens blur the boundaries of state and civil society under restrictive political systems prevalent in many of the Middle Eastern societies.

Son preference and household income in rural China.

Why is it that couples who have a son or whose last child is a son earn higher conditional income? To solve this curious case we tell a detective story: evidence of a phenomenon to be explained, a parade of suspects, a process of elimination from the enquiry, and then the denouement. Given the draconian family planning policy and a common perception that there is strong son preference in rural China, we postulate two main hypotheses: income-based sex selection making it more likely that richer households have sons, and an incentive for households with sons to raise their income. Tests of each hypothesis are conducted. Taken as a whole, the tests cannot reject either hypothesis but they tend to favour the incentive hypothesis; and there is evidence in support of the channels through which the incentive effect might operate. To our knowledge, this is the first study to test these hypotheses against each other in rural China and more generally in developing countries.

Negligence in sterilisation: the changing legal regime.

Negligence in a sterilisation operation is a crucial issue in a country like India where sterilisation operations form an important part of government programmes. This article seeks to highlight the medico-legal dilemmas that surround this issue, and the legal pronouncements on it. The article also deals with a recent policy initiative--the Family Planning Insurance Scheme--that has been formulated in this regard, its legal implications, and its impact on the medical fraternity as well as on society as a whole.