Two-way associations between relationship quality and uptake of couples health screening including HIV testing and counselling together: quantitative analysis of a couples cohort in rural South Africa.

In the context of a couples cohort established to evaluate an optimised couples-focused behavioural intervention in rural South Africa, we examined: (1) Is couples' relationship quality (RQ) associated with couples HIV testing and counselling (CHTC) uptake? (2) Does CHTC uptake or the intervention components uptake improve subsequent RQ? Enrolled couples, (n = 218), previously naïve to couples HIV testing, were invited to two group sessions and offered four couples counselling sessions (CS1-CS4), as part of the intervention and administered a questionnaire individually at baseline, four weeks, and four months, which included item-scales to measure RQ: satisfaction, intimacy, dyadic trust, conflict, and mutual constructive communication. Logistic models indicated that no baseline RQ measures were significantly associated with CHTC uptake. Linear regression models showed that CHTC uptake before four weeks assessment significantly improved couples' satisfaction and trust at four weeks, and intimacy at four months. Attending at least one CS was associated with increased satisfaction, intimacy, and decreased conflict within couples at four weeks; the improvement in intimacy was sustained at four months. Consistent with the theoretical interdependence model, our findings suggest that CHTC and CS seemed to strengthen aspects of relationship quality, possibly leading to further collaboration in managing lifestyle changes and treatment adherence.

A test of the instability hypothesis in low- and middle-income countries.

The instability hypothesis proposes that family structure transitions lead to negative child outcomes through the pathway of stress. However, in many cases, family structure transitions are not associated with stress or negative child outcomes, suggesting that there are specific circumstances under which transitions are more or less stressful. Using five rounds of data (ages 1-15) from the Young Lives study (N = 8,062) which follows children and their caregivers in Ethiopia, India, Peru, and Vietnam, we had two aims: (a) to test the instability hypothesis, and (b) to examine the specific circumstances under which family structure transitions lead to stress and worsened child physical health. First, we used multilevel mediation to assess whether financial stress mediated the link between family structure transitions and children's physical health. We then added household size, multigenerational household, and horizontally extended kin household as moderators to the family structure transition-financial stress relationship. We found that financial stress did not mediate the link between family structure transitions and children's physical health in any of the Young Lives countries. We found some moderated mediation effects for household size and multigenerational households in Peru and Vietnam, but effect sizes were small. These findings highlight the need to further unpack the instability hypothesis to understand the specific circumstances under which family structure transitions lead to stress and worsened child outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family Structure Transitions: Prevalence and Physical Health Effects in Ethiopia, India, Peru, and Vietnam.

This study aimed to identify the prevalence and physical health consequences of family structure transitions among children in Ethiopia, India, Peru, and Vietnam. In many high-income countries, family structure transitions are common, and research suggests that they can lead to worse physical health for children. However, we know little about either the prevalence or consequences of family structure transitions for children in low-and middle-income countries, who make up the vast majority of the world's children. First, we estimated the number of family structure transitions by age 12 using four rounds of Young Lives data from four low-and middle-income countries (N = 8062, Ethiopia, India, Peru, and Vietnam) and validated our prevalence estimates with another dataset from these same countries. The proportion of children experiencing a family structure transition by age 12 was: 14.8% in Ethiopia, 5.6% in India, 22.0% in Peru, and 7.7% in Vietnam. We put these estimates in context by comparing them to 17 high- and upper-middle-income countries. Second, using linear mixed models, we found that family structure transitions were not directly associated with worse physical health for children in Ethiopia, India, Peru, and Vietnam. Children in Peru experienced higher rates of family structure transitions relative to children in the other Young Lives countries, and similar rates to many of the 17 comparison countries, yet physical health was unaffected. It is possible that in low-and middle-income countries, the environment may overwhelm family stability as a determinant of physical health.

Are Children Barriers to the Gender Revolution? International Comparisons.

Children seem to present a barrier to the gender revolution in that parents are more likely to divide paid and domestic work along traditional gender lines than childless couples are. However, the extent to which this is so varies between countries and over time. We used data on 35 countries from the 2012 International Social Survey Programme to identify the contexts in which parents and non-parents differ the most in their division of labour. In Central/South America, Eastern Europe, Southern Europe, Asia, and South Africa, labour sharing configurations did not vary as much with the presence of children as in Australia, Western Europe, North America, and Northern Europe. Our multilevel models helped explain this pattern by showing that children seem to present a greater barrier to the gender revolution in richer and, surprisingly, more gender equal countries. However, the relationship between children and couples' division of labour can be thought of as curvilinear, first increasing as societies progress, but then weakening if societies respond with policies that promote men's involvement at home. In particular, having a portion of parental leave reserved for fathers reduces the extent to which children are associated with traditional labour sharing in the domestic sphere.

Maternal union instability and childhood mortality risk in the Global South, 2010-14.

Efforts to improve child survival in lower-income countries typically focus on fundamental factors such as economic resources and infrastructure provision, even though research from post-industrial countries confirms that family instability has important health consequences. We tested the association between maternal union instability and children's mortality risk in Africa, Latin America and the Caribbean, and Asia using children's actual experience of mortality (discrete-time probit hazard models) as well as their experience of untreated morbidity (probit regression). Children of divorced/separated mothers experience compromised survival chances, but children of mothers who have never been in a union generally do not. Among children of partnered women, those whose mothers have experienced prior union transitions have a higher mortality risk. Targeting children of mothers who have experienced union instability-regardless of current union status-may augment ongoing efforts to reduce childhood mortality, especially in Africa and Latin America where union transitions are common.

Young women's perceived ability to refuse sex in urban Cameroon.

In many sub-Saharan African countries, young women face decreasing educational opportunities, age asymmetries between sexual partners, and high prevalence of HIV infection. This study draws upon data from the 2002 Cameroon Adolescent Reproductive Health Survey to analyze the determinants of young women's perceived ability to refuse sex in urban Cameroon. Our findings are consistent with predictions of social exchange theory: young women's status characteristics predict their vulnerability differently under different circumstances, and, overall, young women report having a lower ability to refuse sex in their relationships with men who offer to pay their school fees than in their relationships with men in positions of power over them. The costs and benefits of sexual exchanges made in order to continue one's education increase simultaneously in a context of declining enrollments and spreading HIV infection. When educational aspirations exceed opportunities, policy supporting access to education could reduce young women's need to employ their sexual resources in order to invest in their future.

Educational reversals and first-birth timing in sub-Saharan Africa: a dynamic multilevel approach.

In many areas throughout sub-Saharan Africa, young adult cohorts are less educated than their predecessors because of declines in school enrollments during the 1980s and 1990s. Because a woman with little education typically becomes a mother earlier and has more children than one with better education, and because of a similar well-established relationship between current education and current fertility at the societal level, one might expect such education reversals to raise fertility. However, if there is an additional negative effect of low educational level among currently young women compared with that in the past, which would accord with ideas about the impact of relative deprivation, the total effect of an education reversal may run in either direction. This possibility has not been explored in earlier studies, which have taken a more static approach. We focus on the initiation of childbearing. Using Demographic and Health Survey data from 16 sub-Saharan African countries with multiple surveys, we estimate a fixed-effects multilevel model for first births that includes the woman's own education, community education, and community education relative to the past. There are negative effects of individual and community education, but no effect of relative education. Thus we conclude that education reversals do seem to speed up entry into parenthood.

Men's influence on the onset and progress of fertility decline in Ghana, 1988-98.

While lower fertility is commonly associated with women's reproductive autonomy, we demonstrate that the influence of men's education on reproductive decision-making increased during the first decade of rapid fertility decline in Ghana. Husband's education exerts a stronger influence on wife's fertility intentions than does her own education, and the magnitude of the effect of his education increased significantly from 1988 to 1998. Lower fertility in Ghana seems to be associated more with men's declining fertility desires than with women's increasing reproductive autonomy. Nevertheless, there is some indication that women's education may play a relatively greater role in reproductive decision-making as fertility decline progresses still further.

Does discussion of family planning improve knowledge of partner's attitude toward contraceptives?

CONTEXT: Results from an analysis of 1998 Demographic and Health Survey (DHS) data from Kenya, where the approval rate of family planning is 90%, have cast doubt on the assumption that spousal discussion improves knowledge of partner's attitude toward family planning. However, it is not known whether this finding also applies to contexts more typical of Sub-Saharan Africa, where approval is not as high. METHODS: DHS data from 21 Sub-Saharan African countries were used to assess the relationship between spousal discussion and correct reporting of partner's attitude toward family planning. Multivariate analyses of data from Chad were conducted to further examine this relationship in a setting where contraceptive approval was not high. RESULTS: In every country, the proportion of women correctly reporting their spouse's disapproval of contraception was smaller among those who had discussed family planning with their husband than among those who had never done so. However, in an analysis of Chad data that included women who did not know their husband's attitude toward contraception, proportions of women correctly citing their husband's attitude were larger if discussion had occurred than if it had not, regardless of the husband's actual approval status. In multivariate analyses of Chad data that controlled for women's demographic characteristics, discussion was positively associated with correct reporting of husband's approval, but negatively associated with correct reporting of his disapproval. CONCLUSIONS: Partner discussion does not necessarily mean an increase in knowledge of a partner's contraceptive attitudes. Therefore, anticipated reductions in unmet need for contraception through improvements in spousal discussion may be overstated.

Continuity of women's work, breastfeeding, and fertility in Ghana in the 1980s.

Much of the inconsistency that has appeared in studies of the effect of women's work on fertility in less developed countries has been attributed to the varying accessibility of employment in the modern sector. The analysis presented in this paper shows that continuity of work matters more than sector of work. It also confirms that, even in a setting of low contraceptive prevalence, increased fecundity associated with the less intense breastfeeding practices of working women do not result in shorter birth intervals. The influence of women's work on fertility control is likely to be underestimated if the effects of sporadic versus continuous work are conflated, or if fecundity differentials by work status are unmeasured.