The influence of neighborhood violent crime on child-rearing: Integrating neighborhood ecologies and stratified reproduction approaches.

While relationships between neighborhood violent crime and adverse child outcomes are well-established, less is known about how neighborhood violent crime influences child-rearing strategies. To address this gap, we blend neighborhood ecologies and stratified reproduction frameworks and examine interview data collected in 2014-2015 from 107 adult caregivers residing in three low and three elevated violent crime neighborhoods in Cleveland, Ohio. Our objective is to examine how perceptions of neighborhood violent crime and its relationship to self-reported child-rearing practices vary by level of neighborhood violence. We find that, although caregivers in low and elevated violent crime neighborhoods shared the perception of neighborhood violent crime as a concern, their narratives of child-rearing practices differed. Caregivers in elevated violent crime neighborhoods were more likely than their low violent crime counterparts to describe in experience-near terms how violent crime threatened their children's well-being. To protect children, caregivers in elevated violent crime neighborhoods reported engaging in severely constrained child-rearing strategies. These constraints have unintended consequences. While they may protect children in the short-term, they may also reproduce inequities by reducing family quality of life in other ways. These findings advance understanding of how neighborhood violent crime differentially affects child-rearing. We integrate neighborhood ecologies and stratified reproduction frameworks to capture how social inequities interact in neighborhood settings to constrain child-rearing and perpetuate inequities over time.

Cross-sectional interview study of fertility, pregnancy, and urogenital schistosomiasis in coastal Kenya: Documented treatment in childhood is associated with reduced odds of subfertility among adult women.

BACKGROUND: Previous research has documented an increased risk of subfertility in areas of sub-Saharan Africa, as well as an ecological association between urogenital schistosomiasis prevalence and decreased fertility. This pilot project examined reproductive patterns and the potential effects of childhood urogenital Schistosoma haematobium infection and individual treatment experience on adult subfertility among women who were long-term residents in an S. haematobium-endemic region of coastal Kenya. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed findings from 162 in-depth interviews with women of childbearing age in a rural, coastal community, linking them, if possible, to their individual treatment records from previous multi-year longitudinal studies of parasitic infections. Reproductive histories indicated a much local higher local rate of subfertility (44%) than worldwide averages (8-12%). Although, due to the very high regional prevalence of schistosomiasis, a clear relationship could not be demonstrated between a history of S. haematobium infection and adult subfertility, among a convenience sub-sample of 61 women who had received documented treatment during previous interventional trials, a significant association was found between age at first anti-schistosomal treatment and later fertility in adulthood, with those women treated before age 21 significantly less likely to have subfertility (P = 0.001). CONCLUSIONS/SIGNIFICANCE: The high subfertility rate documented in this pilot study suggests the importance of programs to prevent and treat pelvic infections in their early stages to preclude reproductive tract damage. The available documented treatment data also suggest that early anti-schistosomal treatment may prevent the fertility-damaging effects of urogenital schistosomiasis, and lend support for programs that provide universal treatment of children in S. haematobium-endemic regions.

Exploring maternal attitudes towards adolescent contraception: implications for use of LARC.

Introduction Maternal attitudes have been shown to impact adolescent girls' sexual decision making and attitudes towards contraception. Given the potential for maternal influence on adolescent contraceptive use, we undertook an exploratory study of mothers' perceptions of the maternal role in adolescent contraceptive decision making, and maternal perceptions of long acting reversible contraceptives (LARC) for adolescent girls. Materials and methods We utilized a mixed methods study design. Acceptability of contraceptive methods and attitudes towards adolescent contraceptive use were assessed using a paper survey of 162 mothers of girls aged 11-19 years in Cleveland, Ohio, USA. Seven survey participants completed subsequent semi-structured interviews, which were analyzed using grounded theory methodology. Results Pills, condoms and injections were most frequently selected as acceptable by 55.4%, 55.4%, and 51.6% of women, respectively. One or more LARC methods were selected by 16.6% of the women. Of those (94.4%) agreed or strongly agreed that, "It is expected of me to make sure that my daughter knows about birth control methods." Important themes that emerged during interviews were the responsibility mothers felt to help their daughters navigate contraception options, appreciation of the effectiveness of LARC methods and concerns about the use of those methods by teenagers due to the invasiveness. Conclusion Our data suggest that mothers want to be involved and support adolescent decision making about contraceptives. We also found that mothers viewed LARC as less acceptable than other forms of birth control for adolescents and have specific concerns about LARC. These results suggest directions for future work to better characterize the impact of maternal attitudes on adolescent LARC use.

Scissors as symbols: disputed ownership of the tools of biomedical obstetrics in rural Indonesia.

In the hands of both traditional and clinic midwives in rural Indonesia a simple biomedical tool, umbilical cord scissors, has come to develop a social life that symbolizes potential futures. In rural Indonesian villages resources are limited, maternal and infant mortality rates are high, and there is robust competition for both patients and status between traditional and clinic midwives, all set against nationalist pressure to "modernize." The perceived right to use the umbilical cord scissors in a professional setting is contested. The folk midwives use the umbilical cord scissors to publically reference access to biomedical obstetric knowledge, a domain claimed by clinic midwives. This paper explores the way that the traditional midwives construct a hybrid modern identity by marking a place for traditional and biomedical obstetric systems in the treatment of childbirth. Further, this paper argues that traditional midwives use the symbolically laden umbilical cord scissors in their attempt to remain locally relevant and to circumvent the mission of the clinic programs to eradicate their practice.