Role of community-level emergency contraceptive pills awareness and possibilities of long-acting reversible or permanent methods in reducing unwanted births in Bangladesh: evidence from a nationwide cross-sectional survey.

OBJECTIVE: This study aims to investigate the role of community-level emergency contraceptive pill (ECP) awareness in reducing unwanted births (UWBs) in Bangladesh and explore the regional variation in women's appropriateness to adopt long-acting reversible contraceptives or permanent methods (LARCPMs) based on their child desire. DESIGN, SETTINGS AND PARTICIPANTS: We used data from the cross-sectional Bangladesh Demographic and Health Survey 2017-2018. We analysed the planning status of the last live birth 3 years preceding the survey of 20,127 ever-married women of reproductive age. METHODS: Considering women were nested within clusters, a mixed-effect multiple logistic regression was implemented to investigate the association between community-level ECP awareness and UWB by controlling for the effects of contextual, individual, and household characteristics. RESULTS: Only 3.7% of women belonged to communities with high ECP awareness. At the national level, 2% of women had UWB. About 2.1% of women who resided in communities of low ECP awareness had UWB, while UWB was only 0.5% among women residing in high ECP awareness communities. The odds of UWB was 71% lower among women who resided in high ECP awareness communities than among those who resided in communities with low ECP awareness. However, community-level ECP awareness could not avert mistimed birth. Dhaka, Chattogram and Rangpur held the highest share of UWB. Fertility persisted for 89% of the women who wanted no more children. Among women who wanted no more children, 15% were not using any method, 13% used traditional family planning methods and only 13% adopted LARCPM. These women mostly resided in Dhaka, followed by Chattogram and Rajshahi. CONCLUSION: This study highlights the significant positive role of ECP awareness in reducing UWB in Bangladesh. Findings may inform policies aimed at increasing LARCPM adoption, particularly among women residing in Dhaka and Chattogram who want no more children.

Saving unwanted children: a proposal for a National Rearing Institute.

Unwanted children are carried, born, and reluctantly raised each year; they are prone to abortion, abandonment, neglect, and abuse. Meanwhile, many developed societies are suffering from depopulation. To address these two issues concurrently, I propose that governments should grant pregnant women and mothers an irreversible and unconditional one-time chance to relinquish all their legal rights and obligations associated with each of their children under a specific age to a National Rearing Institute that adopts the children and rears them to the age when they can fully exercise their rights as adult citizens. I call this set of policy arrangements "Project New Republicans." This project aims to (1) protect and support the best interests of unwanted children, (2) maximize the health outcomes of the mothers who gave birth to these children and help the mothers to achieve self-realization, and (3) preserve an influx to the population from procreation against depopulation. The project is primarily grounded on both the utilitarian and intra- / inter-generational accounts of justice. It also ameliorates the oppression and domination of women by unjust social structures in alignment with the human rights-based approach.

Do unwanted children face growth penalties in resource poor environments? Evidence from Roma Settlements in Serbia.

In a high fertility context, research on the relationship between parental investment, unwanted births and child nutritional outcomes is limited. The implications may be especially relevant for children coming from the most disadvantaged backgrounds and at increased risk of nutritional deprivation. This study assessed the association between maternal investment, unwanted births disaggregated into mistimed and unwanted children, and child nutritional outcomes in a poor population of Serbian Roma. Multiple Indicator Cluster Surveys rounds 5 and 6 data for Serbian Roma settlements were used to account for the association between two measures of maternal investment: weight at birth and parity, and mistimed and unwanted children, and children height-for-age z-score (HAZ), weight-for-age z score (WAZ) and weight-for- height z-score (WHZ). The sample included 130 children aged 0-24 months. The child variables were age, gender, and birth order, while maternal independent variables included age, literacy and access to improved toilet facility as proxies for socioeconomic status. Children born with low birth weight (lower maternal investment in utero) face a significant deficit in terms of their nutritional outcomes, measured by HAZ and WAZ. The effect was aggravated for height if the child was unwanted while there was a positive relationship between access to improved toilet facility and WHZ. Unwanted children were of higher birth order, with older, higher parity mothers than mistimed children. Many of the Roma children may be at risk of undernutrition, however, Roma children who received lower maternal investment in utero, unwanted and living in poorest households may face additional risk.

Implicações da prática profissional no acolhimento institucional de crianças: perspectiva de cuidadoras / Implications of professional practice in children's institutional sheltering: caregivers' perspective / Implicaciones de la práctica profesional en el alojamiento institucional de niños: perspectiva de cuidadoras

Este estudo qualitativo teve como objetivo compreender, a partir da teoria de bioecológica de desenvolvimento, as implicações da prática profissional no processo de acolhimento de crianças em uma casa-abrigo, na perspectiva de cuidadoras. As participantes foram 10 profissionais de uma casa-abrigo localizada na região sul do Brasil. Utilizou-se a entrevista semiestruturada e a organização e análise dos dados sustentou-se na Grounded Theory, com auxílio do software Atlas.ti 8.4.14. Os resultados evidenciaram uma centralização das ações de acolhimento e atenção em torno dos cuidados físicos das crianças. As ações para promover suporte e cuidados emocionais dentro da casa-abrigo eram delegadas às profissionais da equipe técnica da instituição. Observou-se que as dificuldades encontradas pelas cuidadoras diziam respeito à falta de segurança e preparação para responder e acolher as demandas emocionais das crianças, as quais estão presentes em diversos momentos do processo de acolhimento. Percebeu-se que as práticas institucionais afetaram decisivamente tanto as ações de acolhimento das participantes e o suporte emocional oferecido às crianças na passagem pela casa-abrigo quanto as cuidadoras, no sentido de vivenciarem no trabalho sentimentos de insegurança. Os resultados tensionam ecologicamente a interação nos processos proximais presentes no desenvolvimento humano. Advoga-se pela reflexão sobre as implicações das práticas institucionais de uma casa-abrigo e o desenvolvimento infantil, visando o cuidado integral dos acolhidos.(AU)

Based on the developmental bioecological theory, this study analyzes the implications of professional practice in children's user embracement at a shelter from the caregivers' perspective. Semi-structured interviews were conducted with 10 professionals from a shelter located in southern Brazil. Data organization and analysis was performed based on Grounded Theory using the Atlas.ti 8.4.14 software. Results showed that embracement and attention focus on the physical care of children. Support and emotional care activities were delegated to the institution's technical team. Caregivers faced difficulties regarding the lack of security and preparation to respond to and accept the children's emotional demands, which arise at different moments in the embracement process. The institutional practices decisively affected both user embracement actions and the emotional support offered to the children, as well as the caregivers, in the sense of experiencing feelings of insecurity. These findings ecologically tension the interaction in the proximal processes present in human development. Further reflections on the implications of institutional shelter-based practices for child development are needed to provide comprehensive care.(AU)

Este estudio cualitativo tuvo como objetivo comprender, desde la perspectiva de la teoría bioecológica del desarrollo, las implicaciones de la práctica profesional en el proceso de acogida de niños en una institución infantil desde la perspectiva de las cuidadoras. Las participantes fueron 10 profesionales de una institución de acogida infantil ubicada en la región Sur de Brasil. Se utilizó la entrevista semiestructurada, y para la organización y análisis de datos se aplicó Grounded Theory, con el uso del software Atlas.ti 8.4.14. Los resultados mostraron que las acciones de recepción y atención se centran en el cuidado físico de los niños. Las acciones de promoción de apoyo y cuidado emocional dentro del alojamiento se asignaron a los profesionales del equipo técnico de la institución. Se observó que las dificultades encontradas por las cuidadoras estaban relacionadas con la falta de seguridad y preparación para responder y aceptar las demandas emocionales de los niños, las cuales se encuentran presentes en diferentes momentos del proceso de acogida. Se notó que las prácticas institucionales afectaron decisivamente tanto las acciones de acogida de las participantes como el apoyo emocional que la institución brinda a los niños durante su paso, así como a las cuidadoras en el sentido de experimentar sentimientos de inseguridad en el trabajo. Estos resultados tensan ecológicamente la interacción en los procesos proximales presentes en el desarrollo humano. Se aboga por reflexionar sobre las implicaciones de las prácticas institucionales en los alojamientos institucionales y el desarrollo infantil, apuntando a la atención integral de los acogidos.(AU)

Exploration of adverse patterns of placement of young people in secure care: The unwanted child?

BACKGROUND: Emerging evidence suggests that distant placements and multiple moves may be detrimental to young people in care settings. Less is known about the characteristics of young people in secure care most affected by these processes. AIMS: This study examined distance from home and number of previous placements in English young people detained in secure care and their relationships with organisational and individual characteristics. METHODS: Data were derived from the (2016) cross-sectional National Adolescent Study census of English young people in secure care, which included 1322 young people across secure mental health, welfare and Youth Justice establishments. Associations were described with odds ratios/95% confidence intervals (OR/CI). RESULTS: Overall, 285 young people (26.4%) were in secure placements over 100 miles from their family/local authority while 54 (5.6%) had 10 or more previous placements. These rates were higher in secure welfare than other settings (73.8%; OR (CI) = 9.62 (5.72, 16.18), 12.7%; OR (CI) = 2.76 (1.29, 5.91) respectively), and there was significant overlap between long-distance placement and multiple placements (n = 22; OR (CI) = 2.26 (1.27, 4.04)). Younger age and presence of neurodevelopmental disorder were also associated with long-distance placements while psychiatric diagnosis, previous secure placement, and previous service contact were linked to multiple placements. CONCLUSIONS: Distant and/or multiple placements in young people in secure care appear common, particularly for those who are placed in secure welfare and who are younger and/or present with a psychiatric disorder. Multi-agency evaluations that capture the longitudinal experience of these vulnerable young people are needed to understand how undesirable patterns of placement in secure care occur and prevent future instances.

Fertility intentions and child health in India: Women's use of health services, breastfeeding, and official birth documentation following an unwanted birth.

This study examines the relationship between women's prospective fertility intentions and child health, measured via access to healthcare facilities for children and postpartum maternal behaviors that are indicative of future child health. We analyze two waves of nationally representative data (2005 and 2012) from the India Human Development Survey (IHDS). The analytic sample includes 3,442 non-pregnant, currently married women aged 18-40 in 2005 who participated in both rounds of the IHDS, and had at least one birth between 2005 and 2012. We investigate the influence of women's prospective fertility intentions on access to benefits from the Integrated Child Development Services (ICDS), indicators of breastfeeding as recommended by the World Health Organization, and official documentation of births via birth certificates or registration. We find that 58 percent of births among women in the sample were labeled as unwanted. We use an adaptation of propensity score matching-the inverse-probability-weighted regression adjustment (IPWRA) estimator-and show that, after accounting for maternal and household characteristics that are known to be associated with maternal and child health, children who resulted from unwanted births were less likely to obtain any benefits or immunizations from the ICDS, to be breastfed within one hour of birth, and to have an official birth certificate. Results from this study have direct policy significance given the evidence that women's fertility intentions can have negative implications for child health and wellbeing in the short and longer term.

Safely surrendered infants in Los Angeles County: A medically vulnerable population.

BACKGROUND: As a means to provide safety for a population at great risk of harm through abandonment, every state in the United States now has laws and practices for the safe relinquishment of newborns and infants. However, there is no national database tracking the population of infants surrendered through such programmes, and few states monitor these numbers. The primary aim of this study was therefore to examine the descriptive characteristics of infants who have been safely surrendered in a large, socio-economically diverse urban area. The secondary aim was to compare them with local population norms to determine whether differences exist and to begin exploring what implications such differences may have for the treatment provided to these infants. METHODS: A retrospective cross-sectional study was conducted among safely surrendered infants. RESULTS: Over half of the infants had medical issues, and the majority of the infants were surrendered in communities characterized by low median income. CONCLUSIONS: Preliminary information highlights potential economic, social, and medical risk factors, suggesting that these infants may require increased monitoring and/or specialized care.

Sobre la dignidad humana del mortinato y nasciturus. Un nuevo reto bioético a propósito de la STC 11/2016 y la jurisprudencia del TEDH / On the human dignity of a stillborn and unborn child. A new bioethical challenge before the Spanish Supreme Court Case Law 11/2016 and the ECHR Jurisprudence

En febrero de 2016, de forma inédita se falló un asunto concerniente a la bioética y el respeto por los derechos fundamentales de la persona concerniente a la prohibición de dar sepultura digna a un mortinato al que el derecho le negó su existencia por no superar unos límites desnaturalizados. Sin esgrimir una norma verdaderamente habilitante, sin cobertura legal y sin justificar la existencia de un riesgo real para la población o en beneficio del interés general, la administración pública española denegó el ejercicio de los derechos fundamentales a la libertad ideológica, de culto y a la intimidad personal y familiar. Afortunadamente, en esta ocasión el más alto interprete constitucional priorizó la dignidad humana a la codificación siguiendo escrupulosamente la moderna jurisprudencia del Tribunal Europeo de Derechos Humanos

In February 2016, Spanish justice decided - without precedent - on an issue concerning bioethics and the respect for the fundamental rights of the individual, in reference to the prohibition of giving decent burial to a stillborn, whom the law denies its existence for not reaching the established unnatural limits. Without wielding a truly enabling standard, without legal cover and without justifying the existence of a real risk to the population or the benefit of a general interest, the public Spanish administration denied the exercise of fundamental rights based on ideological freedom, of worship and personal and family privacy. Fortunately, in this case, the Spanish Constitutional Court gave priority to the human dignity instead of the codification following the latest European Court of Human Rights case law

Unintended Birth and Children's Long-term Mental Health.

Research has examined the proximate effects of unintended birth on infants and young children, but we know relatively little about the longer-term effects. Given that unintended birth is associated with several childhood risk factors, it might set the stage for poor mental health in adulthood. Drawing on rich intergenerational survey data from the National Longitudinal Survey of Youth, 1979 ( N = 3,742), this study used a variety of statistical techniques to examine whether maternal pregnancy intentions are associated with children's depressive symptoms during early adulthood. Results from ordinary least squares regression suggest that children resulting from unintended pregnancies experienced more depressive symptoms in their 20s than children resulting from intended pregnancies, controlling for a host of characteristics. Results from propensity-weighted and sibling fixed-effects models suggest that there is little to no causal relationship, however. Much of the initial association between maternal fertility intentions and children's depressive symptoms is attributed to the mother's sociodemographic characteristics.

Unintended Childbearing and Child Growth in Northern Malawi.

Objective The study aims to assess whether unintended children experience slower growth than intended children. Methods We analysed longitudinal data linked to the Karonga Health and Demographic Surveillance Site collected over three rounds between 2008 and 2011 on women's fertility intentions and anthropometric data of children. Using the prospective information on fertility intention we assessed whether unintended children are more likely to be stunted than intended children. We applied Propensity Score Matching technique to control for endogenous factors affecting both the probability that a family has an unwanted birth and a child with poor health outcomes. Results We found that 24 % of children from unwanted pregnancies were stunted compared with 18 % of mistimed pregnancies and 17 % of those from wanted pregnancies. However, these differences in probability of children being stunted, though in the expected direction, were not significant either for large or small families, after controlling for age. The number of children in the household was associated with stunting and boys were substantially more likely to be stunted than girls. Conclusion We found no significance difference in probability of being stunted by mother's fertility intention.

Correlates of Unwanted Births in Bangladesh: A Study through Path Analysis.

BACKGROUND: Unwanted birth is an important public health concern due to its negative association with adverse outcomes of mothers and children as well as socioeconomic development of a country. Although a number of studies have been investigated the determinants of unwanted births through logistic regression analysis, an extensive assessment using path model is lacking. In the current study, we applied path analysis to know the important covariates for unwanted births in Bangladesh. METHODS: The study used data extracted from Bangladesh Demographic and Health Survey (BDHS) 2011. It considered sub-sample consisted of 7,972 women who had given most recent births five years preceding the date of interview or who were currently pregnant at survey time. Correlation analysis was used to find out the significant association with unwanted births. This study provided the factors affecting unwanted births in Bangladesh. The path model was used to determine the direct, indirect and total effects of socio-demographic factors on unwanted births. RESULTS: The result exhibited that more than one-tenth of the recent births were unwanted in Bangladesh. The differentials of unwanted births were women's age, education, age at marriage, religion, socioeconomic status, exposure of mass-media and use of family planning. In correlation analysis, it showed that unwanted births were positively correlated with women age and place of residence and these relationships were significant. On the contrary, unwanted births were inversely significantly correlated with education and social status. The total effects of endogenous variables such as women age, place of residence and use of family planning methods had favorable effect on unwanted births. CONCLUSION: Policymakers and program planners need to design programs and services carefully to reduce unwanted births in Bangladesh, especially, service should focus on helping those groups of women who were identified in the analysis as being at increased risks of unwanted births- older women, illiterate, low socioeconomic status, early age at marriage and rural poor susceptible women.

Unmet Needs, Unwanted Persons: A Call for Expansion of Safe Haven Laws.

Legislative strategies for reducing infant abandonment and neonaticide developed in response to a series of sensational cases that occurred in Texas in 1999. The media coverage of these cases implied that the incidence of the crime was increasing, and Texas legislators responded with a law permitting parents to anonymously surrender their newborn at designated locations such as hospitals. This was the first "safe haven" law. Interest peaked nationwide, and by 2008 all states had a similar version of the law. These laws can trigger rapid cessation of parental rights and a fast-tracked adoption to a preapproved family, reflecting the legislators' assumption that it is better to permit struggling mothers to leave their children with well-intentioned strangers than to abandon the children or end their lives. These laws, however, suffer from several inadequacies.

Child Wanted and When? Fertility Intentions, Wantedness, and Child Survival in Rural Northern Ghana.

Panel survey data collected in rural northern Ghana asked women about the "wantedness" status of their children. Parous women were asked whether they wanted more children, while those who had never had a child were asked whether they wanted to have children in the future; those who said that they did not want to have any more children in the future were asked whether they wanted to become pregnant when they last became pregnant and, if so, whether they wanted to become pregnant at the time, or would have preferred to be pregnant earlier or later. This article analyzes longitudinal responses to these questions over a 10-year period. Birth and survival histories of subsequently born children linked to preference data permit investigation of the question: are "wanted" children more likely to survive than "unwanted" children? Hazard models are estimated to determine whether children born to women who indicated that they did not want to have a child at the time they did, or did not want any more children in the future, have a higher risk of mortality relative to children who were reported wanted at the time of pregnancy. Results show no significant differences in adjusted mortality risks between children who were reported to be wanted and those reported to be unwanted.

Desired Fertility and Number of Children Born Across Time and Space.

Economists have often argued that high fertility rates are mainly driven by women's demand for children (and not by family planning efforts) with low levels of unwanted fertility across countries (and hence with little room for family planning efforts to reduce population growth). We study the relationship between wanted fertility and number of children born in a panel of 200 country-years controlling for country fixed effects and global time trends. In general, we find a close relationship between wanted and actual fertility, with one desired child leading to one additional birth. However, our results also indicate that in the last 20 years, the level of unwanted births has stayed at 2 across African countries but has, on average, decreased from 1 to close to 0 in other developing countries. Hence, women in African countries are less able to translate child preferences into birth outcomes than women in other developing countries, and forces other than fertility demand have been important for previous fertility declines in many developing countries. Family planning efforts only partially explain the observed temporal and spatial differences in achieving desired fertility levels.

Is Unwanted Birth Associated with Child Malnutrition in Bangladesh?

CONTEXT: The association between unintended pregnancy and maternal and child health has been well documented. However, the relationship of unintended pregnancy with child malnutrition is not well understood, and may be important in countries such as Bangladesh that have high levels of these events. METHODS: Data from the 2011 Bangladesh Demographic and Health Survey on 6,506 last-born, singleton children younger than five were used to investigate the relationship between pregnancy intendedness and the prevalence of stunting, wasting and underweight during early childhood. Multivariate logistic regression analyses were used to identify associations. RESULTS: Substantial proportions of children were stunted (40%), wasted (16%) and underweight (35%) at the time of the survey. Mothers reported that at the time of conception, 14% of their index pregnancies had been unwanted and 16% had been mistimed. Compared with children whose conception had been intended, those whose conception had been unwanted were more likely to be stunted (46% vs. 39%), wasted (19% vs. 15%) or underweight (43% vs. 33%). In regression analyses, children who had been unwanted at the time of conception had an elevated risk of being stunted (odds ratio, 1.4), wasted (1.4) or underweight (1.3). CONCLUSION: Maternal pregnancy intentions are associated with child stunting, wasting and underweight. If these associations are causal, preventing unwanted pregnancies may help reduce the prevalence of childhood malnutrition in Bangladesh.

Medicaid family planning waivers in 3 States: did they reduce unwanted births?

Effects of Medicaid family planning waivers on unintended births and contraceptive use postpartum were examined in Illinois, New York, and Oregon using the Pregnancy Risk Assessment Monitoring System. Estimates for women who would be Medicaid eligible "if" pregnant in the waiver states and states without expansions were derived using a difference-in-differences approach. Waivers in New York and Illinois were associated with almost a 5.0 percentage point reduction in unwanted births among adults and with a 7 to 8.0 percentage point reduction, among youth less than 21 years of age. Oregon's waiver was associated with an almost 13 percentage point reduction in unintended, mostly mistimed, births. No statistically significant effects were found on contraceptive use.