Attitudes to adolescent pregnancy among families in the Dominican Republic and El Salvador: insights from a longitudinal study.

Over the past few decades growing attention has focused on the perceived challenge of adolescent pregnancy and the need for girls to make 'smart choices'. This has generated considerable debate particularly because of the failure of many programmes and interventions to consider the structural constraints faced by young women in accessing sexual and reproductive health and rights (SRHR). Yet limited attention has been given to the views and experiences of girls' parents and caregivers, many of whom were often adolescent parents themselves. We use data from the Real Choices, Real Lives longitudinal study conducted by Plan International to consider how the experiences of girls' families shape their attitudes to teenage pregnancy in the Dominican Republic and El Salvador. Many families believe girls need to practise abstinence and avoid men and boys but given the lack of provision for SRHR faced by young women this response is not unexpected.

Changing patterns of migration in Latin America: how can research develop intelligence for public health?

Migration patterns in Latin America have changed significantly in recent decades, particularly since the onset of global recession in 2007. These recent economic changes have highlighted and exacerbated the weakness of evidence from Latin America regarding migration-a crucial determinant of health. Migration patterns are constantly evolving in Latin America, but research on migration has not developed at the same speed. This article focuses on the need for better understanding of the living conditions and health of migrant populations in Latin America within the context of the recent global recession. The authors explain how new data on migrant well-being could be obtained through improved evidence from censuses and ongoing research surveys to 1) better inform policy-makers about the needs of migrant populations in Latin America and 2) help determine better ways of reaching undocumented immigrants. Longitudinal studies on immigrants in Latin America are essential for generating a better representation of migrant living conditions and health needs during the initial stages of immigration and over time. To help meet this need, the authors support the promotion of sustainable sources of data and evidence on the complex relationship between migration and health.

Understanding differences in access and use of healthcare between international immigrants to Chile and the Chilean-born: a repeated cross-sectional population-based study in Chile.

INTRODUCTION: International evidence indicates consistently lower rates of access and use of healthcare by international immigrants. Factors associated with this phenomenon vary significantly depending on the context. Some research into the health of immigrants has been conducted in Latin America, mostly from a qualitative perspective. This population-based study is the first quantitative study to explore healthcare provision entitlement and use of healthcare services by immigrants in Chile and compare them to the Chilean-born. METHODS: Data come from the nationally representative CASEN (Socioeconomic characterization of the population in Chile) surveys, conducted in 2006 and 2009. Self-reported immigrants were compared to the Chilean-born, by demographic characteristics (age, sex, urban/rural, household composition, ethnicity), socioeconomic status (SES: education, household income, contractual status), healthcare provision entitlement (public, private, other, none), and use of primary services. Weighted descriptive, stratified and adjusted regression models were used to analyse factors associated with access to and use of healthcare. RESULTS: There was an increase in self-reported immigrant status and in household income inequality among immigrants between 2006 and 2009. Over time there was a decrease in the rate of immigrants reporting no healthcare provision and an increase in reporting of private healthcare provision entitlement. Compared to the Chilean-born, immigrants reported higher rates of use of antenatal and gynaecological care, lower use of well-baby care, and no difference in the use of Pap smears or the number of attentions received in the last three months. Immigrants in the bottom income quintile were four times more likely to report no healthcare provision than their equivalent Chilean-born group (with different health needs, i.e. vertical inequity). Disabled immigrants were more likely to have no healthcare provision compared to the disabled Chilean-born (with similar health needs, i.e. horizontal inequity). Factors associated with immigrants' access to, and use of, healthcare were sex, urban/rural status, education and country of origin. CONCLUSION: There were significant associations between SES, and access to and use of healthcare among immigrants in Chile and a higher prevalence of no health care provision entitlement among poor and disabled immigrants compared to the Chilean-born. Changing associations between access and use of healthcare and SES among immigrants in Chile over time may reflect changes in their socio-demographic composition or in the survey methodology between 2006 and 2009.

Changing patterns of migration in Latin America: how can research develop intelligence for public health? / Cambios en los modelos de migración en América Latina: ¿cómo puede la investigación obtener información útil para la salud pública?

Migration patterns in Latin America have changed significantly in recent decades, particularly since the onset of global recession in 2007. These recent economic changes have highlighted and exacerbated the weakness of evidence from Latin America regarding migration-a crucial determinant of health. Migration patterns are constantly evolving in Latin America, but research on migration has not developed at the same speed. This article focuses on the need for better understanding of the living conditions and health of migrant populations in Latin America within the context of the recent global recession. The authors explain how new data on migrant well-being could be obtained through improved evidence from censuses and ongoing research surveys to 1) better inform policy-makers about the needs of migrant populations in Latin America and 2) help determine better ways of reaching undocumented immigrants. Longitudinal studies on immigrants in Latin America are essential for generating a better representation of migrant living conditions and health needs during the initial stages of immigration and over time. To help meet this need, the authors support the promotion of sustainable sources of data and evidence on the complex relationship between migration and health.

En los últimos decenios, los modelos de migración en América Latina han cambiado significativamente, en particular desde el inicio de la recesión mundial en el 2007. Estos recientes cambios económicos han acentuado y exacerbado la insuficiencia de datos probatorios existentes en América Latina con respecto a la migración, un determinante crucial de la salud. Los modelos de migración están evolucionando constantemente en América Latina, pero la investigación en materia de migración no ha evolucionado a la misma velocidad. Este artículo se centra en la necesidad de un mayor conocimiento de las condiciones de vida y salud de las poblaciones migrantes en América Latina en el contexto de la reciente recesión mundial. Los autores explican cómo se podrían obtener nuevos datos sobre el bienestar de los inmigrantes mediante un mayor aporte de datos probatorios de los censos y las encuestas de investigación en curso para 1) informar mejor a las instancias normativas acerca de las necesidades de las poblaciones migrantes en América Latina; y 2) ayudar a determinar las mejores estrategias para llegar a los inmigrantes indocumentados. Es esencial llevar a cabo estudios longitudinales sobre los inmigrantes en América Latina con objeto de formular una mejor descripción de sus condiciones de vida y sus necesidades de salud durante las etapas iniciales de la inmigración y con el transcurso del tiempo. Para satisfacer esta necesidad, los autores alientan la promoción de fuentes sostenibles de información y datos probatorios sobre la compleja relación entre migración y salud.

Prevention and promotion in decentralized rural health systems: a comparative study from northeast Brazil.

Policies to reform health care provision often combine the organizational restructuring of decentralization with ideological restructuring through a new model of health care that gives greater weight to prevention and promotion. Decentralization provides a discretionary space to the local health system to define and develop its own activities. The central policy aim to shift the model of health care therefore must rely on incentives rather than directives and is likely to result in variation at local levels in the extent and mode of its implementation. The local processes affecting variation in local implementation of policies for prevention and promotion have not been studied in a developing country. This study does so by comparing two rural health systems with different levels of prevention and promotion activities in one of the poorest regions of Brazil, Ceará State in the northeast. The health system with greater activities of prevention and promotion also has a more advanced stage of decentralization, but this is in combination with many other, interacting influences that differentiate the two health systems' ability to adopt and implement new approaches. While beyond the scope of this paper to detail options for regional and national managers to encourage the adoption of a greater focus on prevention and promotion, it is clear that strategies needs to target not only the vision and actions of local health system staff, but critically also the expectations of the local population and the attitudes of local government.

Implementation of promotion and prevention activities in decentralized health systems: comparative case studies from Chile and Brazil.

The policies for restructuring health systems in Latin America during the 1990s have included an emphasis on changing in the model of health care delivery to one that incorporates prevention and promotion activities. At the same time, health systems have been decentralized in their management, allowing room for greater variation in local interpretation and implementation of policy directives. Despite rhetoric and policy debate, there is no documentation or evaluation of actual experiences of prevention and promotion within decentralized health systems in Latin America. This paper explores the ways in which the national structure of a health system influences the implementation of activities for prevention and promotion through a comparison of the experiences in four local health systems in each of Brazil and Chile. These experiences in Brazil and Chile are presented by key themes of national health system structure, local health system structure, partnership and intersectorality, human resources and introducing a family health approach. Five clear factors emerge as operating at the national level that influence prevention and promotion activities in local health systems: vertical (Chile) versus horizontal (Brazil) structure of health system; greater awareness of prevention and promotion issues in Chile; greater urban bias in Chile compared with Brazil; strategies to attract human resources to primary care and rural areas; importance of local capacity building especially in rural areas. This account of case study experiences in Brazil and Chile provides a series of examples of arrangements and strategies that can facilitate implementation and usefully highlights a number of issues that policy-makers and health system managers need explicitly to consider. As such, the paper hopes to provoke debate about the structures and strategies for supporting the implementation of prevention and promotion programmes in Latin America and further health systems research in this field.

El pacto internacional de derechos económicos, sociales y culturales y el empoderamiento de las mujeres / The international covenant on economic, social and cultural rights and the empowerment of women

Busca promover la igualdad de oportunidades para las mujeres en el ámbito del empleo, dada la desigualdad y la inequidad persistentes. Se tratará de incorporar los DES en las políticas públicas, leyes y procedimientos administrativos de los cinco países andin