Effects of birth order and sibling sex composition on human capital investment in children in India

The paper explores the effects of birth order and sibling sex composition on human capital investment in children in India using the Indian Human Development Survey (IHDS). Endogeneity of fertility is addressed using instruments and controlling for household fixed effects. Family size effect is also distinguished from the sibling sex composition effect. Previous literature has often failed to take endogeneity into account and shows a negative birth order effect for girls in India. Once endogeneity of fertility is addressed, there is no evidence for a negative birth order effect or sibling sex composition effect for girls. Results show that boys are worse off in households that have a higher proportion of boys specifically when they have older brothers.

Fertility and rural electrification in Bangladesh

We use a panel dataset from Bangladesh to examine the relationship between fertility and the adoption of electricity with the latter instrumented by infrastructure development and the quality of service delivery. We find that the adoption of electricity reduces fertility, and this impact is more pronounced when the household already has two or more children. This observation can be explained by a simple household model of time use, in which adoption of electricity affects only the optimal number of children but not necessarily current fertility behavior if the optimal number has not yet been reached.

Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy : analysis of routinely collected health care data

Peer reviewed

A importância da metodologia das oficinas formativas na educação sexual na escola

Enquadramento: O interesse pelo tema Educação Sexual germinou da conscientiza-ção de que a sexualidade está na essência do homem, com o ideal de ser experimentada e vivida; procura-se cada vez mais expandir esses conhecimentos com responsabilidade e naturalidade, principalmente frente à responsabilidade de educadores por participar de uma capacitação oferecida pelo grupo do Instituto Kaplan Programa / PROJETO VALE SONHAR. Objetivo: Proposemo-nos analisar a importancia da metodologia das oficinas formati-vas na Educação Sexual na Escola;Determinar a eficácia das oficinas nos conhecimentos sobre sexualidade nos adolescentes;Construir conhecimento sobre sexualidade, desmitifi- cando conceitos. Método: Foi desenvolvida uma intervenção formativa com aplicação de 03 (três) ofi-cinas, em que foram avaliados os conhecimentos antes e após a intervenção formativa. Du-rante estas oficinas foram aplicados questionários e coleta de depoimentos dos participantes. A amostra foi constituída por adolescentes de ambos os sexos, que frequentavam o 1º ano do ensino médio na Escola Estadual de Educação Básica Costa Rêgo, no ano letivo de 2013 e 2014. Resultados: Os conhecimentos sobre planejamento familiar, infecções sexualmente transmissíveis e reprodução dos adolescentes na maioria aumentaram após a intervenção formativa no âmbito da afetividade/sexualidade na adolescência. Os conhecimentos estão relacionados com a idade no sentido em que são os mais novos que demonstram mais co-nhecimentos. Na separação dos conhecimentos por sexo são as meninas que manifestam mais conhecimentos, assim como os residentes em meio urbano. A existência de irmãos, a idade e escolaridade dos pais não influenciam os conhecimentos dos adolescentes. Obser-vou-se também que os adolescentes que já tinham iniciado relações sexuais são aqueles que detêm menos conhecimentos. Conclusão: Os dados mostram que as oficinas realizadas e os questionários servi-ram para conscientização dos alunos e contribuiu para a redução dos índices de evasão escolar por motivos de gravidez, mostrando assim a importância de se tratar de educação sexual no ambiente escolar. Palavras-chave: Adolescência, Sexualidade, Educação Sexual, Planejamento Famili-ar, Infecções Sexualmente Transmissíveis.

Sexualidade nos adolescentes : intervenção formativa

Enquadramento – Os adolescentes com acesso a conhecimentos, informação e motivação, para adotarem comportamentos sexuais seguros, serão capazes de alterar as suas atitudes e os seus comportamentos. Objetivos – Caraterizar os adolescentes relativamente às variáveis de contexto sexual; identificar os conhecimentos dos adolescentes sobre IST e planeamento familiar; identificar as atitudes dos adolescentes face à sexualidade, pílula e preservativos; identificar a motivação dos adolescentes para terem ou não relações sexuais; determinar a eficácia de uma intervenção formativa no âmbito da sexualidade nos conhecimentos sobre IST, Planeamento Familiar, bem como nas suas atitudes face à sexualidade. Métodos - Investigação experimental de campo. O instrumento de recolha de dados é um questionário, elaborado pela equipa de investigadores do Projeto Monitorização de Indicadores de Saúde Infanto-Juvenil (MISIJ) no domínio temático da “Sexualidade Adolescente”. Este permite caracterizar sociodemograficamente e sexualmente os adolescentes, inclui ainda a Escala de atitudes face à sexualidade em adolescentes (AFSA) (Nelas et al., 2010), Escala de conhecimentos sobre infeções de transmissão sexual (Nelas et al., 2010), Escala de atitudes face ao preservativo (Ramos et al., 2009), Escala de atitudes face à pílula (Ramos et al., 2009), Escala de conhecimentos sobre planeamento familiar (Nelas et al., 2010), Escala de motivação para fazer e para não fazer sexo (Alferes, 1997). Resultados - A amostra é constituída por 56 estudantes do 9º ano de escolaridade (28 do grupo de controlo e 28 do grupo experimental). A maioria dos adolescentes do grupo de controlo é do sexo feminino (71,4%), contrariamente ao grupo de controlo onde 64,3% é do sexo masculino. As raparigas do grupo de controlo revelaram mais conhecimentos sobre infeções transmissíveis sexualmente, em ambos os momentos da avaliação, os adolescentes do sexo masculino, em ambos os momentos, revelam mais conhecimentos sobre o planeamento familiar, comparativamente às adolescentes do género feminino. Aos índices positivos antes da intervenção formativa corresponderam melhores índices após a intervenção formativa. Conclusão - Os profissionais de saúde devem, através da educação para a saúde, promover atitudes que promovam a saúde sexual e reprodutiva e promover o desenvolvimento de competências indispensáveis para adoção de comportamentos saudáveis. Palavras-chave - Adolescentes; Sexualidade; Educação sexual; Intervenção formativa.

Safer Conception Among HIV-1 Sero-Discordant Couples in East Africa: Understanding Knowledge, Attitudes, and Experiences

Thesis (Master's)--University of Washington, 2016-06

Dr James George Beaney (1828-1891): A pioneer Australian paediatrician and paediatric surgeon

Dr James George Beaney (1828-1891) was a flamboyant and controversial Melbourne surgeon and paediatrician. He was the first in Australia, in 1859, to publish a medical textbook; and the first, in 1873, to publish a paediatric text, Children: their treatment in health and disease. An analysis of four of his published works relating to paediatrics and paediatric surgery establishes his place as a true pioneer in the chronology of children's medicine and welfare in his adopted land. He undertook heroic yet conservative surgery on children, was the first to write in detail about paediatric anaesthesia, and was the pioneer of family planning in Australia. In Children: their treatment in health and disease, he described in detail the supreme importance of breastfeeding, detailed clear practical concepts for the weaning of infants and discussed the diagnosis and management of diseases of the mouth, ears, eyes and teeth of infants. Beaney was shunned by much of the established medical profession because of his self-promoting flamboyance and his egotism. However, an audit of surviving archives and of his published works affords him a place as another, hitherto unacknowledged true pioneer of Australian paediatrics.

Effectiveness of a mutual support group for families of patients with schizophrenia

Aim. This paper reports a study to examine the effectiveness of a 12-session mutual support group for Chinese families caring for a relative with schizophrenia compared with a psycho-educational group and routine family support services in Hong Kong. Background. Schizophrenia is a disruptive and distressing illness for patients and their families. With the current trend of community care for mental illness, there is evidence that family intervention reduces patient relapse and re-hospitalization, satisfies the health needs of families and enhances their coping capabilities. Methods. A randomized controlled trial was conducted from May 2002 to June 2003 with 96 Chinese families of a relative with schizophrenia selected from two psychiatric outpatient clinics in Hong Kong. Families were randomly assigned to receive mutual support (n = 32), psycho-education (n = 33) or standard care only (n = 31). The interventions were delivered at outpatient clinics over a 6-month period. Pre- and post- (1 week and 6 months) testing took place and families' functioning, mental health service utilization, patients' level of functioning and duration of re-hospitalization were measured. Results. At both post-test periods, family caregivers and patients in the mutual support group reported statistically significant improvements on family and patients' level of functioning, when compared with their counterparts in the psycho-education and standard care groups. Conclusions. The findings support the use of mutual support groups as an effective modality of family intervention in a Chinese population caring for a family member with schizophrenia to improve both family and patient functioning.

Embodied expertise: women's perceptions of the contraception consultation

This research, based on qualitative interviews and non-participant observation, emerges from a larger study investigating what factors influence the ‘contraceptive careers’ of British women in their 30s. The women informants recognized that contraceptive products often impacted on their health, but viewed them as distinct from ‘medical matters’. Rather than doctors being seen as having expertise, it was women health professionals, be they nurses, midwives, health visitors or doctors, who were perceived as the ones who ‘know’ about contraception, through an assumption that they are contraception users.This embodied knowledge is valued by the women above their formal medical training. I will also show how general practice surgeries and family planning clinics were viewed as gendered spaces, which altered the expectations and experiences of the women during contraceptive consultations. This study found that as ‘real’ expertise over contraception stems from embodied rather than textual knowledge, the women’s choices were grounded by a gendered sense of trust.

Three Essays on the Effects of Donor Supplied Contraceptives on Fertility, Usage, and Attitudes

After the 2012 London Summit on Family Planning, there have been major strides in advancing the family planning agenda for low and middle-income countries worldwide. Much of the existing infrastructure and funding for family planning access is in the form of supplying free contraceptives to countries. While the average yearly value of donations since 2000 was over 170 million dollars for contraceptives procured for developing countries, an ongoing debate in the empirical literature is whether increases in contraceptive access and supply drive declines in fertility (UNFPA 2014).

This dissertation explores the fertility and behavioral effects of an increase in contraceptive supply donated to Zambia. Zambia, a high-fertility developing country, receives over 80 percent of its contraceptives from multilateral donors and aid agencies. Most contraceptives are donated and provided to women for free at government clinics (DELIVER 2015). I chose Zambia as a case study to measure the relationship between contraceptive supply and fertility because of two donor-driven events that led to an increase in both the quantity and frequency of contraceptives starting in 2008 (UNFPA 2014). Donations increased because donors and the Zambian government started a systematic method of forecasting contraceptive need on December 2007, and the Mexico City Policy was lifted in January 2009.

In Chapter 1, I investigate whether a large change in quantity and frequency of donated contraceptives affected fertility, using available data on contraceptive donations to Zambia, and birth records from the 2007 and 2013 Demographic and Health Surveys. I use a difference-in-difference framework to estimate the fertility effects of a supply chain improvement program that started in 2011, and was designed to ensure more regularity of contraceptive supply. The increase in total contraceptive supply after the Mexico City Policy was rescinded is associated with a 12 percent reduction in fertility relative to the before period, after controlling for demographic characteristics and time controls. There is evidence that a supply chain improvement program led to significant fertility declines for regions that received the program after the Mexico City Policy was rescinded.

In Chapter 2, I explore the effects of the large increase in donated contraceptives on modern contraceptive uptake. According to the 2007 and 2013 Demographic and Health Surveys, there was a dramatic increase in current use of injectables, implants, and IUDs. Simultaneously, declines occurred in usage of condoms, lactational amenorrhea method (LAM), and traditional methods. In this chapter, I estimate the effect of the increase in donations on uptake, composition of contraceptive usage, and usage of methods based on distance to contraceptive access points. The results show the post-2007 period is associated with an increase in usage of injectables and the pill among women living further away from access points.

In Chapter 3, I explore attitudes towards the contraceptive supply system, and identify areas for improvement, based on qualitative interviews with 14 experts and 61 Zambian users and non-users of contraceptives. The interviews uncover systemic barriers that prevent women from consistently accessing methods, and individual barriers that exacerbate the deficiencies in supply chain procedures. I find that 39 out of 61 women interviewed, both users and non-users, had personal experiences with stock out. The qualitative results suggest that the increase in contraceptives brought to the country after 2007 may have not contributed to as large of a decline in fertility because of bottlenecks in the supply chain, and problems in maintaining stock levels at clinics. I end the chapter with a series of four recommendations for improvements in the supply chain going forward, in light of recent commitments by the Zambian government during the 2012 London Summit on Family Planning.

Estados Unidos y la guerra por el desarrollo: el control de la natalidad en Chile, 1960-1970

Bajo el paradigma de modernización y desarrollo norteamericano -y en un contexto de Guerra Fría-, durante la década de 1960 se adecuaron a la realidad chilena programas de control de natalidad que no sólo buscaron disminuir las altas tasas de mortalidad materno infantil, sino que además respondieron al proyecto de seguridad hemisférica norteamericana de contención a posibles revoluciones populares en países del Tercer Mundo.

Home on a care order: who the children are and what the care order is for

Compared to children in other placements, there is much less known about the characteristics and needs of children in the UK who are returned to their birth parents with a care order still in place. That is in spite of evidence to suggest they face more difficulties than young people in other placements. Based on a 2009 census of looked after children in Northern Ireland, just under 10% (n = 193) were found to be living at home under a care order. Case file reviews were conducted for a quarter of these young people (n = 47) to generate descriptive statistics showing a very diverse population. That was followed by semi-structured interviews with members of eight families (ten children and eight birth parent/s), providing transcripts for thematic analysis. Nearly half of the young people whose case files were reviewed had experienced at least one home placement breakdown, but nearly two thirds had a stable last home placement. Care orders appeared to serve two functions: to give legal authority to social services for the monitoring of placements, and to facilitate family access to family support services. Replacing some care orders with supervision orders might better align legal status and actual function.

Avaliação da sensibilidade médica para o risco de gravidez não planeada

Prémio em Contraceção 2012 da Sociedade Portuguesa de Contraceção

Avaliação da sensibilidade médica para o risco de gravidez não planeada

Prémio em Contraceção 2012 da Sociedade Portuguesa de Contraceção

A prática baseada na evidência : a amamentação como fator preventivo da depressão pós-parto

Enquadramento: É expectável que o pós-parto seja um período de alegria. Todavia, nem sempre é assim, já que pode ser um período marcado por momentos de tristeza, cansaço e desânimo. Reconhecendo as vantagens da amamentação para a saúde e bem-estar do recémnascido e da mãe, acreditamos que esta possa ser preventiva da depressão pós-parto. Objetivos: Obter a melhor evidência científica para compreender se a amamentação tem efeito preventivo na depressão pós-parto. Método: Foi efetuada uma revisão integrativa da literatura sobre a relação entre a amamentação e a depressão pós-parto através das bases de dados: EBSCO host, LILACS, PubMed, SciELO, Repositórios institucionais e Google Académico. Selecionaram-se quinze artigos que obedeceram aos critérios de inclusão deste estudo. Resultados: A maioria dos estudos identifica a amamentação como sendo preventiva da depressão pós-parto, destacando a importância da amamentação para a saúde mental da puérpera e consequentemente para a diminuição das hipóteses de desenvolver depressão pósparto. Cinco artigos identificam-na também como sendo um fator de risco e um estudo não encontrou uma associação clara entre a amamentação e a depressão pós-parto. Conclusões: São descritos vários benefícios da amamentação, os quais terão um efeito preventivo contra a depressão pós-parto. Uma mulher informada e apoiada acerca da amamentação será capaz de se sentir confiante no seu novo papel. É essencial um investimento constante por parte da equipa de saúde, iniciado durante o processo do planeamento do casal para a gravidez, e mantendo-se ao longo da gravidez, parto e pós-parto. Palavras-chave: “Amamentação”, “depressão pós-parto”, “prevenção”.