The regional differences between countries in traffic safety: A cross-cultural study and Turkish Case

Road traffic accidents are a large problem everywhere in the world. However, regional differences in traffic safety between countries are considerable. For example, traffic safety records are much worse in Southern Europe and the Middle East than in Northern and Western Europe. Despite the large regional differences in traffic safety, factors contributing to different accident risk figures in different countries and regions have remained largely unstudied. The general aim of this study was to investigate regional differences in traffic safety between Southern European/Middle Eastern (i.e., Greece, Iran, Turkey) and Northern/Western European (i.e., Finland, Great Britain, The Netherlands) countries and to identify factors related to these differences. We conducted seven sub-studies in which I applied a traffic culture framework, including a multi-level approach, to traffic safety. We used aggregated level data (national statistics), surveys among drivers, and data on traffic accidents and fatalities in the analyses. In the first study, we investigated the influence of macro level factors (i.e., economic, societal, and cultural) on traffic safety across countries. The results showed that a high GNP per capita and conservatism correlated with a low number of traffic fatalities, whereas a high degree of uncertainty avoidance, neuroticism, and egalitarianism correlated with a high number of traffic fatalities. In the second, third, and fourth studies, we examined whether the conceptualisation of road user characteristics (i.e., driver behaviour and performance) varied across traffic cultures and how these factors determined overall safety, and the differences between countries in traffic safety. The results showed that the factorial agreement for driver behaviour (i.e., aggressive driving) and performance (i.e., safety skills) was unsatisfactory in Greece, Iran, and Turkey, where the lack of social tolerance and interpersonal aggressive violations seem to be important characteristics of driving. In addition, we found that driver behaviour (i.e., aggressive violations and errors) mediated the relationship between culture/country and accidents. Besides, drivers from "dangerous" Southern European countries and Iran scored higher on aggressive violations and errors than did drivers from "safe" Northern European countries. However, "speeding" appeared to be a "pan-cultural" problem in traffic. Similarly, aggressive driving seems largely depend on road users' interactions and drivers' interpretation (i.e., cognitive biases) of the behaviour of others in every country involved in the study. Moreover, in all countries, a risky general driving style was mostly related to being young and male. The results of the fifth and sixth studies showed that among young Turkish drivers, gender stereotypes (i.e., masculinity and femininity) greatly influence driver behaviour and performance. Feminine drivers were safety-oriented whereas masculine drivers were skill-oriented and risky drivers. Since everyday driving tasks involve not only erroneous (i.e., risky or dangerous driving) or correct performance (i.e., normal habitual driving), but also "positive" driver behaviours, we developed a reliable scale for measuring "positive" driver behaviours among Turkish drivers in the seventh study. Consequently, I revised Reason's model [Reason, J. T., 1990. Human error. Cambridge University Press: New York] of aberrant driver behaviour to represent a general driving style, including all possible intentional behaviours in traffic while evaluating the differences between countries in traffic safety. The results emphasise the importance of economic, societal and cultural factors, general driving style and skills, which are related to exposure, cognitive biases as well as age, sex, and gender, in differences between countries in traffic safety.

Analyzing changes in macro-level drivers of country-specific emissions : The role of consumption, technology and trade

Industrial ecology is an important field of sustainability science. It can be applied to study environmental problems in a policy relevant manner. Industrial ecology uses ecosystem analogy; it aims at closing the loop of materials and substances and at the same time reducing resource consumption and environmental emissions. Emissions from human activities are related to human interference in material cycles. Carbon (C), nitrogen (N) and phosphorus (P) are essential elements for all living organisms, but in excess have negative environmental impacts, such as climate change (CO2, CH4 N2O), acidification (NOx) and eutrophication (N, P). Several indirect macro-level drivers affect emissions change. Population and affluence (GDP/capita) often act as upward drivers for emissions. Technology, as emissions per service used, and consumption, as economic intensity of use, may act as drivers resulting in a reduction in emissions. In addition, the development of country-specific emissions is affected by international trade. The aim of this study was to analyse changes in emissions as affected by macro-level drivers in different European case studies. ImPACT decomposition analysis (IPAT identity) was applied as a method in papers I III. The macro-level perspective was applied to evaluate CO2 emission reduction targets (paper II) and the sharing of greenhouse gas emission reduction targets (paper IV) in the European Union (EU27) up to the year 2020. Data for the study were mainly gathered from official statistics. In all cases, the results were discussed from an environmental policy perspective. The development of nitrogen oxide (NOx) emissions was analysed in the Finnish energy sector during a long time period, 1950 2003 (paper I). Finnish emissions of NOx began to decrease in the 1980s as the progress in technology in terms of NOx/energy curbed the impact of the growth in affluence and population. Carbon dioxide (CO2) emissions related to energy use during 1993 2004 (paper II) were analysed by country and region within the European Union. Considering energy-based CO2 emissions in the European Union, dematerialization and decarbonisation did occur, but not sufficiently to offset population growth and the rapidly increasing affluence during 1993 2004. The development of nitrogen and phosphorus load from aquaculture in relation to salmonid consumption in Finland during 1980 2007 was examined, including international trade in the analysis (paper III). A regional environmental issue, eutrophication of the Baltic Sea, and a marginal, yet locally important source of nutrients was used as a case. Nutrient emissions from Finnish aquaculture decreased from the 1990s onwards: although population, affluence and salmonid consumption steadily increased, aquaculture technology improved and the relative share of imported salmonids increased. According to the sustainability challenge in industrial ecology, the environmental impact of the growing population size and affluence should be compensated by improvements in technology (emissions/service used) and with dematerialisation. In the studied cases, the emission intensity of energy production could be lowered for NOx by cleaning the exhaust gases. Reorganization of the structure of energy production as well as technological innovations will be essential in lowering the emissions of both CO2 and NOx. Regarding the intensity of energy use, making the combustion of fuels more efficient and reducing energy use are essential. In reducing nutrient emissions from Finnish aquaculture to the Baltic Sea (paper III) through technology, limits of biological and physical properties of cultured fish, among others, will eventually be faced. Regarding consumption, salmonids are preferred to many other protein sources. Regarding trade, increasing the proportion of imports will outsource the impacts. Besides improving technology and dematerialization, other viewpoints may also be needed. Reducing the total amount of nutrients cycling in energy systems and eventually contributing to NOx emissions needs to be emphasized. Considering aquaculture emissions, nutrient cycles can be partly closed through using local fish as feed replacing imported feed. In particular, the reduction of CO2 emissions in the future is a very challenging task when considering the necessary rates of dematerialisation and decarbonisation (paper II). Climate change mitigation may have to focus on other greenhouse gases than CO2 and on the potential role of biomass as a carbon sink, among others. The global population is growing and scaling up the environmental impact. Population issues and growing affluence must be considered when discussing emission reductions. Climate policy has only very recently had an influence on emissions, and strong actions are now called for climate change mitigation. Environmental policies in general must cover all the regions related to production and impacts in order to avoid outsourcing of emissions and leakage effects. The macro-level drivers affecting changes in emissions can be identified with the ImPACT framework. Statistics for generally known macro-indicators are currently relatively well available for different countries, and the method is transparent. In the papers included in this study, a similar method was successfully applied in different types of case studies. Using transparent macro-level figures and a simple top-down approach are also appropriate in evaluating and setting international emission reduction targets, as demonstrated in papers II and IV. The projected rates of population and affluence growth are especially worth consideration in setting targets. However, sensitivities in calculations must be carefully acknowledged. In the basic form of the ImPACT model, the economic intensity of consumption and emission intensity of use are included. In seeking to examine consumption but also international trade in more detail, imports were included in paper III. This example demonstrates well how outsourcing of production influences domestic emissions. Country-specific production-based emissions have often been used in similar decomposition analyses. Nevertheless, trade-related issues must not be ignored.

Pylväskäytävien suojassa : Pompejilainen peristyylipuutarha sosioekonomisen edustamisen muotona

Pro gradu -tutkielmani käsittelee pompejilaisessa yksityistalossa ollutta puutarhaa, jota kiertää pylväskäytävä tai useampia. Tätä tilaa kutsutaan peristyylipuutarhaksi. Peristyyli oli tärkeä osa roomalaisen ja siis myös pompejilaisen talon julkista osaa. Se oli avoin vierailijoille, siksi voidaan olettaa, että peristyylipuutarhalla olisi haluttu esittää omaa vaurautta ja sosiaalista asemaa. Työni keskittyy siihen, miten talon asukkaan varallisuus ja sosiaalinen asema näkyvät peristyylipuutarhassa. Tutkin myös, mitä muuta peristyyli viestii omistajastaan. Tutkimukseni liitteenä on lista Pompejin yksityistalojen peristyyleistä ja niiden tiedoista. Niitä vertailemalla analysoin sitä, millainen tila peristyylipuutarha on ollut. Aineistona tutkielmassani ovat konkreettisesti Pompejin yksityistalojen peristyylipuutarhat ja niiden rakenteet sekä arkeologiset löydöt. Peristyylipuutarhoja on 168 kappaletta. Lisäksi seinämaalaukset ja piirtokirjoitukset välittävät tietoa niin peristyylistä kuin sen omistajasta. Tiedot peristyyleistä olen kerännyt tutkimuskirjallisuudesta löytyneistä luetteloista, joissa on tietoa Pompejin taloista ja puutarhoista. Murto-osassa peristyylipuutarhoista olen käynyt ja kerännyt niistä tietoa työhöni. Huomioin antiikin kirjallisen tradition, sen käsitellessä aihettani. Ensimmäisenä käsittelen peristyylipuutarhaa arkkitehtuurin kannalta. Tutkin, mihin peristyyli on sijoitettu pompejilaisessa talossa ja millaisia arkkitehtonisia ratkaisuja tilassa on käytetty. Peristyyli on usein talon ovelta avautuvalla näköakselilla, joka leikkaa läpi talon tärkeimpien julkisten tilojen. Ne ovat atrium eli eteishalli, tablinum eli vastaanottohuone ja peristyylipuutarha. Aina peristyyli ei ole tällä akselilla. Joissain taloissa peristyyli voi olla atriumin tai tablinumin paikalla. Pompejin peristyyleissä on pylväskäytäviä yhdestä neljään. Usein puutarhaosa on erotettu pylväskäytävistä aidalla. Seuraavaksi tutkin peristyylipuutarhasta löytyneitä rakenteita, irtaimistoa, kasveja ja istutuksia. Tarkastelen näiden yleisyyttä ja sitä, mitä ne kertovat peristyylin käyttötarkoituksesta. Puutarhoissa on ollut vesikouruja, kaivoja, altaita, suihkulähteitä, vesisäiliöitä ja niiden suuaukkojen renkaita. Kiinteitä rakennelmia ovat tricliniumit eli oleskelu- ja ruokailuryhmät, kotijumalien pyhäköt, alttarit, nissit ja katokset. Irtaimia löytöjä on peristyyleissä monenlaisia. Yleisimpiä ovat pöydät, aurinkokellot, lamput, amforat ja erilaiset astiat sekä ruukut. Kasveja on huomioitu vähän Pompejin kaivauksissa, mutta peristyylipuutarhoista on löytynyt merkkejä puista ja pensaista sekä säännöllisistä ja epäsäännöllisistä istutuksista. Viimeisenä käsittelen peristyylipuutarhan koristelua, ja minkälaisen kuvan se välittää talon omistajasta. Puutarhoissa oli veistoksia ja seinämaalauksia. Molemmissa käsitellään luontoaiheita, jotka ovat helposti liitettävissä puutarhaan. Suosittuja ovat myös mytologiset aiheet. Veistoskoristelussa selkeästi yleisin on viinin jumala Dionysos ja häneen liittyvät hahmot. Myös muita jumaluuksia esiintyy kuten Venus. Se ja Dionysos liitettiin antiikissa luontoon ja puutarhaan. Peristyylipuutarha oli monipuolinen tila, jossa eri elämänalueet kohtasivat toisensa. Peristyyleissä voitiin työskennellä. Puutarhaosa saattoi olla hyötykäytössä esimerkiksi kasvimaana. Peristyylissä tai sen ympäristössä oleskeltiin, juhlittiin ja viihdytettiin vieraita, siksi siellä esitettiin omaa varakkuutta runsaalla veistoskoristelulla, altailla ja suihkulähteillä. Jo laaja pinta-alainen peristyyli oli osoitus vauraudesta. Aina ei haluttu näyttää varakkuutta, vaan joskus koristeellinen peristyyli oli syrjässä talon ovelta avautuvalta näköakselilta. Uskonto oli osa peristyyliä, vaikka uskonnon harjoittamiseen liittyvät rakenteet sijoitettiin yleensä talon muihin tiloihin. Uskonto ja mytologia ovat kuitenkin vahvasti läsnä peristyylien koristelussa. Selkeitä poliittisia viittauksia peristyylipuutarhoissa on vähän, mutta roomalaisia piirteitä niissä voidaan havaita. Roomalaiset vaikutteet peristyylin koristelussa ja arkkitehtuurissa viestittävät mahdollisesti talon omistajan roomalaismielisyydestä. Roomalaiset piirteet ovat myös olleet trendejä aikakauden peristyyleissä.

Teini-ikäisten tyttöjen ruokaturva Zambézian kaupungeissa ja maaseudulla

Johdanto Riittämätön ravinnonsaanti haittaa lasten fyysistä ja psyykkistä kasvua. Se myös heikentää Saharan eteläpuoleisen Afrikan tuottavuutta ja taloudellista kehitystä. Erityisen heikossa asemassa ovat lapset ja hedelmällisessä iässä olevat naiset johtuen nopean kasvun, raskauden ja imetyksen aiheuttamista vaatimuksista. Yleensä ruokaturvattomuus johtuu fyysisestä tai taloudellisesta ruoan hankintamahdollisuuden puuttumisesta ja on näin ollen läheisesti yhteydessä köyhyyteen sekä kestävien elinkeinojen ja turvaverkostojen puuttumiseen. Kaupungistumisen myötä monien afrikkalaisten elinkeinot, ruokatottumukset ja elämäntyyli ovat muuttuneet. Koska elämä kaupungeissa poikkeaa monin tavoin elämästä maaseudulla, myös ruokaturva ja sen taustalla olevat tekijät voivat olla erilaiset kaupungissa ja maaseudulla. Tällöin myös ruokaturvaohjelmat tulee suunnitella asuinpaikan mukaan ja kohdistaa voimavarat tarpeen mukaan. Harvat tutkimukset kuitenkaan tarkastelevat ruokaturvaa yhtä aikaa kaupungissa ja maaseudulla, mistä johtuen ruokaturvan erilaisuudesta näissä eri asuinympäristöissä on vähän tietoa. Tutkimuksen tavoite Tutkimuksen tarkoituksena on selvittää teini-ikäisten tyttöjen ruokaturvan taso Zambézian maakunnan maaseudulla ja kaupungeissa sekä tarkastella onko ruokaturva erilainen maaseudulla ja kaupungeissa. Lisäksi selvitetään mitkä tekijät ovat yhteydessä hyvään ruokaturvaan ja ovatko siihen yhteydessä olevat tekijät erilaisia näissä asuinympäristöissä. Aineisto ja menetelmät Tämä pro gradu -tutkielma on osa suomalais-mosambikilaista yhteistyöprojektia: Teini-ikäisten tyttöjen ravitsemus ja ruokavalio Zambéziassa (Estudo do Estado Nutricional e da Dieta em Raparigas Adolescentes na Zambézia). Tutkimus selvittää 15–18-vuotiaiden teinityttöjen ravitsemustilaa, ruokavaliota ja ruokaturvaa maaseudulla ja kaupunkiympäristössä Zambézian maakunnassa, ennen sadonkorjuuta ja sadonkorjuun jälkeen. Tämä osatutkimus perustuu ennen sadonkorjuuta tammi-helmikuussa 2010 kerättyyn aineistoon (n=277). Ruokaturvaa mitattiin Household Food Insecurity Access Scale (HFIAS) -kyselylomakkeella. Taustatietohaastattelusta poimittiin ruokaturvan kannalta mielenkiintoiset tekijät ja tarkasteltiin niiden yhteyttä ruokaturvaan. Tulokset Ruokaturvan havaittiin olevan huomattavasti parempi maaseudulla kuin kaupungissa. Maaseudulla kotieläimiä omistavat perheet kuuluivat harvemmin huonoon ruokaturvaluokkaan, kuin perheet jotka eivät omistaneet eläimiä. Kaupungissa ylimmässä varallisuustertiilissä olevat perheet kuuluivat keskimmäisessä varallisuustertiilissä olevia harvemmin huonoon ruokaturvaluokkaan. Maaseudun ja kaupungin välillä havaittavaa eroa ruokaturvassa selitti varallisuus. Johtopäätökset Maaseutua ja kaupunkeja tulisi ruokaturvatutkimuksissa käsitellä erillisinä tutkimuskohteina. Erilaiset ruokatottumukset saattavat vaikuttaa koettuun ruokaturvaan kaupungeissa ja maaseudulla. Ruokaturvan taustatekijät ovat myös erilaiset, jolloin ruokaturvattomuuden poistaminen vaatii eri toimintatapoja asuinpaikasta riippuen. Varallisuudella saattaa olla suurempi merkitys ruokaturvan kannalta kaupungeissa kuin maaseudulla. Varallisuuden ja ruokaturvan välisen yhteyden selvittäminen kaupungissa ja maaseudulla vaatii kuitenkin luotettavan varallisuusmittarin. Vuodenaika tulisi ottaa huomioon aiempaa paremmin kun tutkitaan kroonista ruokaturvattomuutta. Ruokaturvatutkimuksissa tulisi kerätä tietoa myös ruokavalion monipuolisuudesta ja tehdä antropometrisiä mittauksia, jotta ruokaturvasta saataisiin kokonaisvaltainen kuva.

Perinatal mortality and maternal health in rural China

Background and context Since the economic reforms of 1978, China has been acclaimed as a remarkable economy, achieving 9% annual growth per head for more than 25 years. However, China's health sector has not fared well. The population health gains slowed down and health disparities increased. In the field of health and health care, significant progress in maternal care has been achieved. However, there still remain important disparities between the urban and rural areas and among the rural areas in terms of economic development. The excess female infant deaths and the rapidly increasing sex ratio at birth in the last decade aroused serious concerns among policy makers and scholars. Decentralization of the government administration and health sector reform impacts maternal care. Many studies using census data have been conducted to explore the determinants of a high sex ratio at birth, but no agreement has been so far reached on the possible contributing factors. No study using family planning system data has been conducted to explore perinatal mortality and sex ratio at birth and only few studies have examined the impact of the decentralization of government and health sector reforms on the provision and organization of maternal care in rural China. Objectives The general objective of this study was to investigate the state of perinatal health and maternal care and their determinants in rural China under the historic context of major socioeconomic reforms and the one child family planning policy. The specific objectives of the study included: 1) to study pregnancy outcomes and perinatal health and their correlates in a rural Chinese county; 2) to examine the issue of sex ratio at birth and its determinants in a rural Chinese county; 3) to explore the patterns of provision, utilization, and content of maternal care in a rural Chinese county; 4) to investigate the changes in the use of maternal care in China from 1991 to 2003. Materials and Methods This study is based on a project for evaluating the prenatal care programme in Dingyuan county in 1999-2003, Anhui province, China and a nationwide household health survey to describe the changes in maternal care utilization. The approaches used included a retrospective cohort study, cross sectional interview surveys, informant interviews, observations and the use of statistical data. The data sources included the following: 1) A cohort of pregnant women followed from pregnancy up to 7 days after birth in 20 townships in the study county, collecting information on pregnancy outcomes using family planning records; 2) A questionnaire interview survey given to women who gave birth between 2001 and 2003; 3) Various statistical and informant surveys data collected from the study county; 4) Three national household health interview survey data sets (1993-2003) were utilized, and reanalyzed to described the changes in maternity care utilization. Relative risks (RR) and their confidence intervals (CI) were calculated for comparison between parity, approval status, infant sex and township groups. The chi-square test was used to analyse the disparity of use of maternal care between and within urban and rural areas and its trend across the years in China. Logistic regression was used to analyse the factors associated with hospital delivery in rural areas. Results There were 3697 pregnancies in the study cohort, resulting in 3092 live births in a total population of 299463 in the 20 study townships during 1999-2000. The average age at pregnancy in the cohort was 25.9 years. Of the women, 61% were childless, 38% already had one child and 0.3% had two children before the current pregnancy. About 90% of approved pregnancies ended in a live birth while 73% of the unapproved ones were aborted. The perinatal mortality rate was 69 per thousand births. If the 30 induced abortions in which the gestational age was more than 28 weeks had been counted as perinatal deaths, the perinatal mortality rate would have been as high as 78 per thousand. The perinatal mortality rate was negatively associated with the wealth of the township. Approximately two thirds of the perinatal deaths occurred in the early neonatal period. Both the still birth rate and the early neonatal death rate increased with parity. The risk of a stillbirth in a second pregnancy was almost four times that for a first pregnancy, while the risk of early neonatal deaths doubled. The early neonatal mortality rate was twice as high for female as for male infants. The sex difference in the early neonatal mortality rate was mainly attributable to mortality in second births. The male early neonatal mortality rate was not affected by parity, while the female early neonatal mortality rate increased dramatically with parity: it was about six times higher for second births than for first births. About 82% early neonatal deaths happened within 24 hours after birth, and during that time, girls were almost three times more likely to die than boys. The death rate of females on the day of birth increased much more sharply with parity than that of males. The total sex ratio at birth of 3697 registered pregnancies was 152 males to 100 females, with 118 and 287 in first and second pregnancies, respectively. Among unapproved pregnancies, there were almost 5 live-born boys for each girl. Most prenatal and delivery care was to be taken care of in township hospitals. At the village level, there were small private clinics. There was no limitation period for the provision of prenatal and postnatal care by private practitioners. They were not permitted to provide delivery care by the county health bureau, but as some 12% of all births occurred either at home or at private clinics; some village health workers might have been involved. The county level hospitals served as the referral centers for the township hospitals in the county. However, there was no formal regulation or guideline on how the referral system should work. Whether or not a woman was referred to a higher level hospital depended on the individual midwife's professional judgment and on the clients' compliance. The county health bureau had little power over township hospitals, because township hospitals had in the decentralization process become directly accountable to the township government. In the township and county hospitals only 10-20% of the recurrent costs were funded by local government (the township hospital was funded by the township government and the county hospital was funded by the county government) and the hospitals collected user fees to balance their budgets. Also the staff salaries depended on fee incomes by the hospital. The hospitals could define the user charges themselves. Prenatal care consultations were however free in most township hospitals. None of the midwives made postnatal home visits, because of low profit of these services. The three national household health survey data showed that the proportion of women receiving their first prenatal visit within 12 weeks increased greatly from the early to middle 1990s in all areas except for large cities. The increase was much larger in the rural areas, reducing the urban-rural difference from more than 4 times to about 1.4 times. The proportion of women that received antenatal care visits meeting the Ministry of Health s standard (at least 5 times) in the rural areas increased sharply from 12% in 1991-1993 to 36% in 2001-2003. In rural areas, the proportion increase was much faster in less developed areas than in developed areas. The hospital delivery rate increased slightly from 90% to 94% in urban areas while the proportion increased from 27% to 69% in rural areas. The fastest change was found to be in type 4 rural areas, where the utilization even quadrupled. The overall difference between rural and urban areas was substantially narrowed over the period. Multiple logistic regression analysis shows that time periods, residency in rural or urban areas, income levels, age group, education levels, delivery history, occupation, health insurance and distance from the nearest health care facilities were significantly associated with hospital delivery rates. Conclusions 1. Perinatal mortality in this study was much higher than that for urban areas as well as any reported rate from specific studies in rural areas of China. Previous studies in which calculations of infant mortality were not based on epidemiological surveys have been shown to underestimate the rates by more than 50%. 2. Routine statistics collected by the Chinese family planning system proved to be a reliable data source for studying perinatal health, including still births, neonatal deaths, sex ratio at birth and among newborns. National Household Health Survey data proved to be a useful and reliable data source for studying population health and health services. Prior to this research there were few studies in these areas available to international audiences. 3.Though perinatal mortality rate was negatively associated with the level of township economic development, the excess female early neonatal mortality rate contributed much more to high perinatal mortality rate than economic factors. This was likely a result of the role of the family planning policy and the traditional preferences for sons, which leads to lethal neglect of female newborns and high perinatal mortality. 4. The selective abortions of female foetuses were likely to contribute most to the high sex ratio at birth. The underreporting of female births seemed to have played a secondary role. The higher early neonatal mortality rate in second-born as compared to first-born children, particularly in females, may indicate that neglect or poorer care of female newborn infants also contributes to the high sex ratio at birth or among newborns. Existing family planning policy proved not to effectively control the steadily increased birth sex ratio. 5. The rural-urban gap in service utilization was on average significantly narrowed in terms of maternal healthcare in China from 1991 to 2003. This demonstrates that significant achievements in reducing inequities can be made through a combination of socio-economic development and targeted investments in improving health services, including infrastructure, staff capacities, and subsidies to reduce the costs of service utilization for the poorest. However, the huge gap which persisted among cities of different size and within different types of rural areas indicated the need for further efforts to support the poorest areas. 6. Hospital delivery care in the study county was better accepted by women because most of women think delivery care was very important while prenatal and postnatal care were not. Hospital delivery care was more systematically provided and promoted than prenatal and postnatal care by township hospital in the study area. The reliance of hospital staff income on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care, since delivery care generated much profits than prenatal and postnatal care . Recommendations 1. It is essential for the central government to re-assess and modify existing family planning policies. In order to keep national sex balance, the existing practice of one couple one child in urban areas and at-least-one-son a couple in rural areas should be gradually changed to a two-children-a-couple policy throughout the country. The government should establish a favourable social security policy for couples, especially for rural couples who have only daughters, with particular emphasis on their pension and medical care insurance, combined with an educational campaign for equal rights for boys and girls in society. 2. There is currently no routine vital-statistics registration system in rural China. Using the findings of this study, the central government could set up a routine vital-statistics registration system using family planning routine work records, which could be used by policy makers and researchers. 3. It is possible for the central and provincial government to invest more in the less developed and poor rural areas to increase the access of pregnant women in these areas to maternal care services. Central government together with local government should gradually provide free maternal care including prenatal and postnatal as well as delivery care to the women in poor and less developed rural areas. 4. Future research could be done to explore if county and the township level health care sector and the family planning system could be merged to increase the effectiveness and efficiency of maternal and child care. 5. Future research could be done to explore the relative contribution of maternal care, economic development and family planning policy on perinatal and child health using prospective cohort studies and community based randomized trials. Key words: perinatal health, perinatal mortality, stillbirth, neonatal death, sex selective abortion, sex ratio at birth, family planning, son preference, maternal care, prenatal care, postnatal care, equity, China

Microfinance, Efficiency and Agricultural Production in Bangladesh

The objectives of this study were to make a detailed and systematic empirical analysis of microfinance borrowers and non-borrowers in Bangladesh and also examine how efficiency measures are influenced by the access to agricultural microfinance. In the empirical analysis, this study used both parametric and non-parametric frontier approaches to investigate differences in efficiency estimates between microfinance borrowers and non-borrowers. This thesis, based on five articles, applied data obtained from a survey of 360 farm households from north-central and north-western regions in Bangladesh. The methods used in this investigation involve stochastic frontier (SFA) and data envelopment analysis (DEA) in addition to sample selectivity and limited dependent variable models. In article I, technical efficiency (TE) estimation and identification of its determinants were performed by applying an extended Cobb-Douglas stochastic frontier production function. The results show that farm households had a mean TE of 83% with lower TE scores for the non-borrowers of agricultural microfinance. Addressing institutional policies regarding the consolidation of individual plots into farm units, ensuring access to microfinance, extension education for the farmers with longer farming experience are suggested to improve the TE of the farmers. In article II, the objective was to assess the effects of access to microfinance on household production and cost efficiency (CE) and to determine the efficiency differences between the microfinance participating and non-participating farms. In addition, a non-discretionary DEA model was applied to capture directly the influence of microfinance on farm households production and CE. The results suggested that under both pooled DEA models and non-discretionary DEA models, farmers with access to microfinance were significantly more efficient than their non-borrowing counterparts. Results also revealed that land fragmentation, family size, household wealth, on farm-training and off farm income share are the main determinants of inefficiency after effectively correcting for sample selection bias. In article III, the TE of traditional variety (TV) and high-yielding-variety (HYV) rice producers were estimated in addition to investigating the determinants of adoption rate of HYV rice. Furthermore, the role of TE as a potential determinant to explain the differences of adoption rate of HYV rice among the farmers was assessed. The results indicated that in spite of its much higher yield potential, HYV rice production was associated with lower TE and had a greater variability in yield. It was also found that TE had a significant positive influence on the adoption rates of HYV rice. In article IV, we estimated profit efficiency (PE) and profit-loss between microfinance borrowers and non-borrowers by a sample selection framework, which provided a general framework for testing and taking into account the sample selection in the stochastic (profit) frontier function analysis. After effectively correcting for selectivity bias, the mean PE of the microfinance borrowers and non-borrowers were estimated at 68% and 52% respectively. This suggested that a considerable share of profits were lost due to profit inefficiencies in rice production. The results also demonstrated that access to microfinance contributes significantly to increasing PE and reducing profit-loss per hectare land. In article V, the effects of credit constraints on TE, allocative efficiency (AE) and CE were assessed while adequately controlling for sample selection bias. The confidence intervals were determined by the bootstrap method for both samples. The results indicated that differences in average efficiency scores of credit constrained and unconstrained farms were not statistically significant although the average efficiencies tended to be higher in the group of unconstrained farms. After effectively correcting for selectivity bias, household experience, number of dependents, off-farm income, farm size, access to on farm training and yearly savings were found to be the main determinants of inefficiencies. In general, the results of the study revealed the existence substantial technical, allocative, economic inefficiencies and also considerable profit inefficiencies. The results of the study suggested the need to streamline agricultural microfinance by the microfinance institutions (MFIs), donor agencies and government at all tiers. Moreover, formulating policies that ensure greater access to agricultural microfinance to the smallholder farmers on a sustainable basis in the study areas to enhance productivity and efficiency has been recommended. Key Words: Technical, allocative, economic efficiency, DEA, Non-discretionary DEA, selection bias, bootstrapping, microfinance, Bangladesh.