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Missing men, missing infertility: The enactment of sex/gender in surveys in low- and middle-income countries

Abstract

Although reproduction involves (at least) two sexed bodies, men are often missing from in/fertility research. Surveys such as the widely-used Demographic and Health Surveys (DHS) engage in often unintentional yet highly consequential practices of gendering. Here we identify two processes through which surveys have the potential to render male infertility invisible: defining the population at risk of infertility in an exclusionary way; and designing survey instruments to select out some groups/issues. Compiling information about survey samples and inclusion criteria in the DHS, and combining this with a qualitative examination of instrument design, we identify areas of men’s invisibility across time and place. While inclusion of men in DHS samples has increased over time, some men (e.g. single and divorced, transgender) remain missing in many survey settings. This is problematic from a reproductive justice perspective. Survey results, which both reflect and contribute to men’s invisibility, are widely used as an evidence-base for family and population policies. Moreover, reproductive health services are only made available to those whose reproductive health needs are recognized; men’s exclusion from the reproductive discourse contributes to the stratification of reproduction. Men’s underrepresentation in in/fertility data also reinforces the notion that reproduction is a woman’s domain, and so contributes to a system that places responsibility for reproduction on women. It is vital to explore how gender is enacted or ‘done’ in such research.

Open access
Mothering at a distance and disclosure of maternal HIV to children in Kingston, Jamaica

Abstract

Existing guidelines (WHO, 2011) advise caretakers and professionals to disclose children’s and their caretakers’ HIV status to children, despite a lack of evidence concerning the potential implications in resource-constrained settings. Our research uses feminist Interpretative Phenomenological Analysis (IPA) to explore the experiences of HIV positive mothers in Kingston, Jamaica, focusing on their lived experiences of talking to their children about maternal HIV. This paper will focus on the concept of mothering at a distance and how this presents additional challenges for HIV positive mothers who are trying to establish emotional closeness in relation to talking to their children about their HIV. Using Hochschild’s concept of emotion work and examples from the interviews, we highlight the difficult contexts informing women’s decisions when negotiating discussions about their HIV. Women may choose full, partial or differential disclosure or children may be told their mother’s HIV status by others. Disclosure policy, we argue, reflects Anglo-Northern constructions of the family and parenting which may not adequately reflect the experiences of poor urban mothers in low and middle income countries. We argue that policy needs to recognise culturally-specific family formations, which, in Jamaica includes absent fathers, mothering at a distance and mothering non-biological children. This article reflects on the experiences of an under-researched group, poor urban Jamaican women practising mothering at a distance, using a novel methodological approach (IPA) to bring into relief unique insights into their lived experiences and will contribute to the global policy and research literature on HIV disclosure.

Open access
Changes in demand for children between 2003 and 2013 in Nigeria: Evidence from survey data

Abstract

Nigeria has one of the highest fertility rates in Africa. Data from 2013 Demographic and Health Surveys indicate a virtual stagnation of fertility rate since 2003. Low contraceptive use and pronatalist attitudes are among the factors contributing to the high fertility rate in Nigeria. In this manuscript, we pooled data from three most recent waves of Demographic and Health Surveys to examine trends in demand for children over time and identify the factors associated with change in demand for children. The data show that demand for children has declined since 2003 although not monotonically so. Variables that were positively associated with increased likelihood of desiring no additional children were residence in the South-West (as opposed to residence in the North-Central), exposure to family planning (FP) messages on the mass media, number of children ever born, educational level, and urban residence. In contrast, uncertainty about fertility desire was more widespread in 2008 compared to 2013 although less widespread in 2003 than in 2013. The likelihood of being undecided about fertility desire was positively associated with discrepancies in family size desires between husband and wife, parity and Islamic religious affiliation. Programs should aim to increase access to effective contraceptive methods and promote demand for contraceptives as a way of fostering a sustainable reduction in demand for children. Furthermore, strategies that address uncertainty by fostering women’s understanding of the social and health implications of large family sizes are relevant.

Open access
Potentials for demographic dividend and rapid economic growth in Mali: What policy scenario would yield the greatest dividend?

Abstract

The demographic changes occurring in Mali, evident in high fertility but declining mortality rates have raised optimism about the prospects of reaping demographic dividend. However, it remains unclear how soon and what policy scenario would yield the largest demographic dividend in the country. We used a demographic-economic model “DemDiv” to assess the prospects of reaping a demographic dividend in Mali by 2050. We illuminate this further by examining the cost and implications of different combination of education, family planning and economic policies. The results show that by increasing access to education, family planning services coupled with strong economic reforms, Mali’s GDP per capita will be $27,044 by 2050. This high per capita GDP is almost thrice the benefit of prioritising only economic reforms. Mali would also have a GDP of $977 billion. These findings highlight the need for sound demographic and market-oriented economic policies for Mali to reap a large demographic dividend by 2050.

Open access
What is the association between IPV and Fertility in Uganda?

Abstract

IPV, which emanates as a severe consequence of gender inequality in society, is the most pervasive form of IPV as most cases of abuse is perpetrated by intimate partners and has major health consequences for women. Women with a history of abuse are also at increased risk of reproductive health outcomes; such as high parity, inconsistent and lower levels of contraceptive use, unintended pregnancies, and adverse pregnancy outcomes. Despite concerted efforts by African governments, fertility levels in the region remain high. Africa is the region that has been least responsive to family planning programmes. This study investigates the associations between IPV and fertility in Uganda, using the Ugandan Demographic and Health Survey of 2011. Adult women of reproductive ages (15-49) that were included in the domestic violence module of the individual recode, were included in this study. Univariate, bivariate analysis, and unadjusted and adjusted Poisson Regression models were conducted for children ever born and the different forms of IPV (emotional, physical and sexual), as well as the socio-demographic and women’s empowerment variables. Both bivariate and multivariate analyses show a strong association between both these pervasive health problematics; and may therefore be one of the unexplained proximate determinants of persistently high fertility in countries such as Uganda. These results have important implications for understanding both the fertility transition in Uganda, but also for programmes and policies addressing unwanted pregnancies and unmet need for contraception that is driving fertility up, and IPV amongst women which we know from previous work has severe reproductive health outcomes but which we have now identified is a contributor to high fertility as well.

Open access
Ageing and health in the Arab region: Challenges, opportunities and the way forward

Abstract

In many countries of the Arab region, the demographic transition is already underway with a decrease in fertility and mortality and a rise in the proportion of older adults. Longer life expectancies and higher burden of non-communicable disease co-morbidities bring new health and social concerns to families, societies and governments. In a number of countries in the Arab region, this is compounded with political turmoil, forced displacement, dynamic migration flows and economic and social instability that deplete family cohesion and exhaust societal resources. Such challenges require systematic changes to healthcare and social services delivery. Amidst a number of strategies for interventions that aim at maximizing health and well-being in old age, we focus in this paper on three fundamental approaches that are largely lacking in the Arab region: an integrated and holistic model of healthcare, policies and programmes that incentivize ageing in place and homecare, and knowledge production addressing local concerns and priorities.

Open access
Ageing in the Middle East and North Africa
Measuring Population Ageing Using Prospective Instead of Chronological Age
Open access