Summary Background Family planning is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. We aimed to estimate the effect of contraceptive use ...on maternal mortality and the expected reduction in maternal mortality if the unmet need for contraception were met, at country, regional, and world levels. Method We extracted relevant data from the Maternal Mortality Estimation Inter-Agency Group (MMEIG) database, the UN World Contraceptive Use 2010 database, and the UN World Population Prospects 2010 database, and applied a counterfactual modelling approach (model I), replicating the MMEIG (WHO) maternal mortality estimation method, to estimate maternal deaths averted by contraceptive use in 172 countries. We used a second model (model II) to make the same estimate for 167 countries and to estimate the effect of satisfying unmet need for contraception. We did sensitivity analyses and compared agreement between the models. Findings We estimate, using model I, that 342 203 women died of maternal causes in 2008, but that contraceptive use averted 272 040 (uncertainty interval 127 937–407 134) maternal deaths (44% reduction), so without contraceptive use, the number of maternal deaths would have been 1·8 times higher than the 2008 total. Satisfying unmet need for contraception could prevent another 104 000 maternal deaths per year (29% reduction). Interpretation Numbers of unwanted pregnancies and unmet contraceptive need are still high in many developing countries. We provide evidence that use of contraception is a substantial and effective primary prevention strategy to reduce maternal mortality in developing countries. Funding Bill and Melinda Gates Foundation.
Contraceptive Practice in sub-Saharan Africa Tsui, Amy O.; Brown, Win; Li, Qingfeng
Population and development review,
20/May , Letnik:
43, Številka:
Suppl Suppl 1
Journal Article
Recenzirano
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Forty eight of the African continent's 54 sovereign states are located in the Sub-Saharan Africa (SSA) region, with the government of each defining and shaping its own health services and delivery ...systems. This paper reviews the trends and patterns of contraceptive practice in the region. Using survey data available from the Demographic and Health Surveys and Performance Monitoring and Accountability 2020, the study finds modern contraceptive practice to be on the rise overall but with much geographic variation. The contraceptive methods most frequently used are injectables and, more recently, implants. Higher levels of use are observed among unmarried sexually active than married females. Although use is rising, contraceptive discontinuation rates are also high. Recent program initiatives discussed include expanding long-acting contraceptive options, promoting and delivering contraceptive methods in the postpartum period, and relying on community health workers for contraceptive outreach and service delivery. SSA's family planning situation remains challenged by weak health systems which must address competing priorities to manage disease prevention as well as primary health care. Increasing investments in family planning delivery in many SSA countries, however, augur for continued rapid uptake of modern contraception, possibly matching if not outpacing the record of other regions.
Relative to the attention given to improving the quality of and access to maternal health services, the influence of women's socio-economic situation on maternal health care use has received scant ...attention. The objective of this paper is to examine the relationship between women's economic, educational and empowerment status, introduced as the 3Es, and maternal health service utilization in developing countries.
The analysis uses data from the most recent Demographic and Health Surveys conducted in 31 countries for which data on all the 3Es are available. Separate logistic regression models are fitted for modern contraceptive use, antenatal care and skilled birth attendance in relation to the three covariates of interest: economic, education and empowerment status, additionally controlling for women's age and residence. We use meta-analysis techniques to combine and summarize results from multiple countries. The 3Es are significantly associated with utilization of maternal health services. The odds of having a skilled attendant at delivery for women in the poorest wealth quintile are 94% lower than that for women in the highest wealth quintile and almost 5 times higher for women with complete primary education relative to those less educated. The likelihood of using modern contraception and attending four or more antenatal care visits are 2.01 and 2.89 times, respectively, higher for women with complete primary education than for those less educated. Women with the highest empowerment score are between 1.31 and 1.82 times more likely than those with a null empowerment score to use modern contraception, attend four or more antenatal care visits and have a skilled attendant at birth.
Efforts to expand maternal health service utilization can be accelerated by parallel investments in programs aimed at poverty eradication (MDG 1), universal primary education (MDG 2), and women's empowerment (MDG 3).
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This article explores teachers' identity formation through a narrative inquiry of the professional identity of an EFL teacher, Minfang, in the People's Republic of China. Drawing on Wenger's (1998) ...social theory of identity formation as a dual process of identification and negotiation of meanings, it examines the lived experience of Minfang as an EFL learner and EFL teacher throughout his 6 years of teaching, the processes that were involved as he struggled with multiple identities, the interplay between reification and negotiation of meanings, and the institutional construction and his personal reconstruction of identities. The stories of Minfang highlighted the complex relationships between membership, competence, and legitimacy of access to practice; between the appropriation and ownership of meanings, the centrality of participation, and the mediating role of power relationships in the processes of identity formation.
Gendered economic and social systems can enable relational power disparities for adolescent girls and young women (AGYW), and undercut autonomy to negotiate sex and contraceptive use. Less is known ...about their accumulation and interplay. This study characterizes relationship power imbalances (age disparity, intimate partner violence IPV, partner-related fear, transactional sex, and transactional partnerships), and evaluates associations with modern contraceptive use, and sexual/reproductive autonomy threats (condom removal/"stealthing", reproductive coercion, ability to refuse sex, and contraceptive confidence).
Cross-sectional surveys were conducted with unmarried, currently-partnered AGYW aged 15-24 recruited via respondent-driven sampling in Abidjan, Côte d'Ivoire (n = 555; 2018-19), Nairobi, Kenya (n = 332; 2019), and Lagos, Nigeria (n = 179; 2020). Descriptive statistics, Venn diagrams, and multivariate regression models characterized relationship power imbalances, and associations with reproductive autonomy threats and contraceptive use.
Relationship power imbalances were complex and concurrent. In current partnerships, partner-related fears were common (50.4%Nairobi; 54.5%Abidjan; 55.7%Lagos) and physical IPV varied (14.5%Nairobi; 22.1%Abidjan; 9.6%Lagos). IPV was associated with reproductive coercion in Nairobi and Abidjan. Age disparate relationships undermined confidence in contraception in Nairobi. In Nairobi and Lagos, transactional sex outside the relationship was associated with condom stealthing.
AGYW face simultaneous gendered power differentials, against the backdrop of gendered social and economic systems. Power imbalances were linked with coercive sexual/reproductive health experiences which are often underrecognized yet represent a potent link between gendered social systems and poor health. Pregnancy prevention efforts for AGYW must address reproductive autonomy threats, and the relational power imbalances and broader gendered systems that enable them.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Measuring contraceptive use in India Kumar, Kaushalendra; Singh, Abhishek; Tsui, Amy O.
Demographic research,
07/2022, Letnik:
47
Journal Article
Recenzirano
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India's National Family Health Surveys (NFHS) have provided critical population-level data to inform public policy and research. Although fertility declined, NFHS-4 (2015-2016) reported lower modern ...contraceptive and female sterilization use compared with NFHS-3 (2005-2006). This study assesses selected survey design and interviewer factors' influences on respondent reporting of modern contraceptive and female sterilization use. With data on 582,144 married childbearing-aged females, the analysis pursues multivariable logistic models of both outcomes using survey covariates, assesses interviewer deviance residuals, and estimates multi-level cross-classified random intercept models for state, cluster and interviewer effects. Adjusted odds ratios (AORs) for reporting modern use in NFHS-4 versus NFHS-3 were 1.21 (1.17-1.26) and 1.66 (1.59-1.74) for sterilization. The AOR for each interview month after survey launch was 1.16 (1.15-1.17) for modern use and 1.18 (1.16-1.19) for sterilization. The AOR for respondents interviewed in the first versus second survey phase was 1.35 (1.30-1.40) for modern methods and 1.12 (1.07-1.17) for female sterilization. Interviewer deviance residuals for both contraceptive outcomes were larger in NFHS-4 than NFHS-3. Eliminating problematic interviews raised modern use 2.0% points and sterilization 1.3% points. Larger state, community cluster and interviewer effects were observed for NFHS-4 versus NFHS-3. The five-fold expansion of NFHS-4's sample likely challenged pre-existing survey protocols and may have lowered modern method use by up to 6% points and female sterilization by 2% points.
Medium of instruction policies in education have considerable impact not only on the school performance of students and the daily work of teachers, but also on various forms of social and economic ...(in)equality.
In many multiethnic and multilingual countries, the choice of a language for the medium of instruction in state educational systems raises a fundamental and complex educational question: what combination of instruction in students' native language(s) and in a second language of wider communication will ensure that students gain both effective subject-content education, as well as the second-language skills necessary for higher education and employment? Beyond this educational issue of choice of language(s) of instruction, medium of instruction policies are also linked to a range of important sociopolitical issues, including globalization, migration, labor policy, elite competition, and the distribution of economic resources and political power. The contributors to this volume examine the tension between the educational agendas and other social and political agendas underlying medium of instruction policies in different countries around the world, and unravel the connections between these policies and the related, critically important educational, social, political, and economic issues.
Medium of Instruction Policies: Which Agenda? Whose Agenda? is intended for scholars and specialists in education, language policy, sociolinguistics, applied linguistics, and language teaching, and is intended for use in graduate and advanced undergraduate courses on language education and language policy.
Contents: Preface. A.B.M. Tsui, J.W. Tollefson, The Centrality of Medium-of-Instruction Policy in Sociopolitical Processes. Part I: Minority Languages in English-Dominant States. S. May, Maori-Medium Education in Aotearoa/New Zealand. D.V. Jones, M. Martin-Jones, Bilingual Education and Language Revitalization in Wales: Past Achievements and Current Issues. T.L. McCarty, Dangerous Difference: A Critical-Historical Analysis of Language Education Policies in the United States. Part II: Language in Post-Colonial States. A.B.M. Tsui, Medium of Instruction in Hong Kong: One Country, Two Systems, Whose Language? A. Pakir, Medium-of-Instruction Policy in Singapore. S.K. Gill, Medium-of-Instruction Policy in Higher Education in Malaysia: Nationalism Versus Internationalization. I. Nical, J.J. Smolicz, M.J. Secombe, Rural Students and the Philippine Bilingual Education Program on the Island of Leyte. E. Annamalai, Medium of Power: The Question of English in Education in India. H. Alidou, Medium of Instruction in Post-Colonial Africa. Part III: Managing and Exploiting Language Conflict. V. Webb, Language Policy in Post-Apartheid South Africa. K.A. King, C. Benson, Indigenous Language Education in Bolivia and Ecuador: Contexts, Changes, and Challenges. J.W. Tollefson, Medium of Instruction in Slovenia: European Integration and Ethnolinguistic Nationalism. J.W. Tollefson, A.B.M. Tsui, Contexts of Medium-of-Instruction Policy.
The importance of the family planning service environment and community-level factors on contraceptive use has long been studied. Few studies, however, have been able to link individual and health ...facility data from surveys that are nationally representative, concurrently fielded, and geographically linked. Data from Performance Monitoring and Accountability 2020 address these limitations. To assess the relative influences of the service delivery environment and community, household, and individual factors on a woman's likelihood of using a modern contraceptive in five geographically and culturally diverse sub-Saharan African countries. Nationally representative, cross-sectional data from PMA2020 were linked at the household and service delivery level. Country-specific and pooled multilevel multinomial logistic models, comparing non-users, short- and long-acting method users were used. The variables elected for inclusion in our multivariate analyses were guided by the conceptual framework to profile the different levels of influences on individual use of modern contraception. Average marginal effects were calculated to improve interpretability. We find that the effect of contextual factors varies widely but that being visited by a health worker who spoke about family planning in the past 12 months was consistently and positively associated with individual use of short-acting and long-acting contraception. Characteristics of the nearest health facility did not generally exercise their own independent influences on a woman's use of contraception, except in the case of Burkina Faso, where the average distance between individuals and the nearest family planning provider was significantly greater than other countries. Inclusion of country fixed effects in the pooled models and the relevance of covariates at different levels in the country-specific models demonstrate that there is significant variation across countries in how community, individual, and service delivery environment factors influence contraceptive use and method choice. Context must be taken into account when designing family planning programs.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Contraception and health Cleland, John, Prof; Conde-Agudelo, Agustin, MD; Peterson, Herbert, Prof ...
The Lancet (British edition),
07/2012, Letnik:
380, Številka:
9837
Journal Article
Recenzirano
Increasing contraceptive use in developing countries has cut the number of maternal deaths by 40% over the past 20 years, merely by reducing the number of unintended pregnancies. By preventing ...high-risk pregnancies, especially in women of high parities, and those that would have ended in unsafe abortion, increased contraceptive use has reduced the maternal mortality ratio—the risk of maternal death per 100 000 livebirths—by about 26% in little more than a decade. A further 30% of maternal deaths could be avoided by fulfilment of unmet need for contraception. The benefits of modern contraceptives to women's health, including non-contraceptive benefits of specific methods, outweigh the risks. Contraception can also improve perinatal outcomes and child survival, mainly by lengthening interpregnancy intervals. In developing countries, the risk of prematurity and low birthweight doubles when conception occurs within 6 months of a previous birth, and children born within 2 years of an elder sibling are 60% more likely to die in infancy than are those born more than 2 years after their sibling.
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