Lower infant mortality, higher household size, and more access to contraception reduce fertility in low- and middle-income nations

Challenges in reducing grand multiparity rates in Ethiopia: an analysis of 2019 EDHS data using a multilevel model approach

BACKGROUND

One of the Sustainable Development Goals (2030) focuses on reducing the total fertility rate. Reducing grand multiparity in Ethiopia remains a challenge. Understanding the underlying factors that contribute to this issue is crucial for explaining why grand multiparity remains prevalent despite various health interventions and socio-economic progress.

METHODS

A community-based cross-sectional study was conducted using data from the Ethiopian Demographic and Health Survey 2019. Multilevel multivariable logistic regression analysis was employed to model the hierarchical data. The final findings were presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant.

RESULT

The trend analysis of grand multiparity in Ethiopia over 19 years shows no significant change (linear trend = 1.23, p = 0.27). The prevalence slightly decreased from 72% in the 2000 EDHS to 66.3% (95% CI: 65.7 - 66.96%) in the 2019 mini EDHS. Additionally, the highest prevalence of grand multiparity was observed among illiterate women (79.7%), those from poor households (54.8%), non-family planning users (77.5%), and residents of the Oromia (15.8%) and SNNPR (15.4%) regional states. Significant individual-level factors associated with grand multiparity include wealth index, marital status, maternal education, non-use of family planning, use of short-acting family planning, age at first birth < 18 years, and short birth intervals. At the community level, rural residency was significantly associated with grand multiparity.

CONCLUSION

This study emphasizes the need for targeted interventions to address the socio-economic and reproductive factors driving grand multiparity, especially in rural areas and among disadvantaged populations. To improve maternal and child health outcomes, we recommend that the government focus on lowering fertility rates through need-based family planning services and promoting the well-being of women of reproductive age.

Causes and determinants of infant mortality using verbal autopsy and social autopsy methods in a rural population of Odisha: a community-based matched case-control study

BACKGROUND

The avoidable causes of infant mortality should be identified, and interventions should be made to improve the infant mortality rate. The cause of infant deaths should be assessed in both medical and social contexts.

OBJECTIVES

We aimed to determine the medical causes of infant mortality by verbal autopsy and its determinants in two rural blocks of the Khordha district of Odisha and assess the pathway of care and delay in seeking care for the illness preceding infant death using the three-delay model.

DESIGN

We conducted this community-based matched case-control study to identify the medical causes of infant mortality using the verbal autopsy method along with the identification of delay and pathway of care related to infant deaths using a social autopsy method.

SETTINGS

Two rural blocks of Odisha, India.

PARTICIPANTS

We enumerated 100 infant deaths by active surveillance and data triangulation from Accredited Social Health Activists, Auxiliary Nurse Midwives and block-level health information systems. We selected an equal number of alive infants matched with cases in a 1:1 ratio with regard to age, gender and residential address.

OUTCOME MEASURES

We conducted the verbal autopsy using the Sample Registration System verbal autopsy tool, where the cause of death ascertainment was done by two independently trained physicians followed by adjudication by one senior trained physician in case of conflicts. We used the prevalidated International Network for the Demographic Evaluation of Population and Their Health tool to assess three delays and pathways of care related to infant deaths.

RESULTS

Most infant deaths (70%) happened during the first day of life, and almost 50% of neonatal deaths occurred during the first week of life. The three most common causes of infant mortality were birth asphyxia (30%), pneumonia (18%), prematurity and low birth weight (14%). Larger family size (>5) and the education status of fathers till class 10 were significant determinants of infant mortality. Among the 49 infants whose illnesses were identified at home, 2 died at home without receiving any care. Formal or informal care was sought for 32 and 8 infants, respectively. The median delay was found to be 24 hours for level 1 delay. Level 1 delay was observed for 20 cases (40.8%), with more than 24 hours in decision-making in care-seeking. Thirty-seven (75.5%) sick infants reached the healthcare facility 30 min after deciding to seek care.

CONCLUSION

Birth asphyxia, pneumonia prematurity and low birth weight were found to be the common causes of infant mortality, with larger family sizes and lower education status among fathers being the significant determinants of infant mortality. We observed a significant delay in decision-making regarding seeking care among caregivers of sick infants.

The Combined Contributions of Newborn Stress and Parenting Stress on Toddler Language Development

OBJECTIVE

To examine the longitudinal associations between newborn neurobehavioral stress signs, maternal parenting stress, and several indices of toddler language development.

STUDY DESIGN

Participants include 202 mother-infant dyads (104 girls). We measured stress signs in neonates in the hospital at least 24 hours after birth using the Neonatal Intensive Care Unit Network Neurobehavioral Scale. At 7 months, parenting stress (competence, attachment, and role restriction) was assessed using the Parenting Stress Index. At 18 months, mothers completed the Communicative Development Inventories, which measured toddler gesturing, expressive vocabulary, and receptive vocabulary. Longitudinal path modeling was used to estimate associations between neonatal stress signs, parenting stress, and toddler language, and a model was generated for each language outcome. Child sex, birth weight, and family income were included as covariates.

RESULTS

Infants who exhibited greater neurobehavioral stress signs at birth produced significantly fewer social-communicative gestures at 18 months of age. Among infants whose mothers reported low (but not high) levels of parenting stress during the first postnatal year, newborn stress signs were negatively associated with 18-month-olds' receptive vocabulary size. Neither newborn stress signs nor parenting stress were significantly related to toddler expressive vocabulary size.

CONCLUSIONS

Our findings uncover a negative association between newborn stress signs and toddler gesturing. Furthermore, our results suggest that caregiver stress and neonatal stress signs interact to predict toddler receptive vocabulary. Taken together, these results demonstrate that some neonates who exhibit increased neurobehavioral stress signs may be at heightened risk for experiencing language difficulties. These children may benefit from additional support in infancy.

Net benefit of smaller human populations to environmental integrity and individual health and wellbeing

Introduction

The global human population is still growing such that our collective enterprise is driving environmental catastrophe. Despite a decline in average population growth rate, we are still experiencing the highest annual increase of global human population size in the history of our species-averaging an additional 84 million people per year since 1990. No review to date has accumulated the available evidence describing the associations between increasing population and environmental decline, nor solutions for mitigating the problems arising.

Methods

We summarize the available evidence of the relationships between human population size and growth and environmental integrity, human prosperity and wellbeing, and climate change. We used PubMed, Google Scholar, and Web of Science to identify all relevant peer-reviewed and gray-literature sources examining the consequences of human population size and growth on the biosphere. We reviewed papers describing and quantifying the risks associated with population growth, especially relating to climate change.

Results

These risks are global in scale, such as greenhouse-gas emissions, climate disruption, pollution, loss of biodiversity, and spread of disease-all potentially catastrophic for human standards of living, health, and general wellbeing. The trends increasing the risks of global population growth are country development, demographics, maternal education, access to family planning, and child and maternal health.

Conclusion

Support for nations still going through a demographic transition is required to ensure progress occurs within planetary boundaries and promotes equity and human rights. Ensuring the wellbeing for all under this aim itself will lower population growth and further promote environmental sustainability.

Knowledge and practice of family planning among pregnant tribal women in Southern India: an observational study

BACKGROUND

There are over 700 Scheduled Tribes (ST) living in 30 Indian states. As with other indigenous groups across the world, Indian ST have some of the poorest infant and child health outcomes of any communities in India. A child born to an ST family is 19% more likely to die in the first month of life and has a 45 percent risk of dying in their first year compared with other Indian populations. Research suggests that early conception, high fertility, and low use of family planning methods are large contributors to these disparities.

METHODS

A cross sectional survey in Kannada was conducted among 303 pregnant tribal women in Mysore, India after obtaining informed consent. Univariate and multivariable analyses were carried out to determine the demographic and psychosocial factors associated with knowledge of contraceptive methods using Stata 14.0.

RESULTS

There was widespread knowledge about female sterilization, while only 39.3% of women reported hearing about one or more forms of temporary contraception, and 36.3% knew where to get them. The largest proportion of women had heard about copper-T (33.0%), followed by oral contraceptive pills (23.8%), condoms (11.9%), and injectables (4.6%). Only 2.7% of women reported ever using any form of temporary contraception. Results from the multivariable logistic regression indicated that knowledge of at least one form of temporary contraception was linked to higher age (adjusted odds ratio[AOR]: 1.09; 95% CI: 1.02, 1.17), greater number of years of marriage (AOR: 0.90; 95% CI: 0.85, 0.96), and last birth in a government facility (AOR: 3.67; 95% CI: 1.99, 6.82).

CONCLUSIONS

The study revealed poor knowledge and utilization of temporary contraceptive methods among a tribal population in rural Mysore, India. Interventions aiming to increase knowledge of contraceptive options are important for birth spacing in this population and should target younger women and those without contact with government health facilities.

An evolutionary perspective on social inequality and health disparities: Insights from the producer-scrounger game

There is growing concern with social disparities in health, whether relating to gender, ethnicity, caste, socio-economic position or other axes of inequality. Despite addressing inequality, evolutionary biologists have had surprisingly little to say on why human societies are prone to demonstrating exploitation. This article builds on a recent book, 'The Metabolic Ghetto', describing an overarching evolutionary framework for studying all forms of social inequality involving exploitation. The dynamic 'producer-scrounger' game, developed to model social foraging, assumes that some members of a social group produce food, and that others scrounge from them. An evolutionary stable strategy emerges when neither producers nor scroungers can increase their Darwinian fitness by changing strategy. This approach puts food systems central to all forms of human inequality, and provides a valuable lens through which to consider different forms of gender inequality, socio-economic inequality and racial/caste discrimination. Individuals that routinely adopt producer or scrounger tactics may develop divergent phenotypes. This approach can be linked with life history theory to understand how social dynamics drive health disparities. The framework differs from previous evolutionary perspectives on inequality, by focussing on the exploitation of foraging effort rather than inequality in ecological resources themselves. Health inequalities emerge where scroungers acquire different forms of power over producers, driving increasing exploitation. In racialized societies, symbolic categorization is used to systematically assign some individuals to low-rank producer roles, embedding exploitation in society. Efforts to reduce health inequalities must address the whole of society, altering producer-scrounger dynamics rather than simply targeting resources at exploited groups.