Alice Reid

Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda

BackgroundSpousal communication can improve family planning use and continuation. Yet, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods. This study examines men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives.MethodsA qualitative study using 18 focus group discussions (FGDs) with purposively selected men aged 15–54 and women aged 15–49 as well as eight key informant interviews (KIIs) with government and community leaders was conducted in 2012 in Bugiri and Mpigi Districts, Uganda. Open-ended question guides were used to explore men and women’s perceptions regarding barriers to men’s involvement in reproductive health. All FGDs and KIIs were recorded, translated, and transcribed verbatim. Transcripts were coded and analyzed thematically using ATLAS.ti.ResultsFive themes were identified as rationale for men’s limited involvement: (i) perceived side effects of female contraceptive methods which disrupt sexual activity, (ii) limited choices of available male contraceptives, including fear and concerns relating to vasectomy, (iii) perceptions that reproductive health was a woman’s domain due to gender norms and traditional family planning communication geared towards women, (iv) preference for large family sizes which are uninhibited by prolonged birth spacing; and (v) concerns that women’s use of contraceptives will lead to extramarital sexual relations. In general, knowledge of effective contraceptive methods was high. However, lack of time and overall limited awareness regarding the specific role of men in reproductive health was also thought to deter men’s meaningful involvement in issues related to fertility regulation.ConclusionDecision-making on contraceptive use is the shared responsibility of men and women. Effective development and implementation of male-involvement family planning initiatives should address barriers to men’s supportive participation in reproductive health, including addressing mens negative beliefs regarding contraceptive services.

Neonatal mortality and stillbirths in early twentieth century Derbyshire, England

Neonatal mortality and stillbirths are recognised to be subject to similar influences, but survival after a successful live birth is usually considered in isolation of foetal wastage. Moreover, individual-level data on age-specific influences and causes of death in a historical context are rare. This paper uses an unusual data set to compare the influences on neonatal mortality and stillbirths in early twentieth century Derbyshire, England. Multivariate hazard and logistic analyses are performed to examine the relative roles of various social, environmental, and demographic factors. The influences on and causal structures of neonatal mortality and stillbirths emerge as broadly similar, with previous reproductive history linked to a considerable amount of variation. The clustering of endogenous deaths was much greater than the clustering of exogenous and post-neonatal deaths, probably reflecting the cause-of-death structure and the relatively healthy social and environmental position of early twentieth century Derbyshire.

The Effects of the 1918–1919 Influenza Pandemic on Infant and Child Health in Derbyshire

In early 1919 my father, not yet demobilized, came on one of his regular, probably irregular, furloughs to Carisbrook Street to find both my mother and sister dead. The Spanish Influenza pandemic had struck Harpurhey. There was no doubt of the existence of a God: only the supreme being could contrive so brilliant an afterpiece to four years of unprecedented suffering and devastation. I apparently, was chuckling in my cot while my mother and sister lay dead on a bed in the same room. 1 Towards the end of the First World War, the world was gripped by the ravages of a pandemic of influenza. The disease spread rapidly across the globe with an alarming lack of discrimination as to who it attacked and a tendency to pneumonic complications—causing massive relative increases in mortality in young adults. In the 1920s it was estimated that, between the spring of 1918 and the early summer of 1919, the disease had affected 200 to 700 million people and killed between 10 and 21 million. 2 In 1991 David Patterson and Gerald Pyle increased the estimates to between 24.7 and 39.3 million, but Ian Mills uncovered a death toll of over 21 million in India alone and more recent revisions have raised probable global influenza mortality to between 50 and 100 million. 3 Even the conservative estimates put the death toll from influenza at over twice that produced by the First World War and it is generally accepted to be far higher. Yet while the war has been held responsible for the creation of a ‘‘lost generation’’, the ’flu was rapidly relegated to obscurity. The experience of the war and its consequences in terms of not only mortality but also social and economic re-organization (and, in the UK at least, the arrival of the Armistice during the most virulent period of the epidemic 4 ) must have altered the public perspective and diminished the memory of the influenza epidemic. 5 Although the widespread sickness

Infant feeding and post-neonatal mortality in Derbyshire, England, in the early twentieth century

This paper examines influences on post-neonatal mortality in Derbyshire (England) in the early twentieth century, by applying multivariate hazard analysis to a rare individual-level data set. The data allow detailed patterns of breastfeeding and weaning to be examined. The role of feeding is given special attention as a mediator between mortality and the other environmental, social, and demographic factors considered. Twins and illegitimate children were more likely to have been hand-fed, but this could explain only a small fraction of their increased vulnerability. Artificial feeding was associated with increased risks of death from diarrhoea, respiratory disease, and wasting diseases. It is suggested that the link with wasting diseases was predominantly the result of the greater likelihood of congenitally weak children being hand-fed. Most of the variation in post-neonatal mortality, particularly from respiratory disease, was explained by environmental influences - population density, altitude, and the presence of mining.

Mrs Killer and Dr Crook: birth attendants and birth outcomes in early twentieth-century Derbyshire.

After the passing of the 1902 Midwives Act, a growing proportion of women were delivered by trained and supervised midwives. Standards of midwifery should therefore have improved over the first three decades of the twentieth century, yet nationally this was not reflected in the main outcome measures (stillbirths, early neonatal mortality and maternal death). This paper shows that there was a difference in the risks associated with delivery by the different attendants, with qualified midwives having the best outcome, then bona-fide (untrained) midwives and lastly doctors, even when account is taken of the fact that doctors were called in cases of medical need and may have been booked where a problematic delivery was expected. The paper argues that the lack of improvement in outcome measures could be consistent with improving standards of care among both trained and bona-fide midwives, because increased attention to the rules stipulating when midwives called for medical help meant that a doctor was called into an increasing number of deliveries (including less complicated ones), raising the chance of unnecessary and dangerous interventions.

Birth Attendants and Midwifery Practice in Early Twentieth-century Derbyshire.

Summary The 1902 Midwives Act introduced training and supervision for midwives in England and Wales, outlawing uncertified-and-untrained midwives (handywomen) and phasing out certified-but-untrained (bona fide) midwives. This paper compares the numbers and practices of these two different types of birth attendant with each other, with qualified and certified midwives and with doctors in early twentieth-century Derbyshire during this period of change, and examines the spatial and social factors influencing womens choice of birth attendant. It finds that the new legislation did not entirely eliminate continuity in traditional practices and allegiance, and that both social and spatial factors governed the choice of delivery attendant, with fewer midwives available in rural areas and a surviving network of untrained bona fide midwives in mining communities. Within this spatial pattern, however, although wealthier women were more likely to have chosen a doctor or a qualified midwife, familiarity and loyalty allowed bona fide midwives to maintain their case loads.

Women’s Marriage Age Matters for Public Health: A Review of the Broader Health and Social Implications in South Asia

In many traditional societies, women’s age at marriage acts simultaneously as a gateway to new family roles and the likelihood of producing offspring. However, inadequate attention has previously been given to the broader health and social implications of variability in women’s marriage age for public health. Biomedical scientists have primarily been concerned with whether the onset of reproduction occurs before the woman is adequately able to nurture her offspring and maintain her own health. Social scientists have argued that early marriage prevents women from attaining their rightful education, accessing employment and training opportunities, developing social relationships with peers, and participating in civic life. The aim of this review article is to provide comprehensive research evidence on why women’s marriage age, independent of age at first childbirth, is a crucial issue for public health. It focuses on data from four South Asian countries, Bangladesh, India, Nepal, and Pakistan, in which marriage is near universal and where a large proportion of women still marry below the United Nations prescribed minimum marriage age of 18 years. Using an integrative perspective, we provide a comprehensive synthesis of the physiological, bio-demographic, and socio-environmental drivers of variable marriage age. We describe the adverse health consequences to mothers and to their offspring of an early age at marriage and of childbearing, which include malnutrition and high rates of morbidity and mortality. We also highlight the complex association of marriage age, educational attainment, and low societal status of women, all of which generate major public health impact. Studies consistently find a public health dividend of increased girls’ education for maternal and child nutritional status and health outcomes. Paradoxically, recent relative increases in girls’ educational attainment across South Asia have had limited success in delaying marriage age. This evidence suggests that in order for public health initiatives to maximize the health of women and their offspring, they must first address the factors that shape the age at which women marry.

Automatic Methods for Coding Historical Occupation Descriptions to Standard Classifications

The increasing availability of digitised registration records presents a significant opportunity for research in many fields including those of human geography, genealogy and medicine. Re-examining original records allows researchers to study relationships between factors such as occupation, cause of death, illness and geographic region. This can be facilitated by coding these factors to standard classifications. This chapter describes work to develop a method for automatically coding the occupations from 29 million Scottish birth, death and marriage records, containing around 50 million occupation descriptions, to standard classifications. A range of approaches using text processing and supervised machine learning is evaluated, achieving classification performance of 75 % micro-precision/recall, 61 % macro-precision and 66 % macro-recall on a smaller test set. Further development that may be needed for classification of the full data set is discussed.

Automatic Methods for Coding Historical Occupation Descriptions to Standard

This book addresses the problems that are encountered, and solutions that have been proposed, when we aim to identify people and to reconstruct populations under conditions where information is scarce, ambiguous, fuzzy and sometimes erroneous. The process from handwritten registers to a reconstructed digitized population consists of three major phases, reflected in the three main sections of this book. The first phase involves transcribing and digitizing the data while structuring the information in a meaningful and efficient way. In the second phase, records that refer to the same person or group of persons are identified by a process of linkage. In the third and final phase, the information on an individual is combined into a reconstruction of their life course. The studies and examples in this book originate from a range of countries, each with its own cultural and administrative characteristics, and from medieval charters through historical censuses and vital registration, to the modern issue of privacy preservation. Despite the diverse places and times addressed, they all share the study of fundamental issues when it comes to model reasoning for population reconstruction and the possibilities and limitations of information technology to support this process. It is thus not a single discipline that is involved in such an endeavor. Historians, social scientists, and linguists represent the humanities through their knowledge of the complexity of the past, the limitations of sources, and the possible interpretations of information. The availability of big data from digitized archives and the need for complex analyses to identify individuals calls for the involvement of computer scientists. With contributions from all these fields, often in direct cooperation, this book is at the heart of the digital humanities, and will hopefully offer a source of inspiration for future investigations.

Residential Mobility and Child Mortality in Early Twentieth Century Belfast

The 1911 censuses of the British Isles included questions directed at currently married women, relating to the number of children they had borne in that marriage, the number of those children who were still alive and the number who had died. With the help of the demographic techniques of indirect estimation, the answers to such questions can be made to yield estimates of infant and child mortality over the 15 or 20 years leading up to the census. Although the civil registration system in England and Wales was established in the early nineteenth century, and those for Scotland and Ireland followed in mid-century, accurate, individual level records of birth, marriage and death are not available for research purposes. The records of children born and died from the 1911 census can be used instead in analyses of fertility and early-age mortality in relation to the independent variables measured by the census. This analysis, however, assumes that the variables recorded at the time of the census applied at the time the children were born and grew up, but mobility in nineteenth-century cities was very high: for example, in Belfast fewer than 20 % of household heads in 1911 had been resident in the same house in 1901. Thus the independent variables measured at the time of the census may not have applied a few years previously when the children were at risk of death. This paper uses the 1911 and 1901 censuses of Belfast to explore the child mortality of movers and stayers, and examines the mobility histories of movers to assess the viability of using characteristics measured in 1911 as proxies for those applicable when the children were at risk of death.