Kevin J. A. Thomas

Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data

BACKGROUND Maternal mortality, as a largely avoidable cause of death, is an important focus of international development efforts, and a target for Millennium Development Goal (MDG) 5. However, data weaknesses have made monitoring progress problematic. In 2006, a new maternal mortality working group was established to develop improved estimation methods and make new estimates of maternal mortality for 2005, and to analyse trends in maternal mortality since 1990. METHODS We developed and used a range of methods, depending on the type of data available, to produce comparable country, regional, and global estimates of maternal mortality ratios for 2005 and to assess trends between 1990 and 2005. FINDINGS We estimate that there were 535,900 maternal deaths in 2005, corresponding to a maternal mortality ratio of 402 (uncertainty bounds 216-654) deaths per 100,000 livebirths. Most maternal deaths in 2005 were concentrated in sub-Saharan Africa (270,500, 50%) and Asia (240,600, 45%). For all countries with data, there was a decrease of 2.5% per year in the maternal mortality ratio between 1990 and 2005 (p<0.0001); however, there was no evidence of a significant reduction in maternal mortality ratios in sub-Saharan Africa in the same period. INTERPRETATION Although some regions have shown some progress since 1990 in reducing maternal deaths, maternal mortality ratios in sub-Saharan Africa have remained very high, with little evidence of improvement in the past 15 years. To achieve MDG5 targets by 2015 will require sustained and urgent emphasis on improved pregnancy and delivery care throughout the developing world.

Characterizing the epidemiological transition in Mexico: national and subnational burden of diseases, injuries, and risk factors.

Background Rates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities. Methods and Findings We estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs]) in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000) and the Southern region the highest (5.0 per 1,000); under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus 19 for injuries). Conclusions Mexico is at an advanced stage in the epidemiologic transition, with the majority of the disease and injury burden from noncommunicable diseases. A unique characteristic of the epidemiological transition in Mexico is that overweight and obesity, high blood glucose, and alcohol use are responsible for larger burden of disease than other noncommunicable disease risks such as tobacco smoking. The Southern region is least advanced in the epidemiological transition and suffers from the largest burden of ill health in all disease and injury groups.

What Explains the Increasing Trend in African Emigration to the U.S.

In this study, data from the U.S. State Department on visas issued abroad and information from other sources are used to examine trends in African emigration to the U.S. The results suggest that, on average, moderate increases in African Gross Domestic Product between 1992 and 2007 had a buffering effect on emigration trends. Yet, emigration to the U.S. increased much faster from the poorest than wealthiest countries in Africa. Contrary to expectations, larger emigration increases were found in Africas non-English than English-speaking countries. Despite the increasing overall trend, however, critical differences were observed in the impacts of specific types of flows. For example, overall trends were driven by increases in Diversity Visa migration, refugee movements, and the migration of immediate relatives. However, significant declines were observed in employment-related emigration from Africa to the U.S. The results further suggest that impact of trends in African fertility, urbanization, and phone use are circumscribed to specific contexts and types of migration flows. The findings, therefore, provide an empirical basis for concluding that the dynamics of African migration to the U.S. are becoming increasingly more complex.

Childbearing and Schooling: New Evidence from South Africa.

Many researchers have investigated the relation between educational attainment and childbearing among girls who become pregnant while in school. The predominant view is that young mothers are less likely to finish schooling. Moreover, leaving school prevents them from getting good jobs, which, in turn, can perpetuate a cycle of poverty. While some evidence from subSaharan Africa supports the idea that childbearing impedes educational progress, South African researchers have argued the contrary, that childbearing during the school years does not necessarily prevent a girl from completing her education. In this article, we use both South African census data from 1996 and recently collected qualitative data from one rural area to contribute to this debate. Our findings suggest policy initiatives to delay entry into motherhood and to improve the educational success of young mothers in rural South Africa. The importance of our research can be summarized in several ways. First, it contributes to an ongoing discussion about the relative importance of childbearing in determining a girl’s life chances, particularly in societies undergoing major transitions. Second, the twin issues of adolescent fertility and educational attainment feature prominently in national-level public health agendas focused on youth. This is particularly apparent in South Africa, where the well-being of youth has been given high priority in various sectors. Ten years into democracy, South Africa offers an ideal context in which to examine transitions to adulthood amid a climate of great optimism, fueled by increased educational and employment opportunities but also tempered by high unemployment rates and continuing poverty. Third, our research suggests new possibilities for intervention work in both family planning and schooling. While there are many good reasons to encourage girls to delay childbearing, we need to consider additional strategies that enable girls

Return Migration in Africa and the Relationship between Educational Attainment and Labor Market Success: Evidence from Uganda

The return migration of skilled professionals has been suggested as a policy instrument suitable for reversing the large-scale emigration of skilled professionals from African countries. However, there are no empirical studies showing how migrant professionals from Africa are reintegrated into the labor market after they return. This study examines the relationship between educational attainment and the likelihood of employment among native-born African migrants returning home from abroad. The study focuses on the evidence from Uganda since this country has one of the longest histories of skilled migration in Africa. The results show that returning migrants with university degrees and vocational credentials are more likely to be employed than their nonmigrant and immigrant counterparts. However, this employment advantage was not observed among returning migrants with secondary schooling or below. Furthermore, the results show that returning migrants are generally more likely to be employed as district employment rates increase.

Parental characteristics and the schooling progress of the children of immigrant and U.S.-born blacks.

In this study, I examine disparities in schooling progress among children born to immigrant and U.S.-born blacks. I find that in one- and two-parent families, children born to black immigrants are less likely to fall behind in school than those born to U.S.-born blacks. In two-parent immigrant families, children born to two immigrant parents have a significant schooling advantage over children born to one immigrant parent. While children born to two immigrant parents in the wealthiest black immigrant families do better in the second generation than in the first, the reverse is observed among children in less wealthy families. These findings contribute in two ways to our understanding of the assimilation processes of children born to black immigrant parents. First, they show that there is a positive association between the number of immigrant parents in a family and children’s schooling performance. Second, they suggest that disparities in the assimilation patterns of the children of black immigrants are a likely product of the interaction between their parental characteristics and the socioeconomic circumstances of their families.

Familial Influences on Poverty Among Young Children in Black Immigrant, U.S.-born Black, and Nonblack Immigrant Families

This study examines how familial contexts affect poverty disparities between the children of immigrant and U.S.-born blacks, and among black and nonblack children of immigrants. Despite lower gross child poverty rates in immigrant than in U.S.-born black families, accounting for differences in family structure reveals that child poverty risks among blacks are highest in single-parent black immigrant families. In addition, within two-parent immigrant families, child poverty declines associated with increasing assimilation are greater than the respective declines in single-parent families. The heads of black immigrant households have more schooling than those of native-black households. However, increased schooling has a weaker negative association with child poverty among the former than among the latter. In terms of racial disparities among the children of immigrants, poverty rates are higher among black than nonblack children. This black disadvantage is, however, driven by the outcomes of first-generation children of African and Hispanic-black immigrants. The results also show that although children in refugee families face elevated poverty risks, these risks are higher among black than among nonblack children of refugees. In addition, the poverty-reducing impact associated with having an English-proficient household head is about three times lower among black children of immigrants than among non-Hispanic white children of immigrants.

Household Context, Generational Status, and English Proficiency among the Children of African Immigrants in the United States

This study examines how household and parental-level determinants affect English proficiency among the children of African immigrants in the United States. Within immigrant families, the study finds that childrens level of proficiency has a stronger positive association with the proficiency of their mothers than with that of their fathers. Childrens level of English proficiency significantly increases as the number of other English-proficient children within their household increases. These impacts are stronger on the proficiency levels of first compared to second-generation children. Levels of proficiency are, however, lowest among children in families from Portuguese-speaking countries followed by their counterparts in families from countries where indigenous languages and Arabic are dominant. Although proficiency levels generally improve with increasing generational status, these improvements are smallest for children in families from Portuguese-speaking countries. Except for children in families from English-speaking countries, the largest improvements to proficiency with increasing generational status were observed among children in families from indigenous language backgrounds.

Foreign Student Emigration to the United States: Pathways of Entry, Demographic Antecedents, and Origin‐Country Contexts

This study uses data from various sources to examine the determinants of trends in international student migration to the United States. Our results highlight the differential contributions to these trends made by various entry pathways. For example, we find that the overall growth was driven by students using visas that offered the least possibility of US employment following the completion of their studies. We also find that overall student migration trends were significantly affected by global demographic changes. For example, student emigration from Europe was negatively affected by declining fertility trends, percentage of youths, and youth population size. In Asia and Africa, contrasting demographic trends explained the substantial student migration increases observed from these regions. Increases in youth population size had a particularly positive effect on student migration in contexts of economic growth. Finally, the analysis finds a declining significance of English language contexts for fueling overall student migration trends.

Migration dynamics, entrepreneurship, and African development: Lessons from Malawi.

Using data from Malawi, this study situates the discourse on migration, entrepreneurship, and development within the context of Africas social realities. It examines self-employment differences among three groups of migrants and corresponding group differences in agricultural and non-agricultural self-employment. International migrants are found to be more engaged in self-employment than internal migrants. However, our results suggest that previous findings on the development-related contributions of returning migrants from the West need to be appropriately contextualized. When returnees from the West invest in self-employment, they typically shy away from Africas largest economic sector – agriculture. In contrast, levels of self-employment, especially in agricultural self-employment, are highest among returning migrants and immigrants from other African countries, especially from those nearby. We also underscore the gendered dimensions of migrants’ contribution to African development by demonstrating that female migrants are more likely to be self-employed in agriculture than male migrants. Furthermore, as human-capital increases, migrants are more likely to concentrate their self-employment activities in non-agricultural activities and not in the agricultural sector. The study concludes using these findings to discuss key implications for policy and future research.