Rachel Sullivan Robinson

Counting women's labour: A reanalysis of children's net production using Cain's data from a Bangladeshi village

The economic contribution of children to their parents’ households has long interested demographers because of its potential to influence fertility levels. Valuing childrens labour in pre-industrial economies, however, is inherently difficult. The same is true of womens labour, a crucial component of any analysis of net production. Here we use Mead Cains seminal study (Population and Development Review 3(3): 201–227, 1977) of childrens economic contributions in a Bangladeshi village to illustrate these points. We combine Cains data on landless womens and mens hours of work with data on the efficiency per hour of work from other pre-industrial settings (Mueller, Population and Development: The Search for Selective Interventions. Baltimore, MD: Johns Hopkins University Press, pp. 98–153, 1976; Kramer, Dissertation, Department of Anthropology, University of New Mexico, 1998). When womens labour is incorporated, we find that the Bangladeshi children begin to produce as much as they consume by ages 10 (girls) or 11 (boys). Despite these productive contributions, neither women nor men ‘pay’ for their cumulative consumption until their early 20s. We believe our methods could be usefully applied in other contexts.

From population to HIV: the organizational and structural determinants of HIV outcomes in sub-Saharan Africa

BackgroundThere exists no consistent explanation for why some countries are successful in combating HIV/AIDS and others are not, and we need such an explanation in order to design effective policies and programmes. Research evaluating HIV interventions from a biomedical or public health perspective does not always take full account of the historical and organizational characteristics of countries likely to influence HIV outcomes. The analysis in this paper addresses this shortcoming by testing the impact of organizational and structural factors, particularly those resulting from population interventions, on HIV outcomes at the country level in sub-Saharan Africa.MethodsThe primary independent variables are factors that originated from efforts to slow population growth: whether a country has a long-time affiliate of the International Planned Parenthood Federation and whether a country has a population policy. Additional structural factors likely to impact HIV outcomes include the level of wealth, the level of cultural fractionalization, and the former colonial power. The present study uses multivariate regression techniques with countries in sub-Saharan Africa as the unit of analysis, and four measures of success in addressing HIV: the change in prevalence between 2001 and 2009; the change in incidence between 2001 and 2009; the level of overall antiretroviral coverage in 2009; and the level of antiretroviral coverage for prevention of vertical transmission in 2009.ResultsCountries with the greatest declines in HIV prevalence and incidence had older International Planned Parenthood Federation affiliates and had adopted population policies, even after controlling for age of epidemic, level of antiretroviral coverage, and funding for HIV. Population policies are also important predictors of levels of overall antiretroviral coverage and of coverage of HIV-positive pregnant women to prevent vertical transmission. Structural factors with significant impacts include wealth, cultural fractionalization and former colonial power.ConclusionsThe organizational and structural context of African countries is strongly predictive of HIV outcomes. This finding implies that policy and programmatic efforts should be put towards strengthening existing organizations and perhaps even creating new ones. The fact that cultural fractionalization also influences HIV outcomes suggests that efforts must be put towards identifying ways to reach political consensus in diverse societies.

International norms and the politics of sexuality education in Nigeria

BackgroundProponents have promoted sexuality education as a means of empowering adolescents, yet it has been thwarted in many low and middle-income countries. Nigeria represents an exception. Despite social opposition, the government in 1999 unexpectedly approved sexuality education policy. Since then, implementation has advanced, although efficacy has differed across states. We draw on theory concerning international norm diffusion to understand Nigerian policy development.ResultsWe find that a confluence of international and national norms and interests shaped policy outcomes, including concern over HIV/AIDS. A central dynamic was an alliance of domestic NGOs and international donors pressing the Nigerian government to act.ConclusionsWe argue that theory on international norms can be applied to understand policy dynamics across a variety of health and population areas, finding value in approaches that integrate rather than juxtapose consideration of (1) international and national influences; (2) long and short-term perspectives on policy change; and (3) norms and interests.

Prioritising sexuality education in Mississippi and Nigeria: The importance of local actors, policy windows and creative strategy

ABSTRACT Mississippi and Nigeria are two socially conservative places unlikely to prioritise sexuality education. Nonetheless, Mississippi passed a bill in 2011 mandating all school districts to offer sexuality education, and Nigeria approved a national sexuality education curriculum in 2001. To identify the factors that drove the process of prioritisation of sexuality education in each context, we conducted more than 70 semi-structured interviews with nongovernmental organisations/nonprofits, donor organisations and federal and state ministries involved in the prioritisation and implementation of sexuality education in Mississippi and Nigeria. Prioritisation of sexuality education occurred for similar reasons in both Mississippi and Nigeria: (1) local individuals and organisations committed to sexuality education and supported by external actors; (2) the opening of a policy window that made sexuality education a solution to a pressing social problem (teen pregnancy in Mississippi and HIV/AIDS in Nigeria) and (3) strategic action on the part of proponents. We conclude that promoting sexuality education in challenging contexts requires fostering committed local individuals and organisations, identifying external resources to support implementation costs and building on existing relationships of trust between actors, even if those relationships are unrelated to sexuality education.

Integrating the Demographic and Health Surveys, IPUMS-I, and TerraPopulus to Explore Mortality and Health Outcomes at the District Level in Ghana, Malawi, and Tanzania

In this paper, we first show how the Demographic and Health Surveys (DHS) can be integrated with other data sources to expand the types of variables available for analysis of population and health outcomes. Second, we demonstrate one particular example of such integration by modelling the social, physical, and built environment determinants of health outcomes at the district level in Ghana, Malawi, and Tanzania. To do so, we created district-level measures of a number of variables from the DHS, and then merged them with district-level data from the IPUMS, an environmental data set called TerraPopulus, and other sources. We find that it is feasible to combine the DHS with other data sources, and that many health and environment indicators are heterogeneous within countries, justifying further analysis at low levels of geography and suggesting benefits to using such techniques to design fine-grained programmatic interventions.

Community health workers and accountability: reflections from an international “think-in”

Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a ‘think in’, held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger “accountability ecosystem.” This jointly authored commentary resulted from our deliberations. While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs’ social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, we put forward several propositions for further conceptual development and research related to the question of CHWs and accountability.

Population Policy and Reproduction in Singapore: Making Future Citizens

Singapore is a demographically and economically unique country. The total fertility rate, a reflection of current childbearing trends measured as the average number of children a woman can expect to have in her lifetime, reached replacement level in 1977, and continued to decline from that point onwards. It currently stands at just 1.2, well below the 2.1 children per woman needed to maintain a constant population size. Economically, the country is an Asian ‘‘tiger’’ that went from poverty at the time of independence in 1965 to today having one of the highest GDPs per capita in the world. This rapid economic growth was fostered by a developmentalist and productivist state that actively invested in human capital to increase economic productivity and opened its borders to international capital. It is at this intersection, between the demographic and the economic, that Shirley Sun’s book is situated. Worried about maintaining economic growth as well as the nation’s capacity to defend itself, the government of Singapore, since the late-1980s, has promulgated increasingly expansive pronatalist population policies. Yet baby bonuses, tax rebates, and childcare subsidies have failed to increase fertility. The book asks why, and couches the response within the literature of citizenship studies. The core analytic chapters and conclusions are based on 165 semi-structured interviews and 39 focus groups with Singaporean citizens of different educational, ethnic, and economic backgrounds about their opinions on childbearing, the government’s policies, and the relationship between the two. Population Policy and Reproduction in Singapore makes three main contributions. First, the majority of respondents reported that they would ideally like to have more than one child, indicating that the desired fertility of citizens actually matches the desired fertility of the state. Second, Sun’s data convincingly show that the lack of effectiveness of the pronatalist policy efforts is in large part because they simply do not do enough to offset the cost of children. Life is expensive in Singapore, and children particularly so. Although the government subsidizes education, being ‘‘successful’’ by Singaporean standards requires extensive, out-ofpocket parental contributions to tutors, classes, and other extracurricular activities, and there is significant competition for the best schools. Similarly, although 80 percent of Singaporeans live in subsidized housing, the cost of this housing continues to increase and they still feel financially constrained. Tax rebates, which make up one portion of the pronatalist policies, are known about and relevant only to those within the higher income brackets. And again, they are not sufficiently large to encourage people to have more children. Paid maternity leave, although increased in recent years, stands at only 12 weeks. In short, the state’s policies are not doing enough to overcome the cost of living, children, and time. Third, Sun identifies a pattern noted among many lowfertility European countries, specifically that increasing gender equality in the workplace has not been accompanied by change in gender roles in the home. Men continue to assume it is their responsibility to be the breadwinner, and although labor force participation among women with children is on par with the United States, United Kingdom, and other wealthy countries, many of these working women would prefer to stay home. Importantly, ‘‘career-oriented’’ women (those who wish to have children and work), complain not about the minimal extent of maternity leave, but instead about the absence of legal safeguards against job loss while on maternity leave. Across the board, then, the benefits offered by the government are insufficient to lead Singaporeans to achieve their desired fertility. Reviews 121