Rebecca Winter

Impact of Scale-up of Maternal and Delivery Care on Reductions in Neonatal Mortality in USAID MCH Priority Countries, 2000–2010

Impressive global gains in under-five mortality between 2000 and 2010 have been accompanied by more modest reductions in neonatal mortality . Of the 18 USAID priority countries for maternal and child health with two Demographic and Health Surveys (DHS) available around the years 2000 and 2010, only six have shown statistically significant reductions in neonatal mortality within the study population of most recent children born in the five years preceding the survey. The study investigates the extent to which scale-up of maternal and delivery care is associated with reductions in neonatal mortality in the six countries. We find surprisingly little evidence that changes in coverage of measurable indicators of maternal and delivery care contributed to the improvements in neonatal survival . In the three malarious countries with complete mosquito bednet data for both surveys, household ownership of a mosquito bednet stands out as a driver of the observed reductions. This finding highlights the importance of malaria control in the arsenal of maternal and child health interventions. Overall, weak associations between other indicators of maternal and delivery care and neonatal survival were observed. This may be the result of limitations of population-based surveys to measure accurately the protective aspects of the interventions. The weak findings may also point to an issue of quality of care, highlighting the need for newborn survival strategies to emphasize strengthening health systems and improve quality of care alongside efforts to increase use of delivery health services.

Exploring the Linkages Between Spousal Violence and HIV in Five Sub-Saharan African Countries

There has been increasing recognition that spousal violence and HIV are overlapping vulnerabilities for many women. Yet a direct effect of most forms of spousal violence on women’s HIV status is unlikely, as there is no apparent causal pathway leading from one to the other. This study examines the relationship between spousal violence and women’s HIV status using Demographic and Health Surveys from five African countries: Kenya, Malawi, Rwanda, Zambia, and Zimbabwe. It uses couples data and nuanced measures of five separate forms of spousal violence. We adopt a gender-based framework in which a woman’s experience of spousal violence and her HIV status are mediated by her husband’s and her own behavioral and situational HIV risk factors, factors which are also shown to be associated with spousal violence. A series of regression models test for the direct effect of spousal violence, controlling for risk factors. An initial significant relationship with women’s HIV status is found for suspicion and isolation controlling behaviors in Zambia and Zimbabwe; for emotional violence in Kenya, Rwanda, and Zimbabwe; and for physical violence, in Kenya, Rwanda, and Zimbabwe. Sexual violence is not associated with women’s HIV status. Multiple associations between spousal violence and risk factors, and between these risk factors and women’s HIV status, suggest several possible mediators. When they are added to our base model, spousal violence no longer significantly predicts women’s HIV status with one exception: physical violence retains its association with women’s HIV status in Kenya and Zimbabwe.