Rebekah Burroway

Targeting, Universalism, and Single-Mother Poverty: A Multilevel Analysis Across 18 Affluent Democracies

We examine the influence of individual characteristics and targeted and universal social policy on single-mother poverty with a multilevel analysis across 18 affluent Western democracies. Although single mothers are disproportionately poor in all countries, there is even more cross-national variation in single-mother poverty than in poverty among the overall population. By far, the United States has the highest rate of poverty among single mothers among affluent democracies. The analyses show that single-mother poverty is a function of the household’s employment, education, and age composition, and the presence of other adults in the household. Beyond individual characteristics, social policy exerts substantial influence on single-mother poverty. We find that two measures of universal social policy significantly reduce single-mother poverty. However, one measure of targeted social policy does not have significant effects, and another measure is significantly negative only when controlling for universal social policy. Moreover, the effects of universal social policy are larger. Additional analyses show that universal social policy does not have counterproductive consequences in terms of family structure or employment, while the results are less clear for targeted social policy. Although debates often focus on altering the behavior or characteristics of single mothers, welfare universalism could be an even more effective anti-poverty strategy.

Trends in condom use among female sex workers in Andhra Pradesh, India: the impact of a community mobilisation intervention

Background Community mobilisation interventions for HIV prevention among female sex workers (FSWs) aim to organise FSWs for collective action and challenge the structures of power that underlie HIV risk. Assessing intervention impact is challenging because the importance of direct individual exposure to intervention components may decrease over time as change occurs at social-normative, policy and other structural levels. In this paper, the authors examine changes over time in consistent condom use among FSWs in Rajahmundry, Andhra Pradesh, the location of a long-standing community mobilisation intervention. Methods The authors analyse cross-sectional data collected among FSWs at three time points (n=2276) using respondent-driven sampling. Multiple logistic regression was used to assess the association of programme exposure with consistent condom use and whether this association varied over time. Results The proportion of FSWs having no exposure or only receptive exposure to the intervention decreased over time, while active utilisation increased from 19.4% in 2006 to 48.5% in 2009–2010. Consistent condom use with clients also increased from 56.3% in 2006 to 75.3% in 2009–2010. Multivariate analysis showed that age, age at start of sex work, venue, living conditions and programme exposure were significantly associated with condom use. The positive association between programme exposure and consistent condom use did not vary significantly over time. Conclusions Findings indicate improvements in HIV risk reduction behaviour among FSWs and suggest that the intervention has substantial reach in the FSW population. The interventions strategies may be contributing to population-level HIV risk reduction among FSWs.

Factors associated with awareness and utilisation of a community mobilisation intervention for female sex workers in Andhra Pradesh, India

Objectives Examine factors associated with awareness and active utilisation of a community mobilisation intervention (CMI) to address HIV risk in female sex workers (FSWs) in a context characterised by multiple forms of sex work. Design Data came from two rounds, conducted in Spring 2006 and Spring 2007, of a serial cross-sectional survey of FSWs (n=812 in round 1, n=673 in round 2) recruited through respondent-driven sampling in Rajahmundry, Andhra Pradesh, India. Methods Descriptive statistics compared characteristics of programme aware and unaware FSWs and from among the aware, to characterise active program users. Multinomial logistic regression was used to assess factors associated with programme exposure. Results Between Rounds 1 and 2, programme awareness increased from 41.8% to 69.6% of respondents, and active utilisation (among those who were aware) increased from 49.2% to 61.0%. Street-based FSWs were under-represented and brothel-based FSWs overrepresented in both groups and rounds. Geographic proximity and literacy were associated with programme awareness but not utilisation. The most important factor associated with both forms of intervention exposure across rounds was willingness to be identified in public as a FSWs (OR 2.2–4.8). Conclusion Public visibility is a critical component of CMIs. Such interventions should develop strategies for involving FSWs that allow them to remain invisible, while also working to reduce the threat associated with public visibility. In contexts where sex work occurs in multiple venues, it is important to develop CMIs that include and address the needs of FSWs working in them all.

Empowering Women, Strengthening Children: A Multi-Level Analysis of Gender Inequality and Child Malnutrition in Developing Countries

Abstract Purpose Previous research assumes that economic development is the key to increasing the food supply and alleviating child malnutrition. However, economic development alone does not promise that income is distributed fairly, nor does it guarantee that other human needs will be fulfilled. What has been missing from cross-national research is an analysis of how gender inequality shapes women’s abilities to effectively maintain food security. The current study contributes to this literature by exploring the multidimensional effects of women’s empowerment on child stunting and wasting. Methodology/approach Pooling data from the Demographic and Health Surveys and the World Bank, the analysis estimates a series of multi-level models that examine the country-level influences on malnutrition, while also accounting for household and maternal characteristics that affect food security at the individual level. Findings Results suggest that improvements in women’s education, control over reproduction, representation in national politics, and life expectancy correspond to improvements in child malnutrition. Notably, the effects of gender inequality are comparable to or larger than those of economic development. The multi-level modeling technique illustrates how social forces that are larger than the individual shape the chances of experiencing food insecurity. Research limitations Cross-national data are limited in scope and cannot prove causality. Further research is also needed to better understand the process by which women wield advances in rights and empowerment to affect food security. Social implications If policymakers want to facilitate food security in poor countries, they should not disregard the potential of policies that will promote more equitable rights for women.

Democracy and child health in developing countries

The rise of democracy across the world brought with it expectations that governments would be more attentive and responsive to the welfare of the people, creating better services and better health. Indeed, a considerable body of scholarship finds that democracy has significant, direct effects on multiple measures of well-being, particularly life expectancy and infant mortality. Despite several recent critiques, the paramount theme is that democracy is good for health. This study contributes to this literature by assessing the relationship between democracy and child diarrhea and malnutrition across 52 developing countries. Using a multilevel modeling strategy, the analysis examines the country-level effects of democracy and development on child health, while simultaneously taking into account wealth, education, and other household characteristics at the individual level. Contrary to much previous scholarship, democracy does not exhibit a significant association with diarrhea or malnutrition. Instead, gross domestic product (GDP) per capita and improved sanitation and water have substantial effects on child health at the country level. At the individual level, household wealth and maternal education have the largest health-enhancing impact on child diarrhea and malnutrition. Furthermore, the size and strength of the relationship between wealth and health does not vary by political regime. These results demonstrate the enduring importance of socioeconomic status regardless of political context, and they support a small but growing literature that calls the democracy–health link into question.

Hungry for Equality: A Longitudinal Analysis of Women’s Legal Rights and Food Security in Developing Countries

ABSTRACT Access to food is one of the most basic human needs, yet undernourishment remains one of the greatest barriers to health and development in the Global South. The entitlement approach to hunger maintains that the real issue is not the overall availability of food, but access to it. This paper specifically highlights the access failures of women by focusing on how gender-based stratification limits command over food, even in light of existing food supply. Going beyond traditionally used indicators of gender inequality, we examine how women’s legal rights affect the depth of hunger in developing countries. In a first-time longitudinal study of its kind, we use the 50 Years of Women’s Legal Rights historical dataset from the World Bank to measure changes in women’s property rights and constitutional rights from 1990 to 2010. A two-way fixed effects regression analysis of 42 low- and middle-income nations demonstrates that improving women’s rights is associated with lower levels of hunger over time, even controlling for the food supply, economic development, and other relevant variables.

Education is the antidote: Individual- and community-level effects of maternal education on child immunizations in Nigeria

Nigeria is an interesting case study because it outperforms other lower middle-income countries in economic development, yet ranks among the lowest in the world in immunization coverage rates. Combining multi-level modeling with spatial data techniques, this study investigates the individual- and community-level factors that influence the likelihood that a child is fully immunized, underscoring the importance of maternal education for improving child health. Drawing on data from the Demographic and Health Surveys and the Global Administrative Areas database, the analysis pools data on children aged 12-24 months across 455 communities. The spatial analysis reveals substantial geographic gaps in immunization coverage across Nigeria, demonstrating that not everyone benefits from the purported benefits of economic growth. Results from the multi-level models indicate that womens education has a robust association with vaccinations at the individual level and at the community level, even net of a variety of other household and community characteristics. The education level of a childs own mother influences the likelihood of being immunized, but above and beyond that, living in a community in which many women are educated also influences that likelihood. This suggests that education has a protective effect on child health not only because more individual women are going to school, but also because everyone benefits from the education and empowerment of women in the community. As broad societal transformations take place, education may shape womens capacity to take advantage of better access to power and resources, resulting in a dispersion effect of expanded womens education on health.

Are all jobs created equal? A cross-national analysis of women's employment and child malnutrition in developing countries

Using multi-level models, the analysis examines female employment and child stunting across 49 developing countries. At the country level, female labor force participation is not associated with malnutrition after controlling for economic development. At the individual level, a binary measure of employment is not significantly associated with malnutrition. However, a more nuanced measure of seven occupational categories shows that certain types of employment improve malnutrition. Professional, clerical, sales, and domestic jobs are associated with reduced stunting. These effects are only partially mediated by wealth, perhaps suggesting that some jobs may bring benefits to the household beyond the sheer acquisition of tangible resources. Agricultural jobs are associated with increased malnutrition. Manual labor and service work do not have an effect on malnutrition, compared to unemployment. Thus, womens employment is not necessarily a mechanism for empowerment and wellbeing. Not all jobs are created equal, and many of them do not confer the benefits that are typically associated with working outside the home.