S. Sudha

Fertility Decline and Worsening Gender Bias in India: Is Kerala No Longer an Exception?

This paper examines the notion that Kerala state in southern India remains a (comparative) bastion of female equality as shown by normal sex ratios at birth and by child survival while fertility declines. Studies have shown that much of India seems to be moving towards increased male bias during fertility and mortality declines and socioeconomic development. This is reflected in the increased masculinity of sex ratios at birth resurgent female infanticide and persistent excess female child mortality. While most studies point to Tamil Nadu to illustrate this trend they suggest that Kerala remains an exception. In Kerala data suggest that fertility decline has been accompanied by the rise of female disadvantage in infant/child mortality. Furthermore there are two factors associated with worsening female demographic disadvantage in the rest of India--the rise of dowry customs and the marginalization of women from paid employment--that are now seen in Kerala. In general the paper has drawn attention to recent gender gaps in demographic indicators and to declining womens status in Kerala state.

Ethnicity and Eldercare Comparison of Attitudes Toward Adult Care Homes and Care by Families

This study examines attitudes toward rest homes among elderly African Americans and Whites and their caregivers. Dislike of rest homes, preference for family care, and unwillingness to consider rest home placement are analyzed by linear structural equation and logistic regression models. Results show significant ethnic differences among elderly persons and caregivers. Among elders, African Americans are stronger in their desire for family care but dislike rest homes less than Whites do. African American elders are less willing than Whites to consider rest home placement; care-givers’differences are not as pronounced. Results suggest that the cultural preference for family care often attributed to ethnic differences is also partly determined by dislike of institutionalized care and social structural factors. The authors propose a theoretical framework that models attitudes toward health service use as outcomes of ethnicity and social structural factors and interpret the results against a backdrop of ethnic differences in historical and material conditions.

Violence against women symptom reporting and treatment for reproductive tract infections in Kerala State southern India.

In this article we examine factors associated with womens self-reports of reproductive ill health symptoms and factors associated with seeking and receiving treatment for the symptoms. We focus on indicators of womens societal position, especially empowerment (indicated by experience of and attitudes toward violence against women), autonomy, and education. We used data from the National Family Health Survey-2 from Kerala state in Southern India. Based on our results we suggest that violence against women, whether actually experienced or internalized as acceptance of its justification, is associated with increased ill health symptoms, and the acceptance of violence is associated with decreased chance of treatment. Womens higher formal education appeared to reduce treatment seeking for reproductive ill health, perhaps due to the stigma associated with sexually transmitted disease (STD) in this cultural setting. Womens work participation had no significant impact, nor did indicators of womens economic and personal autonomy.

Childbearing History and Self-Reported Well-Being in Later Life Contrasting Older African American and White Women

The authors examined how numbers of live births and pregnancy losses affected the self-rated health and depressive symptoms of women aged 50 years and older, contrasting African Americans and Whites. The authors used data from Atherosclerosis Risk in Communities, a large, prospective study with substantial minority representation. They tested hypotheses that childbearing-history variables would influence self-rated well-being among older women and that perceived social support would mediate the associations. The authors also tested whether these associations would be stronger among older African American versus White women. The results suggest that the impact of child-bearing history is greater among older African American than White women. Pregnancy loss worsened depressive symptoms and self-rated health among African American women; the effect was reduced by social-support variables. High parity was associated with worse self-rated health among African American women, mediated by social support. Having no live births was not associated with diminished well-being among older women of any race.

Marital Violence and Women's Reproductive Health Care in Uttar Pradesh, India

OBJECTIVE Although the impact of marital violence on womens reproductive health is recognized globally, there is little research on how womens experience of and justification of marital violence in developing country settings is linked to sexually transmitted infection (STI) symptom reporting, and seeking care for the symptoms. METHOD This study analyzes data on 9,639 currently married women from Indias 2006-2007 National Family Health Survey-3 from the Central/Northern Indian state of Uttar Pradesh. The likelihood of currently married womens reporting STIs or symptoms, and the likelihood of seeking care for these, are analyzed using multivariate logistic regression techniques. RESULTS Currently married womens experience of physical, sexual, and emotional marital violence in the last 12 months was significantly associated with greater likelihood of reporting a STI or symptom (odds ratio [OR], 1.364 [95% confidence interval (CI), 1.171-1.588] for physical violence; OR, 1.649 [95% CI, 1.323-2.054] for sexual violence; OR, 1.273 [95% CI, 1.117-1.450] for emotional violence). Experience of physical violence (OR, 0.728; 95% CI, 0.533-0.994) and acceptance of any justification for physical violence (OR, 0.590; 95% CI, 0.458-0.760) were significantly associated with decreased chance of seeking care, controlling for other factors. CONCLUSION This study suggests that experiencing marital violence may have a negative impact on multiple aspects of womens reproductive health, including increased self-report of STI symptoms. Moreover, marital physical violence and accepting justification for such violence are associated with decreased chance of seeking care. Thus, policies and programs to promote reproductive health should incorporate decreasing gender-based violence, and overcoming underlying societal gender inequality.

Cultural Adaptation Resources for Nutrition and Health in New Immigrants in Central North Carolina

This paper presents results of a study that was conducted for the purposes of describing available human services resources relating to nutrition, physical health, and behavioral health for new and recent immigrants (predominantly Mexican immigrants, but groups from Southeast Asia and continental Africa as well) in Guilford County, NC. Sixty-five service providers were determined to represent cultural adaptation resources providing either direct and/or ancillary assistance to limited English proficient immigrants. Seventeen direct assistance providers specialized in food and nutrition programs, but only 2 had targeted programs for addressing food scarcity, insecurity, and nutritional deficiencies in immigrant households. Four of 15 direct physical health services providers had clinical care or specialty programs for immigrants. Finally, 5 of 16 direct behavioral health care providers offered mental health treatment and counseling services adapted specifically for targeted immigrant groups. These findings highlight the limited development of the existing human services network to increase its capacity to provide nutrition and health related services to a growing community of diverse immigrant groups. These descriptive results underscore a need for additional local level or community based resources to be directed towards increasing the community’s ability to provide essential human services to population groups not yet language proficient and acculturated to “American community standards.”

Satisfaction with Care among Elderly African American and White Residents of Adult Care Facilities

Satisfaction with long-term care has received the attention of academics, policymakers, and the general public. However, little attention has been paid to ethnic differences in satisfaction, despite the increasing proliferation of long-term care options and minority representation in such facilities. The authors find that ethnic differences exist in satisfaction with adult care homes. Dependency, satisfaction with health, resident involvement in placement decisions, home type, and percentage of private rooms vary in their impact on satisfaction by ethnicity. Predictors of satisfaction within groups are primarily intra/interpersonal versus organizational characteristics. African Americans are more affected than Whites by organizational factors. Different predictors of satisfaction by ethnicity may indicate that elders bring different life experiences, cultural beliefs, and expectations with regard to long-term care that may influence their degree of satisfaction. Service delivery in long-term care institutions should be aware of the unique experiences of their residents and implement services to ensure optimal satisfaction and care.

Family-building Strategies in Urban India: Converging Demographic Trends in Two Culturally Distinct Communities

This article examines desired family size and sex composition, the extent of son preference, the underlying motivations for the preference, and the knowledge and use of the new reproductive technologies to achieve these preferences in two culturally distinct but economically similar immigrant communities in New Delhi, India. The two groups – one group from Punjab, north India, and the other from Kerala, south India – are considered in the literature to be two extremes in the socio-cultural spectrum, particularly in terms of kinship organizations, gender relations, womens decision-making power, and levels of womens autonomy. The results of the study suggest that shared urban experience, acceptance of a small family norm, and easy accessibility of new reproductive technologies and abortion services have led to similarities in desired family size, preference for sons, and means taken to realize their preference in the two communities. The article concludes with a discussion of the intricate and intersecting views of parents on family size, son preference and daughter neglect, and the many ways of regulating family size and sex composition in urban India, and draws parallel with similar research findings in India and elsewhere in Asia.

En sus proprias palabras (in their own words): Latina women’s perspectives on enablers of HIV testing using freelisting

Objective: Comprehensive information on the facilitators of HIV testing in Latino women (Latinas) in the Southeastern USA is lacking. Efforts to rectify this should include Latina perspectives on the issue. This study aimed to (1) solicit Latina perspectives using qualitative methodology and (2) characterise enablers of HIV testing follow-through. Method: The study used the freelisting interview approach to document the perspectives of Latinas (18 years and older). The purposive sample included HIV-tested (n = 21) and non-tested (n = 10) women. The setting was Non-Traditional Counseling, Testing and Referral Sites in five counties in Central North Carolina, USA. The protocol was guided by the PEN-3 framework, which aims to take culture into account as part of health education. The focus was on the enablers (i.e. social groups, networks, information channels, systems and environments) of health behaviours. Results: While participants listed 66 enablers, 37 met the criteria for analyses. The top 10 enablers were TV advertisements/commercials, friends, personal health, family wellbeing, children, TV shows, pamphlets, self-interest, knowing someone HIV positive and spouse/partner. The most salient enabler for HIV-tested Latinas was children. For non-tested Latinas, it was friends. Conclusion: Freelisting proved to be a simple and effective data collection strategy with literate and low-literate women, providing culturally relevant concepts for inclusion in subsequent quantitative survey instruments. Study participants identified a number of important enablers that could serve as supports or reinforcements for health education outreach and interventions to enhance HIV testing uptake.

Race and Ethnicity, Nativity, and Issues of Health Care:

“Age and Health in a Multiethnic Society: Health Care Issues” highlights two very important social facts of the early twenty-first century. U.S. immigration is at new highs, paralleling the influx of persons at the beginning of the century and contributing to greater heterogeneity. The second social fact is the ever-increasing emphasis on health, health care, and health policy as expressed in political campaigns and in President Bill Clinton’s call for Healthy People 2010. While it is well-known that America’s elderly population is growing ethnically diverse, in-migration as an appreciable contribution to growing ethnic diversity is less often pointed out. The end of the twentieth century saw the numbers migrating to this country approximate the level of the first decade of the century: 7,338,000 in the 1980s compared with 8,795,000 in 1900-10 (Table 1). However, the larger population base at the end of the century makes the proportion of immigrants smaller now than at the beginning of the century. After the changes in the immigration laws of the 1960s, much in-migration to the United States has been from non-European countries composed of both work and family reunification streams. Thirty years later, the impact of this increasingly diverse in-migration can be seen in the changing composition of American elders, especially in terms of both ethnicity and nativity (Table 2). The proportion of White non-Hispanic persons among those aged 65 and older declined between 1990 and 1999, while that of every other ethnic group increased (column 3 vs. column 6). Strikingly, we see that the proportion of foreign-born