scholarly journals Projecting sex imbalances at birth at global, regional and national levels from 2021 to 2100: scenario-based Bayesian probabilistic projections of the sex ratio at birth and missing female births based on 3.26 billion birth records

2021 ◽  
Vol 6 (8) ◽  
pp. e005516
Author(s):  
Fengqing Chao ◽  
Patrick Gerland ◽  
Alex Richard Cook ◽  
Christophe Z Guilmoto ◽  
Leontine Alkema
Keyword(s):  
At Risk ◽  
Sex Ratio ◽  
Sex Discrimination ◽  
Sub Saharan Africa ◽  
Reference Scenario ◽  
Sex Ratio At Birth ◽  
Uncertainty Interval ◽  
Bayesian Hierarchical ◽  
Sub Saharan ◽  
Birth Records

IntroductionSkewed levels of the sex ratio at birth (SRB) due to sex-selective abortions have been observed in several countries since the 1970s. They will lead to long-term sex imbalances in more than one-third of the world’s population with yet unknown social and economic impacts on affected countries. Understanding the potential evolution of sex imbalances at birth is therefore essential for anticipating and planning for changing sex structures across the world.MethodsWe produced probabilistic SRB projections from 2021 to 2100 based on different scenarios of sex ratio transition and assessed their implications in terms of missing female births at global, regional and national levels. Based on a comprehensive SRB database with 3.26 billion birth records, we project the skewed SRB and missing female births with a Bayesian hierarchical time series mixture model. The SRB projections under reference scenario S1 assumed SRB transitions only for countries with strong statistical evidence of SRB inflation, and the more extreme scenario S2 assumed a sex ratio transition for countries at risk of SRB inflation but with no or limited evidence of ongoing inflation.ResultsUnder scenario S1, we projected 5.7 (95% uncertainty interval (1.2; 15.3)) million additional missing female births to occur by 2100. Countries affected will be those already affected in the past by imbalanced SRB, such as China and India. If all countries at risk of SRB inflation experience a sex ratio transition as in scenario S2, the projected missing female births increase to 22.1 (12.2; 39.8) million with a sizeable contribution of sub-Saharan Africa.ConclusionThe scenario-based projections provide important illustrations of the potential burden of future prenatal sex discrimination and the need to monitor SRBs in countries with son preference. Policy planning will be needed in the years to come to minimise future prenatal sex discrimination and its impact on social structures.

scholarly journals Projecting sex imbalances at birth at global, regional, and national levels from 2018 to 2100: scenario-based Bayesian probabilistic projections of the sex ratio at birth and missing female births

2021 ◽  
Author(s):  
Fengqing Chao ◽  
Patrick Gerland ◽  
Alex R. Cook ◽  
Christophe Z. Guilmoto ◽  
Leontine Alkema
Keyword(s):  
At Risk ◽  
Sex Ratio ◽  
Sex Discrimination ◽  
Reference Scenario ◽  
Sex Ratio At Birth ◽  
Uncertainty Interval ◽  
Bayesian Hierarchical ◽  
Sub Saharan ◽  
To Come

Introduction: Skewed levels of the sex ratio at birth (SRB) due to sex-selective abortions have been observed in several countries since the 1970s. They will lead to long-term sex imbalances in more than a third of the world’s population with yet unknown social and economic impacts on affected countries. Understanding the potential evolution of sex imbalances at birth is therefore essential for anticipating and planning for changing sex structures across the world. Methods: We produced probabilistic SRB projections from 2018 to 2100 based on different scenarios of sex ratio transition and assessed their implications in terms of missing female births at global, regional, and national levels. Based on a comprehensive SRB database, we project the skewed SRB and missing female births with a Bayesian hierarchical time series mixture model. The SRB projections under reference scenario S1 assumed SRB transitions only for countries with strong statistical evidence of SRB inflation, and the more extreme scenario S2 assumed a sex ratio transition for countries at risk of SRB inflation but with no or limited evidence of ongoing inflation.Results: Under scenario S1, we projected 8.1 (95% uncertainty interval [2.3; 19.6]) million additional missing female births to occur by 2100. Countries affected will be those already affected in the past by imbalanced SRB, such as China and India. If all countries at risk of SRB inflation experience a sex ratio transition as in scenario S2, the projected missing female births increase to 24.8 [13.1; 44.1] million with a sizeable contribution of sub-Saharan Africa.Conclusion: The scenario-based projections provide important illustrations of the potential burden of future prenatal sex discrimination and the need to monitor SRBs in countries with son preference. Policy planning will be needed in the years to come to minimize future prenatal sex discrimination and its impact on social structures.

scholarly journals Levels and trends in sex ratio at birth in provinces of Pakistan from 1980 to 2020 with scenario-based missing female birth projections to 2050: a Bayesian modeling approach

2021 ◽  
Author(s):  
Fengqing Chao ◽  
Muhammad Asif Wazir ◽  
Hernando Ombao
Keyword(s):  
Sex Ratio ◽  
Sex Discrimination ◽  
Credible Interval ◽  
Sex Ratio At Birth ◽  
Bayesian Hierarchical ◽  
Female Birth ◽  
Child Mortality Rate ◽  
Birth Records ◽  
Male To Female ◽  
Postnatal Stage

BACKGROUND: Pakistan has a strong preference for boys over girls; previous evidence on sex preference is primarily reported at the postnatal stage in which the child mortality rate is higher for females than males. Prenatal sex discrimination in Pakistan, reflected in the inflated sex ratio at birth (SRB; ratio of male to female births) has been barely mentioned before this study.OBJECTIVE: We estimate the SRB and missing female births in Pakistan provinces from 1980 to 2020 and identify provinces with imbalanced SRB. We provide scenario-based projections of missing female births in provinces without the existing SRB inflation.METHODS: An extensive SRB database of 832,091 birth records was compiled from all available surveys and censuses. To synthesize different data sources and provide annual estimates and their associated uncertainties of SRBs across provinces, we adopted a Bayesian hierarchical time series model.RESULTS: As per our model, Balochistan has had SRB imbalance since 1980. The maximum SRB was estimated as 1.121 (95% credible interval [1.066; 1.142]) in 1997. Assuming different start year of SRB inflation process in provinces without existing imbalance, the largest female birth deficit is projected to be 76.2 thousand in Punjab in 2033 when the SRB inflation starts in 2021.CONTRIBUTION: This is the first study on estimating the SRB from 1980 to 2020 and providing scenario-based projections of missing female births up to 2050 by Pakistan province. We identified the Balochistan province with imbalanced SRB and demonstrated important disparities in the occurrence and quantity of female birth deficits before 2050.

scholarly journals Systematic assessment of the sex ratio at birth for all countries and estimation of national imbalances and regional reference levels

2019 ◽  
Vol 116 (19) ◽  
pp. 9303-9311 ◽  
Author(s):  
Fengqing Chao ◽  
Patrick Gerland ◽  
Alex R. Cook ◽  
Leontine Alkema
Keyword(s):  
Sex Ratio ◽  
Direct Consequence ◽  
Sub Saharan Africa ◽  
Sex Ratio At Birth ◽  
Reference Levels ◽  
Uncertainty Interval ◽  
Selective Abortion ◽  
National Reference ◽  
Sex Selective Abortion ◽  
Regional Reference

The sex ratio at birth (SRB; ratio of male to female live births) imbalance in parts of the world over the past few decades is a direct consequence of sex-selective abortion, driven by the coexistence of son preference, readily available technology of prenatal sex determination, and fertility decline. Estimation of the degree of SRB imbalance is complicated because of unknown SRB reference levels and because of the uncertainty associated with SRB observations. There are needs for reproducible methods to construct SRB estimates with uncertainty, and to assess SRB inflation due to sex-selective abortion. We compile an extensive database from vital registration systems, censuses and surveys with 10,835 observations, and 16,602 country-years of information from 202 countries. We develop Bayesian methods for SRB estimation for all countries from 1950 to 2017. We model the SRB regional and national reference levels, the fluctuation around national reference levels, and the inflation. The estimated regional reference levels range from 1.031 (95% uncertainty interval [1.027; 1.036]) in sub-Saharan Africa to 1.063 [1.055; 1.072] in southeastern Asia, 1.063 [1.054; 1.072] in eastern Asia, and 1.067 [1.058; 1.077] in Oceania. We identify 12 countries with strong statistical evidence of SRB imbalance during 1970–2017, resulting in 23.1 [19.0; 28.3] million missing female births globally. The majority of those missing female births are in China, with 11.9 [8.5; 15.8] million, and in India, with 10.6 [8.0; 13.6] million.

SEX RATIO AT BIRTH AND FAMILY COMPOSITION IN SUB-SAHARAN AFRICA: INTER-COUPLE VARIATIONS

2009 ◽  
Vol 41 (3) ◽  
pp. 399-407 ◽  
Author(s):  
MICHEL GARENNE
Keyword(s):  
Sex Ratio ◽  
Sex Ratios ◽  
The United States ◽  
Sub Saharan Africa ◽  
Family Composition ◽  
Sex Ratio At Birth ◽  
First Birth ◽  
Wide Range ◽  
Sub Saharan ◽  
Linear Logistic Model

SummaryIn this study, sex ratios at birth (male/female births) were found to vary according to family composition. Using Demographic and Health Survey (DHS) maternity histories from sub-Saharan Africa, the study shows that the sex ratio at birth increases with the number of previous male births and decreases with the number of previous female births. For families with only males, the sex ratio increases from 1·046 for the first birth to 1·083 for the 8th birth. For families with only females, the sex ratio decreases from 1·046 for the first birth to 0·942 for the 8th birth. The differences were highly significant when tested with a linear logistic model (p=0·018 for males; p=1·85✕10−11 for females). The effect was not symmetrical, and was found to be significantly stronger for females. These effects could be reproduced assuming a strong heterogeneity between couples. The distribution of sex ratios was fitted with an asymmetrical log-gamma function, which revealed a wide range of variation in the sex ratio between 0·50 and 1·30, and a peak around 1·14. The results and their implications are discussed in the light of former findings in France and in the United States of America.

scholarly journals Contraceptive dynamics during COVID-19 in sub-Saharan Africa: longitudinal evidence from Burkina Faso and Kenya

2021 ◽  
pp. bmjsrh-2020-200944
Author(s):  
Celia Karp ◽  
Shannon N Wood ◽  
Georges Guiella ◽  
Peter Gichangi ◽  
Suzanne O Bell ◽  
...  
Keyword(s):  
At Risk ◽  
Burkina Faso ◽  
Unintended Pregnancy ◽  
Sexual And Reproductive Health ◽  
Universal Access ◽  
Sociodemographic Factors ◽  
Sub Saharan Africa ◽  
Contraceptive Services ◽  
Logistic Regressions ◽  
Sub Saharan

IntroductionEvidence from health emergencies suggests COVID-19 will disrupt women’s sexual and reproductive health (SRH). In sub-Saharan Africa, which experiences the highest rates of unintended pregnancy and unsafe abortion globally, COVID-19 is projected to slow recent progress toward universal access to contraceptive services.MethodsWe used longitudinal data collected from women at risk of unintended pregnancy in Burkina Faso (n=1186) and Kenya (n=2784) before (November 2019–February 2020) and during (May–July 2020) COVID-19 to quantify contraceptive dynamics during COVID-19; examine sociodemographic factors and COVID-19 experiences related to contraceptive dynamics; and assess COVID-19-related reasons for contraceptive non-use. Bivariate and multivariate logistic regressions were used to examine correlates of contraceptive dynamics amid COVID-19.ResultsMost women did not change their contraceptive status during COVID-19 (68.6% in Burkina Faso and 81.6% in Kenya) and those who did were more likely to adopt a method (25.4% and 13.1%, respectively) than to discontinue (6.0% and 5.3%, respectively). Most women who switched contraceptives were using methods as or more effective than their pre-pandemic contraception. Economic instability related to COVID-19 was associated with increased contraceptive protection in Burkina Faso but not in Kenya. Altogether, 14.4% of non-contraceptive users in Kenya and 3.8% in Burkina Faso identified COVID-19-related reasons for non-use.ConclusionsThe vast majority of women at risk of unintended pregnancy did not change their contraceptive status during COVID-19, and more women adopted than discontinued methods. A minority of women reported COVID-19-related reasons for non-use, underscoring the importance of expanding safe modes of service delivery during health crises.

scholarly journals Sex ratio at birth in Vietnam among six subnational regions during 1990–2050, estimation and probabilistic projection using a Bayesian hierarchical time series model

2021 ◽  
Author(s):  
Fengqing Chao ◽  
Christophe Z. Guilmoto ◽  
Hernando Ombao
Keyword(s):  
Time Series ◽  
Sex Ratio ◽  
Local Maximum ◽  
Credible Interval ◽  
River Delta ◽  
Red River ◽  
Sex Ratio At Birth ◽  
Red River Delta ◽  
Mountain Areas ◽  
Bayesian Hierarchical

The sex ratio at birth (SRB, i.e., the ratio of male to female births) in Vietnam has been imbalanced since the 2000s. Previous studies have revealed a rapid increase in the SRB over the past 15 years and the presence of important variations across regions. More recent studies suggested that the nation’s SRB may have plateaued during the 2010s. Given the lack of exhaustive birth registration data in Vietnam, it is necessary to estimate and project levels and trends in the regional SRBs in Vietnam based on a reproducible statistical approach. We compiled an extensive database on regional Vietnam SRBs based on all publicly available surveys and censuses and used a Bayesian hierarchical time series mixture model to estimate and project SRB in Vietnam by region from 1980 to 2050. The Bayesian model incorporates the uncertainties from the observations and year-by-year natural fluctuation. It includes a binary parameter to detect the existence of sex ratio transitions among Vietnamese regions. Furthermore, we model the SRB imbalance using a trapezoid function to capture the increase, stagnation, and decrease of the sex ratio transition by Vietnamese regions. The model results show that four out of six Vietnamese regions, namely, Northern Midlands and Mountain Areas, Northern Central and Central Coastal Areas, Red River Delta, and South East, have existing sex imbalances at birth. The rise in SRB in the Red River Delta was the fastest, as it took only 12 years and was more pronounced, with the SRB reaching the local maximum of 1.146 with a 95% credible interval (1.129, 1.163) in 2013. The model projections suggest that the current decade will record a sustained decline in sex imbalances at birth, and the SRB should be back to the national SRB baseline level of 1.06 in all regions by the mid-2030s.

scholarly journals Strongyloides stercoralis infection in San Marino Republic: first epidemiological data from an observational study

2019 ◽  
Vol 147 ◽  
Author(s):  
E. D. Cappella ◽  
A. C. Piscaglia ◽  
A. Cadioli ◽  
S. Manoni ◽  
R. Silva ◽  
...  
Keyword(s):  
At Risk ◽  
Epidemiological Data ◽  
Strongyloides Stercoralis ◽  
Northern Italy ◽  
Sub Saharan Africa ◽  
Routine Practice ◽  
Travel History ◽  
Imported Case ◽  
Serology Test ◽  
Sub Saharan

AbstractStrongyloides stercoralis is a neglected parasite that can cause death in immunocompromised individuals. There were no data on the epidemiology of S. stercoralis infection in San Marino Republic until two patients (one of whom died) were diagnosed with severe strongyloidiasis (hyperinfection) between September 2016 and March 2017. A serology test for Strongyloides spp. was introduced in routine practice in the laboratory of the State Hospital to test patients considered to be at risk for strongyloidiasis. Between August 2017 and August 2018, of 42 patients tested with serology, two (4.8%) were positive. An additional case was found by gastric biopsy. Two of the positive cases were presumably autochthonous infections (elderly people with no significant travel history), while the other was a probable imported case (young man born in Nigeria and settled in Europe since 2003). Epidemiology of strongyloidiasis in San Marino might be similar to Northern Italy, where a relevant proportion of cases was diagnosed in immigrants (mainly from sub-Saharan Africa) and in elderly Italians with eosinophilia. Screening for strongyloidiasis might be worthwhile in inhabitants of San Marino in the same categories of individuals, particularly those at risk of immune suppression.

scholarly journals Reaching at-risk women for PrEP delivery: What can we learn from clinical trials in sub-Saharan Africa?

PLoS ONE ◽  
2019 ◽  
Vol 14 (6) ◽  
pp. e0218556 ◽  
Author(s):  
Kayla Stankevitz ◽  
Katie Schwartz ◽  
Theresa Hoke ◽  
Yixuan Li ◽  
Michele Lanham ◽  
...  
Keyword(s):  
At Risk ◽  
Clinical Trials ◽  
Sub Saharan Africa ◽  
Sub Saharan

The ABC Approach and the Feminization of HIV/AIDS in the Sub-Saharan Africa

2008 ◽  
pp. 10-15 ◽  
Author(s):  
Lynette Kvasny ◽  
Jing Chong
Keyword(s):  
At Risk ◽  
Spatial Location ◽  
Sub Saharan Africa ◽  
The Internet ◽  
Health Campaigns ◽  
Health Campaign ◽  
The West ◽  
Cultural Images ◽  
Vulnerable Subjects ◽  
Sub Saharan

Women, the dominant subjects of AIDS discourses, are placed at risk by common systems of oppression such as gender, race, class, and social and spatial location. Through the health campaigns which are disseminated and reproduced through television, radio, newspapers, and more recently the internet, women are uniquely constructed by privileged “experts” from the West as consumable subjects. In the case of women in Sub- Sahara Africa, we found that health campaigns which feminize AIDS are rooted in largely hegemonic cultural images which portray women as vulnerable subjects under siege. Through our analysis, we problematize the ABC health campaign and its appropriateness for women in Sub-Saharan Africa.

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