Adolescent pregnancy, public policies, and targeted programs in Latin America and the Caribbean: a systematic review

Objective. To present and assess evidence from Latin America and the Caribbean (LAC) on public policies and targeted programs which may have influenced variations in adolescent pregnancy or its proximate determinants, and to identify knowledge gaps that require further research. Methods. A systematic review was performed based on the 2015 PRISMA protocol. Five databases were searched for articles published between 2000 and 2019 that refer to at least one country in LAC. The outcomes of interest were adolescent pregnancy or its proximate determinants (sexual behavior, contraceptive use, and/ or abortion). Only studies exploring correlations between the outcomes of interest and public policies or targeted programs were included in the analysis. Results. Thirty studies spanning 14 countries were selected for analysis. Twenty-three of these (77%) were not included in prior systematic reviews on adolescent pregnancy. Public policies related to conditional cash transfers and compulsory education have the strongest evidence of correlation with adolescent pregnancy prevention. Emerging research points to the potential positive impact of life-skills programs for adolescents. Evidence from public health policies and programs was limited. Conclusions. Further research which incorporates an intersectional analysis is needed to better understand which policies and programs could lead to steeper declines in adolescent pregnancy in the region. Evidence on effects of expanded family planning services and secondary school attainment upon adolescent pregnancy are particularly absent.

The Coexistence of Dual Malnutrition At Household Level in India: Evidence From The Comprehensive National Nutrition Study 2016–18

Objective To examine the prevalence of DBM at national, state, regional level and its proximate determinants in households with a mother and child under 5 years of age. Methods The present study includes data on 38,060 children under 5 years of age and their biological mothers, drawn from the nationally representative Comprehensive National Nutrition Survey (CNNS) of children and adolescents aged 0–19 years in India. The outcome variable for this study was the double burden of malnutrition at the household level. A child was classified as stunted if the height was at least -2SD below the mean for their age. A mother with a body mass index (BMI) of more than or equal to 25kg/m2 (BMI ≥ 25 kg/m2) was considered as overweight. A binary variable with coexistence of both conditions was created and categorized as 1 (existence of stunted child and overweight mother), and 0 otherwise. Multivariate regression analysis was used to examine the association between DBM and covariates at maternal, child and household level. Results 3.4% of households were found to be with DBM, with higher prevalence in urban areas (6.2%) as compared to rural areas (2.5%). Inter-state and regional variations were present in the prevalence of DBM. The proportion of DBM was higher in households with mothers aged 30 years or more, mothers not working and those who had cesarean births. Prevalence of DBM was found to be higher in urban area and rich households. Conclusion This study shows the prevalence of DBM and its proximate determinants. These findings highlight the need for a comprehensive nutrition programme that targets both undernutrition and overnutrition. While formulating standalone policies for both forms of malnutrition is relatively easier, customized policies and programmes are needed to combat the conflicting situation of dietary excess and deprivation at the household level.

The Role of Proximate Determinants and Distal Variables On Recent Fertility in Dabat Health and Demographic Surveillance System Site, Northwest Ethiopia: A Mediation Analysis

Background In Ethiopia, previous studies have explored the role of the proximate determinants for recent fertility decline at national and regional levels. However, none of these studies have examined the role of socioeconomic factors on the observed fertility decline through these proximate variables. This study aimed to estimate the effects of proximate determinants of fertility and the contribution of distal variables in recent fertility in Dabat Health and Demographic Surveillance Site, northwest Ethiopia. Methods A community based cross-sectional survey was carried out in 2020 among 1649 women of reproductive age group. Data were collected using structured and interviewer administered questionnaire. Generalized structural equation model was employed for the mediation analysis to estimate the relationships among distal and mediating variables with outcome variable, children ever born, simultaneously. A difference approach was used to test whether the effects of predictor variables were mediated. Results The Total Fertility Rate (TFR) for the three years preceding the survey was estimated at 3.4 children per woman. The Age Specific Fertility Rate (ASFR) in the study area reached its peak in the age group of 25–29 with 191 children per 1000 women. Among the proximate determinants, only marriage was a significant proximate determinant of recent fertility. The probability of having birth was more than fivefold higher among currently married women (IRR = 5.6 with a P-value = 0.000) than their unmarried counterparts. Age of women, occupation of women, household wealth status, ideal number of children, and experiencing child death had a significant total effect on recent fertility that were decomposed to direct and indirect or mediated effects of variables. Conclusion Marriage was the only proximate determinant that stood out as a significant mediated variable through which the distal variables affected fertility. Findings also clearly indicated that female participation in non-agricultural occupation affected the recent fertility. Hence, women's level of employment should be raised to increase their economic independence that will reduce the desirability of early marriage which in turn lower the number of children. In addition, the prevailing strategies on family planning programs should be improved to enhance the prevalence of contraceptive use among married women that will accelerate the current fertility transition.

A population-based study of neonatal deaths in Indonesia based on the Indonesian demographic health survey: what determinants play an essential role?

Background Neonatal mortality appears to be one of the most concerning problems to fulfill Sustainable Developmental Goals globally. Indonesia, as a developing country with uneven distribution of standardized health facilities over the archipelago, has been reported to be the country with the highest fatality cases of the newborn in Southeast Asia. To address this problem, we evaluate how substantive the socioeconomic spectrum and proximate determinants as a substantial predictor of the neonatal mortality rate in advance to maximize the health policies’ quality in reducing the rate of newborn death. Method The analysis was conducted using the data source of the 2017 Indonesia Demographic Health Survey from 11.965 live-born infants born from singleton pregnancy in the year of 2017. By using a hierarchical approach and logistic regression, the multilevel analysis was carried out to assess the possible contributing factors including socioeconomic, household, and proximate factors to neonatal mortality. Results At socioeconomic determinants, the odds of newborn death was significantly higher for those who born from mothers with poor education level (OR = 1.72, p = 0.03), insufficient antenatal visits (OR = 3.98, p = 0.01), and not being involved to postnatal care (OR = 6.60, p = 0.01). Regarding community factors, the variable of traditional birth attendants was significantly higher for the odds of newborn death (OR = 2.06, p = 0.01) as well as the delivery in government public hospitals (OR = 1.89, p = 0.01). In terms of proximate determinants, the odds of newborn death found to be higher for male infants (OR = 1.43, p = 0.03) and low birth (< 2.5 kg) weight infants (OR = 4.15, p = 0.01). After the adjustment of these covariates, the newborn death were associated to mothers with insufficient antenatal care (OR = 2.58, p = 0.01), not participating in postnatal care (OR = 5.66, p = 0.01), assisted by traditional birth attendants (OR = 1.46, p = 0.03), and neonatal factors such as male gender (OR = 5.66, p = 0.01 and low birth weight (OR = 4.37, p = 0.01). Conclusion In reducing neonatal death, public health interventions should be targeted to individual and community-level factors of socioeconomic determinants. Improving the quality and coverage of perinatal health services such as the utilization of either antenatal care or postnatal care, the availability of trained birth attendants, and the optimization in public hospitals’ services have a significant meaning for better infants’ lives.

Mexico

This chapter focuses on income inequality in Mexico, which increased between 1989 and 1994. Between 1994 and 2006, inequality declined; between 2006–14, inequality was again on the rise. The authors apply decomposition techniques to analyse the proximate determinants of labour income inequality and fiscal incidence analysis to estimate the first-order effects of taxes and social spending on the distribution of income. The key component that underlies the ‘rise–decline–rise again’ pattern was the evolution of returns to skills. In addition, while changes in fiscal policy in the 1990s were progressive and pro-poor, the redistributive effect has declined significantly since 2010, as transfers have become less progressive and net indirect taxes have increased.

Proximate Determinants and Decomposition of Changes in Fertility Levels in Nigeria, 2003-2018

BackgroundThere is disparity in fertility level across the six geopolitical zones in Nigeria. Deeper uunderstanding about the drivers of fertility trends are necessary to prioritize zonal specific strategies for fertility reduction in Nigeria. Thus, this study examined the proximate determinants (PDs) of fertility and decomposed the change in its level across the six geo-political zones in Nigeria.MethodData from Nigeria Demographic and Health Surveys of 2003 and 2018 were analyzed. Fertility data were based on the report of full birth history from women of reproductive age. The Revised Bongaarts framework was used to estimate PDs and fertility levels. The contribution of each PDs to the observed changes in fertility levels was quantified using Das Gupta’s five- factor decomposition method.ResultAcross the zones, there was a change in the fertility inhibiting effect of Contraception (Cc) between 2003 and 2018. The fertility inhibiting effect of Postpartum Infecundability (Ci) and Abortion was the highest and smallest respectively across the zones. The Total fertility rate (TFR) in 2003 and 2008 across the zones are South-South (5.04 vs 4.36), South-West (4.88 vs 4.26), North West (7.25 vs 6.85), North East (6.87 vs 6.54), North Central (5.72 vs 5.48), South East (5.06 vs 4.86), Nigeria (6.00 vs 5.59). Delayed sexual exposure (Cm) and contraceptive use (Cc) contributed the most to the change across the regions. The percentage contribution of Cm in South-South, South West, and South East was 87.04%, 52.89%, and 172.85% respectively. Furthermore, most of the fertility change observed in North Central was attributable to Cc.ConclusionAbortion index was not an important inhibiting factor of fertility in Nigeria. Delayed sexual exposure and contraceptive use accounted for the largest change observed in fertility levels across the six geo-political zones in Nigeria between 2003 and 2018. Strategies that promote delayed sexual exposure, contraceptive use and breast feeding practices will enhance fertility transition in Nigeria.

Agricultural Market Integration in India

We assess the degree of cross-market price discrepancy (a proxy for market integration), its evolution over time, and proximate determinants, using monthly price data for 21 agricultural goods and 60 markets in India. Econometric analysis shows that cross-market price integration is positively associated with the level of transportation infrastructure, and distance between market pairs. There is no robust evidence that price integration has increased in recent years, suggesting that any positive effects of recent policy initiatives are either small, outweighed by the identified determinants of integration, or yet to come.

Putting choice in the spotlight to advance theory on organizational adaptation to technological discontinuities

Purpose This paper aims to develop and argue for a new research path to advance theory on incumbent firm adaptation to discontinuous technological change. Integrating variance and process epistemologies, implications of distinguishing a firm's capacity to adapt from their adaptive choices are highlighted. Design/methodology/approach The concepts and argument presented are based on an extensive review and synthesis of the literature on the phenomenon. Findings Distinguishing resource-based capacity variables and behavioral-based choice variables can fuel progress in the literature on incumbent adaptation to technological changes. More attention is needed on the direct, proximate determinants of what occurs in the process of adaptation, e.g. the intermediate choices to adapt, the timing of adaptive actions and the selection of a means for adapting. Work must then associate specific choices with performance outcomes to complete both sides of the mediated cause-effect model connecting characteristics of the decision issue to performance. Originality/value Most studies toward understanding how incumbent firms adapt to discontinuous technological innovation have used variance analyses to identify firm and technology characteristics that explain adaptation outcomes. Focusing on characteristics and content, however, does not adequately explain why or how firms adapt. Scholars thus continue to lament the lack of clear, practical theory. I contend one heretofore unaddressed reason for this dissatisfaction is that too much of the research base neglects the importance of understanding choices and the factors affecting them.