Critical medical ecology and intersectionality perspectives in schistosomiasis prevention and control in selected communities in Mindanao, the Philippines

Schistosomiasis japonica remains a public health concern in many areas of the Philippines. Periodic Mass Drug Administration (MDA) to at-risk populations is the main strategy for morbidity control of schistosomiasis. Attaining MDA coverage targets is important for the reduction of morbidity and prevention of complications due to the disease, and towards achieving Universal Health Care. The study employed a qualitative case study design. Key informant interviews and focus group discussions were conducted to provide in-depth and situated descriptions of the contexts surrounding the implementation of MDA in two selected villages in known schistosomiasis-endemic provinces in Mindanao in the Philippines. Data analysis was done using the Critical Ecology for Medical Anthropology (CEMA) model coupled with the intersectionality approach. It was found that within various areas in the CEMA model, enabling as well as constraining factors have been encountered in MDA in the study settings. The interplay of income class, geographical location, gender norms and faith-based beliefs may have led to key populations being missed during the conduct of MDA in the study sites. The constraints faced by the target beneficiaries of MDA, as well as programme implementers, must be addressed to enhance service delivery and to control morbidity due to schistosomiasis. Improving compliance with MDA also requires a holistic, integrated approach to addressing barriers to participation, which are shaped by wider socio-political and power structures.

Cross-national data on informal caregivers of older people with long-term care needs in the European population: time for a more coordinated and comparable approach

To promote long-term care policies for older adults, accurate mapping of the often invisible and insufficiently recognized role of their informal caregivers is needed. This paper measures the prevalence of informal caregivers in the European population, illustrates current difficulties in gathering unequivocal information on this topic and deals with the scientific and policy implications of the problem. Using the European Health Interview Survey (EHIS), the European Quality of Life Survey (EQLS) and the Study on Health and Ageing in Europe (SHARE), the current difficulties in gathering unequivocal information on this topic are illustrated. In most countries, the share of informal caregivers varies, sometimes markedly, among the three surveys. As for the sex of caregivers, while confirming the well-known higher prevalence of caregivers among women than among men, large variations emerge across the three surveys in most countries in respect of the two sexes. The takeaway message of the paper is that it is urgent to promote international concerted action in gathering comprehensive informal caregiving information and/or exploring in greater depth the different intercultural understandings of informal care itself.

Caesarean deliveries, subsequent reproductive behaviour and children ever born in India

Against the backdrop of the alarming rise in Caesarean section (C-section) births in India, this study aimed to examine the association between C-section births, fertility decline and female sterilization in the country. A cross-sectional design was used to investigate the association between C-section delivery and subsequent reproductive behaviour in women in India. Data were from the National Family Health Survey (NFHS-4). The study sample comprised 255,726 currently married women in the age group of 15–49 years. The results showed a strong positive relationship between C-section births and female sterilization. The predicted probabilities (PP) from the multivariate regression model indicated a higher chance of female sterilization in women with C-section births (PP = 0.39, p<0.01) compared with those with non-C-section births (PP = 0.20, p<0.01). Both state-level correlation plots and Poisson regression estimates showed a strong negative relationship between C-section births and mean children ever born (CEB). Based on the results, it may be concluded that the use of C-sections and sterilization were strongly correlated in India at the time of the NFHS-4, thus together contributing to fertility decline. A strong negative association was found between the occurrence of C-sections and CEB. The increased and undesired use of C-section births and consequent female sterilization is a regressive socio-demographic process that often violates women’s rights. Fertility decline should happen through informed choice of family planning and must protect the reproductive rights of women.

Safer sex negotiation and parity among women in sub-Saharan Africa

Women’s ability to negotiate for safer sex has effects on their sexual and reproductive health. This study investigated the association between safer sex negotiation and parity among women in sub-Saharan Africa. The data were sourced from the Demographic and Health Surveys of 28 sub-Saharan African countries conducted from 2010 to 2019. A total of 215,397 women aged 15–49 were included in the study. Multilevel logistic analysis was conducted to examine the association between safer sex negotiation and parity among women in sub-Saharan Africa. The results were presented as adjusted odds ratios (aOR) and the significance level set at p<0.05. The overall prevalences of safer sex negotiation and high parity among women in sub-Saharan Africa were 82.7% and 52.1%, respectively. The prevalence of high parity ranged from 32.3% in Chad to 72.1% in Lesotho. The lowest prevalence of safer sex negotiation was in Chad (16.8%) while the highest prevalence was recorded in Rwanda (99.7%). Women who had the capacity to negotiate for safer sex were less likely to have high parity compared with those who had no capacity to negotiate for safer sex (aOR = 0.78, CI: 0.75–0.81). Other factors that were associated with high parity were age, educational level, marital status, exposure to media, contraceptive use, religion, wealth quintile, sex of household head, and place of residence. The study identified significant association between safer sex negotiation and high parity among women of reproductive age in sub-Saharan Africa. It is worth noting that women’s ability to negotiate for safer sex could reduce high parity among women in sub-Saharan Africa. Therefore, policies and programmes aimed at birth control or reducing high parity among women could be targeted at improving their capacity to negotiate for safer sex through education.

Non-use of modern contraceptives among women in humanitarian contexts: evidence from a qualitative study in Akwa Ibom State, Nigeria

The continuing conflict situation in Nigeria have created over 2 million displaced persons. In 2019, women and children accounted for about 80% of the internally displaced population in the country. Displacement increases the need for reproductive health services. This study explored the reasons for non-use of modern contraceptives among forcibly displaced Bakassi women in Akwa Ibom State, southern Nigeria. Focus group discussions were used to collect data from a convenience sample of 40 women of reproductive age (15–49 years) in two makeshift resettlement camps in the region in January and February 2020. Data were analysed using a qualitative inductive approach, with thematic organization and analysis of the transcribed responses from the focus group discussions. The findings revealed that many of the women were not using modern contraceptives at the time of the study, and the major reasons they gave for non-use were misconceptions, costs, religious beliefs, desire for more children and the inaccessibility and unavailability of contraceptive services. The use of family planning services can be a life-saving intervention in unstable, crisis environments. Programme implementation to address non-use of contraceptive services among women in crisis contexts should target social norm change, reproductive health education, empowerment programmes and health service provision.

Missing men in family planning: understanding the socio-spatial differentials in male sterilization and male spacing methods of contraception in India

Male involvement in family planning results in improved reproductive health and gender outcomes for women. In India, the use of family planning methods remains largely female-dominated. Recent media reports have indicated a rapid decline in male sterilization use in the past few years. This study aimed to assess the trends in, patterns of and factors associated with the use of male sterilization and male spacing methods in India using data from four rounds of the National Family Health Survey, conducted from 1992 to 2016. Bivariate analysis was done to see the trends in, and patterns of, male sterilization and spacing methods, while multinomial logistic regression was used to understand the factors associated with male spacing methods and sterilization. The results show a marked decline in the prevalence of male sterilization from 1992–93 (3.5%) to 2015–16 (0.3%) in India. Of the 640 districts, only 21 had a more than 2% prevalence of male sterilization. Scheduled tribe couples were two times more likely to use male sterilization than other (upper/no caste) groups. Couples from the northern region were significantly more likely to use male sterilization (aOR: 1.68, 95% CI: 1.43–1.97) compared with those from the south. There was a regional disparity in male condom use, with a very small proportion of couples in the southern (1.1%), north-eastern (2.4%) and eastern (3.3%) regions using the method compared with couples from the northern region (9.7%). Couples from the northern (aOR: 8.89, 95% CI: 8.44–9.38), north-eastern (aOR: 11.37, 95% CI: 10.62–12.18), eastern (aOR: 6.96, 95% CI: 6.60–7.34), western (aOR: 4.65, 95% CI: 4.40–4.92) and central (aOR: 10.89, 95% CI: 10.35–11.46) regions were also significantly more likely to use male spacing methods than those from southern India. Therefore, a greater focus on increasing the use of male sterilization and condoms is required in India to reduce the gender disparity in the use of family planning methods.

Surnames in south-eastern France: structure of the rural population during the 19th century through isonymy

An analysis of the distribution of surnames through time and space allows us to understand the structure of human groups, their exchanges or even their possible isolation. The French population has already been studied through surnames and it has been shown that the Sud-Provence-Alpes-Côte d’Azur region differed from the rest of France in both the 20th and 21st centuries (Mourrieras et al., 1995; Scapoli et al., 2005). The objective of this study was to understand the population evolution and particularities of the Sud-Provence-Alpes-Côte d’Azur region through an analysis of the distribution of surnames over an earlier period: the 19th century. For this work, 806,069 birth records from 521 communes between 1810 and 1890 were recorded and a total of 23,340 surnames were collected. The estimation of various isonymic parameters has allowed a description of this corpus never exploited before. In order to appreciate the population evolution, the data set was divided into three periods of 25 years. The canton was the geographical unit of this study, and similarities and differences between each of them were evaluated using Lasker distances, which allow the construction of dendrograms. A positive and significant correlation (p<0.0001) was found between Lasker distances and geographical distances using the Mantel test. The lowest inbreeding estimates were found in the Durance Valley. Migration, estimated from the v-index of Karlin and McGregor (1967), showed higher values in the south-western quarter of the region. The decrease in Rst values across the three periods is consistent with a homogenization of the patronymic between the cantons. This three-period approach showed a population evolution influenced by linguistic, cultural, historical and migratory phenomena since the Middle Ages, disrupted by the socioeconomic changes of the 19th century.

Ideal body image for the opposite sex and its association with body mass index

This research studied the preferences reported by women and men about their Ideal Body Image for the Opposite Sex (IBIOS), and its association with body mass index (BMI). It also analysed the preferences of each sex for a woman’s ideal body image (W-IBI) and a man’s ideal body image (M-IBI). A total of 450 participants aged 18–70 years with different weights were studied. Their IBIOS was assessed using standard figural stimuli. The sample was divided in four groups by sex and age (<45 years; ≥45 years). Sex and age differences in IBIOS, as well as sex differences in the preferences for a woman’s ideal body image (W-IBI) and a man’s ideal body image (M-IBI), were tested using a non-parametric Mann-Whitney U test. The association between IBIOS and BMI was analysed using Spearman’s correlation. In all groups, the most chosen silhouette as IBIOS was number 4. In the under-45 years group, women chose bigger silhouettes for the opposite sex than men did (p<0.05). In this age group women chose as ideal smaller silhouettes for the female body than men did (p<0.01). In addition, women and men in the younger age group and with normal weight chose smaller silhouettes, while those who were overweight or obese selected larger silhouettes (p<0.001). Age was found to be a relevant factor in IBIOS preferences, and in the association between IBIOS and nutritional status as measured by BMI, which was only observed to be significant in the younger age group.

Understanding the sex inequality in childlessness: an approach using Swedish register data

In most countries, men are more likely to be childless than women. Understanding how this inequality arises is important given the significance of parenthood for individuals’ lives. The objective of this study was to explore how three prominent explanations for sex inequalities in childlessness relate to the Sex Gap in Childlessness (SGC) in Sweden. The three explanations examined were sex ratio imbalance (more men than women), mismeasurement of fatherhood (inequalities in registration) and partnership differences (inequality in multi-partner fertility). Administrative register data for cohorts born in 1945–1974 were used. The population was restricted to men and women who were born in Sweden or arrived prior to the age of 15, and all registered childbearing partnerships were examined. To explore the possible significance of the three explanations, counter-factual standardization was used. Of the three explanations examined, the population sex ratio had the largest positive impact on the SGC, while multi-partner fertility had a negative impact. The results show that inequalities in the sex ratio can explain about 20–34% of the SGC depending on cohort. Inequalities in registration of fathers explain about 9–24% of the SGC depending on cohort. Finally, results show that women are slightly more likely to have multiple partners, and that this behaviour has a substantial minimizing effect on the SGC (minimizing it by 6–65%). To the authors’ knowledge this was the first paper to estimate the scope of the impacts of these three mechanisms on the SGC. Differences in multi-partner fertility have in many instances been used as an explanation for men’s higher childlessness. This study shows that women have slightly more childbearing partners than men, and that this actually leads to a smaller SGC in the studied population.

The prevailing trend of consanguinity in the Arab society of Israel: is it still a challenge?

The aim of this study was to determine the trend of consanguineous marriage among the Arab population in Israel. Socio-demographic data for the Arab population were extracted from national health surveys conducted in Israel in 2007 and 2017. The prevalence of consanguineous marriage among the Arab population in Israel increased significantly from 36.3% to 41.6% in the decade from 2007 to 2017. First-cousin and closer marriages constituted about 50% of total consanguineous marriages in the two periods surveyed. Consanguinity was found to be significantly related to religion and place of residence. Thus, the prevalence of consanguineous marriage remains high among the Arab population in Israel, similar to other Arab societies. These findings affect the health of future generations and impose a challenge for health care professionals.