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Children and young people

One of the Eldis RSS newsfeeds on major development issues

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Patterns and drivers of internal migration among youth in Ethiopia, India, Peru and Vietnam

28 Mar 2017 10:25:53 GMT

There is general consensus in literature on migration that migrants are primarily young people. During the transition to adulthood, young people make important choices regarding education, labour force participation, and family formation.

Using a unique panel dataset on youth born in 1994-95 in Ethiopia, India, Peru, and Vietnam, this working paper investigates how life-course transitions to adulthood relate to patterns and predictors of internal migration in low- and middle-income countries. It documents patterns on prevalence, frequency, timing, reasons and streams of migration, employment at destination, subjective well-being, and migration aspirations.

The paper then describes the factors associated with young men and women’s decision to migrate, and the reasons for migrating. The results suggest that there is a significant share of migrants between 15 and 19 years old across all four countries, and they are very likely to move more than once. In all countries, migrants are more likely to move after the school-age years, between ages 17 and 18.
These patterns on frequency and timing of moves provide new evidence that young individuals migrate very often even before having finished school, which is key to understanding educational performance. The patterns on the reasons for moving provide evidence that young people move for a variety of reasons that go beyond the economic-related: family formation and family reunion are also important motives for migrating, especially in the studied age range. The migration streams presented show that these youth do not necessarily follow rural-urban migration as it is generalised in literature, and they shed light on the dynamics of the less studied rural-rural migration. The results suggest that at this age, migration is a household strategy: although migrants do not necessarily contribute remittances to their previous household, they are often receiving them from their caregiver.

Choices made during the transition to adulthood shape young people’s migration patterns, and migrants are therefore a very heterogeneous group as there are systematic differences in their characteristics depending on their reasons for moving. This is important because understanding this puts us in a better position to propose more effective policies that target young migrants’ well-being in developing countries.

Perceptions and experiences of children associated with armed groups in northeast Nigeria

24 Mar 2017 11:21:17 GMT

The recruitment and use of children by armed forces or armed groups is prohibited by international and regional legal instruments, to which Nigeria is a party. Recruitment and use of children in conflict is considered to be one of the six grave violations of children's rights under United Nations Security Council Resolution 1612 (2005). Where there is evidence of parties to a conflict committing violations, they will be 'listed' in the annual report of the Secretary General to the Security Council. This listing triggers a monitoring and reporting mechanism, administered by the United Nations in a country, which submits quarterly and annual reports documenting violations and the steps taken to prevent and respond to the violations.

Jama'atu Ahlis Sunna Lidda'awati wal-Jihad (JAS), more commonly known as Boko Haram was listed for recruitment and use of children in June 2015² and for abduction of children (one of the other six grave violations) in April 2016, having been first listed in 2014 for killing and maiming of children and attacks on schools and hospitals. The Civilian Joint Task Force (CJTF) was listed for recruitment and use in April 2016.

The study examines the pathways and drivers for recruitment of children into these groups, the pathways for exiting the armed groups, and the challenges and opportunities for reintegration including the role of family and community perception and potential for stigmatisation.

The findings of the study will inform the development of policies, strategies and programmes that can effectively support the reintegration of children who have been associated with armed groups.

Young women and work in Nigeria: how young women, including those with disabilities, can be supported to find employment and earn an income

23 Mar 2017 04:01:10 GMT

While the current Nigerian government’s commitment to youth employment is evident in the investments being made  through these youth employment and empowerment programmes, this study provides further evidence that such schemes lack a gender analysis  and responsiveness, which combined with  other issues, affect such programmes’ transparency, operational effectiveness, politicisation  and  impact.

While young women appreciate and are benefiting from some of the higher quality programmes, there is limited evidence of impact and sustainable increases in employment and income  earning. In particular, youth employment and empowerment programmes often suffer from poor design, targeting, implementation and monitoring.  

This report presents findings from a qualitative study commission by the Nigeria Stability and Reconciliation Programme  (NSRP), exploring the extent to which government youth employment and empowerment programmes are targeting, reaching and working for young women, with a particular focus on the most prominent federal level programmes including the Subsidy Reinvestment and Empowerment Programme (SURE-P); Youth Enterprise with Innovation in Nigeria Programme (YouWIN!); Youth Employment and Social Support  Operation (YESSO); Vocational Skills Development (VSD); and Growing Girls and Women in Nigeria (G-WIN).  

The study focuses on the experiences of young women, including those with physical disabilities, in rural and semi-urban areas in three of NSRP’s target states:  Kaduna (Middle  Belt), Kano (North-west) and Rivers States (South-South).

Maternal undernutrition and childbearing in adolescence and offspring growth and development: is adolescence a critical window for interventions against stunting?

24 Feb 2017 04:11:48 GMT

Maternal undernutrition and adolescent childbearing are prevalent in low- and middle-income countries and have harmful consequences for children. However, less is known on whether these implications persist throughout the offspring’s life course. Moreover, although adult nutritional status has been suggested to largely reflect conditions during the period from conception to 2 years old (“the first 1,000 days”), others have argued that adolescence is an equally important period for nutrition. This is not well established, however, and there is less evidence on the relative importance of conditions during the first 1,000 days of a girl’s life, versus during adolescence, for her nutritional status during pregnancy.

This working paper addresses these gaps through two interrelated investigations. First, the paper documents associations of mothers’ stunting and adolescent childbearing with their children’s developmental outcomes from in fancy through early adolescence, using data on a cohort of children and their mothers from Ethiopia, India, Peru, and Vietnam. Second, in order to infer whether maternal adult undernutrition may reflect undernutrition during adolescence, the authors use data from another cohort of girls in each of these countries who were surveyed throughout adolescence to estimate the extent of catch-up growth during adolescence.

The results suggest that maternal stunting and adolescent childbearing are both associated with offspring stunting at infancy, that the association between the mother’s and offspring’s stunting persists through the offspring’s early adolescence, and that the two maternal outcomes are not systematically associated with offspring cognitive achievement. For example, taking account of many variables which could affect children's stunting, the authors find that being born to a stunted adolescent mother was associated with a 15 percentage point increased chance of child being stunted, compared with being born to a non-stunted older mother.

The research also finds that among adolescent girls with height below the WHO standard at 12 years old, on average, 40 per cent of the height deficit was recovered by age 19. As most of this change is likely to have occurred during early adolescence (in this data 12-15 years old), this may be a particularly promising time for interventions to take place.

Overall, the findings reinforce concerns over the long-term implications of mother’s nutritional circumstances for their children’s healthy growth. An important implication of these findings is that interventions that aim to delay childbearing and promote catch-up growth among adolescent girls, particularly in early adolescence, may be effective in breaking the intergenerational cycle of stunting
in low- and middle-income countries.

Understanding children’s experiences of violence in Andhra Pradesh and Telangana, India: evidence from Young Lives

10 Feb 2017 11:59:31 GMT

Physical and emotional violence towards children in India appears to be so widespread that it is often difficult to trace the direct effects of poverty; the findings suggest that a range of factors appear to play a role, especially age and gender norms.
This paper explores children’s accounts of violence in Andhra Pradesh, India, and the ways in which factors at the individual, family, community, institutional and society levels affect children’s experiences of violence. The paper analyses cross-sectional survey data and case studies from longitudinal qualitative data gathered over a seven-year period, from Young Lives.

The paper reveals that a child’s disapproval of violence does not necessarily influence behaviour in later life, confirming the need for interventions to prevent and tackle violence as children grow up.

More promisingly, children also describe strategies through which to protect themselves from violence and the threat of violence. The paper contributes to knowledge about the nature and experience of violence among children in resource poor settings, and concludes with some suggestions for policy, programming and practice.

Understanding children’s experiences of violence in Ethiopia: evidence from Young Lives

10 Feb 2017 11:52:39 GMT

Violence affecting children in many forms is widespread in Ethiopia, and indeed in sub-Saharan Africa more generally. Physical, emotional and sexual violence in the home and community are commonplace; however, the underlying factors contributing to the incidence of violence against children in different settings are not well understood. Based on the evidence from Young Lives’ research in Ethiopia, we find that corporal punishment is the most prevalent form of violence both at school and at home, whereas in communities, emotional violence in the form of insults and harassment is more common. Children’s experiences of violence also vary along the lines of age and gender, and in different ways at various points of the life course.
his research report explores children’s accounts of everyday violence in Ethiopia, and the ways in which factors at individual, family, community, institutional and society levels affect children’s experiences of violence. The report primarily draws on analysis of four rounds of longitudinal qualitative data gathered over seven years, complemented with analysis of cross-sectional survey data from Young Lives. After a brief description of the policy context and literature review, the paper describes the study then presents findings from the survey and qualitative research, exploring home, schools, communities, differences by age and gender, and children’s responses to violence. Violence affecting children – mostly physical punishment and emotional abuse – is widespread, accepted, and normalized. Differing economic activities affect family dynamics and the likelihood of children experiencing violence, which is often linked to the challenges of poverty and the expectation that children will contribute to the household economy. The report adds to knowledge about the nature and experiences of violence affecting children in resource-poor settings, and concludes with some suggestions for policies, programming and practice.

Understanding children’s experiences of violence in Peru: evidence from Young Lives

10 Feb 2017 11:46:27 GMT

In Peru, violence is considered a major public health concern. In the last 20 years, there have beens ignificant efforts to prevent, punish and eradicate violence, particularly in the case of violence against women. Nevertheless, the prevalence of violence against children in Peru remains very high (around 30 per cent).

The paper has been commissioned as part of the UNICEF Multi-Country Study on the Drivers of Violence Affecting Children in Italy, Peru, Viet Nam and Zimbabwe. The Multi-Country Study is analysing how factors at the individual, inter-personal, community, institutional and structural levels interact to shape everyday violence in children’s homes. It uses the socio-ecological model to
explore the complexities of violence affecting children in order to help communities develop more effective national strategies for violence prevention.
This paper focuses on children’s accounts oftheir experiences of violence at home, and explores drivers of violence at the individual,
interpersonal and community level. In line with international definitions, the authors analyse the occurrence of three forms of violence enacted by parents on children: physical violence (the intentional use of physical force against a child that either results in or has the potential to harm the child’s health, survival, development or dignity); mental or psychological violence (not providing an appropriate and supportive environment for the child, including acts that can be detrimental to a child’s psychological development, emotional health and well-being); and neglect or negligent treatment (the failure to meet children’s physical and psychological needs, protect them from danger or obtain medical, birth registration or other services when those responsible for their care have the means, knowledge and access to services to do so).

Understanding children’s experiences of violence in Viet Nam: evidence from Young Lives

10 Feb 2017 11:38:36 GMT

Despite the fact that the Vietnamese Government has issued many laws and regulations to protect children from harm and exploitation, research has shown that violence against children in Viet Nam is widespread. With the aim of developing better national strategies for preventing violence against children, UNICEF’s Office of Research is conducting a Multi-Country Study on the Drivers of Violence Affecting Children in Italy, Peru, Viet Nam and Zimbabwe.

This paper has been commissioned as part of this ongoing study. Drawing on Young Lives longitudinal qualitative data and school survey data, this paper provides an account of children’s and young people’s perspectives on violence in the home.

Specifically, the paper addresses the following questions: a) what do children know about violence in the home and how do they experience it?; b) what do they think drives violence in the home?; c) what do they perceive to be the consequences of the violence they experience?; and d) what support do they find to be most effective in addressing violence in the home?

Ending child marriage and stopping the spread of HIV ...opportunities and challenges for action

10 Feb 2017 04:14:39 GMT

AIDS is now the number-one killer of adolescents in Africa. What is more worrying is that seven of every 10 new infections of HIV among adolescents are girls, which shows how vulnerable girls are to acquiring HIV. Similar socioeconomic factors drive both HIV and child marriage, but very few studies have shown the causal effects and links between the two.
This desk review examines some of the existing literature to highlight what is known about the links between child marriage and HIV, and spotlights opportunities for further action. Very few studies have explicitly explored the two phenomena. Given recent increases in the number of adolescent girls who are HIV-positive and the high numbers and rates of child marriage in countries with high HIV prevalence, the data do suggest a correlation between ending child marriage and stopping the spread of HIV/AIDS.
This review argues that gender, gender relations and women’s empowerment play a significant role in linking child marriage and HIV. When girls marry young, usually to older men, they are vulnerable to gender-based disadvantages. The imbalance of power in a child marriage significantly erodes a girl’s control of her body and her social and economic potential.

Transmission, spread and control of HIV hinges on improving gender relations, and this may be even truer with child marriage. Fundamentally, child marriage is a construct and a result of gender imbalances.

Child labor in Myanmar’s garment sector challenges and recommendations

10 Feb 2017 03:03:21 GMT

Buyers and investors are back in Yangon looking for opportunities, attracted in part by the country’s low labour costs. However, Myanmar has spent over a decade cut off from Western markets and the compliance culture that has evolved around social and environmental management of supply chains.

Meeting buyer expectations now requires not only investing to meet higher requirements for speed and quality, but also ensuring that labor practices meet or exceed international standards.

Child labour is a particular area of concern. In a country with high levels of poverty, low rates of secondary school enrollment, and weak enforcement of labour laws, child labour is unsurprisingly a common option for families in need of additional income. Underage workers (younger than 14, the legal minimum) are prevalent in many sectors, ranging from construction to teashops.
This report explains the context of child labour in Myanmar, both across sectors and specifically for garment manufacturing.
Findings include:
  • young workers are participating in the garment sector but usually make up a small percentage of a factory’s workforce, and underage workers are rare. However, young workers are often working the same hours as adults, and laws regulating their working hours and conditions are not being enforced
  • increased access to U.S. and European markets is reshapin g the garment industry, but the majority of factories are not yet selling to U.S. and European buyers, and their labour practices are lagging

Key recommendations:

To prevent and remediate child labour, buyers and investors should support the establishment of a protective framework. This will require consistent and sustained action by diverse stakeholders, including:
  • enacting clear and coherent laws and regulations
  • fostering cultural norms that prioritize education for children until the legal minimum working age
  • ensuring livelihoods for adults that can support the entire household
  • implementing a system of monitoring and enforcement that includes workers, management, inspectors, unions, and community members

Eliminating child labour, achieving inclusive economic growth

10 Feb 2017 02:50:35 GMT

Whilst weak and unequal economic growth can also lead to child labour through its impact on poverty and labour markets, this report seeks to address the issue from a new angle: showing that eliminating child labour can in itself contribute to economic growth. This approach builds economic elements into the already strong child rights case for eliminating child labour, appealing to policy-makers who typically neglect child labour as a ‘social’ or ‘rights’ issue, when it is also an important economic one.
This report shows the different transmission pathways through which child labour contributes to slower economic growth, particularly where it is more prevalent. It draws clear links between eliminating child labour and the UK government’s ability to fulfil its international development objectives. Indeed, several of the UK's Department for International Development’s (DFID) policy commitments cannot be fully achieved without tackling child labour. This analysis is equally applicable to other development actors globally, including donors and non-governmental organisations (NGOs).
This report argues that a focus on ending child labour resonates strongly with the following two DFID strategic objectives:
  • promoting global prosperity: the UK government will use official development assistance (ODA) to promote economic development and prosperity in the developing world
  • tackling extreme poverty and helping the world’s most vulnerable: the government will strive to eliminate extreme poverty by 2030, and support the world’s poorest people to ensure every person has access to basic needs, including prioritising the rights of girls and women



The interplay between community, household and child level influences on trajectories to early marriage in Ethiopia

10 Feb 2017 01:10:22 GMT

Child marriage is a global concern and a priority issue for the African Union; the Ethiopian government has devised a strategy to eliminate the practice by 2025.

This paper analyses Young Lives survey and qualitative data from girls aged 19 to understand pathways to early marriage, which the authors argue can best be explained by a combination of interacting factors at community, household and individual levels.

Findings confirm that child marriage is primarily a female, rural phenomenon, with regional and local differences related to cultural norms. Early teen marriage is more common in regions in the north and is often related to family poverty. Customs of dowry in the north and bridewealth in the south present constraints, especially for teenagers from poorer families.

Household characteristics are also important; parental education, especially that of the father, reduces the likelihood of child marriage. Parental death and absence was highlighted in the qualitative case material. Household wealth was particularly significant, with less than 10 per cent of early marriages among the top tercile, and family circumstances such as ill-health and drought were compounding factors. Parental imposition of marriage was stronger and girls’ agency more limited among the younger teenage girls, whereas older teenagers were more likely to make their own marital choices.

The gender imbalance is stark, with 13 per cent of teenage girls married compared to less than 1 per cent of boys. Girls continuing with schooling were less likely to get married, but most left school first due to family poverty and problems. Paid work at 15 was found to be statistically significant as a predictor of early marriage, while case material suggests that some girls chose marriage over jobs involving hard labour. Once married, return to schooling was constrained by social norms and childcare.

The findings suggest a need to recognise that there are early marriage ‘hotspots’, and conversely other areas where the practice is declining faster and girls marrying later, which can provide important lessons for interventions. Policies should further promote girls’
education, including for already married girls, and focus more on protection for younger teenager girls who are at more risk from imposed marriages.

The sooner the better but it’s never too late: the impact of nutrition at different periods of childhood on cognitive development

09 Feb 2017 02:20:16 GMT

Although it has been argued that undernutrition and its consequences for child development are irreversible after the age of 2, the evidence in support of these hypotheses is inconclusive. This working paper investigates the impact of nutrition at different periods from conception to middle childhood on cognitive  achievement in early adolescence using data from Ethiopia, India, Peru, and Vietnam. In order to address estimation problems the paper develops a conceptual framework that delineates the channels through which child health impacts cognitive development and uses exogenous variation in nutritional status arising from weather shocks.

Results suggest that child growth both before and after the first 1,000 days is responsive to weather shocks and impacts cognitive achievement in early adolescence. The paper also finds that part of the effect of early growth on later cognitive achievement manifests through growth in interim periods. Another novel result is that parental investment responses to a change in child health depend on the timing of this change.

These findings have important policy implications. On the one hand, results indicate that nutrition early in life is important for physical growth and cognitive development in subsequent stages of childhood, but on the other hand they suggest that nutrition-promoting investments after infancy and early childhood can act as a remedy for early nutrition and
cognitive deficits and protect from nutritional insults in later stages that may also lead to developmental setbacks.

Overall, the evidence suggests that nutrition-promoting interventions that start early in life and continue to subsequent stages of childhood, combined with support in other areas such as cognitive stimulation and parental involvement, may hold the most promise for the promotion of child development.

Child marriage and early child-bearing in India: risk factors and policy implications

09 Feb 2017 01:53:47 GMT

Prevalence rates of child marriage and early child-bearing have been declining across India over the past two decades, but absolute numbers remain high. This paper uses data collected from 3,000 children over 15 years in Andhra Pradesh and Telangana by Young Lives, a longitudinal study of childhood poverty, to provide an evidence base from which to strengthen policy and programming in this area.

An ecological life-course framework is used to explore the causes of child marriage and early child-bearing and the factors which help to prevent them. Findings show that:
  • girls who stay in school for longer marry later, but gender gaps in enrolment widen during adolescence
  • where household resources are limited, gendered social risks become more acute and parents are forced to make decisions which disadvantage girls
  • aspirations matter but reflect wider realities
  • and social norms that encourage early child-bearing are compounded by inequitable access to health and education services
The paper finds that, whilst child marriage and early child-bearing are driven by entrenched patriarchal norms regarding the role and value of girls (and women) in society, structural factors are critical. Poverty and social disadvantage constrain girls’ opportunities and exacerbate the risks they face, forcing individual girls and their families to maintain ‘normal’ practices, thus reinforcing norms. An ecological life-course framework helps to demonstrate the need for a layered strategy to tackle the gendered disadvantages which drive child marriage and early child-bearing.

Parental background and child human capital development throughout childhood and adolescence: evidence from four low- and middle-income countries

09 Feb 2017 01:29:47 GMT

Although there are a vast number of empirical studies documenting a strong positive link between parental socio-economic status (SES) and child outcomes, we do not know whether these associations remain robust when other parental background dimensions are controlled.

This working paper investigates the association of child human capital indicators with a wide range of parental background dimensions across four low- and middle-income countries, and at different stages of childhood and adolescence, using data from the Young Lives cohort study in Ethiopia, India, Peru, and Vietnam.

The key finding is that parental income is strongly and positively associated with child nutritional status and cognitive achievement across all countries and at all stages of childhood and adolescence, even after controlling for other background dimensions, but the same does not hold for parental education. Child non-cognitive skills across all countries and at different ages, however, are mostly predicted by the mother’s personality traits reflected in her non-cognitive skills, social capital, and aspirations for the child’s education. Associations of parental background factors with child human capital measures do not change systematically with child age, except that mother’s aspirations for child education exhibits a positive association with child cognitive and non-cognitive skills that is increasing in child age across countries.

Overall, the results suggest that policies that seek to improve the material circumstances of the household and mother’s education and socioemotional competencies may be effective in promoting child cognitive and socioemotional development in low- and middle-income countries.

How effective are CCTs in low income settings? A review exploring factors impacting on programme outcomes in Honduras and Nicaragua

27 Jan 2017 02:51:10 GMT

Conditional cash transfer (CCT) programmes have been evaluated extensively and show by and large an increase of consumption amongst beneficiaries resulting in sometimes substantial reductions in poverty. Nonetheless important questions remain outstanding.

CCTs have very heterogeneous impacts in different contexts. This paper presents the findings of a systematic review of papers looking at evidence of effect of CCTs in Nicaragua and Honduras. In particular, this review wanted to look at wider contextual factors and their relationship with programme outcomes. These factors were: household characteristics and intra-household relations; programme design and delivery; supply side conditions; wider political, social and economic factors.
The review included 13 papers and found that:
  • household, programme and wider contextual factors shape the size and nature of programme effects
  • poorer households and communities tend to experience greater relative effects on school enrolment, and a reduction of child working hours
  • programme effects are greater when economic conditions are favourable
  • however, CCTs also help to lessen the effect of economic shock on household consumption
  • how external factors (e.g. economic shock) affect nutrition and health outcomes remains unclear
  • real and perceived dimensions of programme implementation affect participants’ incentives to comply with conditionalities
The paper further suggests that a key gap in existing knowledge is better knowledge of the causal pathways through which different household and economic factors affect the outcomes experienced.

Child Under-weight and Agricultural Productivity in India: Implications for Public Provisioning and Women’s Agency

19 Jan 2017 04:10:05 GMT

The well-known pathways that link agriculture to child nutrition are food, quality of food, and care of feeding. Further, agricultural productivity growth contributes significantly to poverty reduction and reduction in child undernutrition. Care of children and feeding practices depend upon women’s knowledge, and hence women’s education and their freedom to act are closely related to child nutrition.

A recent global hunger index indicated a 12 percent decline in child underweight rates. This study attempts an empirical explanation of the factors that influence child underweight rates at the district level.
The aim of the paper is to look at the association of the proportion of underweight children, with the overall agricultural productivity, women’s agency, child and maternal health status, and the available public services across 430 districts in India with the help of linear regressions and quantile regressions.
Agricultural land productivity, share of women educated above the secondary level and participating in work, maternal, and child health seem to contribute to the reduction in child underweight. However government health and water supply facilities turn out to be ineffective.

Mobilizing young people as climate-smart agriculture infomediaries: what do we know?

20 Dec 2016 05:12:11 GMT

While efforts to adapt to the impacts of climate change have generally increased, the impression is that there is a negligible effort to include the vulnerable areas in the agenda. This paper seeks to fill in the gap by presenting an agricultural extension mechanism to tap high school students as information providers of climate-smart rice agriculture information in their rice-farming communities. This paper looks at the characteristics of the high school students who served as infomediaries as well as their information sources and perceptions on climate change; the best teaching media that can be used; and the infomediation pathways that can be drawn from this initiative. 

Two survey rounds, 2014 and 2015, were used as data sources. Focus group discussions and interviews were also conducted. Chi-square tests were also employed. Data show that females are more likely to be infomediaries than males. Schools serve as the primary sources of information on climate change, and students generally equate climate change to extreme weather events such as drought. Various teaching media explored seem to be useful in various development contexts. Teachers are seen as the champions of this initiative. Hence, this initiative rests heavily on the extent of capacity enhancement that can be extended to the teachers so they are in a better position to train their students in the future.

Averting 'New Variant Famine' in Southern Africa: building food-secure livelihoods with AIDS-affected young people

06 Dec 2016 12:19:41 GMT

Numerous reports have linked AIDS’ impacts on young people and their long term food insecurity, through, for instance, orphans’ failure to inherit property and resources; inability to retain rights to land which they are too young or inexperienced to farm; or interruption of intergenerational knowledge transfer following parental deaths. Hitherto, however, reports have only addressed isolated aspects of young people’s livelihood prospects, and most lack substantive evidence. Impacts of AIDS on young people’s attitudes and dispositions remain neglected.  responds to the clear need to understand better how AIDS affects young people’s livelihood participation in varying geographical/livelihood contexts.

The research covered in this report aimed to generate new, in- depth understanding of how AIDS, in interaction with other factors, is impacting on the livelihood activities, opportunities and choices of young people in rural southern Africa. This was intended to support the development of policies and interventions that enhance AIDS- affected young people’s prospects of achieving sustainable, food -secure livelihoods throughout the region.

Averting ‘New Variant Famine’ in Southern Africa: building food-secure rural livelihoods with AIDS-affected young people

02 Dec 2016 04:51:34 GMT

Southern Africa is experiencing the world’s highest HIV prevalence rates alongside recurrent food crises. This has prompted scholars to hypothesise a 'New Variant Famine' in which inability to access food is driven by the effects of AIDS. In line with this, it has been suggested that the impacts of AIDS on young people today is likely to diminish their prospects of food security in adult life. In particular, children whose parents die of AIDS may fail to inherit land or other productive assets, and transmission of knowledge and skills between the generations may be disrupted, leaving young people ill-prepared to build food-secure livelihoods for themselves. However, prior to this research, those propositions were largely untested.

The ‘Averting New Variant Famine’ research project was therefore undertaken to generate new, in-depth understanding of how AIDS, in interaction with other factors, is impacting on the livelihood activities, opportunities and choices of young people in rural southern Africa.

The research was conducted in two villages in Malawi and Lesotho, two of the worst affected countries. The fieldwork comprised four elements:

  • community and household profiling to provide a contextual understanding of livelihood responses to sickness and death, and in particular how young people are incorporated in livelihood strategies
  • participatory research with more than thirty 10-24-year-olds in each community (around half of whom were affected by AIDS) to explore their aspirations, means of accessing livelihood opportunities, obstacles faced and decision-making processes
  • semi-structured interviews with policy makers and other key informants to explore the linkages with macro-level policies and processes
  • life history interviews with more than twenty 18-24 year olds in each village to explore the factors shaping their lifecourses and livelihoods

There are a number of policy recommendations arising from the research:

  • focusing on increasing school attendance (which has hitherto been the main response to the impacts of AIDS on young people) is an inadequate response. Education needs to be much more relevant to the livelihood options available to the majority of rural youth
  • rural young people would benefit particularly from opportunities for vocational skills training, but also business education and the identification of opportunities that rely not only on the local market, if they are to engage successfully in rural enterprise
  • although fertiliser subsidies, food aid and food for work programmes are aimed principally at securing immediate subsistence rather than buildingassets for the future, they can free young people’s time and energy to devote to activities with secure long term prospects
  • equally, cash transfers, including those directed at elderly people, can help young people do business and find employment by putting more cash into local circulation
  • significantly, however, the project findings do not support the targeting of interventions specifically at AIDS-affected young people

Political violence, drought and child malnutrition: empirical evidence from Andhra Pradesh, India

22 Nov 2016 03:41:31 GMT

Households in developing countries have to cope with a myriad of uncertain events, some of which may happen simultaneously. One important example is the interplay between climatic shocks and violent conflict.Although the extent to which conflict and disasters interact differs across countries and contexts, in general, people living in fragile and conflict-affected states find it harder to cope with natural disasters given the impact of violence and instability on health, basic service provision, social cohesion, mobility opportunities and livelihoods.

Existing evidence on how individuals, households and communities cope simultaneously with violence and natural disasters is, however, largely anecdotic and descriptive. This is partially due to lack of data, but also to challenges in identifying empirical causal effects when endogeneity biases may be potentially large.

The objective of this paper is to address this gap in the literature by analysing the combined effect of exposure to political violence and drought on child nutrition. The context of the analysis is the southern Indian state of Andhra Pradesh, which was for several decades affected by a left-wing (Naxal) guerilla insurgency. Households in Andhra Pradesh face in addition cyclical climatic shocks that affect the nutrition levels of their children, often quite severely.

The paper shows two important results. First, drought exerts a strong impact on malnutrition, but only when it occurs in a violent environment. Second, the authors found that political violence exerts a long term impact on child malnutrition only indirectly, when the combination of conflict with drought prevents households to appropriately protect their children against adverse nutritional shocks. Although existing data does not show irrefutable evidence for the mechanisms at play, analysis strongly suggests that the adverse combined welfare impact of conflict and drought is explained by a failure of economic coping strategies and restricted access to public services and aid in conflict affected communities, possibly due to fear, insecurity and isolation.

Association between malaria and malnutrition among children aged under-five years in Adami Tulu District, south-central Ethiopia: a case-control study

21 Nov 2016 04:21:00 GMT

Background: Malaria and malnutrition are the major causes of morbidity and mortality in under-five children in developing countries such as Ethiopia. Malnutrition is the associated cause for about half of the deaths that occur among under-five children in developing countries. However, the relationship between malnutrition and malaria is controversial still, and it has also not been well documented in Ethiopia. The aim of this study was to assess whether malnutrition is associated with malaria among under-five children.

Methods: A case–control study was conducted in Adami Tulu District of East Shewa Zone in Oromia Regional State, Ethiopia. Cases were all under-five children who are diagnosed with malaria at health posts and health centres. The diagnosis was made using either rapid diagnostic tests or microscopy. Controls were apparently healthy under-five children recruited from the community where cases resided. The selection of the controls was based on World Health Organization (WHO) cluster sampling method. A total of 428 children were included. Mothers/caretakers of under-five children were interviewed using pre-tested structured questionnaire prepared for this purpose. The nutritional status of the children was assessed using an anthropometric method and analyzed using WHO Anthro software. A multivariate logistic analysis model was used to determine predictors of malaria.

Results: Four hundred twenty eight under-five children comprising 107 cases and 321 controls were included in this study. Prevalence of wasting was higher among cases (17.8 %) than the controls (9.3 %). Similarly, the prevalence of stunting was 50.5 % and 45.2 % among cases and controls, respectively. Severe wasting [Adjusted Odds Ratio (AOR) =2.9, 95 % CI (1.14, 7.61)] and caretakers who had no education [AOR = 3, 95 % CI (1.27, 7.10)] were independently associated with malarial attack among under-five children.

Conclusion: Children who were severely wasted and had uneducated caretakers had higher odds of malarial attack. Therefore, special attention should be given for severely wasted children in the prevention and control of malaria.

How are young people in South Africa using mobile phones to bridge healthcare gaps?

17 Nov 2016 10:21:29 GMT

Young people account for 30% of the population in South Africa, with just under 15 million young people aged 10 – 24 years. Adolescence is considered a time of both risk and opportunity: When rapid physical and psychological changes may lead to a rise in risk behaviour, substance abuse, sexual and reproductive health problems, violence and mental illness.2 Adolescent health and behaviour are also key determinants of the adult burden of disease. It is therefore critical to invest in youth friendly services that promote physical and mental health, and enable young people to successfully navigate the challenges of adolescence and take on adult responsibilities.

Young people experience a range of barriers that limit their access to healthcare services including transport costs, clinic hours clashing with school timetables, negative attitudes from healthcare workers and a lack of privacy and confidentiality.

The rapid development of information and communication technology (ICTs) – particularly access to mobile phones – has the potential to address these challenges and improve young people’s access to health-related information and services, especially in poor, remote settings. The World Health Organisation has recognised how mobile health (m-health) programmes have the potential to bring services closer to adolescents by providing 24-hour access and confidential, anonymous and personalised interactions.

While there has been significant investment in m-health initiatives across Africa, little research has been done on how young people actually use mobile phones to seek healthcare – insight that is critical in understanding how the uptake of new ICTs might entrench and/or disrupt health inequalities. This research brief presents key findings from a study led by Durham Universityi to investigate the use of mobile phones amongst youth in Sub-Saharan Africa and considers the implications for policy and practice.

Specific recommendations:

  • improve access and coverage especially in rural areas.ii This includes lobbying government and service providers to extend coverage, reduce data costs and/or provide free access to m-health initiatives and government services
  • improve digital literacy through initiatives that target in- and out-of-school youth and adolescents so that they are empowered and enabled to navigate the unregulated digital world and evaluate the trustworthiness of online information
  • engage with young people and youth organisations to develop m-health resources that are responsive to young peoples’ real needs
  • strengthen links between m-health initiatives and youth-friendly clinics and school health services to ensure that health-seeking behaviour is supported by access to quality healthcare
  • raise public awareness about m-health initiatives to increase uptake through carefully targeted multimedia campaigns, public service announcements, school health services, and youth-friendly clinics
  • regulate medical advertising, particularly advertising that targets young people

Learning from young people about their lives: using participatory methods to research the impacts of AIDS in southern Africa

15 Nov 2016 12:52:36 GMT

Methods of participatory research have become popular among children’s geographers as they are believed to enable young people to speak openly about their lives in unthreatening contexts. In this paper the authors reflect on their experience of using participatory methods to explore the sensitive topic of (indirect) impacts of AIDS on young people’s livelihoods in Malawi and Lesotho.
The paper examines how different methodological approaches generate varying knowledges of children’s lived realities; challenges of using ‘insider’ and ‘outsider’ research assistants, place of group-based approaches in participatory research and ethical issues. The authors suggest that researchers of young people’s lives should take full account of the relationship between epistemology and methodology in selecting and employing methods appropriate to particular research questions.

Averting ‘New Variant Famine’ in Southern Africa: building food secure rural livelihoods with AIDS-affected young people

15 Nov 2016 04:22:34 GMT

Southern Africa is experi-encing the world’s highest HIV prevalence rates alongside recurrent food crises. This has prompted scholars to hypothesise a 'New Variant Famine' in which inability to access food is driven by the ef-fects of AIDS. In line with this, it has been suggested that the impacts of AIDS on young people today is likely to diminish their prospects of food security in adult life. In particular, children whose parents die of AIDS may fail to inherit land or other pro-ductive assets, and trans-mission of knowledge and skills between the genera-tions may be disrupted, leaving young people ill-prepared to build food-secure livelihoods for themselves. However, prior to this research, those propositions were largely untested.

The ‘Averting New Vari-ant Famine’ research pro-ject was therefore under-taken to generate new, in-depth understanding of how AIDS, in interaction with other factors, is im-pacting on the livelihood activities, opportunities and choices of young peo-ple in rural southern Africa.

Research was conducted in two villages in Malawi and Lesotho, two of the worst affected countries, and fieldwork included participatory research with 10-24-year-olds in each community (around half of whom were affected by AIDS) to explore their aspirations, means of accessing livelihood oppor-tunities, obstacles faced and decision-making processes.

Policy recommendations:

  • focusing on increasing school attendance is an inadequate response
  • rural young people would benefit particularly from opportunities for vocational training and development of market opportunities
  • measures to improve access to productive assets such as land
  • social protection measures that allow young people to devote their energies to accruing livelihood assets to depend on in the long term
  • however, targeting of AIDS-affected youth is not advocated

Shame, social exclusion and the effectiveness of anti-poverty programmes

15 Nov 2016 02:55:59 GMT

A two year qualitative investigation of the nature and consequences of shame associated with poverty was conducted in seven settings located in rural Uganda and India; urban China, Pakistan, Korea and United Kingdom; and small town and urban Norway. The research presented results consistent with the thesis that the shame is always associated with poverty and that this may reduce personal efficacy and contribute to the duration and prevalence of poverty, a process that may be aggravated by policies that stigmatise recipients of social protection.

The research explores the contention that shame is a universal attribute of poverty which is common to people experiencing poverty in all societies. It investigates whether shame has internal and external components such that people are shamed because they are poor and feel shame due to being poor - and that both reduce individual agency and increase social exclusion.

The research initially seeks within different cultural settings to:

  • explore the social construction of shame (including its synonyms and antonyms) as expressed in public discourse
  • identify the cultural coincidence of shame and poverty as revealed in public discourse

Because personal experiences and public understanding of poverty are shaped by cultural expectations and resource constraints, the research will:

  • investigate how publics conceptualise poverty and people in poverty and whether in thought or deed they contribute to shaming people in poverty
  • explore how people directly experience poverty, social exclusion and shame and recognise connections between them

Children’s mobility in Ghana: an SBHA Special Issue

15 Nov 2016 02:18:17 GMT

Children throughout Sub-Saharan Africa are extraordinarily mobile. Every day children travel to school, to markets, to fetch water and firewood, to work on farms and take farm produce to grinding mills, as well as to visit friends and family and to play. However, children’s mobility is relatively invisible: most journeys that children undertake cover short distances and the vast majority are on foot. As such, very little research has been conducted into the extent of children’s mobility and impacts on education, livelihoods, health and well-being.

In this special issue of Society, Biology and Human Affairs, a group of Ghanian scholars co-ordinated by guest editors Drs Gina Porter and Kate Hampshire, present the results of various aspects of a larger project on ‘Children, Transport and Mobility in Sub-Saharan Africa’, by presenting a series of papers on children’s mobility in Ghana.

Research used an innovative child-centred approach, in which 70 children (aged 11-19 when they started the project) received training and supervision to conduct research on mobility issues among their peers in their home communities.

Article titles include:

  • Children’s mobility in Ghana: An overview of methods and findigns from the Ghana research study
  • Work and happiness: Children’s activities in Ghana
  • Child labour or skills training? A rights-based analysis of children’s contributions to household survival in Ghana
  • Child fostering and education in Ghana
  • Exploring the influence of household internal migration and parents’ main livelihood activities on children’s occupational aspirations in Ghana
  • Mobility and economic constraints as key barriers to children’s healthseeking in Ghana
  • Moving on two wheels

While the papers underline how mobile children in Ghana are, both on a daily basis and undertaking longer-term movements, another key issue to emerge from the study was the limitations and constraints that children face in terms of mobility. Getting to schools, health centres, markets, and other places that they need or want to go, is often very difficult. The difficulties can be particularly acute for those living in remote rural areas, but even children living in urban and peri-urban settlements often struggle to travel around their communities easily and safely. Large distances, high costs of public transport, infrequent transport services to rural areas, and dangers experienced while traveling (such as the risks of traffic accidents, or encountering hazards along the way) mean that daily journeys to school, for example, could become a major ordeal, and even unfeasible for some children.

Income generating activities as components of sustainable rural livelihoods for young southern Africans - AIDS and other constraints

15 Nov 2016 01:33:36 GMT

The literature dedicated to exploring rural livelihoods in southern Africa has devoted comparatively little attention to non-agricultural livelihoods, as several authors have pointed out. This gap in knowledge about non-agricultural livelihoods is also reflected in the literature looking at the effects of AIDS on rural livelihoods in Southern Africa. In general, research focusing on the effects of AIDS on livelihoods has also tended to neglect effects on young people’s abilities to create sustainable livelihoods for themselves in the future, and consequently, AIDS-affected young people’s abilities to engage in non-agricultural livelihoods have been even less explored.

This paper reports on a study with rural young people (aged 10-24 years) in Malawi and Lesotho, focusing on their opportunities to learn skills and access capital and assets to engage in income generating activities (IGAs). Participatory group exercises and individual interviews provide many examples of how young people learn skills and start small businesses, as well as insight into their strategic thinking around engaging in these livelihood options.

Various factors, including the effects of AIDS, are shown to affect young people’s prospects of succeeding in their ventures. Young people are themselves very keen on starting IGAs, and are supported by adult members of their communities in asking for interventions to help them do so. The paper argues that expanded vocational and business training, focusing on locally appropriate types and scale of businesses, coupled with help to raise start-up capital has the potential to improve poor and/or AIDS-affected young people’s chances of securing sustainable rural livelihoods in their futures.

Since AIDS is intertwined with many other issues affecting young people’s livelihoods, it is however problematic to single out and target only AIDS-affected young people with interventions on skills building and IGAs. Policy makers’ attitudes to vocational skills training and support for IGAs in Malawi and Lesotho are also explored, and policy recommendations made in relation to supporting vulnerable rural young people in their attempts to build sustainable livelihoods for themselves.

Young people are themselves very keen to learn various skills and to try running small businesses, and often mention IGAs when asked about future plans and aspirations. Adult community members also talk about wishing that vocational skills training and loans for businesses were available to young people locally, and in participatory dissemination activities with the communities, these issues were mentioned repeatedly when generating recommendations for governments and NGOs.

Changing children's geographies

11 Nov 2016 12:44:22 GMT

The social approach to childhood, though having earlier antecedents, flourished from the 1990s onwards in geographies of children, youth and families. Some researchers such as Matthews came to this from a history in children’s environmental cognition, but this shift in sub-disciplinary approach was also in large measure shaped by the advent of interest from new researchers with backgrounds in feminist, Marxist and post-structural approaches. This in part explains the lack of a hard-fought intellectual struggle over a ‘paradigm shift’: this new wave of researchers often took their inspiration from elsewhere (seeing spatial cognition as largely irrelevant to their concerns). This social approach to children’s geographies – which concentrated on understanding children’s experiences as subjects in the world, rather than their abilities to perceive space – was further fuelled by the changing global landscapes which have elevated children’s position on the political agenda.

This keynote explores the changing nature of children’s geographies as an academic project. It proceeds in four parts. Part 1 considers the shift away from research on children’s spatial cognition which envisaged the child in largely biological terms, and contemplates contemporary efforts to rework the nature/culture dualism. Part 2 traces the incorporation of new social studies of childhood into geography, emphasising the importance of children’s voices, their positioning within axes of power, and the need for quantitative and qualitative methods. Part 3 explores how feminist research led to interest in parents, educators and other actors/institutions which shape, and are shaped by, children’s lives. Part 4 ponders what children’s geographies might add to, and learn from, broader interdisciplinary debates, and the benefits and pitfalls of research impact. The conclusion argues that a well-informed appreciation of sub-disciplinary history provides a strong vantage point from which to engage with new ways of thinking.


Agency and advocacy: disabled students in Higher Education in Ghana and Tanzania

11 Nov 2016 11:12:46 GMT

Between 10% and 15% of the world’s population are thought to be disabled. The 2006 United Nations Convention on the Rights of Persons with Disabilities is an example of emerging global policy architecture for human rights for disabled people. Article 24 states that disabled people should receive the support required to facilitate their effective education. In research, links between higher education access, equalities and disability are being explored by scholars of the sociology of higher education. However, with the exception of some small-scale studies from Zimbabwe, South Africa, Rwanda, Namibia, Uganda and Pakistan, literature tends to come from the global North. Yet there is a toxic correlation between disability and poverty – especially in the global South.

This article is based on a review of the global literature on disability in higher education and interview findings from the project ‘Widening Participation in Higher Education in Ghana and Tanzania: developing an Equity Scorecard’, (WPHEGT) funded by the Economic and Social Research Council and the Department for International Development. A central finding was that while disability was associated with constraints, misrecognition, frustration, exclusion and even danger, students’ agency, advocacy and achievement in higher education offered opportunities for transforming spoiled identities.

The students in the WPHEGT study have shown their detailed knowledge of what they need to enable them to contribute to their societies materially and socially. Their narratives of struggle to succeed in education demonstrate the agency and advocacy that they have exercised individually and collectively through disabled people’s organisations. For many of the students, disability was at least partly about a positive identity rather than only about impairment.

It was the built environment and social relations that created difficulties for them as they sought to develop their capacities and realise their educational and professional potential. Questions remain about the disabled students who were unable to maintain the struggle to be educated in schools largely serving to select the few rather than educate all. The students in this study aspired to be advocates for other disabled people as they sought to redefine what it means to be a disabled person in Ghana and Tanzania. Universities need to provide an education in learning to live together, for disabled and non-disabled students alike. As a pivotal knowledge hub, HE needs to play an enhanced role in the creation and dissemination of knowledge by and with disabled people in order to challenge prejudice and promote social inclusion. In a globalised knowledge economy, the value of HE needs to be seen in terms of social justice, well-being, wealth distribution and poverty alleviation, and not only as wealth creation.

Youth-led accountability for the SDGs

11 Nov 2016 02:05:08 GMT

The new Sustainable Development Goals (SDGs), have set out an ambitious agenda for global development for the next fifteen years, leading up to 2030. Empowering young people to hold governments and duty-bearers accountable is one of the most important means of implementation for an agenda that “leaves no one behind”.

More than half the world is currently under the age of 30 but decision-making processes largely remain in the hands of older generations. Young people, particularly young women, are not adequately represented in formal political processes or institutions - including parliaments, political parties, elections, and public administrations. Young people are also among the hardest hit by the effects of poverty, climate change and inequality.

Despite these barriers to participation in formal or conventional spaces, young people are frequently at the forefront of change and development, such as mass citizen and digital activism. Where traditional structures are failing to include them, young people are finding new ways to engage. Youth have driven many of the high impact social movements of recent years (e.g. on climate change and inequality) characterised by self-organising and the innovative use of new technologies. Youth-led action can help governments fill gaps in implementation, follow-up and monitoring, as well as programmes and policy.

Key principles to enable youth-led accountability: inclusion, responsiveness, collaboration, transparency:

  • inclusion: actively engaging the most marginalised young people to promote social and political inclusion and ensuring effective opportunities and resources (information, capacities) to participate in the accountability processes
  • responsiveness: government officials listening, responding to and acting upon the inputs of young people
  • collaboration: governments and stakeholders working actively with young people through mechanisms and structures that encourage interaction and discourse
  • transparency: young people having access to government data relevant to their policy focus areas. Political processes are widely publicised and communicated

Gender, youth and urban labour market participation: evidence from the tailoring sector in Kabul, Afghanistan

11 Nov 2016 01:21:46 GMT

The creation of good jobs and decent work in conflict-affected places is widely seen to generate not just better-off households, but also safer societies and more legitimate states. However, so much of the good jobs agenda is dominated by technical approaches more concerned with balancing out supply and demand than with serious analysis of the role of institutions, identity and power in mediating access to opportunities. This study is about understanding how labour markets actually work in insecure and dynamic contexts, with a particular focus on: how young women and men acquire skills and enter the urban labour market in the first place, particularly in light of the highly gendered nature of boundaries between public and private spacewhat the nature, terms and limits of their labour market participation look like; andwhether participation in that urban labour market is working for or against them (in terms of its effects on various dimensions of their wellbeing).More specifically, it looks at young women’s and men’s experiences in Kabul’s tailoring labour market.labour market participation are socially regulated and deeply gendered. Networks matter, and labour market outcomes have a strong relational dimension to them. For example, gaining the support of key male figures (fathers, uncles, husbands) appears important for young women wanting to enter the sector, and, for young men, access to tailoring ‘apprenticeships’ (informal, but widespread) is largely dependent on social connections and the relationship between teachers and students’ parents. Second, the multiple ways in which women’s access to the market is regulated can be understood as a kind of informal tax on women’s livelihoods. The combination of years of unpaid labour, a more limited and lower quality skill-set relative to male tailors, and restricted access to various parts of the physical marketplace works to reduce economic returns for most women (although examples of real success are also apparent, but in far smaller numbers). And third, participation in the tailoring labour market has quite different meanings for young women compared to young men: while for the latter, the acquisition of tailoring skills is often seen as forming an economic safety net when times get tough – a long-term Plan B, as it were – for women, participation is much more about the hard-won outcome of a struggle against institutional bounds on economic activity. In some ways, the very act of being able to operate visibly in the urban labourmarket constitutes if not a major achievement, then at least a symbol of resistance against the (highly patriarchal) social rules of the game. However, the generally poor terms of women’s participation in the urban labour market serve to remind us that there is still a long way to go before we might consider calling this a good news story.These findings suggest that the labour market ultimately functions as a social economy: one’s access and participation are socially regulated not only by one’s networks, but also by institutionalised ideas about what is seen to constitute acceptable behaviour for different social groups. As such, donor programming seeking to create better work for young peo[...]

Nutritional improvement for children in urban Chile and Kenya

10 Nov 2016 10:22:49 GMT

Since 2010, the NICK study has sought to help two project countries, Chile and Kenya, reduce urban malnutrition in young children by facilitating intersectoral actions to change the social determinants. In urban Kenya chronic stunting is an endemic problem jeopardizing children’s physical and mental development. In urban Chile child overweight and obesity is a serious public health problem associated with increased risk of morbidity and mortality from chronic diseases such as diabetes mellitus and coronary heart disease.The 2010 and 2013 Lancet Series on Maternal and Child Nutrition identified the need for increased inter-sectoral action to address the complex causation of child malnutrition. The 2013 Series called for more studies to strengthen the evidence base for ‘nutrition sensitive’ programming to address the social determinants and find out what works and how programmes should be designed in specific country contexts. Now that more people worldwide are living in cities than rural areas, there have also been calls for more attention to be paid to the poorest and most vulnerable families living in urban informal settlements. The NICK study responds to these calls by addressing the question: Can child malnutrition amongst families living in poverty in informal settlements in the cities of Mombasa in Kenya, and Valparaíso in Chile, be reduced through broadening community and stakeholder participation to change the social determinants of nutritional status?Findings from the situational analysis confirmed that the social determinants of child malnutrition in the study areas were a broad range of social, economic and environmental factors operating at local, municipal, provincial and central levels. They included education, income, working conditions, housing, neighbourhood and community conditions, the status of women and level of social inclusion. These determinants impacted child nutrition through influencing access to nutritious foods, child care practices and access to basic services.Key lessons learnt: What works? What does not work?creating supportive environments for intersectoral actions: support is needed to enable group members to begin to think differently about the causes of child undernutrition and how to tackle them, to decide and implement mutually agreed co-ordinated action plans and to negotiate with line managers on the need for ensuring that group membership remains relatively stable. The in-country researchers in Kenya are continuing to be supportive of the urban nutrition working group as it now prepares to transform and transition into a county level nutrition working groupstrengthening community action: in Mombasa, three community self-help groups were identified, trained and supported to implement the action plans made by the working group. They too became part of the planning meetings to engender ownership. The community members began to appreciate the benefits of the interventions in their lives, and some decided to take further the actions to improve the material and nutritional status of their families. Some of the actions proposed and implemented to tackle domestic violence emerged from the community itselfdeveloping personal s[...]

Intergenerational relations and the power of the cell phone: perspectives on young people's phone usage in Sub-Saharan Africa

08 Nov 2016 12:40:07 GMT

Cell phones present new forms of sociality and new possibilities of encounter for young people across the globe. Nowhere is this more evident than in sub-Saharan Africa where the scale of usage, even among the very poor, is remarkable.

This paper reflects on the inter-generational encounters which are embedded in young people’s cell phone interactions, and consider the wider societal implications, not least the potential for associated shifts in the generational balance of power. An intriguing feature of this changing generational nexus is that while many young people’s phone-based interactions, from their mid-teens onwards, are shifting away from the older generation towards friendship networks in their own age cohort, at the same time they are repositioning themselves – or becoming repositioned – as family information hubs, as a consequence of their phone expertise.

The paper draws on mixed-methods research with young people aged c. 9–25 years and in-depth interviews with older age-groups in 24 sites (ranging from high density poor urban to remote rural) across Ghana, Malawi and South Africa.

Evidence suggests that a generational power-struggle is being played out on a daily basis in many urban and rural homes across the continent: recourse to subterfuge is, on both sides, an inevitable response. With increasingly cheap, imported Chinese handsets and rapid reduction in phone-related costs, however, parental control is probably slipping, especially when young people (by virtue of their phone skills) take on – or are bestowed with – a hub role in family networks. There is limited evidence, for instance, of successful surveillance by elders, since young people’s phone competency increasingly contains surveillance efforts and associated supervision. The cell phone is changing the rules regarding who interacts with whom (and how). Cell phone diffusion thus arguably marks a significant step in the intergenerational power shift in Africa from disproportionately gerontocratic and patrimonial systems towards a new, increasingly technologically-shaped era where young people – of both genders – play a much more proactive role in society.

Mobile phones and education in Sub-Saharan Africa: from youth practice to public policy

08 Nov 2016 12:09:14 GMT

Young people's use of mobile phones is expanding exponentially across Africa. Its transformative potential is exciting, but findings presented in this paper indicate how the downside of mobile phone use in African schools is becoming increasingly apparent. Drawing on mixed-methods field research in 24 sites across Ghana, Malawi and South Africa and associated discussions with educational institutions, public policy makers and network providers, we examine the current state of play and offer suggestions towards a more satisfactory alignment of practice and policy which promotes the more positive aspects of phone use in educational contexts and militates against more damaging ones.

Through this paper, the authors aim to contribute to demands for a more substantial body of evidence in African contexts. Mixed-methods field research in 24 sites across Ghana, Malawi and South Africa and associated discussions with mobile phone network providers, educational institutions and policy makers suggests that while there are some positive aspects of mobile phone use for African pupils, their downside is also becoming increasingly apparent, especially in urban and peri-urban sites.

This research start with some background details (key literature, study methodology and phone ownership and usage), and then charts available evidence of positive educational value of mobile phones in the research sites before moving on to examine a range of negative impacts associated with youth (and teacher) practice. The paper then asks how, and to what extent, should and can public policy address issues such as phone-related classroom disruption (whether caused by pupil or teachers' phones), lengthy periods spent by young people on social network sites, disruption in adolescent sleep patterns associated with cheap night calls and widespread circulation of pornography? The final section of the paper considers the potential to address some of the most negative aspects of phone use in educational contexts and to promote more positive aspects through engagement with policy makers.

Teenage childbearing and educational attainment in South Africa

08 Nov 2016 11:04:52 GMT

Teenage childbearing and attainment at school in South Africa are investigated using nationally-representative data from the National Income Dynamics Study. The analysis focuses on the outcomes by 2010 of a panel of 673 childless young women aged 15–18 in 2008. Girls who had their first birth by 2010 had 4.4 times the odds of leaving school and 2.2 times the odds of failing to matriculate, controlling for other factors. Girls from the highest-income households were unlikely, and girls who were behind at school relatively likely, to give birth. More than half the new mothers enrolled in school in 2010. They were most likely to enroll if they were rural residents who resided with their own mother and she had attended secondary school.

Poor educational attainment, teenage motherhood and childhood poverty are interrelated problems in South Africa: for middle-class families, avoiding early motherhood contributes to the intergenerational transmission of privilege. Dissuading girls in their mid-teens who are behind at school from becoming teenage mothers may require intervention at an earlier stage of their schooling.

A community-­driven approach to reducing teenage pregnancy in Sierra Leone: midline evaluation brief

08 Nov 2016 10:36:14 GMT

Preliminary evidence from a 2009 global evidence review suggested that community-based child protection mechanisms are likely to be more effective and sustainable if they are linked with formal aspects of the child protection system. To test the value of nonformal-formal linkages, this action research uses a quasi-experimental design to test the effectiveness of a community owned and driven intervention that seeks to reduce teenage pregnancy.In each of Moyamba and Bombali Districts, there were two clusters of three communities in different but comparable chiefdoms. One cluster was an intervention cluster, whereas the other was a comparison cluster. In the intervention clusters, community members from three villages worked collaboratively to develop an intervention that addressed a child protection concern of their choosing. In both intervention clusters, the communities elected to focus on teen pregnancy, an issue that had been documented as a key concern in previous ethnographic work. The intervention, which was developed by the community, included components on family planning, sexual and reproductive health education, and life skills and was implemented in partnership with NGOs and District Ministry of Health partners.Using a survey of adolescents (13-19 years of age), this study reports on mid-term (T2) changes in contrast to the baseline (T1) findings: exposure to the intervention was found to increase with age, and was particularly high among individuals who had a partner but were unmarried. The latter individuals had 1.7 times the odds of  attending a presentation when compared to those who were marriedbetween baseline (T1) and T2, the percentage of teenagers aged 15-17 in intervention areas who were willing to ask their partners to use a condom increased by 17.1 percentage points, whereas the control villages  showed a decrease of 6.2 percentage pointsgirls and adolescents under 15 years in intervention areas showed a significant increase in their intention to  use condoms regularly, while the opposite was true in control areassimilarly, adolescents who were exposed to the intervention’s programs were nearly twice as likely (1.74 times the odds) to report intending to say no to unwanted sexsexual activity was also found to have increased between T1 and T2 in control  areas,  while  no  increase occurred in intervention areas, suggesting possible signs of impact of the programSeveral lessons can be gleaned from these initial findings, which may influence future efforts. First and foremost, data from the T2 survey support  the proposed theory of change with some early evidence of changes in knowledge, attitudes, intentions, and behaviour around sexual health in the intervention communities in Moyamba and Bombali districts.  The findings around behaviour, specifically the intent to turn down unwanted sex and increase condom use, are promising, and point to the importance (and early effectiveness) of peer discussions of these sensitive topics in a comfortable, safe space. In particular, the incre[...]

Children, transport and mobility in sub-Saharan Africa: developing a child-centred evidence base to improve policy and change thinking across Africa

08 Nov 2016 04:58:21 GMT

This project focused on the mobility constraints faced by children in accessing health, educational and other facilities in sub-Saharan Africa, lack of direct information on how these constraints impact on children's current and future livelihood opportunities, and lack of guidelines on how to tackle them. The aim was to produce an evidence-base strong enough to substantially improve policy in the three focus countries - Ghana, Malawi and South Africa - and to change thinking across Africa.

The project successfully tested and implemented an innovative two-strand, childcentred methodology, involving both academic researchers and 70 young researchers. Research was conducted in 8 sites per country (remote rural, rural with services, periurban and urban sites in two agro-ecological zones): 24 sites in total. The qualitative data covers the themes education, health, activities and transport, based on focus groups and individual interviews with children, parents and other key informants. The survey questionnaire covers a wide range of issues with 2,967 children c. 9-18 years, allowing comparisons across sites and countries. This large dataset enables a more nuanced understanding than has hitherto been available of the way mobility and transport constraints interact with other factors to shape particular young lives in particular places. Findings cover topics from pain and negative impacts on education associated with load carrying and other work, to the virtual mobility impacts of mobile phones and the complex interconnections between mobility, gender, work and education. The findings are sufficiently substantial to allow the development of clear guidelines for policy-makers and practitioners.

Adapting Agriculture Platforms for Nutrition: A Case Study of a Participatory, Video-Based Agricultural Extension Platform in India

08 Nov 2016 03:23:09 GMT

Successful integration of nutrition interventions into large-scale development programmes from nutrition-relevant sectors, such as agriculture, can address critical underlying determinants of undernutrition and enhance the coverage and effectiveness of on-going nutrition-specific activities. However, evidence on how this can be done is limited.

This study examines the feasibility of delivering maternal, infant, and young child nutrition behaviour change communication through an innovative agricultural extension programme serving nutritionally vulnerable groups in rural India. The existing agriculture programme involves participatory production of low-cost videos promoting best practices and broad dissemination through village-level women’s self-help groups. For the nutrition intervention, 10 videos promoting specific maternal, infant, and young child nutrition practices were produced and disseminated in 30 villages. A range of methods was used to collect data, including in-depth interviews with project staff, frontline health workers, and self-help group members and their families; structured observations of mediated video dissemination sessions; nutrition knowledge tests with project staff and self-help group members; and a social network questionnaire to assess diffusion of promoted nutrition messages.

The authors found the nutrition intervention to be well-received by rural communities and viewed as complementary to existing frontline health services. However, compared to agriculture, nutrition content required more time, creativity, and technical support to develop and deliver. Experimentation with promoted nutrition behaviours was high, but sharing of information from the videos with non-viewers was limited.

Key lessons learned include the benefits of and need for:

  • collaboration with existing health services
  • continued technical support for implementing partners
  • engagement with local cultural norms and beliefs
  • empowerment of women’s group members to champion nutrition
  • and enhancement of message diffusion mechanisms to reach pregnant women and mothers of young children at scale

Understanding the experience of developing and delivering this intervention will benefit the design of new nutrition interventions which seek to leverage agriculture platforms.

Identifying and tackling the social determinants of child malnutrition in urban informal settlements and slums: a cross national review of the evidence for action

08 Nov 2016 01:49:17 GMT

Urbanisation can bring many benefits the rate of change but in many developing countries the rate of change has been so fast and so dramatic that many cities have been unable to cope. Rapid, unplanned urbanisation has led to widespread social inequity and stratification, the rapid growth of informal settlements and slums, environmental degradation, heavy migrant inflows, and breakdown of the social support systems and networks.

It is not surprising, therefore, that there is a strong and well established link between child malnutrition and various dimensions of disadvantage in the urban setting. Child undernutrition has become an endemic problem in many poor urban areas of developing countries, jeopardizing the physical and mental development of growing children.

At the same time, social conditions and globalisation create the emerging risk of child overweight and obesity due to consumption of inappropriate foods, promoted as a part of the processes of globalization of food production systems, and lack of physical activity linked to changes in occupational and leisure activities. Many cities in the developing world are therefore facing a double burden of child under-nutrition and obesity and municipal governments are uniquely positioned to play a leading role in addressing these problems.

The primary aim of this structured literature review is to synthesize what is known about the effectiveness of interventions to reduce child malnutrition through changing the social determinants in poor urban areas of developing countries. The review focuses on child malnutrition because studies have shown that the early childhood years are the most critical. The importance of nutrition intervention throughout the lifecycle is also acknowledged.

A secondary aim is to draw out the implications of the findings for the further development of a three year research study known as the NICK Project (Nutritional Improvement for children in urban Chile and Kenya). This project aims to help two cities, Mombasa and Valparaiso, reduce child malnutrition in children less than five years of age living in poor urban areas of these cities by intervening at the municipal level to broaden community and stakeholder participation and provide exemplars of successful small-scale interventions that can change the social determinants. If successful, the innovative approach used in this study could serve as a useful guide for action in the cities of other high burden countries.

Factors shaping the HIV-competence of two primary schools in rural Zimbabwe

04 Nov 2016 04:36:05 GMT

School attendance often has positive impacts on the well-being of HIV-affected and HIV-vulnerable children in sub-Saharan Africa. In the context of the growing emphasis on the need for schools to go ‘beyond education’, international policy accords schools and teachers a central role in the care and protection of such children, particularly in relation to facilitating their school access and their health and well-being. However, much remains to be learned about (i) the readiness and ability of schools to take on these roles, and (ii) the impacts of wider contextual factors on school efforts.

This paper explores these issues through a multi-method study of two primary schools in a rural Zimbabwean province, one in a rural area and one in a small town. The rural school is located in a relatively settled rural farming settlement, and small-town primary school is located in a small roadside town. Compared to the small-town school, the rural school is associated with

  • higher levels of school attendance by HIV-affected children in its catchment area; and
  • higher well-being scores among HIV-affected children

The authors use the method of dichotomous case comparison, involving comparisons of very different cases, to flag up factors facilitating or hindering each school in providing support and care for HIV-affected children.

Inequities in under-five child nutritional status in South Africa: what progress has been made?

04 Nov 2016 03:27:15 GMT

Despite the emphasis given to poverty reduction in policy statements and a substantial increase in social spending, money-metric poverty has shown little improvement since South Africa's transition to democracy in 1994. Alternative approaches to measuring well-being and inequality may show a more positive trend.

This article uses the 2008 National Income Dynamics Study to assess the magnitude of inequalities in under-five child malnutrition ascribable to economic status. The article compares these results with those of Zere and McIntyre, who analysed similar data collected in 1993. In both cases, household income, proxied by per-capita household expenditure, was used as the indicator of socio-economic status. Children's heights and weights have increased since 1993 and being stunted or underweight has become less common. Furthermore, pro-rich inequalities in stunting and being underweight have significantly declined since the end of apartheid. This suggests that pro-poor improvements in child welfare have taken place. Policies that may have contributed to this include the Child Support Grant, introduced in 1998, and improvements in healthcare and the education of women.

The role of schools in supporting HIV-affected children in sub-Saharan Africa: a systematic review

04 Nov 2016 02:35:18 GMT

HIV-affected children (themselves sick/with sick parents/orphaned) are particularly vulnerable to poor nutrition, mental and physical health, sexual abuse and poverty - which consequently tend to have a negative impact on their school enrolment and academic progress.

Reviewing existing literature on schools and the health and well-being of vulnerable children, this literature review aims to address the following question:

What interventions have been made to improve school environments to facilitate support for the health and well-being of vulnerable children in Zimbabwe and similar socio-economic contexts in sub-Saharan Africa?

Establishing an overview of existing literature on this topic is essential to learn from previous experiences and identify what supplementary research is needed in order to fully understand the potential possibilities of school capacities to facilitate contexts of care and support for HIV-affected children.

This review has demonstrated positive correlations between school enrolment and the health of children, as well as acknowledged the potential of school-based interventions to support the health of children and promote their health knowledge. However, there is a need for schools to go beyond knowledge and provide more comprehensive support for HIV-affected and orphaned children, particularly in light of the dwindling capacity of struggling households to provide adequate care and support for children in their care. Rather than relying on the implementation of external resources to do this, there is a need to supplement existing research exploring the pathways through which some schools in challenging socio-economic contexts manage to support HIV-affected learners by drawing on already available resources and by involving local communities.

Furthermore, there is a need to explore the interface between schools and external organizations in order to strengthen supportive school environments. This should be done by developing the existing literature with more in-depth qualitative research focusing on children’s perspectives, allowing HIV-affected children to express how they experience the school environment and cope with adversity in their everyday lives.

Religion and child death in India

03 Nov 2016 12:37:24 GMT

On average the burden of disease and death is born primarily by poorer people within poorer countries.The high rates of child mortality in developing countries today constitute one of the harshest failures of development. It is estimated that about 10 million children die each year before their first birthday and that a fourth of these deaths occur in India.

The initial motivation of project disussed in this paper was to present and analyse evidence that challenges the conventional wisdom on the overwhelming importance of socio-economic status, introducing a systematic role for culture (identified here as religion). In India, Muslims have poorer socioeconomic status (SES) on average but they have persistently achieved substantially higher child survival rates than Hindus. This remarkable fact has escaped attention and analysis. An aspect of religion that is closely examined in this project is gender preference. This research also extends the analysis of religion differentials in health to look at religion differentials in education as this helps sort explanations in terms of investments in children vs healthy behaviours.

The author finds some evidence that the Muslim advantage in child survival may derive partly from the fact that they are less likely than Hindus to favour sons over daughters. The research shows that the Muslim advantage is greater for girl survival although they do have an advantage for boy survival. It is argued that this is related to their better maternal health - which is supported by the fact that most of the differential is apparent soon after birth. The author also argues that better maternal health is also related to lower son preference.

Research challenges, implicitly, the popular perception that the status of women in Muslim communities is lower than that of men, showing that it is even lower in Hindu communities. This research also undermines the argument that Muslims have “lower human capital” than Hindus because they have been discriminated against. It shows that they have stronger health capital and suggests that they may have stronger social capital, alongside their clearly weaker educational capital.

The equity impact of participatory women's groups to reduce neonatal mortality in India: secondary analysis of a cluster-randomised trial

03 Nov 2016 02:14:26 GMT

Progress towards the Millennium Development Goals (MDGs) has been uneven. Inequalities in child health are large and effective interventions rarely reach the most in need. Little is known about how to reduce these inequalities. We describe and explain the equity impact of a women’s group intervention in India that strongly reduced the neonatal mortality rate (NMR) in a cluster-randomised trial. We conducted secondary analyses of the trial data, obtained through prospective surveillance of a population of 228, 186. The intervention effects were estimated separately, through random effects logistic regression, for the most and less socio-economically marginalised groups.

Key messages:

  • the effects of the women’s group intervention on NMR were substantially stronger among the most socio-economically marginalised than among less marginalised groups in the Ekjut trial.
  • socio-economic inequalities in neonatal mortality can be substantially reduced through a low-cost participatory community intervention.
  • universal coverage combined with ‘soft targeting’ of high-risk groups with effective interventions can have very substantial and equitable effects on mortality

Youth in Tanzania’s urbanizing mining settlements: prospecting a mineralized future

03 Nov 2016 01:43:17 GMT

Over the last fifteen years many African countries have experienced a ‘mining takeoff’. Mining activities have bifurcated into two sectors: large-scale, capital-intensive production generating the bulk of the exported minerals, and small-scale, labour-intensive artisanal mining, which, at present, is catalyzing far greater immediate primary, secondary and tertiary employment opportunities for unskilled African labourers. Youth residing in mining settlements, have a large vested interest in the current and future development of mining.Focusing on Tanzania as typical of the emerging ‘new mineralizing Africa’, this paper, examines youth’s role in mining based on recent fieldwork in the country’s northwestern gold fields. Youth’s current involvement in mining as full-fledged, as opposed to part-time, miners is distinguished. The attitudes of secondary school students towards mining as a form of employment and its impact on economic and social life in mining communities are discussed within the context of the uneasy transitions from an agrarian to a mining-based country, from rural to urban lifestyles, and the growing scope and power of foreign-directed, capital-intensive, corporate mining relative to local  labour-intensive artisanal mining.Youth are playing an active role in the emergence of new economic sectors and are currently engaging in and shaping the artisanal mining sector. Nonetheless, there is a discontinuity with the past in terms on the part of full-time, youthful miners, intent on improving their lives and gaining autonomy, who tend to be completely removed from elder or parental control and are rarely planning to return to their home areas. They are no longer endeavouring to earn bridewealth payments and return to their home areas to farm, which marks a distinct break in the inter-generational contract between older and younger generations. So too, secondary school students’ criticisms of their parents’ absence from the home and their lack of parental care, can be interpreted as a new tension between the young and older generation.Artisanal mining, particularly that related to mineral rushes, places high demands on male mobility and has an erosive effect on family life. There are several other drawbacks: artisanal mining is physically dangerous, its excavation depth is technically limited and as large-scale mining expands, it is bound to contract spatially as government-granted large-scale mineral rights increasingly gain precedence over those of artisanal miners, displacing artisanal miners and fuelling their conflictual incursions on large-scale mining. Most miners and mining settlement residents see artisanal mining as an opportunity of the moment, not one that can be counted on far into the future. Thus Tanzanian youth, whether they are full-time or part-time miners think of art[...]

Climate change, children and poverty: engaging children and youth in policy debate and action

14 Oct 2016 04:00:19 GMT

Children’s vulnerability to climate change can be understood as an intersection of three axes. The first is exposure; the extent to which children live in a physical location that is vulnerable to drought, floods, extreme weather events and sea level rise. Recent estimates by UNICEF indicate that 160 million children live in drought-prone areas, and half a billion more live in zones at risk to high floods and severe storms.

The second axis is socio-economic, with vulnerability to hazards due to a lack of resources, poverty and marginalization. Families without adequate incomes and assets, protective infrastructure and housing, access to basic services, and inadequate nutrition and clean water, face the greatest risk in a changing climate. The third axis is time, today’s children and future generations will bear the brunt of environmental impacts, creating an inter-generational injustice without precedent. All children fall somewhere along these three axes, but it is the children who live in greatest poverty and in the most exposed places that face the greatest risks. More than just passive victims, these young people, often with the support of their caregivers and communities, also represent agents of change and have consistently demonstrated the capacity to devise local solutions, participate in global conversations and contribute to a safe and sustainable future.

This brief argues that:

  • children and young people, particularly those living in poverty, are among the most vulnerable to the impacts of climate change
  • nevertheless, children and youth have shown that they can take an active role in raising awareness and creating innovative solutions
  • they must be empowered and supported to project their voice and to be part of the conversation in mitigation and adaptation planning and action
  • including the voice and needs of children at all levels of decision-making will help create a more sustainable, equitable and resilient society

Youth in Tanzania’s urbanizing mining settlements

14 Oct 2016 03:48:04 GMT

Over the last fifteen years many African countries have experienced a ‘mining takeoff’. Mining activities have bifurcated into two sectors: large-scale, capital-intensive production generating the bulk of the exported minerals, and small-scale, labour-intensive artisanal mining, which, at present, is catalyzing far greater immediate primary, secondary and tertiary employment opportunities for unskilled African labourers. Youth residing in mining settlements, have a large vested interest in the current and future development of mining.

Focusing on Tanzania as typical of the emerging ‘new mineralizing Africa’, this paper, examines youth’s role in mining based on recent fieldwork in the country’s northwestern gold fields. Youth’s current involvement in mining as full-fledged, as opposed to part-time, miners is distinguished. The attitudes of secondary school students towards mining as a form of employment and its impact on economic and social life in mining communities are discussed within the context of the uneasy transitions from an agrarian to a mining-based country, from rural to urban lifestyles, and the growing scope and power of foreign-directed, capital-intensive, corporate mining relative to local labourintensive artisanal mining.

Youth, mobility and mobile phones in Africa: findings from a three-country study

14 Oct 2016 03:42:58 GMT

The expansion of mobile phone use in sub-Saharan Africa, particularly over the last five years, has been remarkable in terms of speed of adoption, spatial penetration and, not least, the fact that this is an essentially spontaneous development firmly embedded in private sector activity. Country-level adoption and usage rates suggest that, in many countries, mobile phone use, even in poor households, is rapidly becoming an everyday part of life. Much of this use is based on shared access, rather than ownership, but for millions of very poor children and young people1 the mobile phone is now perceived as an essential requisite: an object of desire and a symbol of success.

This paper we examine mobile phone use by young people across 24 sites in three countries, Ghana, Malawi and South Africa, drawing on intensive qualitative and survey research, and relate this to issues of gendered physical mobility.

Findings point to significant variations between the three study countries and between urban and rural locations within them. There is also, of course, variation within individual sites, since the circumstances of young people living in one neighbourhood can differ quite substantially, depending not only on gender and age but also on factors such as family structure and socio-economic circumstances.

Nonetheless, some trends can be discerned from this socio-spatial analysis which build on findings from earlier (often single site or single country) studies in Africa: in particular, the growing importance of phones as urban-rural connectors, enhancing resource flows and young people’s construction of network capital, and concerns about their less positive aspects, not least the potential for encouraging or supporting illicit activities such as robbery or possibly dangerous underage sexual liaisons.

The equity impact of participatory women's groups to reduce neonatal mortality in India: secondary analysis of a cluster-randomised trial

14 Oct 2016 03:32:57 GMT

Progress towards the Millennium Development Goals (MDGs) has been uneven. Inequalities in child health are large and effective interventions rarely reach the most in need. Little is known about how to reduce these inequalities.

This paper describes and explains the equity impact of a women’s group intervention in India that strongly reduced the neonatal mortality rate (NMR) in a cluster-randomised trial. The authors conducted secondary analyses of the trial data, obtained through prospective surveillance of a population of 228 186. The intervention effects were estimated separately, through random effects logistic regression, for the most and less socio-economically marginalised groups.

Among the most marginalised, the NMR was 59% lower in intervention than in control clusters in years 2 and 3 (70%, year 3); among the less marginalised, the NMR was 36% lower (35%, year 3). The intervention effect was stronger among the most than among the less marginalised (P-value for difference = 0.028, years 2-3; P-value for difference = 0.009, year 3).

The stronger effect was concentrated in winter, particularly for early NMR. There was no effect on the use of health-care services in either group, and improvements in home care were comparable. Participatory community interventions can substantially reduce socio-economic inequalities in neonatal mortality and contribute to an equitable achievement of the unfinished MDG agenda.