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Second Birth (second + birth)
Selected AbstractsThe Impact of Medicaid Managed Care on Pregnant Women in Ohio: A Cohort AnalysisHEALTH SERVICES RESEARCH, Issue 4p1 2004Embry M. Howell Objective. To examine the impact of mandatory HMO enrollment for Medicaid-covered pregnant women on prenatal care use, smoking, Cesarean section (C-section) use, and birth weight. Data Sources/Study Setting. Linked birth certificate and Medicaid enrollment data from July 1993 to June 1998 in 10 Ohio counties, 6 that implemented mandatory HMO enrollment, and 4 with low levels of voluntary enrollment (under 15 percent). Cuyahoga County (Cleveland) is analyzed separately; the other mandatory counties and the voluntary counties are grouped for analysis, due to small sample sizes. Study Design. Women serve as their own controls, which helps to overcome the bias from unmeasured variables such as health beliefs and behavior. Changes in key outcomes between the first and second birth are compared between women who reside in mandatory HMO enrollment counties and those in voluntary enrollment counties. County of residence is the primary indicator of managed care status, since, in Ohio, women are allowed to "opt out" of HMO enrollment in mandatory counties in certain circumstances, leading to selection. As a secondary analysis, we compare women according to their HMO enrollment status at the first and second birth. Data Collection/Extraction Methods. Linked birth certificate/enrollment data were used to identify 4,917 women with two deliveries covered by Medicaid, one prior to the implementation of mandatory HMO enrollment (mid-1996) and one following implementation. Data for individual births were linked over time using a scrambled maternal Medicaid identification number. Principal Findings. The effects of HMO enrollment on prenatal care use and smoking were confined to Cuyahoga County, Ohio's largest county. In Cuyahoga, the implementation of mandatory enrollment was related to a significant deterioration in the timing of initiation of care, but an improvement in the number of prenatal visits. In that county also, women who smoked in their first pregnancy were less likely to smoke during the second pregnancy, compared to women in voluntary counties. Women residing in all the mandatory counties were less likely to have a repeat C-section. There were no effects on infant birth weight. The effects of women's own managed care status were inconsistent depending on the outcome examined; an interpretation of these results is hampered by selection issues. Changes over time in outcomes, both positive and negative, were more pronounced for African American women. Conclusions. With careful implementation and attention to women's individual differences as in Ohio, outcomes for pregnant women may improve with Medicaid managed care implementation. Quality monitoring should continue as Medicaid managed care becomes more widespread. More research is needed to identify the types of health maintenance organization activities that lead to improved outcomes. [source] Vladimir Putin on Raising Russia's Birth RatePOPULATION AND DEVELOPMENT REVIEW, Issue 2 2006Article first published online: 26 JUN 200 The total fertility rate in what is now the Russian Federation has been below replacement level during much of the last 40 years. By the late 1990s it was barely above 1.2 children per woman. There may have been some recovery since: the United Nations estimate for 2000,05 is 1.33. Other reports set the 2004 rate at 1.17. Countries elsewhere in Europe have fertility levels that are equally low or even lower, but the Russian demographic predicament is aggravated by mortality that is exceptionally high by modern standards. Thus, despite large-scale net immigration (mostly due to return of ethnic Russians from other republics of the former Soviet Union), the population in the last decade-and-a-half has been shrinking: of late by some 700,000 persons per year. The United Nations medium estimate assumes a steady recovery of the total fertility rate to reach a level of 1.85 by 2050 and a considerable improvement in survival rates during that period,notably an increase in male life expectancy at birth of more than ten years. It also assumes further modest net immigration at a steady rate, amounting to a total of somewhat over 2 million by midcentury. Under these stipulations the projected population of Russia in 2050 would be 112 million,some 31 million below its present size. By that time, 23 percent of the population would be aged 65 and older. The government's concern with the demographic situation of the country and its intent to improve it have been manifest in various official statements, notably in the annual State of the Nation Address given by the president to the Federal Assembly (or State Duma). Formerly a subordinate theme (see the Documents item in the June 2005 issue of PDR), the issue constituted the centerpiece of the 2006 Address, delivered on 10 May in the Kremlin by President Vladimir Putin. Policies regarding health and mortality were given short shrift in the speech,road safety, bootleg alcohol, and cardiovascular diseases being singled out as areas of special concern. The president's remarks on immigration are of greater interest: immigration of skilled persons is to be encouraged. They must be educated and law-abiding and must treat the country's culture and national tradition with respect. The main focus of the address, however, was on the birth rate and policies to be introduced to raise it. (The need for an "effective demographic policy" as seen from the Kremlin was of course also voiced in the later stages of the Soviet era. See, for example, the excerpts from the addresses delivered by then Party Chairman Leonid Brezhnev and Premier Nikolai Tikhonov to the 26th Congress of the Communist Party of the Soviet Union in February 1981 that appear in the Documents item in the June 1981 issue of PDR.) In detail and specificity, and also in terms of the economic cost of the measures envisaged, Putin's speech is without parallel in addressing population policy matters by a head of state in Europe. The demo graphically relevant portion of the address is reproduced below in the English translation provided by the website of the president's office «http://www.kremlin.ru/eng». Calling Russia's demographic situation "the most acute problem facing our country today," Putin terms its causes as "well known," but lists only economic factors, presumably because these, at least in principle, lend themselves to remedial measures that the Russian government, its coffers now swollen with petrodollars, should be able to provide. His starkly economic interpretation of the problem of low fertility (in Russia apparently taking the form of convergence to a single-child pattern) may be overly optimistic. Causes of electing to have only one child may lie deeper than those Putin names: low incomes, inadequate housing, poor-quality health care and inadequate educational opportunities for children, and even lack of food. Putin's proposed policies to attack these problems in part consist of a major upgrading of existing child care benefits: to 1,500 roubles a month for the first child and 3,000 roubles for the second. The latter amount is roughly equivalent to US$113, a significant sum given Russian income levels. Maternity leave for 18 months at 40 percent of the mother's previous wage (subject to a ceiling) and compensation for the cost of preschool childcare round out the basic package proposed. Benefits are to be parity-dependent, highlighting the pronatalist intent of the measures. Thus the child benefit for the second child is to be twice as large as for the first, and payment for preschool childcare is to cover 20 percent of parental costs for the first, 50 percent for the second, and 70 percent for the third child. Putin mentions "young families" as recipients, but the payments are clearly directed to mothers. (Even the usually obligatory reference to western European,style paternity leave is missing.) The most innovative element of the proposed measures, however, is support for women who have a second birth. The state should provide such women (not the child, as called for in some European precedents) "with an initial maternity capital that will raise their social status and help resolve future problems." Citing expert opinion, Putin says that such support "should total at least 250,000 roubles [about $9,300] indexed to annual inflation." Evidently assuming, optimistically, that there will be many takers, Putin says that carrying out all these plans will require not only a lot of work but also "an immense amount of money." The measures are to be launched starting January 2007. [source] From Soviet Modernization to Post,Soviet Transformation: Understanding Marriage and Fertility Dynamics in UzbekistanDEVELOPMENT AND CHANGE, Issue 3 2003Victor Agadjanian In this article we analyse the dynamics of marriage and childbearing in Uzbekistan through the prism of the recent socioeconomic and political history of that country. After becoming an independent nation in 1991, Uzbekistan abandoned the Soviet modernization project and aspired to set out on a radically different course of economic, social, and political development. We argue, however, that not only independence but also the preceding period of perestroika reforms (1985,91) had a dramatic effect on social conditions and practices and, consequently, the demographic behaviour of the country's population. Using data from the 1996 Uzbekistan Demographic and Health Survey we apply event,history analysis to examine changes in the timing of entry into first marriage, first and second births over four periods: two periods of pre,perestroika socialism, the perestroika years, and the period since independence. We investigate the factors that influenced the timing of these events in each of the four periods among Uzbeks, the country's eponymous and largest ethnic group, and among Uzbekistan's urban population. In general, our results point to a dialectic combination of continuity and change in Uzbekistan's recent demographic trends, which reflect the complex and contradictory nature of broader societal transformations in that and other parts of the former Soviet Union. [source] Ultrasonography and Sex Ratios in ChinaASIAN ECONOMIC POLICY REVIEW, Issue 1 2009Hongbin LI J13; J16; O10 This paper directly measures the causal effects of sex-selective abortions on the sex ratio at birth by exploiting the exogenous county-level variation in the availability of B-ultrasound machines. Using data from the 1990 Census of Fujian Province and local records on the introduction time of B-ultrasound machines, we find that the availability of B-ultrasound machines increases the sex ratio at birth by 0.025 in rural areas and 0.117 in urban areas. The rise of sex ratio is especially significant for second births in rural areas when the first birth is a girl. [source] | ||||||||||