Education, HIV, and Early Fertility: Experimental Evidence from Kenya.
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ABSTRACT:
SUBMITTER: Duflo E
PROVIDER: S-EPMC4624413 | biostudies-literature | 2015 Sep
REPOSITORIES: biostudies-literature
Publications
Education, HIV, and Early Fertility: Experimental Evidence from Kenya.
Duflo Esther E Dupas Pascaline P Kremer Michael M
The American economic review 20150901 9
A seven-year randomized evaluation suggests education subsidies reduce adolescent girls' dropout, pregnancy, and marriage but not sexually transmitted infection (STI). The government's HIV curriculum, which stresses abstinence until marriage, does not reduce pregnancy or STI. Both programs combined reduce STI more, but cut dropout and pregnancy less, than education subsidies alone. These results are inconsistent with a model of schooling and sexual behavior in which both pregnancy and STI are de ...[more]
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Project description:BackgroundAdolescent fertility in Kenya is vital in the development and execution of reproductive health policies and programs. One of the specific objectives of the Kenyan Adolescent Sexual Reproductive Health (ASRH) policy developed in 2015 is to decrease early and unintended pregnancies in an attempt to reduce adolescent fertility. We aimed to establish determinants of adolescent fertility in Kenya.MethodsThe Kenya Demographic and Health Survey (KDHS) 2014 data set was utilized. Adolescent's number of children ever born was the dependent variable. The Chi-square test was utilized to determine the relationship between dependent and independent variables. A Proportional-odds model was performed to establish determinants of adolescent fertility at a 5% significance level.ResultsOver 40% of the adolescent girls who had sex below 17 years had given birth i.e, current age 15-17 years (40.9%) and <15 years (44.9%) had given birth. In addition, 70.7% of the married adolescents had given birth compared to 8.1% of the unmarried adolescents. Moreover, 65.1% of the adolescents who were using contraceptives had given birth compared to only 9% of the adolescents who were not using a contraceptive. Approximately 29.4% of the adolescents who had no education had given birth compared to 9.1% who had attained secondary education. Age at first sex (18-19 years: OR: 0.221, 95% CI: 0.124-0.392; 15-17 years: OR: 0.530, 95% CI: 0.379-0.742), current age (18-19 years: OR: 4.727, 95% CI: 3.318-6.733), current marital status (Not married: OR:0.212, 95% CI: 0.150-4.780), and current contraceptive use (Using: OR 3.138, 95% CI: 2.257-4.362) were associated with adolescent fertility.ConclusionThe study established that age at first sex, current age, marital status, and contraceptive use are the main determinants of adolescent childbearing. The stated determinants should be targeted by the government to control the adolescent birth rate in Kenya. Consequently, delaying the age at first sex, discouraging adolescent marriage, and increasing secondary school enrollment among adolescent girls are recommended strategies to control adolescent fertility in Kenya.
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Project description:In this review, we will investigate the pathways linking education and health to understand why education appears to improve health in some settings or among certain populations, and not in others, as well as to inform recommendations about how best to target investments in education to maximize the benefits to health. We will seek to answer the following key research questions, focusing specifically on the mechanisms that affect fertility, HIV, and infant and child mortality. If feasible, these answers will include meta-analyses of comparable education and mediator outcomes: (1) Do changes in education affect the primary theorized mediators (e.g., knowledge, attitudes, resources, and agency; health behaviors and harmful practices) of the relationship between education and fertility, HIV and child mortality? (2) How does the relationship between these mediators and education vary across different aspects of education (e.g., grade attainment vs. literacy/numeracy vs. attendance)?
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Project description:We deliver one month's average profit to a randomly selected group of female microenterprise owners in Dandora, Kenya, arriving just in advance of an exponential growth in COVID-19 cases. Relative to a control group, firms recoup about one third of their initial decline in profit, and food expenditures increase. Control profit responds to economic conditions and government announcements during our study period, and treatment effects are largest when control profit is at its lowest. PPE spending and precautionary management practices increase to mitigate the health risks of more intensive firm operation, but only among those who perceive COVID-19 as a major risk.
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Project description:Preventing unwanted pregnancies in Women Living with HIV (WLHIV) is a recognised HIV-prevention strategy. This study explores the fertility intentions and contraceptive practices of WLHIV using services in Kenya.Two hundred forty women self-identifying as WLHIV who attended reproductive health services in Kenya were interviewed with a structured questionnaire in 2011; 48 were also interviewed in-depth. STATA SE/13.1, Nvivo 8 and thematic analysis were used.Seventy one percent participants did not want another child; this was associated with having at least two living children and being the bread-winner. FP use was high (92%) but so were unintended pregnancies (40%) while living with HIV. 56 women reported becoming pregnant "while using FP": all were using condoms or short-term methods. Only 16% participants used effective long-acting reversible contraceptives or permanent methods (LARC-PM). Being older than 25 years and separated, widowed or divorced were significant predictors of long-term method use. Qualitative data revealed strong motivation among WLHIV to plan or prevent pregnancies to avoid negative health consequences. Few participants received good information about contraceptive choices.WLHIV need better access to FP advice and a wider range of contraceptives including LARC to enable informed choices that will protect their fertility intentions, ensure planned pregnancies and promote safe child-bearing.Integra is a non-randomised pre-post intervention trial registered with Current Controlled Trials ID: NCT01694862 .
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Project description:Models of ageing predict that sperm function and fertility should decline with age as sperm are exposed to free radical damage and mutation accumulation. However, theory also suggests that mating with older males should be beneficial for females because survival to old age is a demonstration of a male's high genetic and/or phenotypic quality. Consequently, declines in sperm fitness may be offset by indirect fitness benefits exhibited in offspring. While numerous studies have investigated age-based declines in male fertility, none has taken the integrated approach of studying age-based effects on both male fertility and offspring fitness. Here, using a cohort-based longitudinal study of zebrafish (Danio rerio), we report a decline in male mating success and fertility with male age but also compensating indirect benefits. Using in vitro fertilization, we show that offspring from older males exhibit superior early survival compared to those from their youngest counterparts. These findings suggest that the high offspring fitness observed for the subset of males that survive to an old age (approx. 51% in this study) may represent compensating benefits for declining fertility with age, thus challenging widely held views about the fitness costs of mating with older males.
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Project description:We estimate costs and their predictors for three HIV prevention interventions in Kenya: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC). As part of the 'Optimizing the Response of Prevention: HIV Efficiency in Africa' (ORPHEA) project, we collected retrospective data from government and non-governmental health facilities for 2011-12. We used multi-stage sampling to determine a sample of health facilities by type, ownership, size and interventions offered totalling 144 sites in 78 health facilities in 33 districts across Kenya. Data sources included key informants, registers and time-motion observation methods. Total costs of production were computed using both quantity and unit price of each input. Average cost was estimated by dividing total cost per intervention by number of clients accessing the intervention. Multivariate regression methods were used to analyse predictors of log-transformed average costs. Average costs were $7 and $79 per HTC and PMTCT client tested, respectively; and $66 per VMMC procedure. Results show evidence of economies of scale for PMTCT and VMMC: increasing the number of clients per year by 100% was associated with cost reductions of 50% for PMTCT, and 45% for VMMC. Task shifting was associated with reduced costs for both PMTCT (59%) and VMMC (54%). Costs in hospitals were higher for PMTCT (56%) in comparison to non-hospitals. Facilities that performed testing based on risk factors as opposed to universal screening had higher HTC average costs (79%). Lower VMMC costs were associated with availability of male reproductive health services (59%) and presence of community advisory board (52%). Aside from increasing production scale, HIV prevention costs may be contained by using task shifting, non-hospital sites, service integration and community supervision.
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Project description:How can governments and nonprofits design aid programs that afford dignity and facilitate beneficial outcomes for recipients? We conceptualize dignity as a state that manifests when the stigma associated with receiving aid is countered and recipients are empowered, both in culturally resonant ways. Yet materials from the largest cash transfer programs in Africa predominantly characterize recipients as needy and vulnerable. Three studies examined the causal effects of alternative aid narratives on cash transfer recipients and donors. In study 1, residents of low-income settlements in Nairobi, Kenya (N = 565) received cash-based aid accompanied by a randomly assigned narrative: the default deficit-focused "Poverty Alleviation" narrative, an "Individual Empowerment" narrative, or a "Community Empowerment" narrative. They then chose whether to spend time building business skills or watching leisure videos. Both empowerment narratives improved self-efficacy and anticipated social mobility, but only the "Community Empowerment" narrative significantly motivated recipients' choice to build skills and reduced stigma. Given the diverse settings in which aid is delivered, how can organizations quickly identify effective narratives in a context? We asked recipients to predict which narrative would best motivate skill-building in their community. In study 2, this "local forecasting" methodology outperformed participant evaluations and experimental pilots in accurately ranking treatments. Finally, study 3 confirmed that the narrative most effective for recipients did not undermine donors' willingness to contribute to the program. Together these studies show that responding to recipients' psychological and sociocultural realities in the design of aid can afford recipients dignity and help realize aid's potential.
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