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Balancing fertility and livelihood diversity in mixed economies.

ABSTRACT: Mixed economies provide a unique context for testing theories of fertility change. Because they have a stake in two traditions, mixed-economy households balance the demands of both a labor-based subsistence economy, which benefits from a large family, and a wage-labor economy, which benefits from reduced fertility. Additionally, household size changes over the course of its life-cycle and shapes available economic opportunities. Here we argue that in mixed economies, fertility may reflect opportunities for livelihood diversity rather than simply responding to the restricted socioeconomic benefits of small families. While low fertility may in some cases have an economic benefit, low fertility can also limit the livelihood diversity of a household which is a key strategy for long-term economic success. We test this prediction with longitudinal data from a Maya community undergoing both a sustained decline in fertility and rapid integration into the market economy. Using household-level fertility, number of adults, and livelihood diversity at two time points, we find that household size is positively related to livelihood diversity, which in turn is positively related to household income per-capita. However, household size also has a negative association with income per capita. The results reflect a balancing act whereby households attempt to maximize the economic diversity with as few members as possible. Broadly, these results suggest that theories of fertility decline must account for how households pool resources and diversify economic activities in the face of increasing market integration, treating fertility as both an outcome and an input into economic and reproductive decision-making.

SUBMITTER: Hackman JV

PROVIDER: S-EPMC8224957 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundCervical cancer is the fourth most common cancer among women worldwide, many of who are still within their reproductive lifespan. Advances in screening and treatment have increased the 5-year survival for early stage disease to over 90 % in developed countries. The focus is now shifting to reducing morbidity and improving fertility outcomes for cervical cancer patients. Radical trachelectomy with lymph node assessment became the standard of care for selected women with lesions <2 cm who desire fertility preservation. However, several questions still remain regarding the degree of surgical radicality required for tumors <2 cm, and fertility-sparing options for women with early-stage disesase ≥2 cm, and those with more advanced disease. Here, we compile a narrative review of the evidence for oncologic and pregnancy outcomes following radical trachelectomy, non-radical fertility-sparing surgery, and the use of neoadjuvant chemotherapy prior to surgery for larger lesions. We also review the literature for assisted reproductive technologies in women with more advanced disease.FindingsAvailable literature suggests that the crude recurrence and mortality rates after radical trachelectomy are <5 and <2 %, respectively (approx. 11 and 4 % for tumors ≥ 2 cm). Among 1238 patients who underwent fertility-sparing surgery for early cervical cancer there were 469 pregnancies with a 67 % live birth rate. Among 134 cases with lesions ≥ 2 cm, there were ten conceptions with a live birth rate of 70 %. Outcomes after non-radical surgery (simple trachelectomy or cervical conization) are similar, although only applicable among a highly selected patient population. For patients ineligible for fertility-preserving surgery or who require adjuvant radiation therapy, current options include ovarian transposition and cryopreservation of oocytes or embryos but other techniques are under investigation.ConclusionToday, many cervical cancer survivors have successful pregnancies. For those with early-stage disease, minimally invasive and fertility sparing techniques have resulted in improved obstetrical outcomes without compromising oncologic safety. Results from three ongoing trials on non-radical surgery for low-risk tumors <2 cm will further inform the need for radical surgery in such patients. For those in whom natural childbearing is unachievable, advances in assisted reproductive technologies provide reproductive options. Despite our advances, the effects of cervical cancer survivorship on quality of life are not fully elucidated.

Project description:BackgroundBangladesh's islands, because of their geographical location, frequently encounter crises like floods and river erosion, which pose significant threats to the residents' well-being and livelihoods. To delve into the effects of these disasters on livelihood and healthcare challenges, a mixed-method study was undertaken in a riverine-island near a major river of Bangladesh.MethodologyBetween February 15th and February 28th, 2023, a cross-sectional study was conducted on an island in Bangladesh. The quantitative method involved conducting a survey of 442 households, with a total of 2921 participants. Additionally, 10 in-depth interviews and 10 key-informant interviews were conducted using semi-structured guidelines. Qualitative interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Triangulation was employed in this study through the integration of qualitative and quantitative analysis, resulting in the presentation of findings that offer an in-depth comprehension of the phenomenon being investigated.ResultsRiver erosions and floods are common and recurring natural disasters that significantly impact the lives of the riverine island inhabitants. These disasters often disrupted their livelihoods, forced many residents to endure substandard living conditions or relocated during flood events. The island faced a low diagnostic prevalence of chronic diseases (e.g., 5.1% of adults were hypertension and 2.5% are diabetes) because of the absence of diagnostic facilities and a shortage of certified doctors. A significant number of chronic illness people in the community turned to alternative medicine sources (39.3%) such as homeopathy, Kabiraj, and Ayurvedic medicine, especially it gets increased during periods of natural disasters. Moreover, reproductive aged women revealed that 79.4% of them gave birth at home, with 6.0% of these home deliveries resulting in miscarriage or infant death. The destruction of crops, unstable job opportunities, an inadequate educational system, and a deficient healthcare delivery system exacerbated the hardships faced by the population affected by these disasters.ConclusionThe failure to seek treatment for chronic diseases and undiagnosed diseases is a significant health issue among the aging adults on the island. Island residents face the challenge of establishing effective prevention strategies for the well-being of older adults especially at the period of natural disasters. It is crucial for the government and non-governmental organizations (NGOs) to collaborate to prevent the negative effects of floods and river erosions. This should include efforts to enhance the quality of education, healthcare services, job opportunities, and financial assistance for rebuilding homes.

Project description:BackgroundDiverse livelihood portfolios are frequently viewed as a critical component of household economies in developing countries. Within the context of natural resources governance in particular, the capacity of individual households to engage in multiple occupations has been shown to influence important issues such as whether fishers would exit a declining fishery, how people react to policy, the types of resource management systems that may be applicable, and other decisions about natural resource use.Methodology/principal findingsThis paper uses network analysis to provide a novel methodological framework for detailed systemic analysis of household livelihood portfolios. Paying particular attention to the role of natural resource-based occupations such as fisheries, we use network analyses to map occupations and their interrelationships- what we refer to as 'livelihood landscapes'. This network approach allows for the visualization of complex information about dependence on natural resources that can be aggregated at different scales. We then examine how the role of natural resource-based occupations changes along spectra of socioeconomic development and population density in 27 communities in 5 western Indian Ocean countries. Network statistics, including in- and out-degree centrality, the density of the network, and the level of network centralization are compared along a multivariate index of community-level socioeconomic development and a gradient of human population density. The combination of network analyses suggests an increase in household-level specialization with development for most occupational sectors, including fishing and farming, but that at the community-level, economies remained diversified.Conclusions/significanceThe novel modeling approach introduced here provides for various types of livelihood portfolio analyses at different scales of social aggregation. Our livelihood landscapes approach provides insights into communities' dependencies and usages of natural resources, and shows how patterns of occupational interrelationships relate to socioeconomic development and population density. A key question for future analysis is how the reduction of household occupational diversity, but maintenance of community diversity we see with increasing socioeconomic development influences key aspects of societies' vulnerability to environmental change or disasters.

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Balancing fertility and livelihood diversity in mixed economies.

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