The impact of type of employment on women's use of prenatal-care services and family planning in urban Cebu, the Philippines.

This study re-evaluates the relationship of urban women's employment to their health-service and contraceptive use, drawing on data from the Cebu Longitudinal Health and Nutrition Survey. Multivariate analyses reveal significant differences across types of work for the likelihood of both obtaining timely prenatal care and practicing contraception at one year postpartum. Wage workers in white-collar jobs are significantly more likely than those not employed for pay to have obtained prenatal care and are substantially more likely to have adopted a contraceptive method in the year following childbirth. Women who are self-employed also are significantly more likely than those not employed for pay to be using contraceptives. Blue-collar wage work and piecework employment have no relationship to either dependent variable. These findings suggest that work-related autonomy encourages women to exercise control in other areas of their lives.

PIP: This article examined the relationship between women's employment and use of prenatal care services and family planning in Cebu, the Philippines. Data were obtained from the Cebu Longitudinal Health and Nutrition Baseline and Follow-up Survey among a 12-month birth cohort of 2695 Filipino infants and their mothers, residing in a sample of 33 urban and rural barangays in 1983 and 1984. The largest percentage of women who had early prenatal care were white collar workers (WCWs) and professionals (57%), followed by blue collar, service, and self-employed workers (22%), and non-wage workers (23%). The smallest percentage of women obtaining prenatal care were pieceworkers (15%). Modern contraceptive use at 1 year postpartum was greatest among WCWs (34%), followed by self-employed workers (32%) and non-wage workers (26%). The lowest proportion were pieceworkers among modern method users, and blue collar workers and service workers among traditional method users. Logistic models indicate that WCWs were 2.5 times more likely than non-wage workers to obtain care within the first 5 months of pregnancy. Among women who received free care, WCWs still had the best prenatal care patterns. The likelihood of prenatal care was the same for blue collar workers, self-employed workers, and pieceworkers. Women aged 25-34 years were more likely than older women to obtain early prenatal care. Husband's education, a resident grandmother, and household assets contributed to a higher likelihood of seeking early prenatal care. The degree of autonomy on the job was more closely related to contraceptive and health service use.

Geographic concentration of violence between intimate partners.

OBJECTIVES: To explore geographic patterns of violence between intimate partners in a metropolitan area with one of the highest injury mortality rates in the nation-Duval County, Florida, which includes the city of Jacksonville. METHODS: Using police reports of all serious violent incidents in Duval County in 1992 excluding robberies, the authors analyzed patterns in the location of the incidents. Only cases for which the relationship between the offender and victim was recorded were used. RESULTS: Thematic maps reveal that census tracts with rates above the 75th percentile of assaultive violence between intimates are clustered in certain parts of the city. Concentrated poverty tracts had median rates of violence between intimate nine times higher than other tracts. CONCLUSIONS: The finding that violence between intimate partners is concentrated in central city poverty neighborhoods opens up avenues for prevention.

Alcohol use among pedestrians and the odds of surviving an injury: evidence from Florida law enforcement data.

Alcohol consumption by pedestrians is widely recognized as a factor influencing the risk of being hit by a motor vehicle, but its effect on the likelihood of dying, given that a collision has occurred, is more uncertain. Studies of drivers find that alcohol increases the risk. Unlike previous studies based on clinical data, the present study is population-based and takes into account indicators of crash severity. Using Florida law enforcement data, logistic regression models yielded a four to fivefold increase in the odds ratios associated with alcohol use, depending on the model. Findings from a model investigating the magnitude of the potential bias due to differential investigative behavior indicated bias may account for some but not all of the increase in the odds of dying. Recommendations include improving law enforcement procedures for identifying alcohol impairment and increasing public awareness of the risk involved in mixing heavy drinking and walking.

Inequities in health care and survival after injury among pedestrians: explaining the urban/rural differential.

This study investigated whether rural/urban differences in injury mortality and morbidity are primarily due to medical care maldistribution or to other factors such as sociodemographic or environmental characteristics that are highly correlated with location. To separate incidence from case-fatality rates, the study analyzed the determinants of survival rather than cause-specific mortality rates. Using information from Florida traffic crash reports for 1988 through 1990, the study focused on Florida pedestrians hit by motor vehicles. It explores the effect of individual-level demographic characteristics, crash-level indicators of impact severity, and county-level measures of socioeconomic and medical care resources, on the odds a pedestrian survived an injury. Logistic regression analyses reveal the importance of both road environment and percent of the county that is rural. However, these analyses are not able to isolate the influence of medical care from the level of urbanization. Although the percent rural was statistically significant, indicators of the mechanical energy involved in producing the injury, posted speed, and a dark road environment were substantively more important determinants of survival.

"Empowering" women.

PIP: Healthcare providers and policymakers have been confused by suggestions that empowering women will help them to practice family planning. Two experts on women's health stress that empowerment is a process rather than a single event and should be considered as such when exploring the relationship between women's empowerment and women's use of family planning. Empowerment is a series of steps by which individuals gain access to critical economic and educational resources such as information, assets, cash, and skills. These resources are then used to bring about environmental change and influence other persons and institutions with competing or conflicting interests. Empowerment should be viewed as a process in which all voices are encouraged to be heard for the ultimate goal of securing mutually beneficial solutions. Spouses, partners, and mothers-in-law often make decisions for women on contraceptive choice and use. Women also may not have the money needed to pay for desired and needed family planning and health services. The relationship between empowerment and women's use of family planning is therefore complex and problematic. Comprehensive reproductive health programs, however, help empower women as a result of their ability to transform power relations within the family, community, and society, and challenge female subordination. The authors note that researchers in exploring the relationship between family planning, reproductive health, and empowerment may want to consider the political, economic, and household dimensions of women's lives. It is also noted that results from at least one study suggest that work alone may not be a vehicle for women's empowerment.^ieng