RESUMO
Measuring variations and gaps in health and wellbeing across individuals, social groups and societies is a critical issue confronting social scientists in their quest to explain why gaps in health between the rich and the poor persist within and across societies. This article provides a systematic review of the measurement of inequalities and their implications on rural and remote health. A comprehensive literature review was conducted using online databases and other collections of published research on measuring health gaps between the rich and the poor in order to trace the development of this field of inquiry. Despite the enormous information on the subject area, it is not always easy to disentangle the independent effects of social class or socio-economic status (SES) on health inequalities from genetic or biological differences when analyzing racial/ethnic, gender or age gaps in mortality and morbidity. The meaning of SES or social class also varies from one culture to the other. Despite decades of work in this field, it is not clear what it is about SES or social class that is associated with inequalities in health. Is it simply a question of access to resources? And on the issue of measurement, studies from various disciplines have shown that it is important to employ a raft of measures in order to measure and present the distributions fully from various angles and value judgments. In the rural African context, tackling vertical and horizontal inequalities in health requires tackling the root causes of poverty and promoting social policies that empower individuals and communities. Hence, the review discusses recent methodological developments that hold promise for addressing the knowledge gap that remain. We hope that researchers will reflect on the dynamics in measures of inequalities discussed in this paper as they continue to assess the status of health in Africa's contemporary and largely dominated rural population.
RESUMO
Between 1990 and 2000, the total fertility rate (TFR) in Ethiopia declined moderately from 6.4 to 5.9 children per woman of reproductive age. During the same period, the TFR in the capital city of Addis Ababa declined from 3.1 to 1.9 children per woman. Even more striking than the magnitude of this decline is that it occurred in the absence of a strong and effective national family planning program. In this study, the components of this fertility decline are identified using the Bongaarts framework of the proximate determinants of fertility. The results of a decomposition analysis indicate that a decrease in the age-specific proportions of women who are married, followed by an increase in contraceptive use are the most important mechanisms by which fertility has declined in Addis Ababa. Poor employment prospects and relatively high housing costs are likely factors that encourage couples to delay marriage and reduce marital fertility.
