Comparing summary measures of quality of care for family planning in Haiti, Malawi, and Tanzania.

Measuring quality of care in family planning services is essential for policymakers and stakeholders. However, there is limited agreement on which mathematical approaches are best able to summarize quality of care. Our study used data from recent Service Provision Assessment surveys in Haiti, Malawi, and Tanzania to compare three methods commonly used to create summary indices of quality of care-a simple additive, a weighted additive that applies equal weights among domains, and principal components analysis (PCA) based methods. The PCA results indicated that the first component cannot sufficiently summarize quality of care. For each scoring method, we categorized family planning facilities into low, medium, and high quality and assessed the agreement with Cohen's kappa coefficient between pairs of scores. We found that the agreement was generally highest between the simple additive and PCA rankings. Given the limitations of simple additive measures, and the findings of the PCA, we suggest using a weighted additive method.

Benefits of biodiverse marine resources to child nutrition in differing developmental contexts in Hispaniola.

There is an urgent need for an improved empirical understanding of the relationship among biodiverse marine resources, human health and development outcomes. Coral reefs are often at this intersection for developing nations in the tropics-an ecosystem targeted for biodiversity conservation and one that provides sustenance and livelihoods for many coastal communities. To explore these relationships, we use the comparative development contexts of Haiti and the Dominican Republic on the island of Hispaniola. We combine child nutrition data from the Demographic Health Survey with coastal proximity and coral reef habitat diversity, and condition to empirically test human benefits of marine natural resources in differing development contexts. Our results indicate that coastal children have a reduced likelihood of severe stunting in Haiti but have increased likelihoods of stunting and reduced dietary diversity in the Dominican Republic. These contrasting results are likely due to the differential in developed infrastructure and market access. Our analyses did not demonstrate an association between more diverse and less degraded coral reefs and better childhood nutrition. The results highlight the complexities of modelling interactions between the health of humans and natural systems, and indicate the next steps needed to support integrated development programming.

The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda.

While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage-Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care.

Muslim and Hindu Women's public and private behaviors: gender, family, and communalized politics in India.

Prior research on fundamentalist religious movements has focused attention on the complicated relationship among gender, family, and religion. Using data from a nationally representative survey of 30,000 Hindu and Muslim women, this study compares the daily public and private behaviors of women in India to examine how gender and family norms are shaped in the context of communalized identity politics. Building on the theoretical framework of "doing gender," we argue that because communal identities are expressed through externally visible behaviors, greater religious differences are expected in external markers of gendered behaviors and family norms. Results indicate that Muslim women are more likely to engage in veiling and less likely to venture outside the home for recreation and employment. However, religious differences are absent when attention is directed at private behaviors, such as household decision-making power, gender segregation within households, and discrimination against daughters. Results underscore the multidimensionality of gender.