Health

2015
de Silva de Alwis, Rangita, and Jeni Klugman. “Freedom from Violence and the Law: A Global Perspective”. (2015). Web. Publisher's VersionAbstract

As UN Women has powerfully argued, concrete actions to eliminate the debilitating fear of violence must be a centerpiece of any future global development framework. The main objective of this paper is to review constitutional and legislative developments around gender-based violence, and how a human rights framework can support this critical element of the post 2015 global development agenda. We find that there has been major progress in establishing the right of women to live free of violence in both international and national law, and progress on both fronts has been especially rapid over the past decade or so. Today, national legislation in much of the world is consistent in not only prohibiting and criminalizing violence but also providing mechanisms to support victims and their families in a range of ways. The evolving jurisprudence on due diligence is a promising basis for holding governments accountable for gender-based violence in the context of the post-2015 framework. At the same time we recognize that the implementation of the laws on paper is often weak, and violence too often goes unreported. Moreover, information about the effectiveness of legislation and their implementation is scarce, and better efforts are needed in terms of both regular monitoring and evaluation. The important role of women’s groups and civil society is highlighted, both in terms of bringing about reform and monitoring implementation.

freedom-from-violence-and-the-law.pdf
2014
Gerritzen, Berit C.Intra-Household Bargaining Power and HIV Prevention: Empirical Evidence from Married Couples in Rural Malawi”. 2014. Web. Publisher's VersionAbstract
This paper studies the dynamics between intra-household bargaining power and HIV prevention from a systemic perspective, using a panel data set of 500 married couples in rural Malawi from 2004-2008. All information has been matched at the couple level, which allows to directly assess the effect of a relative increase in bargaining power, as measured by economic, social and relationship variables, on both spouses' attitudes towards HIV prevention, while controlling for HIV status. I employ a fixed effects linear probability model with national and region-specific time trends in order to capture both unobserved heterogeneity at the individual level as well as differences in HIV prevalence and intensity of HIV campaigns in the three regions that are studied. The results show that factors that are associated with a relative increase in female bargaining power, such as own earnings and attendance of women at local political meetings, are related to improved acceptance of HIV prevention.
household_bargaining_power.pdf
Klugman, Jeni. Voice and Agency: Empowering Women and Girls for Shared Prosperity. Washington, DC: World Bank Open Knowledge Repository, 2014. Web. Publisher's VersionAbstract
The 2012 report recognized that expanding women's agency - their ability to make decisions and take advantage of opportunities is key to improving their lives as well as the world. This report represents a major advance in global knowledge on this critical front. The vast data and thousands of surveys distilled in this report cast important light on the nature of constraints women and girls continue to face globally. This report identifies promising opportunities and entry points for lasting transformation, such as interventions that reach across sectors and include life-skills training, sexual and reproductive health education, conditional cash transfers, and mentoring. It finds that addressing what the World Health Organization has identified as an epidemic of violence against women means sharply scaling up engagement with men and boys. The report also underlines the vital role information and communication technologies can play in amplifying women's voices, expanding their economic and learning opportunities, and broadening their views and aspirations. The World Bank Group's twin goals of ending extreme poverty and boosting shared prosperity demand no less than the full and equal participation of women and men, girls and boys, around the world.
9781464803598.pdf
Klugman, Jeni. “Women's health and human rights: Public spending on health and the military one decade after the African Women’s Protocol”. African Human Rights Law Journal 14.2 (2014): , 14, 2, 705 - 734. Web. Publisher's VersionAbstract

The Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa has been hailed for its efforts to promote women’s health and rights.. The Protocol has now been signed and ratified by approximately two-thirds of African Union member states, from the most populous and largest to the smallest countries on the continent. The Protocol envisages major steps to improve the status of women on the continent, from economic opportunities and food security through to marriage and the rights of widows. This article seeks to contribute to the emerging literature on gender, health and rights, by exploring how government commitments to the health mandates of the Women’s Protocol have transpired in practice, one decade after its enactment, with a focus on resource allocations. The article’s scope includes a review of why sexual and reproductive rights matter, intrinsically, as rights, and evidence about their instrumental importance for development. Available evidence about status and trends in women’s health in Africa is presented, highlighting some advances as well as major shortcomings. This is the important empirical background against which to explore the human rights obligations of African states on this front, in particular the right to sexual and reproductive health and the potential contribution of the African Women’s Protocol. New analysis is undertaken of the extent to which governments have responded to the Protocol’s specific mandates with respect to military spending and social development, which suggests some promising trends. The conclusions highlight the finding that resource allocations in favour of health have significantly improved in countries that have ratified the Protocol, while underlining the importance of appropriate indicators and monitoring, and actions to ensure state accountability.

Jayachandran, Seema, and Rohini Pande. “Why Are Indian Children So Short?”. (2014). Web. Publisher's VersionAbstract

We examine height-for-age for 170,000 Indian and African children to understand why, despite two decades of sustained economic growth, the child malnutrition rate in India remains among the highest in the world. First, we show that Indian firstborns are actually taller than African firstborns; the Indian height disadvantage appears with the second child and increases with birth order. The patterns hold even when we only use between-sibling variation. Second, the birth order patterns vary with child gender and siblings' gender. Specially, the Indian firstborn height advantage only exists for sons. In addition, daughters in India with no older brothers show the sharpest height deficit relative to African counterparts; their parents are likely to have more children than planned in order to try for a son. These patterns suggest that the cultural norm of eldest son preference, which causes parents to differentially allocate resources across children by birth order and gender, keeps the average Indian child short.

india_malnutrition_paper_3nov2014.pdf
2013
Seabury, Seth A, Amitabh Chandra, and Anupam B Jena. “Trends in the Earnings of Male and Female Health Care Professionals in the United States, 1987 to 2010”. JAMA Internal Medicine 173.18 (2013): , 173, 18, 748-1750. Web. Publisher's VersionAbstract

Nearly 40 years after the adoption of the Title IX Amendments of the US Civil Rights Act, women account for almost 50% of US medical students and more than one-third of all physicians. Historically, female physicians have earned considerably less than male physicians, though in the 1990s much of this was attributable to gender differences in specialty choice and hours worked. However, more recent data suggest that female physicians currently earn less than male physicians even after adjustment for specialty, practice type, and hours worked. Salary differences between men and women currently exist among physician researchers as well. This raises questions about whether the gender gap in earnings among US physicians has closed over time, particularly compared with the earnings gap for other health care professionals and workers overall. Comparing earnings of male and female physicians over time is important in assessing the impact of policies to promote gender equality among physicians.

trends_in_earnings.pdf
Ashraf, Nava, Erica Field, and Jean Lee. “Household Bargaining and Excess Fertility: An Experimental Study in Zambia”. (2013). Web. Publisher's VersionAbstract

We posit that household decision-making over fertility is characterized by moral hazard due to the fact that most contraception can only be perfectly observed by the woman. Using an experiment in Zambia that varied whether women were given access to contraceptives alone or with their husbands, we find that women given access with their husbands were 19% less likely to seek family planning services, 25% less likely to use concealable contraception, and 27% more likely to give birth. However, women given access to contraception alone report a lower subjective well-being, suggesting a psychosocial cost of making contraceptives more concealable.

householdbargaining.pdf
2012
Hanna, Rema, Esther Duflo, and Michael Greenstone. “Up In Smoke: The Influence Of Household Behavior On The Long-run Impact Of Improved Cooking Stoves”. NBER Working Paper (2012). Web. Publisher's VersionAbstract

It is conventional wisdom that it is possible to reduce exposure to indoor air pollution, improve health outcomes, and decrease greenhouse gas emissions in the rural areas of developing countries through the adoption of improved cooking stoves. This belief is largely supported by observational field studies and engineering or laboratory experiments. However, we provide new evidence, from a randomized control trial conducted in rural Orissa, India (one of the poorest places in India), on the benefits of a commonly used improved stove that laboratory tests showed to reduce indoor air pollution and require less fuel. We track households for up to four years after they received the stove. While we find a meaningful reduction in smoke inhalation in the first year, there is no effect over longer time horizons. We find no evidence of improvements in lung functioning or health and there is no change in fuel consumption (and presumably greenhouse gas emissions). The difference between the laboratory and field findings appear to result from households’ revealed low valuation of the stoves. Households failed to use the stoves regularly or appropriately, did not make the necessary investments to maintain them properly, and usage rates ultimately declined further over time. More broadly, this study underscores the need to test environmental and health technologies in real-world settings where behavior may temper impacts, and to test them over a long enough horizon to understand how this behavioral effect evolves over time.

2007
Baker, Laurence C, et al.Differences in neonatal mortality among whites and Asian American subgroups: evidence from California”. Archives of pediatrics & adolescent medicine 161.1 (2007): , 161, 1, 69-76. Web. Publisher's VersionAbstract

OBJECTIVE:

To obtain information about health outcomes in neonates in 9 subgroups of the Asian population in the United States.

DESIGN:

Cross-sectional comparison of outcomes for births to mothers of Cambodian, Chinese, Filipino, Indian, Japanese, Korean, Laotian, Thai, and Vietnamese origin and for births to non-Hispanic white mothers. Regression models were used to compare neonatal mortality across groups before and after controlling for various risk factors.

SETTING:

All California births between January 1,1991, and December 31, 2001.

PARTICIPANTS:

More than 2.3 million newborn infants.

MAIN EXPOSURE:

Racial and ethnic groups.

MAIN OUTCOME MEASURE:

Neonatal mortality (death within 28 days of birth).

RESULTS:

The unadjusted mortality rate for births to non-Hispanic white mothers was 2.0 per 1000. The unadjusted mortality rate for births to Chinese and Japanese mothers was significantly lower (Chinese: 1.2 per 1000, P<.001; Japanese: 1.2 per 1000, P=.004), and for births to Korean mothers the rate was significantly higher (2.7 per 1000, P=.003). For infants of Chinese mothers, observed risk factors explain the differences observed in unadjusted data. For infants of Cambodian, Japanese, Korean, and Thai mothers, differences persist or widen after risk factors are considered. After risk adjustment, infants of Cambodian, Japanese, and Korean mothers have significantly lower neonatal mortality rates compared with infants born to non-Hispanic white mothers (adjusted odds ratios, 0.58 for infants of Cambodian mothers, 0.67 for infants of Japanese mothers, and 0.69 for infants of Korean mothers; all P<.05); infants of Thai mothers have higher neonatal mortality rates (adjusted odds ratio, 1.89; P<.05).


CONCLUSIONS:

There are significant variations in neonatal mortality between subgroups of the Asian American population that are not entirely explained by differences in observable risk factors. Efforts to improve clinical care that treat Asian Americans as a homogeneous group may miss important opportunities for improving infant health in specific subgroups