Reduction in child marriage is highly correlated with a decline in maternal and child morbidity and mortality. Nigeria has taken a step to reduce child marriage through the Child Rights Act; however, 11 states in the Northeast and Northwest are yet to implement these laws despite the documented benefits. Estimates predict that a 70% reduction of maternal deaths can be achieved by a 10% reduction in child marriage. Additionally, the $7.6 billion lost in (...) earning and productivity of human capital from child marriage annually can be averted. A reduction in child marriage can also decrease violence against girls and improve educational level attainment. We propose that the Nigerian government should enact the Maternal and Child Health Country-wide Policy to give a national security treatment to maternal and child health matters. It will ensure that policies passed at the federal level with the potential to reduce maternal and child mortality can be automatically adopted nationwide. (shrink)

This pаpеr invеstigаtеs thе intеrgеnеrаtiоnаl еffеcts оf mаtеrnаl еducаtiоn оn child hеаlth in 68 dеvеlоping cоuntriеs аcrоss fivе cоntinеnts оvеr nеаrly thrее dеcаdеs. Еxplоiting thе bеtwееn-sistеrs vаriаtiоn in thе еducаtiоnаl аttаinmеnt оf thе mоthеrs, wе find thаt mоthеr’s еducаtiоn is pоsitivеly аssоciаtеd with child hеаlth mеаsurеd by thе thrее mоst cоmmоnly usеd indicеs, nаmеly hеight-fоr-аgе, wеight-fоr-hеight, аnd wеight-fоr-аgе. Оur mеchаnism аnаlysеs furthеr shоw thаt thеsе fаvоrаblе еffеcts cоuld bе, аt lеаst in pаrt, аttributеd tо fеrtility bеhаviоr, аssоrtаtivе mаtching, (...) hеаlth cаrе utilizаtiоn, аccеss tо infоrmаtiоn, hеаlth knоwlеdgе, аnd lаbоr mаrkеt оutcоmе. Givеn thе lоng-lаsting impаcts оf еаrly-lifе hеаlth оvеr thе lifе cyclе, оur findings undеrlinе thе impоrtаncе оf mаtеrnаl еducаtiоn in imprоving еcоnоmic аnd sоciаl cоnditiоns in dеvеlоping cоuntriеs. (shrink)

Background: There are many reports in the mass media and scientific literature about child abuse caused by parents. Medical practitioners also are concerned about child abuse and need to grapple with the prevention and early detection of child abuse when working in medical facilities. Aim: The aim of this descriptive study was to explore the relationship between maternal and child factors contributing to child abuse. Methods: A sample of 50 multiparas (mothers with more than (...) 1 child) in a 48-bed postpartum hospital unit in Okinawa prefecture were asked to fill out an anonymous questionnaire regarding the relationship between mothers and their first child in September, 2007. The questionnaire contained 30 items of physical punishment that are quoted from “The Handbook of Correspondence to Child Abuse” (Ministry of Health, Labor and welfare in Japan), 24 items relating to maternal factors and 22 items to child factors, plus items related to mothers’ satisfaction with the health guidance given in the hospital. Data were analyzed using JMP (ver. 14.2; SAS Institute Inc., Cary, NC, U.S.). The significance level was set at 0.05. Results: Forty-one (82%) questionnaires were analyzed. Of the 41 valid responses, 19 mothers reported abusing their children. Child factors contributing to the abuse included the first child’s regression to infantile behavior, bullying younger brothers or sisters and being rough and violent to their friends. The significant maternal factor leading to abuse was the belief that mothers were irritated by their child. Conclusion: A first child’s developmental difficulties had a significant relationship with the harsh punishment by their mothers. The mothers need to understand their child’s developmental behavior and provide a favorable environment for nurturing young children. (shrink)

Background: Educated women tend to have a greater awareness of the existence of ANC services, more aware of health problems, know more about the availability of health care services, and utilize the information more effectively than non-educated women. Moreover, higher levels of education tend to positively affect healthseeking behaviors, and education may increase a woman’s control over her pregnancy and expose women to more health education messages and campaigns, enabling them to recognize danger signs and complications and (...) take appropriate action. In this study, we tried to analyze to what level the maternal education can influence the antenatal care services and childcare. Methods: A community-based cross-sectional study was conducted on 93 randomly selected mothers who have children less than 7 years by using a pre-tested structured questionnaire for data collection at various tribal villages, at an average 25 kms away from Adilabad town from April-October 2019. Analysis was done using SPSS for windows version 16, Microsoft excel and Open epi website. Results: Out of 93 study subjects, 19.3% (18) of the study subjects were not registered for the antenatal services. Higher the maternal education higher the age at pregnancy (p<0.05), was associated with more preference for deliveries by doctors (p<0.05). More the frequency of exclusive breast feeding, long lasting breast feeding was associated more than a year (p<0.05), a smaller number of children with wasting (p<0.05). Conclusion: This study revealed that utilization of ANC services was relatively better for the mother’s educated higher than secondary school, but they are still low. Educational status is important in having more health seeking behavior. In this study, it proves that health education is more important than the mere school education which can help to improve knowledge on ANC. (shrink)

The Millennium Development Goals (MDG) set time-bound targets that are powerful shapers of how and for whom health is pursued. In this paper we examine some ramifications of both the temporal limitation, and maternal-child health targeting of MDG 4 and 5. The 2015 end date may encourage increasing the number of mass campaigns to meet the specific MDG objectives, potentially to the detriment of a more comprehensive approach to health. We discuss some ethical, political, and (...) pragmatic ramifications of this tendency, and show that these are not unique to the MDGs but rather have a long history in health policy debates. We also examine attempts to counter a narrow focus on vertical interventions in campaigns through integrated health system delivery platforms. We argue that the way forward is not to assume that evidence is value free, but rather to make explicit the political and ethical decisions in the design of metrics and evaluation research. We propose an index of five factors that should be included in research designed to inform decision making about providing interventions as part of routine services or periodic campaigns, toward serving more members of the population, and long-term strengthening of the health system via integrated health interventions. (shrink)

Non-communicable diseases now account for the majority of the global burden of disease and an international campaign has emerged to raise their priority on the post-2015 development agenda. We argue, to the contrary, that there remain strong reasons to prioritize maternal and child health. Policy-makers ought to assign highest priority to the health conditions that afflict the worst off. In virtue of how little healthy life they have had, children who die young are among the globally (...) worst off. Moreover, many interventions to deal with the conditions that cause mortality in the young are low-cost and provide great benefits to their recipients. Consistent with the original Millennium Development Goals, the international community should continue to prioritize reductions in communicable diseases, neonatal conditions, and maternal health despite the shifts in the global burden of disease. (shrink)

In this editorial, we argue that midwives should focus on climate change, a link which has been underexplored.

Sheep production is the most representative livestock activities in Brazil and in the world. However, the reproductive performance of these animals is determined by factors genetic, physical environment, management and, especially, nutritional. Thirty half-breed lambs from Dorper × Santa Inês were used, with initial weight and age of 31.87 ± 0.5 kg and 157 days, respectively. These animals were prepared on a diet with three food levels (ad libitum, 30% and 70%). Morphometric measurements were measured at intervals of 16 to (...) 20 days in 56 experimental days. The measurements performed were scrotal circumference (CE), chest circumference (CT), body condition score (ECC), withers height (AC) and scrotal bag thickness (EBE), body weight (CP) and semen collection. Interaction occurrence for biometric measurements between food levels and age (p <0.05). The TC and ECC values were higher in animals fed ad libitum (p <0.001). EBE had higher values in animals ad libitum and at 211 days of age (p <0.001). The CP was increasing for the animals ad libitum and (p <0.05) throughout the experiment, while the T30 was only in the initial period. T70 animals did not grow during the whole experiment. CE was influenced by diet (p <0.001) and age (p <0.001) independently. So that animals under food restriction had less development and was higher in older animals. The AC values were influenced only by age (p <0.001), demonstrating the effect of age growth. We conclude that it is not advantageous to submit lambs, it corrects food reproduction. Although it was not possible to assess whether initial malnutrition would bring future problems for the animal's seminal quality, it proved to be immensely negative for the onset of puberty and the development of reproductive structures. -/- REFERÊNCIAS BIBLIOGRÁFICAS AKUMBUGU, F. E., et al. 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Prediction of postpubertal reproductive potential according to prepubertal body weight, testicular size, and testosterone concentration using multiple regression analysis in Kıvırcık ram lambs. Turkish journal of veterinary and animal sciences, v. 32, n. 5, p. 335-343, 2008. JUCÁ, A. F. et al. Performance of the Santa Ines breed raised on pasture in semiarid tropical regions and factors that explain trait variation. Tropical animal health and production, v. 46, n. 7, p. 1249-1256, 2014. FOURIE, P. J. et al. Scrotal, testicular and semen characteristics of young Dorper rams managed under intensive and extensive conditions. Small Ruminant Research, v. 54, n. 1-2, p. 53-59, 2004. GUNN, R. G.; SIM, D. A.; HUNTER, E. A. Effects of nutrition in utero and in early life on the subsequent lifetime reproductive performance of Scottish Blackface ewes in two management systems. Animal Science, v. 60, n. 2, p. 223-230, 1995. HÖTZEL, M. J. et al. Morphometric and endocrine analyses of the effects of nutrition on the testis of mature Merino rams. Reproduction, v. 113, n. 2, p. 217-230, 1998. Instituto Brasileiro de Geografia e Estatística (IBGE). Produção Pecuária municipal. Rio de Janeiro, v. 46, p.1-8, 2018. KENYON, P. R.; MALONEY, S. K.; BLACHE, D. Review of sheep body condition score in relation to production characteristics. New Zealand Journal of Agricultural Research, v. 57, n. 1, p. 38-64, 2014. KHERADMAND, A.; BABAEI, H.; ALI BATAVANI, R. Effect of improved diet on semen quality and scrotal circumference in the ram. Veterinarski arhiv, v. 76, n. 4, p. 333-341, 2006. KORKMAZ, M. K.; EMSEN, E. Growth and reproductive traits of purebred and crossbred Romanov lambs in Eastern Anatolia. Anim. Reprod., v. 13, n. 1, p. 3-6, 2016. KRIDLI, R. T. et al. Age at puberty and some biological parameters of Awassi and its first crosses with Charollais and Romanov rams. Italian journal of animal science, v. 5, n. 2, p. 193-202, 2006. LOUW, D. F. J.; JOUBERT, D. M. Puberty in the male Dorper sheep and Boer goat. S. Afr. J. Agric. Sci, v. 7, p. 509-520, 1964. MAIA, A. S. C.; SILVA, R. G.; ANDRADE, P. C. Efeitos da temperatura e da movimentação do ar sobre o isolamento térmico do velo de ovinos em câmara climática. Revista Brasileira de Zootecnia, v. 38, n. 1, p. 104-108, 2009. MARTINS, R. D. et al. Avaliação da sazonalidade reprodutiva de carneiros Santa Inês criados no Distrito Federal. R. Bras. Zootec., Viçosa, v. 32, n. 6, supl. 1, p. 1594-1603, Dec. 2003. MENDES, A. M. P. et al. Zoneamento bioclimático para a raça ovina Dorper no Estado de Pernambuco. Pesquisa Agropecuária Brasileira, v. 49, n. 12, p. 986-993, 2014. MOULLA, F. et al. Characterization of the onset of puberty in Tazegzawt lambs, an endangered Algerian sheep: Body weight, thoracic perimeter, testicular growth, and seminal parameters. Veterinary world, v. 11, n. 7, p. 889, 2018. NATIONAL RESEARCH COUNCIL (NRC). Nutrient Requirements of Small Ruminants: Sheep, Goats, Cervids, and New World Camelids. Washington, D.C.: National Academy Press, 2007. NOTTER, D. R.; LUCAS, J. R.; MCCLAUGHERTY, F. S. Accuracy of estimation of testis weight from in situ testis measures in ram lambs. Theriogenology, v. 15, n. 2, p. 227-234, 1981. SEJIAN, V. et al. Effect of body condition score on the allometric measurements and reproductive performance of Garole X Malpura ewes under hot semi-arid environment. Journal of Dairy, Veterinary & Animal Research, v. 2, n. 6, p. 1-4, 2015. PACHECO, A.; MADELLA-OLIVEIRA, A. F.; QUIRINO, C. R. Biometria e formas dos testículos em cordeiros da raça Santa Inês explorados em regime de manejo intensivo. Revista Brasileira de Ciências Agrárias, v. 5, n. 1, p. 123-128, 2010. REGO NETO, A. A. et al. Population genetic structure of Santa Inês sheep in Brazil. Tropical animal health and production, v. 50, n. 3, p. 503-508, 2018. RHIND, S. M. Effects of maternal nutrition on fetal and neonatal reproductive development and function. Animal Reproduction Science, v. 82, p. 169-181, 2004. RIBEIRO, E. L. A.; GONZÁLEZ-GARCÍA, E. Indigenous sheep breeds in Brazil: potential role for contributing to the sustainability of production systems. Tropical animal health and production, v. 48, n. 7, p. 1305-1313, 2016. RIBEIRO, M. S. et al. Repeatability and effect of age on reproductive characteristics in Santa Ines rams. Archivos de zootecnia, v. 67, n. 257, p. 143-147, 2018. RUSSEL, A. J. F.; DONEY, J. M.; GUNN, R. G. Subjective assessment of body fat in live sheep. The Journal of Agricultural Science, v. 72, n. 3, p. 451-454, 1969. SILVA, N. V. et al. Medidas in vivo e da carcaça e constituintes não carcaça de ovinos alimentados com diferentes níveis do subproduto agroindustrial da goiaba. Revista Brasileira de Saúde e Produção Animal, v. 17, n. 1, p. 101-115, 2016. SILVA, P. et al. Influence of placentally mediated fetal growth restriction on the onset of puberty in male and female lambs. Reproduction, v. 122, n. 3, p. 375-383, 2001. SIQUEIRA FILHO, E. R. Influência dos níveis protéicos fornecidos na dieta sobre o sistema reprodutivo de carneiros. 2007. 75 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina Veterinária e Zootecnia de Botucatu, 2007. SOUZA, J. S da et al. Biometric measurements of Santa Inês meat sheep reared on Brachiaria brizantha pastures in Northeast Brazil. Plos one, v. 14, n. 7, p. e0219343, 2019. (shrink)

Highlights: -/- • Breastfeeding and breastfeeding support can contribute to mitigating climate change. • Achieving global nutrition targets will save more emissions than fuel-switching. • Breastfeeding support programmes support a just transition. • This work can support the expansion of mitigation options in energy system models. -/- Abstract: -/- Renewable gas has been proposed as a solution to decarbonise industrial processes, specifically heat demand. As part of this effort, the breast-milk substitutes industry is proposing to use renewable gas as a (...) substitute for fossil natural gas. However, decarbonising the industrial processing of breast-milk substitutes can increase social license for these products, potentially undermining breastfeeding. World Health Organisation nutrition targets aim to increase exclusive breastfeeding to at least 50% globally by 2025 to improve maternal, infant, and young child health and nutrition. This target will have implications for the energy transition. A weakness of existing energy models is that demands for end-use products such as breast-milk substitutes are typically not considered explicitly. This paper develops an analytical framework for explicitly representing infant feeding methods in energy systems models. We compare the emissions saved in Ireland from decarbonising the industrial processing of breast-milk substitutes with renewable gas with the emissions saved by an increase in exclusive breastfeeding to 50% in both Ireland and a key export market, China. We demonstrate that the emissions saved from achieving the minimum global breastfeeding target are greater than when renewable gas is used to displace natural gas in the production of breast-milk substitutes in Ireland. We discuss the decarbonisation of breast-milk substitutes in relation to the principle of justice as non-maleficence, a principle based on the commitment to avoid harm, a novel application of a principle of justice. We conclude that breastfeeding support can be considered a demand-side measure for mitigating climate change by reducing the demand for energy services to produce breast-milk substitutes. A key recommendation is to position breastfeeding support as both a public health and a climate justice issue that is relevant for a just transition. The framework developed for this paper could be applied to support the inclusion of a wider range of mitigation options with social justice outcomes in energy system models. [Open access]. (shrink)

Background Bronchial asthma is one of the most common chronic conditions among children. Despite the improvement in asthma treatment regimens, its prevalence and related morbidity are increasing, especially among underserved, minority children. There are barriers in the management of asthma, which may impact the quality of outcomes. The goal of this study is to explore these barriers. Methods A cross-sectional study was conducted on interview data collected through 2019 from mothers of children (aged 6 - 12 years) with asthma visiting, (...) for convenience, a public shopping mall. The interviewees were randomly selected, because they met the inclusion criteria. Participants were considered if the mother answered “yes” to the following questions: Has your child had physician-diagnosed asthma? Is your child currently taking asthma medications of asthma? Two community nurses conducted the interviews. Data was obtained using administrative questionnaires. Data were analyzed using SPSS version 21.0 (IBM Inc., Chicago, IL, USA). Descriptive statistics of percentage, mean, frequency and standard deviation were applied for categorical and continuous variables. Results Three hundred mothers participated in this study. Their average age was 36.8 years, 55% were housekeepers by profession, and 34% had obtained less than high school education. The majority of children (61%) were males, 45% had moderate asthma, and 42% had mild asthma. The most frequent types of barriers identified by parents were environmental factors (67.7%), followed by health care providers (63%), the health care system (48%), and patient or family characteristics (43%). Mothers were specifically concerned about the use, safety, and long-term complications of medications, the impact of exercise limitation on their child’s quality of life, and their own quality of life. Conclusion This study showed several barriers against asthma care in Saudi Arabia, which mainly related to environmental or personal characteristics. This highlights the need to enhance current policies within the health care system in Saudi Arabia to overcome these barriers. (shrink)

The dissertation, comprising a clinical intervention and three supporting studies, aimed to assess if it is possible to prevent nonsynostotic plagiocephaly while promoting safe infant sleeping practices. Five individuals were trained to assess cranial asymmetry and then reliability-tested; the interpreted results indicate substantial strength of rater-agreement. Intervention participants were allocated to group. Only intervention group nurses participated in the continuing education on plagiocephaly developed for nurses. A survey compared information intervention and control group parents received from nurses; intervention group parents (...) were significantly more aware of recommendations than the controls. Nurse education was evaluated by asking intervention and control group nurses and parents two open-ended questions; the intervention group reported new re-positioning strategies. The effect of the intervention on cranial shape was evaluated by assessing asymmetry at 2, 4, and 12 months (176 intervention group; 92 controls). It was nine times more common that cranial asymmetry at two months reversed by four months when parents were aware of written recommendations from their nurse (OR = 9.09 [0.02; 0.48], p = 0.004) when adjusted for group. An infant’s risk of asymmetry persisting until 12 months was significantly reduced in the intervention group (RR = 0.35 [0.13; 0.94], p = 0.03). Preventing brachycephaly was difficult. Conclusions: the assessors were considered reliable; educating nurses promoted the integration of new recommendations in practice; the intervention was associated with early reversal of nonsynostotic plagiocephaly. (shrink)

In this book, Alison Stone develops a feminist approach to maternal subjectivity. Stone argues that in the West the self has often been understood in opposition to the maternal body, so that one must separate oneself from the mother and maternal care-givers on whom one depended in childhood to become a self or, in modernity, an autonomous subject. These assumptions make it difficult to be a mother and a subject, an autonomous creator of meaning. Insofar as mothers (...) nonetheless strive to regain their subjectivity when their motherhood seems to have compromised it, theirs cannot be the usual kind of subjectivity premised on separation from the maternal body. Mothers are subjects of a new kind, who generate meanings and acquire agency from their position of re-immersion in the realm of maternal body relations, of bodily intimacy and dependency. Thus Stone interprets maternal subjectivity as a specific form of subjectivity that is continuous with the maternal body. Stone analyzes this form of subjectivity in terms of how the mother typically reproduces with her child her history of bodily relations with her own mother, leading to a distinctive maternal and cyclical form of lived time. (shrink)

The current thesis discusses how tools for analysing power are developed predominately for adults, and thus remain underdeveloped in terms of understanding injustices related to age, ethnicity/race and gender in childhoods. The overall aim of this dissertation is to inscribe a discourse of intersecting social injustices as relevant for childhoods and child welfare, and by interlinking postcolonial, feminist, and critical childhood studies. The dissertation is set empirically within the policy and practice of Swedish child welfare, here exemplified by (...) the assessment framework Barns Behov i Centrum. It aims to explore how Swedish child welfare, as a field of knowledge, modes of knowing and knowing subjects, constitutes an arena for claims and responses to intersecting social justice issues. The material consists of BBIC primers and selected samples from, a total of 283 case reports from a Swedish social service agency. The case reports address assessments of children. This dissertation is based on four qualitative studies using discourse analysis, as well as analysis inspired by thematic and case-study methodology. Two studies focus on child welfare discourses in BBIC documents involving social problems and violence, and two studies are based on child welfare case reports. Studies I­­-II address child welfare policy and practice by analysing the conditions required for children to participate, in terms of children’s moral status and in terms of status of ‘evidencing’ needs for protection. Studies III­­-IV explore this further from the perspective of intersecting and embodied social injustices in childhoods. Together, the studies interconnect child welfare as a field of knowledge, modes of knowing and knowers with child welfare as a moral arena for claims to rights, recognition, and social justice. The synthesised findings point to child biowelfare, in which justice discourses are largely absent. Biowelfare is informed by a mode of knowing and ‘evidencing’ risks to children’s health and development, which are confined to scientific predicting-believing, seeing-believing by professionals and a moral economy of care, all of which constrain the idea that injustices are structural and intersecting. Biowelfare primarily responds to children as ‘speaking’ biological bodies, rather than as voices of justice. In this sense, injustices of an epistemological nature are interconnected with social injustices. When issues of justice are mobilised in case reports and policy, they come across as rather ‘unjust’, primarily confined to the sphere of the family home of racialised children and not connected to ‘general’ children. In addition to intersections of age, ethnicity/race and gender, class and health are fundamental to recognition and protection in biowelfare. Finally, the dissertation indicates the need for a moral economy which responds to intersecting social injustices such as racial, gender-based and ageist violence in childhoods, and violations of children’s bodily integrity. (shrink)

Lạm dụng và bỏ bê trẻ еm đаng diễn rа phổ biến trên tоàn сầu. Nó thаy đổi từ sự đối xử tệ bạс về thể сhất, tinh thần và xã hội gây hại сhо đứа trẻ. Nó сó những hậu quả ngắn hạn và lâu dài, сuối сùng сó thể làm сhậm sự phát triển kinh tế và xã hội сủа сáс quốс giа một сáсh gián tiếp. Người tа ướс tính rằng сứ 5 phụ nữ và 1 trоng (...) số 13 nаm giới thì сó 1 người bị lạm dụng tình dụс trоng thời thơ ấu. Mặс dù vấn đề khá phứс tạp và rõ ràng соn số trên đánh giá thấp giá trị thựс tế. Phần lớn, đó là dо сấu trúс xã hội trоng сộng đồng bị phá vỡ. Những trụ сột сủа сộng đồng như trường họс, tổ сhứс, giа đình thất bại trоng việс thông báо kịp thời và сó hành động сhống lại сáс сơ quаn сhứс năng thíсh hợp để duy trì vị thế сао сủа tổ сhứс mình và tránh bị kỳ thị. Nghiên сứu điển hình này mô tả сáсh một nữ sinh bị bóс lột tình dụс và сáсh thứс phối hợp giữа сáс сơ quаn сó thể ngăn сhặn điều đó. (shrink)

When talking about sexual abuse of children we can understand culture as one of the leading determinants of child health. As a public health problem, sexual abuse has different causes, from which we can distinguish the silence and secrecy that is kept by third parties. In every single abuse there is a person or people that are present at the moment of the abuse, or without being present know that the abuse is in progress, or even help (...) in any way the perpetrator to commit the abuse. In order to work consistently in this type of abuse of children, we need to work in adding values to a culture that contribute to freely and openly talk about sexuality and to teach how to gain transparency in communities that could help disclose sexual abuses. (shrink)

Health policy changes in Nepal displayed struggles against a poor political, geographical, and economic setting; Millennium Development Goal #4 demanded improved infant and child mortality, as well as adequate measles vaccine coverage by the year 2015. Research in this report presents progress and direction of child health care policy across more than a decade of time in attempts of attaining MDG #4 and general child health care advancements. Subsequent observations and suggestions were delineated and (...) offered. Progress since the 1990’s up to 2012 was analyzed by review of serial national survey and report data. Trends and variations between regions were mostly analyzed amongst various child health care determinants. Results indicated many improved factors; Nepal will likely achieve MDG regarding child under-5 mortality, but may not achieve measles vaccine coverage or infant mortality goals. Furthermore, severe regional disparities were evident within Nepal, particularly in the Mid and Far-Western regions. A call for integrated community-based primary health care (CB-PHC) for infants and children became an ultimate ideal. A comprehensive, multidisciplinary, and community based primary care delivery service would address many of the deficits identified as well as reach rural and remote areas that still suffered. Risk and data-based resource allocation promise improved utilization, but also demands more frequent and better data reporting. Coordinated, multi-sector health policy initiatives have been underway; this demonstrated a strong direction in improving child health care from urban to every village. (shrink)

In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds (...) in philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making. (shrink)

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in (...) maternity care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)

In this article I critically re-examine Julia Kristeva's view that becoming a speaking subject requires psychical matricide: violent separation from the maternal body. I propose an alternative, non-matricidal conception of subjectivity, in part by drawing out anti-matricidal strands in Kristeva's own thought, including her view that early mother–child relations are triangular. Whereas she understands this triangle in terms of a first imaginary father, I re-interpret this triangle using Donald Winnicott's idea of potential space and Jessica Benjamin's idea of (...) an intersubjective space of thirdness. I argue that this space provides a maternal third term: a relation of connection and difference between two, a relation that inherits the affective, mobile, generative qualities of the maternal body as the infant (according to Kristeva) imagines it. This connecting space allows both mothers and children to emerge as subjects in their own right. I then suggest that potential-maternal space expands into language, so that language intrinsically allows the possibility of a speaking position of connection with the mother. Entrance into language need not entail separation or matricide: the problem is not language as such but the particular way that speech and logos have been defined historically. (shrink)

Imagine you fly home from vacation with your one-and-a-half-year-old son who is traveling for free as a “lap child.” In the airport parking lot, you put him into his forward-facing car seat, where he sits much more contentedly than he did in the rear-facing one that was mandatory until his first birthday. After he falls asleep on the way home, you transfer him to his crib without waking him, lowering the side rail so you can lift him in more (...) easily. -/- Many parts of this idyllic parenting picture are deemed unacceptably risky according to recent child safety proposals. While these proposals all aim to improve child safety, their possible impact is unclear because there has been little discussion of the absolute risk and risk reduction involved in each. And while precise figures are lacking, rough estimates indicate that the magnitudes are quite small. I will argue that this risk and benefit data raises important questions about the proposals, including whether parents might reasonably believe that the small absolute risk reduction offered by the proposed changes does not justify the attendant burdens. This possibility—termed the “prevention paradox” in other contexts—highlights ethical and theoretical challenges in this area of public health. (shrink)

Ableist attitudes and structures regarding disability are increasingly recognized across all sectors of healthcare delivery. After Dobbs, novel questions arose in the USA concerning how to protect reproductive autonomy while avoiding discrimination against and devaluation of disabled persons. As a case study, we examine the Louisiana’s Department of Public Health August 1st Emergency Declaration, “List of Conditions that shall deem an Unborn Child ‘Medically Futile.’” We raise a number of medical, ethical, and public health concerns that lead (...) us to argue the declaration should be rescinded. The ethically objectionable declaration provides valuable lessons concerning how to uphold both reproductive and disability justice in a post-Dobbs landscape. (shrink)

Parenthood is one of the best gifts nature and god has given to humans. Being a parent is a feeling that can be compared to none other but as a baby caretaker a nanny can do this. As a parent, we always strive to provide the best of everything to our children. This however often comes at a price. Mostly it means that both the parents have to be working in order to provide the best facilities and at the same (...) time secure the future of their children and Newborn Baby. Even if one of the parent chooses to sacrifice the career and stay at home, raising a child in a nuclear family set up is still a challenge. -/- This is when an experienced and gentle baby caretaker can be of utmost help. However such caretaker who can be entrusted with the care and security of your child is often hard to find. Especially in cities like NOIDA baby caretaker are available for your service. Well no more. -/- No more is the need to sacrifice your career or professional aspirations. You can peacefully leave to work, entrusting your lovely children in the hands of the baby caretaker. Majority of the time that your child will be spending is with the caretaker and it is therefore absolutely necessary that a baby caretaker possess all the qualities of a good parent. Benevolence, patience, care and attention, all these qualities can be found in the baby caretaker provided by us. Our caretaker ensures the welfare of the child, creating the environment for sound mental, emotional and health development of the children. -/- We need to guarantee that the caretaker has the child's best interest at heart and looks at the security of our child with the same eye as we do. We select the baby caretakers that view this profession as means of contentment and satisfaction in their lives and not just another menial job to earn their livelihood. Children have the inherent need to have somebody always around them in oder to feel secure and wanted, avoiding loneliness and boredom. A Caretaker for baby in Noida not only provides this companion but also ensures that the natural curiosity of a child is kept alive even in the absence of their parents. -/- Big cities with the diverse kind of population, mostly coming to work from various parts of the country, have had some history of violent cases. And that’s why precaution should be taken while hiring Best caretaker in Noida . With thorough background check and verified references, all such apprehensions can be laid to rest.+ . (shrink)

In order to achieve the World Health Organization’s Millennium Development Goal of reducing maternal mortality by three quarters by 2015, a strong global commitment is needed to address this issue in low-income nations where the risk to women is greatest. A comprehensive international effort must include provision of obstetric and general medical care as well as community-based interventions, with an emphasis on the latter in nations where the majority of women deliver babies at home without a trained attendant. (...) Methods: This systematic analysis evaluates interventions published in Medline and CINAHL whose outcome measure is maternal mortality. Analysis includes components of the intervention, nation and maternal death rates. Results: Nine studies documented the effectiveness of various clinical and community-based interventions, including specific drug regimens and procedures, in reducing the risk of maternal death. Six studies reported interventions that did not significantly alter maternal mortality outcomes, and the intervention in one study demonstrated increased risk of maternal death. Conclusion: The dearth of evidence highlights the need for increased focus on translational research that bridges the gap between medical advances and community-based interventions that are feasible in low-income nations. This cannot be accomplished without a stronger commitment to reducing maternal mortality by global health practitioners and researchers. (shrink)

The study investigated factors that influence the uptake of maternal healthcare services by women in Zimbabwe, using a logit model. Data from the Zimbabwe Demographic Health Survey (ZDHS, 2015) was used. Deteriorating maternal health indicators motivated the study. The effect of socio-economic and demographic factors on the probability of utilising maternal healthcare services was examined. Descriptive statistics and a logit model were used for data analysis. Results from the logit model show that region of residence, (...) insurance cover, educational level, employment status, maternal age, birth order, place of residence, number of living children, maternal age and household income all influence the utilisation of maternal healthcare services by women in Zimbabwe. Basing on research findings, the study recommends that relevant authorities make more available vocational training centres and education institutions since education was found to influence the uptake of maternal healthcare services. There is need to encourage family planning so as to reduce the number of children, especially among the apostolic sect, which affects the uptake of maternal healthcare. Compulsory national health insurance schemes could be adopted to mitigate the effect of low income that discourages the use of institutional facilities for delivery. The issue of balanced regional development needs to be pursued through accelerating devolution to ensure equal access to maternal healthcare facilities in all provinces. (shrink)

Is the “act itself” of separating a pregnant woman and her previable child neither good nor bad morally, considered in the abstract? Recently, Maureen Condic and Donna Harrison have argued that such separation is justified to protect the mother’s life and that it does not constitute an abortion as the aim is not to kill the child. In our article on maternal–fetal conflicts, we agree there need be no such aim to kill (supplementing aims such as to (...) remove). However, we argue that to understand “abortion” as performed only where the death of the child is intended is to define the term too narrowly. Respect for the mother, the fetus, and the bond between them goes well beyond avoiding any such aim. We distinguish between legitimate maternal treatments simply aimed at treating or removing a damaged part of the woman and illegitimate treatments that focus harmfully on the fetal body and its presence within the mother’s body. In obstetrics as elsewhere, not all side effects for one subject of intervention can be outweighed by intended benefits for another. Certain side effects of certain intended interventions are morally conclusive. (shrink)

For children, the collateral damage of the COVID-19 pandemic response has been considerable. In this paper, we use the framework of evidence-based medicine to argue that child abuse is another negative side effect of COVID-19 lockdowns. While it was certain that school closures would have profound social and economic costs, it remains uncertain whether they have any effect on COVID-19 transmission. There is emerging evidence that lockdowns significantly worsened child abuse on a global scale. Low-income and middle-income countries (...) are particularly vulnerable to increases in child abuse. The best available external evidence from systematic research during the pandemic demonstrates an increase in the risk of child maltreatment, an increase in child maltreatment hospitalisations and a concerning decrease in official child maltreatment referrals. The paradoxical phenomenon of increased hospitalisations and decreased reports is unlikely to be explained by a genuine decrease in child abuse. We conclude that lockdowns have an unacceptably high risk of negative side effects for children, as evidenced by child abuse, the true extent of which appears to be masked by lockdown-related disruptions to schools and other surveillance systems. The desire for a sense of security may be a tempting bias towards emphasising the resilience of children, but it is ethically problematic to push children towards abuse in the name of public health. It is our view that the collateral damage of prolonged school closures for society’s most vulnerable members is a powerful ethical consideration against any pandemic response which involves their use. (shrink)

This pаpеr invеstigаtеs thе intеrgеnеrаtiоnаl еffеcts оf mаtеrnаl еducаtiоn оn child hеаlth in 68 dеvеlоping cоuntriеs аcrоss fivе cоntinеnts оvеr nеаrly thrее dеcаdеs. Еxplоiting thе bеtwееn-sistеrs vаriаtiоn in thе еducаtiоnаl аttаinmеnt оf thе mоthеrs, wе find thаt mоthеr’s еducаtiоn is pоsitivеly аssоciаtеd with child hеаlth mеаsurеd by thе thrее mоst cоmmоnly usеd indicеs, nаmеly hеight-fоr-аgе, wеight-fоr-hеight, аnd wеight-fоr-аgе. Оur mеchаnism аnаlysеs furthеr shоw thаt thеsе fаvоrаblе еffеcts cоuld bе, аt lеаst in pаrt, аttributеd tо fеrtility bеhаviоr, аssоrtаtivе mаtching, (...) hеаlth cаrе utilizаtiоn, аccеss tо infоrmаtiоn, hеаlth knоwlеdgе, аnd lаbоr mаrkеt оutcоmе. Givеn thе lоng-lаsting impаcts оf еаrly-lifе hеаlth оvеr thе lifе cyclе, оur findings undеrlinе thе impоrtаncе оf mаtеrnаl еducаtiоn in imprоving еcоnоmic аnd sоciаl cоnditiоns in dеvеlоping cоuntriеs. (shrink)

The Psychological Society of Ireland’s (PSI) response to the call from the United Nations (UN) Committee on the Rights of the Child: Draft General Comment No. 26 Calls for comment on the draft general comment on children’s rights and the environment with a special focus on climate change III. ‘Specific rights of the Convention as they relate to the environment’, B. The right to the highest attainable standard of health (art. 24), 27. … children’s current and anticipated psychosocial, (...) emotional and mental health problems and suffering caused by environmental harm. The PSI wishes to express sincere thanks to the Society’s Special Interest Group in Human Rights and Psychology, particularly Dr Michelle Cowley-Cunningham, Dr Elaine Rogers, and Ms Alexis Carey, who coordinated the following response on behalf of the Society. 1. Environmental degradation, loss of biodiversity, and climate change impact children’s human rights and present a serious threat to future generations’ enjoyment of human rights. Distressingly, 1.7 million children lose their lives annually as a result of avoidable environmental impacts, while millions more are impacted by disease, displaced from their homes and miss out on receiving education1. The PSI Special Interest Group in Human Rights and Psychology (SIGHRP) is grateful to the Committee on the Rights of the Child for this opportunity to submit a stakeholder comment in advance of the drafting of the Draft General Comment No. 26. SIGHRP is appreciative of the work of the Committee in monitoring the implementation of the Convention on the Rights of the Child (UNCRC) and welcomes the Committee's stakeholder call for ideas to aid the development of policies, both domestically and internationally, to address critical climate change issues. Specifically, SIGHRP welcomes the opportunity to comment on the connection between child and adolescent mental health and human rights obligations, and advocates for policies and initiatives to address this issue in the context of climate change. (shrink)

Background Previous analyses of democracy and population health have focused on broad measures, such as life expectancy at birth and child and infant mortality, and have shown some contradictory results. We used a panel of data spanning 170 countries to assess the association between democracy and cause-specific mortality and explore the pathways connecting democratic rule to health gains. -/- Methods We extracted cause-specific mortality and HIV-free life expectancy estimates from the Global Burden of Diseases, Injuries, and Risk (...) Factors Study 2016 and information on regime type from the Varieties of Democracy project. These data cover 170 countries and 46 years. From the Financing Global Health database, we extracted gross domestic product (GDP) per capita, also covering 46 years, and Development Assistance for Health estimates starting from 1990 and domestic health spending estimates starting from 1995. We used a diverse set of empirical methods—synthetic control, within-country variance decomposition, structural equation models, and fixed-effects regression—which together provide a robust analysis of the association between democratisation and population health. -/- Findings HIV-free life expectancy at age 15 years improved significantly during the study period (1970–2015) in countries after they transitioned to democracy, on average by 3% after 10 years. Democratic experience explains 22·27% of the variance in mortality within a country from cardiovascular diseases, 16·53% for tuberculosis, and 17·78% for transport injuries, and a smaller percentage for other diseases included in the study. For cardiovascular diseases, transport injuries, cancers, cirrhosis, and other non-communicable diseases, democratic experience explains more of the variation in mortality than GDP. Over the past 20 years, the average country's increase in democratic experience had direct and indirect effects on reducing mortality from cardiovascular disease (−9·64%, 95% CI −6·38 to −12·90), other non-communicable diseases (−9·14%, −4·26 to −14·02), and tuberculosis (−8·93%, −2·08 to −15·77). Increases in a country's democratic experience were not correlated with GDP per capita between 1995 and 2015 (ρ=–0·1036; p=0·1826), but were correlated with declines in mortality from cardiovascular disease (ρ=–0·3873; p<0·0001) and increases in government health spending (ρ=0·4002; p<0·0001). Removal of free and fair elections from the democratic experience variable resulted in loss of association with age-standardised mortality from non-communicable diseases and injuries. -/- Interpretation When enforced by free and fair elections, democracies are more likely than autocracies to lead to health gains for causes of mortality (eg, cardiovascular diseases and transport injuries) that have not been heavily targeted by foreign aid and require health-care delivery infrastructure. International health agencies and donors might increasingly need to consider the implications of regime type in their efforts to maximise health gains, particularly in the context of ageing populations and the growing burden of non-communicable diseases. (shrink)

Purpose: The purpose is to identify what difficulties fathers have with the roles of fatherhood during pregnancy and early infancy, and to make apparent what their educational support needs are. Methods: This study follows a qualitative descriptive design. The subjects were new first-time fathers of Japanese nationality. Subjects participated in semi-structured interviews administered according to interview guidelines. Results: There were 15 subjects in total. The average age of the subjects’ children was 5.5 months. Fathers’ difficulties with their new roles were (...) abstracted in to five main categories: < Difficulties during early engagement with child >, < Difficulties related to child crying >, < Difficulties arising after getting through the early engagement stage >, < Difficulties related to support of partner >, and < Mental burdens associated with childrearing >. Additionally, the types of support fathers requested to help maintain their mental health after the birth of their infants were abstracted into three main categories: < Support with childcare knowledge/acquiring skills >, < Support in building a positive marital relationship >, and < Support in maintaining own mental health >. Conclusions: 1) The stress experienced by fathers from the birth of their child through early infancy, originating in two elements of fatherhood (engagement with the child and spousal support), placed a great mental burden upon them in a multi-layered structure; 2) The support that needs fathers expressed to maintain their mental health pre- and postpartum is based on the difficulties they experienced with paternal roles; 3) There is a disparity between the needs of fathers expressed through the results of this study and current paternal support practices in Japan. The supplementation and revision of existing paternal support practices is an issue that merits further consideration. Furthermore, the existing group interview method suffers from low attendance, and attending has become increasingly difficult due to the COVID-19 pandemic spreading throughout Japan. It is necessary to consider alternative methods of educational support moving forward. (shrink)

In this paper we aim to demonstrate the enormous ethical complexity that is prevalent in child obesity cases. This complexity, we argue, favors a cautious approach. Against those perhaps inclined to blame neglectful parents, we argue that laying the blame for child obesity at the feet of parents is simplistic once the broader context is taken into account. We also show that parents not only enjoy important relational prerogatives worth defending, but that children, too, are beneficiaries of that (...) relationship in ways difficult to match elsewhere. Finally, against the backdrop of growing public concern and pressure to intervene earlier in the life cycle, we examine the perhaps unintended stigmatizing effects that labeling and intervention can have and consider a number of risks and potential harms occasioned by state interventions in these cases. (shrink)

Child health inequalities violate children’s rights to optimal wellbeing. Different issues worldwide affect children’s physical and mental health as well as their development, influencing their future as adults. Inequities are avoidable inequalities. Despite improvements in the past two decades, the ambitious goals of global agendas have, for the most part, remained as expectations with regard to childhood rights, social justice, and health equity in practice. The concept of social determinants of health has become part of (...) the common language in certain settings, but this is still too little to improve health in practice on a global scale, particularly for underprivileged subgroups of the community, as children and adolescents often are. Pediatric health professionals and their organizations are also responsible for guaranteeing children’s and adolescents’ right to health and better wellbeing, helping to reduce health inequalities. (shrink)

Women constituting almost half of the population of a country are the major human resource and accordingly the involvment of women in every sphere - economic, social, political is urgently felt for the development of a country. Health is one of the major infrastructures to constitute a strong human resource and is emerging as a significant element of human capital and a vital indicator of human development. Improvement in the health status of women plays a very important role (...) in the improvement of socio-economic condition of an economy. In India nearly 70% of the population are coming from rural areas and are suffering and dying from preventable diseases due to unavailability and inaccessibility of health care services. Among the rural population women are the most sufferer. They are trapped in poverty, malnutrition, low level of literacy, and are facing high rate of infant and maternal mortality rate with low expectancy of life at birth etc. Providing sound health care to these rural women is the urgent need and accordingly the Government of India has launched National Rural Health Mission to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, and women. ASHA – one of the stakeholders of NRHM play a very important role in smoothening the delivery of health care services to the rural population specially the woman. A female from a village acts as an ASHA in improvising the health condition of the rural women. The present paper is prepared with the following objectives: 1. To study how ASHA is functioning in providing health care services. Methodology and data base: The study will be based on both primary and secondary data. The primary data will be collected by using multistage sampling. In the first stage of sample selection 2 Community Blocks of Karimganj will be selected at random. From the selected 2(two) Community Blocks 1 Gaon Panchayat from each Blocks will be selected on the basis of simple random sampling. From each of 2 selected Gaon Panchayat 2 villages will be selected by using simple random sampling. From each village 10% of total household will be surveyed and the ASHA workers will be directly interviewed. The main sources of secondary data are the official publication of governments. (shrink)

Most mental health research largely ignores or minimises gender and age differences in depression. In ‘Don't mind the gap: Why do we not care about the gender gap in mental health?’, Patalay and Demkowicz identify a dearth of research on the causal factors of depression in young women. They attribute this to an over-reliance on biological accounts of gender differences in depression. Patalay and Demkowicz conclude that a person-centred approach that meaningfully engages with the reports of young women (...) with depression is more likely to expose the social drivers of depression that impact this group. This commentary focuses on Patalay and Demkowicz's call to examine the patient's lived experience. We argue that there is an urgent need to reflect upon the methodologies involved in examining lived experience and how they can be best utilised. Ultimately, we advocate for an approach known as ‘phenomenological psychopathology’, through a phenomenological investigation of depression in young women, we can go some way towards closing the gender gap. (shrink)

This paper examines the complexity and fluidity of maternal identity through an examination of narratives about "real motherhood" found in children's literature. Focusing on the multiplicity of mothers in adoption, I question standard views of maternity in which gestational, genetic and social mothering all coincide in a single person. The shortcomings of traditional notions of motherhood are overcome by developing a fluid and inclusive conception of maternal reality as authored by a child's own perceptions.

I recently told my uncle that I thought I had come up with a way of showing that a mother who saw her child about to be stung by a wasp should try to intervene. I’d been working on this for several months. My uncle did not look very impressed. To be fair, it doesn’t sound like a very impressive result. Surely it is just utterly obviously that mothers should protect their children from wasps? So why had this taken (...) me months of work? I am trying to come up with a moderate account of maternal duties. Maternal duties pick out what a mother is morally required to do for her children. In doing so, I’ve discovered that it is harder than it might at first appear to come up with a moderate account of maternal duties that recognises ‘obvious’ duties like the duty not to let your child be stung by a wasp. I’ve also found that in the context of maternal duties, even more than in other contexts, we need be cautious before we accept our judgments about what seems obvious. Yet, it is absolutely vital to come up with a good moderate account of maternal duties – because doing so is necessary to protect vulnerable women and children. (shrink)

The conditions animals experience during the early developmental stages of their lives can have critical ongoing effects on their future health, welfare, and proper development. In this paper we draw on evolutionary theory to improve our understanding of the processes of developmental programming, particularly Predictive Adaptive Responses (PAR) that serve to match offspring phenotype with predicted future environmental conditions. When these predictions fail, a mismatch occurs between offspring phenotype and the environment, which can have long-lasting health and welfare (...) effects. Examples include metabolic diseases resulting from maternal nutrition and behavioral changes from maternal stress. An understanding of these processes and their evolutionary origins will help in identifying and providing appropriate developmental conditions to optimize offspring welfare. This serves as an example of the benefits of using evolutionary thinking within veterinary science and we suggest that in the same way that evolutionary medicine has helped our understanding of human health, the implementation of evolutionary veterinary science (EvoVetSci) could be a useful way forward for research in animal health and welfare. (shrink)

The principles which can justify significantly risky nontherapeutic research on children are a combination of: (1) direct or indirect benefits to the child participants now and/or in the future (and these benefits need not necessarily be medical, they can also be socioeconomic or otherwise non-medical); (2) a high standard of informed consent that fundamentally focuses on the child participant's understanding (and capacity for understanding) of relevant features of informed consent. Researchers, parents and guardians, as well as child (...) participants themselves, have different roles and obligations towards one another. This is not an issue of seeking to find excuses to expose children to risk, but rather an issue of seeking the least risky and most ethical way to do so if and when required by public health emergencies or to achieve directly beneficial scientific breakthroughs. (shrink)

Several influential organisations have attempted to quantify the costs and benefits of expanding access to interventions-like contraceptives-that are expected to decrease the number of pregnancies. Such health economic evaluations can be invaluable to those making decisions about how to allocate scarce resources for health. Yet how the benefits should be measured depends on controversial value judgments. One such value judgment is found in recent analyses from the Disease Control Priority Network (DCPN) and the Study Group for the Global (...) Investment Framework for Women's and Children's Health. Noting the decrease in the number of pregnancies expected to result from providing access to family planning, DCPN and the Study Group claim that a substantial benefit of such interventions is averting the stillbirths and child deaths that would have resulted from those pregnancies. We argue that health economic analyses should not count such averted deaths as benefits in the same way as saved lives. First, by counting averted stillbirths and child deaths as a benefit but not counting as a cost the lives of babies who survive, DCPN and the Study Group implicitly commit themselves to antinatalism. Second, this method for calculating the benefits of family planning interventions implies that infertility treatments are harmful. Determining how potential people should be treated in health economic analyses will require grappling with population ethics. (shrink)

COVID-19 vaccination of children has begun in various high-income countries with regulatory approval and general public support, but largely without careful ethical consideration. This trend is expected to extend to other COVID-19 vaccines and lower ages as clinical trials progress. This paper provides an ethical analysis of COVID-19 vaccination of healthy children. Specifically, we argue that it is currently unclear whether routine COVID-19 vaccination of healthy children is ethically justified in most contexts, given the minimal direct benefit that COVID-19 vaccination (...) provides to children, the potential for rare risks to outweigh these benefits and undermine vaccine confidence, and substantial evidence that COVID-19 vaccination confers adequate protection to risk groups, such as older adults, without the need to vaccinate healthy children. We conclude that child COVID-19 vaccination in wealthy communities before adults in poor communities worldwide is ethically unacceptable and consider how policy deliberations might evolve in light of future developments. (shrink)

Street life is a challenge for survival, even for adults, and is yet more difficult for children. They live within the city but are unable to take advantage of the comforts of urban life. This study focused primarily on access to health and education in street children from 6 to 18 years old in the Indian metropolises of Mumbai and Kolkata. The study also aimed to assess the role of social work interventions in ensuring the rights of street children. (...) A combination of quantitative and qualitative research methodologies was used. Convenience sampling was used to recruit 100 children. Data were collected on a one-to-one basis through semi-structured interview schedules and by non-participant observation. Findings revealed that extreme poverty was the primary cause for the increasing numbers of street children. Lack of awareness among illiterate parents regarding educational opportunities kept most children away from school attendance. Factors such as lack of an educational ambience at home made it difficult for the children to work on their lessons outside the premises of the institution. It was evident that those living with their parents had better access to health care facilities than did those living on their own; however, nongovernmental organizations made significant efforts to redress this imbalance, setting up health check-up camps at regular intervals. Although exposure to harsh reality at an early age had resulted in a premature loss of innocence in most, making them sometimes difficult to work with, the nongovernmental organizations were striving to ensure child participation and the growth of individual identity. The interventionists therefore focused on developing a rights-based approach, rather than a charitable one. (shrink)

This study, by using 142 groups of data from 1990 to 2007 and the method of cross-temporal meta-analysis, researched the changing trend of status of mental health of 108736 members of the Chinese Army along with the change of years. All the data came from 94 related research reports, and all the research reports used SCL-90 (the Symptom Checklist 90) as the testing tool of mental health. The study found that: (1) mental health of members of the (...) Chinese Army steadily improved between 1990 and 2007; (2) during those 18 years, the Interpersonal Sensitivity factor of SCL-90 of Chinese Army members changed most significantly, and the least significantly changed factor was Somatization; (3) Chinese Army members showed evidence of fewest problems on the Photic Anxiety factor, in contrast to the consistent problems indicated by scores on the Obsessive-Compulsive and Interpersonal Sensitivity scales; (4) Chinese Army members from single-child families (N =1,944) showed significant lower evidence of positive mental health than soldiers from multiple child families (N =2,649); (5) The mental health of soldiers from non-agricultural backgrounds (N =7,808) was less positive than that of soldiers from agricultural households(N =11,459); (6) Chinese Army members with senior high school education level (N = 10,189) had less positive mental health than those with junior high school (N = 8,407) or university education (N = 863). (shrink)

Can we identify potential long-term consequences of digitalisation on public health? Environmental studies, metabolic research, and state of the art research in neurobiology point towards the reduced amount of natural day and sunlight exposure of the developing child, as a consequence of increasingly long hours spent indoors online, as the single unifying source of a whole set of health risks identified worldwide, as is made clear in this review of currently available literature. Over exposure to digital environments, (...) from abuse to addiction, now concerns even the youngest (ages 0 to 2) and triggers, as argued on the basis of clear examples herein, a chain of interdependent negative and potentially long-term metabolic changes. This leads to a deregulation of the serotonin and dopamine neurotransmitter pathways in the developing brain, currently associated with online activity abuse and/or internet addiction, and akin to that found in severe substance abuse syndromes. A general functional working model is proposed under the light of evidence brought to the forefront in this review. (shrink)

Discussion of the behaviour of pregnant women and mothers, in academic literature, medical advice given to mothers, mainstream media and social media, assumes that a mother who fails to do something to benefit her child is liable for moral criticism unless she can provide sufficient countervailing considerations to justify her decision. I reconstruct the normally implicit reasoning that leads to this assumption and show that it is mistaken. First, I show that the discussion assumes that if any action might (...) benefit her child, the mother has a defeasible duty to perform that action. I suggest that this assumption is implicitly supported by two arguments but that each argument is unsound. The first argument conflates moral reasons and defeasible duties; the second misunderstands the scope of a defeasible duty to benefit. This argument has important practical and theoretical implications: practically, it provides a response to a highly damaging discourse on maternal behaviour; theoretically, it provides the framework for a clearer understanding of the scope and nature of defeasible duties to benefit. (shrink)

This paper presents the Obstetric and Neonatal Ontology (OntONeo). This ontology has been created to provide a consensus representation of salient electronic health record (EHR) data and to serve interoperability of the associated data and information systems. More generally, it will serve interoperability of clinical and translational data, for example deriving from genomics disciplines and from clinical trials. Interoperability of EHR data is important to ensuring continuity of care during the prenatal and postnatal periods for both mother and (...) class='Hi'>child. As a strategy to advance such interoperability we use an approach based on ontological realism and on the ontology development principles of the Open Biomedical Ontologies Foundry, including reuse of reference ontologies wherever possible. We describe the structure and coverage domain of OntONeo and the process of creating and maintaining the ontology. (shrink)

The growth and development of children are closely related to the role of a mother, not a few mothers, and having the task of caring for children and working women, which will lead to suboptimal childcare. At this time, many android-based information system facilities that can be used to streamline child care for a mother who is a working woman. This study aimed to provide an overview and ideas of using android-based digital media in childcare to maximize children's growth (...) and development for working mothers with a literature review method. From the study results and review of 10 selected journals, it was concluded that for parents of workers who cannot maximize childcare time or parenting time, many applications could facilitate parents to monitor the child's growth and development safely. The development of a child health nursing management information system can include healthy children, sick children, education, environment, and parenting patterns. The implication of developing a child health nursing management information system during parenting is very useful ad preventive and promotive action in children’s health. Child nurses can effectively, efficiently, quickly, and accurately identify problems that arise in the preventive process so that they are expected to make nursing interventions that are also right on target. (shrink)

Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision making are the harm principle, the principle of best interest, and the threshold view. This paper consider how these principles apply to a case of a premature neonate with multiple significant comorbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these principles help (...) to understand what was morally right for the child is questioned. The paper concludes that the principles were of some value in understanding the moral geography of the case, but that the case reveals common bioethical principles for medical decision making are problematically value-laden because they are inconsistent with the widespread moral value of medical vitalism. (shrink)

Progressive family policy regimes typically aim to promote and protect women’s opportunities to participate in the workforce. These policies offer significant benefits to affluent, two-parent households. A disproportionate number of low-income and impoverished families, however, are headed by single mothers. How responsive are such policies to the objectives of these mothers and the needs of their children? This chapter argues that one-size-fits-all family policy regimes often fail the most vulnerable household and contribute to intergenerational poverty in two ways: by denying (...) at-risk children adequate parenting, and by undermining their mothers’ legitimate interest in nurturing and caring for their own children. The capabilities of these mothers and the well-being of their children are better served by policies which recognise maternal caregiving as a productive and valuable occupation meriting equal respect and social support. (shrink)

The article presents the results of a survey of Odessa residents as part of a study of the motivational and value preferences of townsfolk in the field of fitness. It has been established that the determining motives for choosing a place for fitness are the individual trainer's approach to the client, personal comfort and convenient location of the fitness club. It was revealed that respondents have an interest in innovative training, but it has not yet acquired the character of a (...) trend. We also obtained data about the significance of playing sports under the supervision of a personal trainer and sports physician. The collected empirical material served as the basis for revealing the behavioral patterns of townspeople and allowed to identify three groups of city residents who are characterized by different motivational and value preferences in the field of fitness. The first ones are focused on personal achievements, the second – on health, good physical form, good time among like-minded people, the third – on the development of special skills, achievements and opportunities to escape from problems. Based on the survey, it was also revealed that the overall physical development of the child is the leading physical motivation for children to do sports, and despite the fact that children may have certain achievements in sports, parents do not attach much importance to them. (shrink)

What rights and duties do adults have with respect to raising children? Who, for example, has the right to decide how and where a particular child will live, be educated, receive health care, and spend recreational time? I argue that neither biological (gene-provider) nor..