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Department of Population, Family and Reproductive Health

Research and Practice

Comparing How Bangladesh Escaped being a ‘Basket Case’ with the Potential for Niger to do the Same

Stan Becker
In the 1970s an aide to U.S. Secretary of State Henry Kessinger called Bangladesh a “basket case”. Since then Bangladesh has made great strides to lift its population from poverty and it has now joined the Middle Income group of countries. At present Niger might be called a “basket case” as it has very rapid population growth and limited ability to feed its people. We consider parallels and differences in the two countries to give insights on what Niger might do to escape the poverty trap as Bangladesh did.

Contraceptive Use and Birth Intervals

Amy Tsui, Qingfeng Li
Crossnational analysis of DHS data to estimate effects of contraceptive use on birth spacing and limiting and infant survival. (Completed)

Covert Use of Contraception in Sub-Saharan Africa

Stan Becker
Covert use of contraception is quite high among women in Sub Saharan Africa. It is typically estimated to occur when wives report a female modern method of contraception but their husband reports no contraceptive use. In some surveys, estimates are also available from a direct question to women “Does your husband know that you are using contraception?” The purpose of this research is to document levels, trends and differentials in this practice using Demographic and Health Survey data over time in 10 SSA countries. (Completed)

Developing Innovative Analytics to Estimate Age- and Cause-Specific Child Mortality for Low- and Middle-Income Countries

Li Liu
The goals of this study are to systematically describe and make publicly available empirical age patterns of child causes of deaths in low- and middle-income countries (LMICs) with accurate uncertainty intervals, and to develop the innovative theory-driven, parsimonious Bayesian hierarchical modeling framework to derive estimates of national cause-of-death distributions in LMICs with partial data among finer age groups than previous research.

Estimation of Unaccompanied Children in Disaster Situations

Court Robinson
In most humanitarian emergencies little is known about the most vulnerable children – those who are separated from parents or unaccompanied by a family member– including population size, age/sex distribution, etc. Working with Save the Children-UK and the Child Protection Working Group (a global forum) this study aims to develop better estimations of the numbers of unaccompanied and separated children in emergencies and disasters.

Evaluation of Sexual Health Curriculum for Health Students in Tanzania

Maria Trent
As documented in the US Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior, training of health providers in sexual health care is critical to addressing a broad array of the nation's sexual and reproductive health concerns. Yet rigorous trials evaluating the effects of sexual health curricula on provider behavior are rare. In sub-Saharan Africa, an environment which has the highest rates of HIV, STI, teen pregnancy, unwanted pregnancy, unsafe abortion, child marriage of girls and sexual assault of boys in the world, and where female genital cutting, wife-beating, marital rape, criminalization of homosexuality, stigmatization of Lesbian, Gay, Bisexual and Transgender (LGBT) persons, myths about masturbation leading to dysfunction, and rates of sexual dysfunction in both men and women are common, we could find no formalized training of health providers in sexual health care. Sexual health education, even of health providers, is a sensitive issue in Africa. Consequently, a rigorous study of its effects is needed, if such education is to be widely adopted. Recently, at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, we adapted a PAHO/WHO sexual health curriculum training for healthcare providers for implementation in Tanzania. Participants were 87 nursing, midwifery, and allied health science students. Pre-post evaluations show the curriculum to be highly acceptable, needed, and desired by students, feasible in implementation, and effective in improving student knowledge, attitudes, and skills in providing sexual health care to patients. The logical next step in this line of research is to conduct the first rigorous trial of a comprehensive sexual health training curriculum for health professionals in Tanzania. There are three specific aims. Aim 1 is to conduct a social ecological needs assessment of sexual health care delivery in Tanzania. To determine whether midwifery, nursing, medical, and allied health science students would benefit from one curriculum or separate curricula tailored by discipline, we will conduct focus groups (3 from each discipline). We will also conduct individual interviews with key informants to address structural and cultural issues. In Aim 2, we will further adapt our curriculum, ensure it is culturally tailored to the Tanzanian/sub-Saharan context, and pilot test it. Aim 3 is to evaluate the effectiveness of an African-based, culturally-appropriate, sexual health curriculum. We will conduct a randomized, controlled, single blinded trial of the curriculum against a waitlist control assessing effects on sexual health knowledge, attitudes, and counseling skills (n=206 students per arm; 412 in total). Hypotheses will test if the curriculum is effective, and whether it is more effective for one discipline than another. If effective, MUHAS has committed to implement the curriculum for all their health students. Given MUHAS is preeminent in health student education across Africa, the curriculum assessed in this study has high potential to be widely adopted as a new standard of training for health professionals across Africa.

Family Health & Wealth Study

Amy Tsui
This atudy assesses the effect of childbearing patterns on family health and wealth outcomes. It is a Longitudinal study of nearly 5,000 families from 8 periurban communities in Egypt, Ghana, Nigeria, Ethiopia, Malawi Uganda, China and India. There have been two rounds to date: 2010 and 2012. Specific outcomes examined are marital relationship quality, household transitory and permanent wealth, living arrangements, fertility preferences, child nutrition and child schooling.

Global Age Patterns of Under-Five Mortality

Li Liu
To improve our understanding of age patterns of under-5 mortality by gathering the largest database to date on high-quality global mortality information by detailed age from birth until age 5, by sex. This database will serve as a basis for generating models summarizing regularities about how under-5 mortality is distributed by detailed age in human populations. These models will then be used for evaluating and correcting under-5 mortality information by detailed age in less-developed countries.

Improving the Estimation of Adolescent Causes of Deaths

Li Liu
This project seeks to expand upon previous work by providing cause of death estimates for older child and adolescent (5-19) age groups, and further studying the etiological burden of prioritized diseases (acute lower respiratory illness and diarrhea) in children and adolescents.

Improving the Estimation of Under-Five Causes of Deaths

Li Liu
Improving under-five causes of deaths project builds upon the work of CHERG and Maternal and Child Epidemiology Estimation by further refining methodological advancements in the estimation of child cause of death, including establishment of finer age categorizations in the under-five age group, further delineating the “other” causes of death and providing more sub-national cause of death estimates in prioritized countries.

Maternal Mortality Estimation from Survey Data: Quality Assessment

Saifuddin Ahmed
The study is examining the quality of sibling history data in Demographic and Health Survey (DHS) and its impact on the estimation of maternal mortality. DHS data are the main source of MMR estimation in developing countries, where complete vital registration data are not available.

Maternal Risks at Birth and Daughters’ Health, Schooling and Work Outcomes

Amy Tsui, Qingfeng Li
A DHS-based cohort analysis of risks at birth and subsequent outcomes in adulthood. (Completed)

Performance Monitoring and Accountability 2020 – PMA2020

Scott Radloff
A five-year Gates Foundation funded project that supports rapid-turnaround surveys using mobile devices to monitor progress in family planning access and use, as well as tracking equity and quality dimensions of service delivery. The project employs a network of female resident enumerators, recruited from or near the selected survey clusters, trained to use mobile smart phones to gather survey data, and deployed to conduct multiple rounds of the survey. The project supports surveys in 10 countries. A first survey round has been completed in Ghana, DR Congo, Ethiopia, Uganda, and Kenya. Plans are underway to launch surveys in the coming year in Nigeria, Burkina Faso, Niger, Indonesia, and India.
For more information please visit the PMA2020 page.

PMA Plus – Civil Registration and Vital Statistics

Amy Tsui, Scott Radloff, Stephane Helleringer, Li Liu
To test and support the buildout of the Performance Monitoring and Accountability 2020 (PMA2020)’s platform as a sample vital registration system, working with national agencies in Ethiopia to strengthen alliances with national and global partners around data measurement needs of the Sustainable Development Goals and national capacity to respond independently.

Recent Trends in Levels and Causes of Child Mortality in China: A Critical Assessment of the National Disease Surveillance Point Data

Li Liu
This research project aims to derive recent trends in levels and causes of child mortality using National Disease Surveillance Point data while evaluating its usability. (Completed)

State and County Mortality Trends

Faculty
This study is estimating models of state and county mortality levels over the last 40 years so as to identify the impact of state and local spending by public health departments on population health.

Trends and Correlates of Family Formation Patterns in India: 1992-2016

Amy Tsui
This analysis of four rounds of the National Family Health Survey in India is being done in collaboration with demographers at the International Institute for Population Sciences to describe period and cohort change in the timing of women’s family formation events and assess their correlates.

Understanding Misclassification Between Stillbirths and Neonatal Deaths

Li Liu
This project seeks to expand upon our previous work by understanding misclassification between stillbirths and neonatal deaths through studying provider-patient communications in a low- or middle-income setting.

Unmet Need for Contraception

David Bishai
This study plots the percent of women who had sex in the last 4 weeks against the percent with unmet need for contraception from DHS survey data. The relationship is a line of about 45 degrees. That is, for every 5 point reduction in unmet need the percent of women who had sex in the last 4 weeks goes up by 5 points. Further work is in progress.