Hiller, J. | Search bioRxiv

bioRxiv2018

Interrelationships among key Reproductive Health indicators in Sub-Saharan Africa

IntroductionIndicators of reproductive health (RH) services, outputs, outcomes and impacts are expected to be related with each other and with key social determinants. As the provision of RH services is usually integrated, the effort expended to improve one component is also expected to affect the other components. There is a lack of evidence-based models demonstrating the interrelationships among these indicators and between RH indicators and social determinants.\n\nObjectiveTo examine interrelationships among key RH indicators and their relationship with key social determinants in Sub-Saharan Africa (SSA).\n\nMethodThis study used data from the most recent demographic and health survey conducted during the period from 2010 to 2016 in 391 provinces of 29 SSA countries. We focused on seven RH indicator -- antenatal care, skilled birth attendance, postnatal care, contraceptive prevalence rate (CPR), ideal number of children, birth interval and total fertility rate (TFR), along with selected socio-demographic indicators. The unit of analysis was sub-national, at provincial level. Structural equation modelling was used to examine the strength of interrelationships among the indicators based on the total standardized effect sizes. Significance tests and 95% confidence intervals for the total effects were presented using a bias-corrected bootstrap method.\n\nResultsWomens literacy rate, at the centre of the model, has direct connections with all the RH indicators included in the final model. The strongest relationship was observed between womens literacy rate and CPR with a total standardized (std.) effect size of 0.79 (95% CI: 0.74, 0.83). RH indicators are interrelated directly and/or indirectly. A strong direct effect was also observed in the relationship between CPR and birth interval ({beta}=0.63, 95%: 0.50, 0.77) and the model suggests that the reported ideal number of children is a key predictor of birth interval (Std. effect size=-0.58, 95% CI: -0.69, -0.48) and TFR (Std. effect size=0.52, 95% CI: 0.38, 0.62).\n\nConclusionRH indicators are strongly interrelated and are all associated with womens literacy. The model of interrelationships developed in this study may guide the design, implementation and evaluation of RH policies and programs.

epidemiology↗

bioRxiv2018

Policy lessons from spatiotemporal enrollment patterns of Payment for Ecosystem Service Programs in Argentina

Over the last 50 years, payment for ecosystem services schemes (PES) have been lauded as a market-based solution to curtail deforestation and restore degraded ecosystems. However, PES programs often fail to conserve sites under strong long-term deforestation pressures and allocate financial resources without having a sizeable impact on long-term land use change. Underperformance, in part, is likely due to adverse selection as landowners with land at the lowest threat from conversion or loss may be most likely to enroll or enrollment may be for short time-periods. Improving program performance to overcome adverse selection requires understanding attributes of landowners and their land across large scales to identify spatial and temporal enrollment patterns that drive adverse selection. In this paper, we examine these patterns in Argentinas PES program in the endangered Chaco forest ecoregion, which was established in 2007 under the National Forest Law. Our study area covers 252,319 km2. Among our most important findings is that large parcels of enrolled land and land owned by absentee landowners show greater evidence of spatiotemporal adverse selection than smaller plots of land and land owned by local actors. Furthermore, lands managed for conservation and restoration are more likely to be associated with adverse selection than lands that provide financial returns such as harvest of non-timber forest products, silviculture, and silvopasture. However, prior to recommending that PES programs focus on land uses with higher potential earnings, a greater understanding is needed of the degree to which these land uses meet ecological and biodiversity goals of PES programs. Because of this, we posit that a PES incorporating a market-based compensation strategy that varies with commodity prices, along with approaches that provide incentives for conservation and restoration land uses and enrollment of local landowners, could promote long-term conservation of endangered lands.

ecology↗