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Child Health And Wellbeing Essay Definition

by Laurie DeRose, Paúl Corcuera, Montserrat Gas, Luis Carlos Molinero Fernandez, Andrés Salazar, and Claudia Tarud

Executive Summary

Improving children’s health in lower-income countries around the globe is one of the paramount concerns of the international community. Research on this topic has focused on the role of financial resources, women’s education, and public health interventions, largely overlooking the ways in which family structure, and union instability in particular, may shape children’s health. Union instability may affect children’s health by redirecting attention and time away from children, causing stress, disrupting networks of social support, and reducing the socioeconomic resources available to parents. These consequences of union instability, in turn, may make it more difficult for parents to give children the kind of consistent care they need to thrive—from the attention and affection associated with health to the medical care needed to treat an acute condition. While there are many forms of union instability, this essay specifically explores the relationship between family instability—measured here by divorce or dissolution of a cohabiting partnership, widowhood, or repartnership (i.e., remarriage or new cohabitation)—and children’s health in a wide variety of societies, each with a variety of customs related to age at marriage and widowhood, and laws governing marriage and divorce. The analyses find that divorce or partnership dissolution and repartnering are associated with higher levels of diarrhea, stunting (i.e., poor growth), and child mortality in a number of lower-income regions around the globe. For instance, in most of these regions, family instability is associated with an elevated child mortality risk of at least 20 percent. However, family instability is not associated with negative child health outcomes in the Middle East. Finally, this essay finds that unlike in Europe and North America, single mothers in lower-income countries are more likely to be among their society’s most socioeconomically advantaged mothers.

Introduction

Improving children’s health in lower-income countries around the globe is one of the paramount goals of the international community—as articulated, for instance, in the United Nations’ Millennium Development Goals. In pursuit of this goal, researchers have focused on the important roles that financial resources, women’s education, public health interventions, and environmental conditions play in children’s health.1 But scholars have shown less interest in the role that family life plays vis-à-vis children’s health. In particular, comparatively little attention has been paid to the ways in which family structure may shape the care that children in lower-income countries receive and their health.

This essay examines the relationship between family structure and children’s health in a wide variety of societies using a measure that is known to have a negative effect on children’s well-being in the United States and Europe: union instability.2 Whether children in non-Western societies whose mothers have experienced union instability—measured here by divorce or dissolution of a cohabiting partnership, widowhood, or repartnership—fare worse than those in stable unions is an open empirical question with little evidence to date. A recent study that started to fill this gap with evidence from sub-Saharan Africa showed that children of remarried mothers in a number of African countries were more likely to have died than children born to their mother’s first and still-enduring union, even after accounting for socioeconomic factors.3 Likewise, a new study of child anemia (i.e., clinical iron deficiency) in Mexico indicates that children in Mexico are less likely to suffer from anemia if they grow up in a stable, two-parent married home, even after controlling for household economic resources.4 This new research suggests that stable, two-parent families may foster health for children in lower-income countries around the globe.

Accordingly, this essay explores the association between family stability and children’s health across three important outcomes: diarrhea, stunted growth, and death. Diarrhea represents an acute health crisis; it is not only a leading cause of death among children under 5, killing nearly 1 million children each year across the world, but heavy incidence of childhood diarrhea is also associated with poor cognitive development and school performance.5 Stunted growth is a longer-term measure; it results from chronic nutritional deprivation or repeated episodes of poor food intake, disease, or both. Like diarrhea, childhood stunting is linked to poorer productivity later in life.6 Therefore, both of these health outcomes reflect childhood disadvantage, burdens for caretakers, and obstacles to adult success that in turn place a drag on national-level socioeconomic development. This analysis also addresses childhood death, which is associated with many of the same risk factors, and tests whether union instability is associated with childhood death in regions other than sub-Saharan Africa.

The findings detailed below suggest that union instability is associated with worse child health outcomes in several regions of the world. The findings are stronger for diarrhea and death than for stunted growth. Union instability seems to matter in Africa, Asia, and Central/South America and the Caribbean, but not the Middle East. Moreover, children of single mothers who have never experienced a union transition have fewer disadvantages than children of mothers with union instability, but there is still some evidence of disadvantage for them.

Caregiving & Children’s Health

Environmental conditions, poor living conditions, and fewer parental resources in lower-income countries are fundamental determinants of children’s health, but the research shows that so too is the direct parental care that children receive from their parents. Children who receive high levels of attention and affection are more likely to enjoy good health, even when controlling for external environmental factors.7 Moreover, the impact of health hazards or health resources found in the larger environment is often mediated by parental caregiving, as the UNICEF extended care model notes.8 For example, households with poor resources, such as those that lack piped water, may nonetheless have healthy children if caregivers take time to boil drinking water. Conversely, richer households that can afford nutrient-dense foods to help children transition away from breastmilk or infant formula may still have children who suffer if parents do not take the time to feed toddlers frequently throughout the day because the children’s small stomach capacity precludes getting enough to eat from only two to three meals. Of course, the worst-off families who have neither piped water nor the means to compensate by routinely boiling water do not have much latitude to foster good health in their children, but in much of the lower-income world there are considerable opportunities for caregiving to matter at a wide variety of income levels.9

Caregiving also matters in another way: stress. Children who receive adequate food, affection, attention, and consistent discipline are less likely to be stressed.10 In turn, they are less likely to be affected by the physical ailments associated with stress.11 So, when it comes to children’s health, parental caregiving matters both in shaping the kinds of resources available to children, and in protecting them from the stresses that can be debilitating to their health.

Caregiving and Family Structure

Caregivers’ own education, health status, mental health, control over resources, available time, and social support all help determine how well they fare and in turn how effective they are in giving care. These factors are often related to union instability.13 More specifically, we hypothesize that union instability may:

  1. Be time- and attention-consuming;
  2. Be stressful;
  3. Disrupt networks of social support; and
  4. Reduce the socioeconomic resources available to parents.

These consequences of union instability, in turn, may make it more difficult for parents to give children the kind of consistent care they need to thrive—from the attention and affection associated with health to the medical care needed to treat an acute condition. For instance, use of health care seems to be conditioned by family structure in some countries.14 Further, evidence from sub-Saharan Africa and the United States suggests that when parental unions are disrupted, children receive daily care from more caregivers and spend more hours away from their parents; both of these changes appear to be associated with poorer health outcomes.15 Mothers in non-intact families also appear to be less likely to breastfeed their infants and thus confer both short-term and long-term health benefits.16 Finally, any negative associations between union instability and children’s health may be mediated by the economic dislocation that often follows in the wake of a union breakdown.17

Challenges of Cross-National Comparisons

Cross-national comparisons become tricky, however, because how care factors relate to union instability may vary between societies. That is, the socioeconomic resources or social support available in different countries may or may not buffer against the effects of union instability. For instance, in the United States, single mothers have significantly less education than do married mothers whereas in Central/South America, they have significantly more.18 And while any path to single motherhood—nonmarital childbearing, divorce or union dissolution, widowhood—usually involves a great deal of stress, social support for widows may be greater than for divorcées, especially in countries with strong marriage cultures like those in East Asia.19 Customs, attitudes, and laws regarding marriage and cohabitation, divorce and union dissolution, and widowhood, vary widely across cultures, and these are no doubt related to the health outcomes of children whose mothers experience these various states, yet this is not accounted for in these analyses. For example, laws in a country may dictate whether a wife can leave an abusive relationship, and this has not been considered in the analyses.

While investigating all of the pathways through which family structure could influence children’s health across a wide variety of societies is not possible, it is possible to determine the net association of union instability on children’s health across societies around much of the globe. This is the focus of the work that follows. Nonetheless, because socioeconomic status predicts union instability differently in poorer countries than richer countries, this essay also pays careful attention to the ways in which controls for parental socioeconomic resources affect the links between union instability and children’s health.

In particular, whereas in many rich industrialized countries today, union instability and single-parent families are more common among the disadvantaged, in many lower-income countries, the pattern between privilege and family structure is quite different: it is often the most privileged women who live as single mothers. That is because, as noted in the pioneering work of William Goode, family change often happens first among elites, who have the economic resources and the educational background to experiment with nontraditional family life or to leave an unsatisfying or abusive marriage.20 Later, when union instability and single parenthood have become more common, they tend to be concentrated among those with less income and education, as is the case in much of the industrialized world.21

Put differently, in some poor regions of the world, it is difficult for young women with limited education and few economic resources to raise children on their own, either before marriage or in the wake of a divorce.22 So women with access to comparatively little education and income tend to remain in their relationships in many lower-income countries. To pick an example from Central America, the Lenca in Honduras are one of the least educated ethnic groups in the country; they also do not participate much in the modern economy and have few economic resources. It is very difficult to imagine a Lenca woman divorcing and raising a child independently given her few employment options, and Lenca marriages are relatively stable.23 By contrast, highly educated and higher-income women in Honduras are more likely to have children on their own or divorce.24 This example illustrates why in poorer countries never-married and divorced mothers are typically of higher status than their counterparts who have remained married, or have repartnered, or are widowed, as seen in Figure 1.

As a result, in low-income countries single motherhood and family instability are not systematically associated with lower socioeconomic status. This is noteworthy for this essay because differential health outcomes associated with family instability, then, may not be a consequence of material or social deprivation on the part of mothers. That is, because single mothers tend to have more education than their married peers in lower-income countries, their children may not suffer as many material and social disadvantages as they would if their mothers were less educated.

Data and Methods

The data analyzed in the essay are from the Demographic and Health Surveys (DHS) and include countries of Central/South America and the Caribbean, Africa, the Middle East, and Asia.25 The DHS survey team administered the individual woman’s questionnaire to a nationally representative sample of reproductive-aged women in each country; the questionnaire included a complete birth history (including children who had died) as well as current health measures.26 The analyses include all children born in the five years before the survey.

Although the data are cross-sectional, they can nonetheless be used to assess the relationship between union instability and children’s health outcomes under some reasonable assumptions. First, it is possible to identify children whose mothers have experienced no union transitions in their lifetimes, namely those whose mother has been continuously in her first union from before their birth until the survey,27 and those whose mother has never been in a union (either married or cohabiting). Children born during their mother’s first and still-enduring union likely have biological parents who are still together, even though some do not live with both biological parents (for example, their father may be a migrant laborer). The questionnaire does not ask whether the mother has adopted the child, and asks about a union with a man; therefore no conclusions can be drawn about union stability and child outcomes for adoptive or same-sex parents from this analysis. In contrast to children born during their mother’s first and continuous union, those born to mothers who have never been in a union are much less likely to have their biological fathers involved in their lives, but their mothers also have not experienced union instability (even the breakup of a cohabiting union). Women who have never been in a union were not included in most of the DHS in the Middle East (which interviewed ever-married women rather than reproductive-aged women as in the other regions’ DHS), and therefore there is no “never in union” category for these countries. Note also that nonmarital childbearing in the Middle East is virtually nonexistent.28 (See Table 1 for the distribution of mothers across the union categories in world regions.)

Children whose mothers have experienced union instability may be either single or repartnered at the time of the DHS interview. The currently single with a history of union instability include those who have been divorced,29 have experienced the dissolution of a cohabiting partnership, or have been widowed. Union instability could have preceded the child’s birth (e.g., the child was born after the mother divorced), so it is much more accurate to think of these categories as representing the mother’s union instability rather than union instability during the life of the child. In fact, some of the children of repartnered women may live with their biological fathers, as the DHS data do not provide union dates other than for first union, and therefore it is not possible to determine whether children of repartnered women were born during the current union. Children whose mothers entered their first union after their birth are also counted as having repartnered mothers.

There are three health outcomes: recent diarrhea30 (an indicator of acute illness), stunted growth31 (an indicator of long-term health), and death (the most extreme health outcome, regardless of cause). This diverse set of measures allows us to determine whether union instability is associated with different domains of child health. Additionally, while children’s health conditions can contribute to union instability,32 there is little concern that an episode of diarrhea in the two weeks before an interview has caused previous union transitions—in contrast to a child’s death, which might destabilize a marriage.

The analytic models for recent diarrhea and childhood stunting are logistic regression models with controls for child’s gender, urban residence, birth order, length of preceding birth interval, whether the child has dead siblings, maternal age, maternal education level, a household asset index,33 and variables for each region of each country. Additional household structure variables are: the presence of women other than the mother, presence of men other than the mother’s partner, the number of children under age 5, and the number of children aged 5-15.34

The childhood death model is quite similar except that the outcome is whether the child lives or dies in every month from their birth to either their death or the interview (it is a discrete-time event history model that follows Clark and Hamplová’s (2013) work on single motherhood and childhood death in Africa very closely, including a statistical correction for correlated observations between siblings). Child’s age is included as an additional control (grouped according to relative probabilities of death in particular age intervals). The number of children under age 5 in the household must be omitted in the death analysis because that count is influenced directly by death (there are fewer children under 5 living in the household if a child has died in the past 5 years). It is retained for diarrhea and stunting because young children may compete for resources and spread disease among themselves.

Results

EDUCATION AND UNION INSTABILITY
The findings indicate that in poor countries single motherhood is not systematically associated with material disadvantage; indeed, our results suggest that mothers with more resources may feel freer to remain single. The Middle East resembles rich countries in that mothers in their first union have the most education; union instability is more characteristic of less educated segments of the population in this region (Figure 1). The pattern in the other three regions is quite different: mothers who have never been in a union and those who have divorced or dissolved a union (and are currently single) have the most education. Repartnered and widowed mothers do have less education than mothers whose child was born in their first union.35 That means that in Central/South America and the Caribbean, Africa, and Asia, single mothers besides widows are of higher socioeconomic status36 than mothers living with partners.

PATTERNS IN CHILD HEALTH OUTCOMES
Although our focus here is on the effects of union instability on children’s health, our other results are in keeping with established findings regarding children’s health. First, health outcomes vary widely within world regions. Some of this variation is between countries, but health outcomes also varied significantly between regions within countries.37 Second, socioeconomic status clearly matters: children in wealthier households and those with more educated mothers both had better health outcomes.38 Third, boys were at higher risk of death everywhere, and more likely to have had recent diarrhea everywhere but the Middle East. Boys were also more likely to be stunted in Central/South America and the Caribbean, Africa, and the Middle East, but less likely to be stunted in Asia.

Just as previous research has established, children everywhere were most likely to die in the first month of life, and also, if they were their mother’s first child. In Asia and Central/South America, children after the first born were more likely to have stunted growth. Both death and stunting were more prevalent among children born less than two years after the most recent sibling, or if any of a child’s siblings had died. Children of mothers over 20 had better health outcomes across all three measures than those of teen mothers, except children of mothers in their forties were not less likely to die than children of teen mothers.

Although the effects of others in the household (adult women, adult men, other children) besides parents are not completely consistent, they seem to suggest that living with extended family helps protect children from having stunted growth.

UNION INSTABILITY AND DIARRHEA
The most consistent result from the acute illness analysis is that children with repartnered mothers are more likely to have had recent diarrhea than those born during their mother’s first and continuing union (far right bars, Figure 2). Only in the Middle East was the relationship between mother’s repartnering and acute illness insignificant. In the other three regions, children of repartnered mothers were significantly more likely to have had recent diarrhea. In Central/South America and the Caribbean the disadvantage associated with having a repartnered mother was relatively small: it increased the chance of recent diarrhea by about 7 percent. In Africa and Asia, the effects were larger with recent diarrhea being 16 percent and 35 percent more common among children of repartnered mothers than among children born to mothers continuously in their first union.

In contrast, children of widows are not at a disadvantage anywhere. Moreover, children of widows in Africa are less likely to have diarrhea, compared to children in families where the mother was never in a union. Children of mothers who have divorced or dissolved a union are about 19 percent more likely to have had recent diarrhea in both Africa and Central/South America and the Caribbean.

Children of mothers who have never been in a union comprise 0.2 percent of children in Asia and an unknown percentage in the Middle East, where all but one of the surveys was of ever-married women rather than reproductive-aged women (Table 1). Thus the association between having a never-partnered mother and poorer health is meaningful only for Africa and Central/South America (with almost 3 percent of children and over 6 percent of children, respectively). In both these regions, children of never-partnered mothers have significantly more recent diarrhea (20 percent more and 14 percent more, respectively).

UNION INSTABILITY AND STUNTING
Turning next to childhood growth, children of never-partnered mothers in Central/South America and the Caribbean are more likely to have stunted growth than children born to mothers continuously in their first union; this is not the case in Africa (Figure 3). Again, children are very rarely raised by mothers who have never been in a union in the other two regions. Children of divorced mothers or those whose unions have dissolved are more likely to be stunted in Central/South America and the Caribbean (12 percent more likely), Africa (18 percent more likely), and Asia (52 percent more likely). Widowhood is associated with more childhood stunting only in Central/South America and the Caribbean. In contrast to the results for recent diarrhea, repartnering is not associated with childhood stunting anywhere.

UNION INSTABILITY AND DEATH
Finally, with respect to child survival, an unequivocally important measure of child well-being, mothers who have experienced union instability in some regions are more likely to have had a child die, regardless of whether they have divorced or dissolved a partnership, are widowed, or are in a union at the time of the interview (Figure 4). In all regions except the Middle East, children of mothers who have divorced or dissolved a partnership are about 30 percent more likely to have died, and children of widows were in Africa 20 percent more likely and in Asia 43 percent more likely to die. Children of repartnered mothers face a 20-34 percent elevated death risk in regions besides the Middle East. The results for deaths of children born to never-partnered mothers follow the exact same pattern as for stunting: children of never-partnered mothers in Africa and Asia are no more likely to have died, but in Central/South America and the Caribbean, they are 30 percent more likely to have died.

These elevated death risks of course matter more in absolute terms where childhood death is most frequent. In Africa, where 9.1 percent of children born in the five years before the interview had died, a death rate 30 percent higher than the regional average means about 12 percent of children will die. By contrast, in Asia, 30 percent higher is the difference between 5.1 percent and 6.6 percent of children dying, and in Central/South America between 3.1 percent and 4.1 percent.

Discussion

In our analysis, mothers’ union instability seems to matter less for children’s health in the Middle East than in other regions. It is possible that there were no significant effects due to other factors that are beyond the scope of this essay, such as laws governing marriage and unions, or simply because health is generally better there and most mothers are in their first marriage: rare events occurring to small portions of the population limit statistical power. Understanding the complexities of factors that could account for this difference in the Middle East as compared to the other regions would require additional research.

In the other three regions, union instability matters. It seems to matter the most in Central/South America and the Caribbean where, compared to children born during their mother’s first and continuing union, children of divorced mothers were significantly worse off across all three health outcomes, and children of widowed or repartnered mothers were worse off in two of the three outcomes. It is also in Central/South America and the Caribbean that children whose mothers have never been in a marital or cohabiting union have poor health outcomes: more diarrhea, more stunting, and more death. In Africa, children whose mothers have never been in a union have only more diarrhea; in Asia, they are not disadvantaged for any of the health outcomes, though there are so few children in this category in Asia that accurate comparisons may not be possible.

It also appears that having a mother who divorced or dissolved a union is associated with the worst outcomes, but if we discount stunting—the outcome where union status overall had the weakest impact—the results for children of mothers who have divorced or dissolved unions and repartnered are remarkably similar. The fact that some children of repartnered mothers are children of second unions who live with both biological parents makes the disadvantage associated with repartnering all the more striking: both the economic advantages associated with two-parent homes and the other advantages to living with both biological parents would make it unlikely that we would find a significant disadvantage for children of repartnered mothers, and yet we find it for both recent diarrhea and child death in Africa, Asia, and Central/South America and the Caribbean. Remarriage does seem to protect children from having stunted growth, however.

With an outcome like child death, it is easy to imagine a child’s death destabilizing the mother’s union rather than a union transition leading to the child’s death. However, studies with data that can establish the order of events indicate that marital instability precedes child death.39 The results here also indicate that marital instability often likely comes first: diarrhea within two weeks of the interview is unlikely to have caused union transitions, and children of mothers who have divorced, dissolved their unions, or repartnered often have more recent diarrhea, just as they are more likely to have died.

Note also that Figures 2 through 4 indicate that children with never-partnered single mothers do about as poorly in Central/South America and the Caribbean as do children in families marked by union instability. This finding suggests that in some cases it is not instability alone that matters for children’s health, but also having access to two (stably partnered) parents.

Taking differences in socioeconomic status into account did little to alter the association between a mother’s union status and any of her children’s health outcomes. In richer countries, part of the disadvantage associated with single parenthood and union instability can be explained by socioeconomic status,40 but in these data differences by union status are instead marginally (not significantly) enhanced when controlling for socioeconomic status.

Finally, the association between union instability—specifically, divorce or union dissolution and repartnering—and children’s health is greater than that of an additional level of maternal education when it comes to diarrhea and death. For instance, African children whose mother has completed primary school are about 10 percent more likely to have had recent diarrhea or to have died than those whose mothers have completed secondary school, while children of mothers who have divorced or dissolved unions or repartnered are about 16 percent more likely to have had recent diarrhea and about 26 percent more likely to have died. In Central/South America and the Caribbean, incidence of recent diarrhea is about the same between children of stably married primary-educated women and those of secondary-educated women who have divorced or dissolved unions or repartnered, but children in the latter group face a greater risk of death, even with the mothers’ educational advantage. In Asia, the health benefit associated with an additional level of education is smaller than the deficit associated with union instability.

Overall, the analyses find the best health outcomes for children whose mothers have been in their first union for the children’s entire lives. In some ways this simply extends findings from wealthier countries that show advantages in multiple domains for children who have not experienced the stress associated with union transitions. The data also indicate there may be health disadvantages associated with having a mother who has undergone union transitions, even if they were not during the child’s lifetime. Because the children in our sample are under 5 years old, many of them are products of the mother’s current union. Further analyses could test whether a mother’s previous union instability reduces the health benefits associated with marriage in wealthy and poor countries alike.

Note, of course, that union stability is likely to be beneficial to children when parents enjoy average or high levels of relationship quality, but could be harmful when parents have high-conflict relationships.41 In fact, domestic violence against women is a primary reason for a marriage or union to dissolve, and this analysis does not take into account the reasons leading to union instability. In addition, the DHS does not include data on adoptive or same-sex parents, so no comparisons can be made between the family structures reported here and those categories of parents. Moreover, other family factors besides union stability, such as direct measures of parental monitoring, affection, and engagement with children, are known to be important influences on child health outcomes, yet current international data do not allow for such analyses.

Conclusion

Policymakers, NGOs, and scholars have devoted substantial attention to understanding and addressing the environmental, economic, and educational challenges affecting children’s health in lower-income countries around the globe. This essay suggests that the family contexts of caregiving also deserve attention in ongoing efforts to improve children’s health around the world. In Asia, Central/South America and the Caribbean, and sub-Saharan Africa, children raised by mothers who have experienced union instability are more likely to have health problems, especially diarrhea, and to die than children raised by a mother who has remained in her first union since before their birth. The results found in this study suggest that family instability may compromise parents’ ability to provide the kind of consistent and attentive care that is most likely to foster good health in children. Accordingly, international efforts to improve children’s health should also explore ways to stabilize the contexts of family care—assuming parents do not have high-conflict relationships—and to help children whose care is compromised by family instability.


1   E. Gakidou et al., “Increased Educational Attainment and its Effect on Child Mortality in 175 countries between 1970 and 2009: A Systematic Analysis,” Lancet 376, no. 9745 (2010).
2    S. Bzostek and A. Beck, “Familial Instability and Young Children’s Physical Health,” Social Science & Medicine 73, no. 2 (2011); P. Fomby, “Family Instability and College Enrollment and Completion,” Population Research and Policy Review 32 (2013); S. Liu and F. Heiland, “New Estimates on the Effect of Parental Separation on Child Health,” in Causal Analysis in Population Studies Vol. 23 (2009).
3   S. Clark and D. Hamplová, “Single Motherhood and Child Mortality in sub-Saharan Africa: A Life Course Perspective,” Demography 50, no. 5 (2013).
4   K. Schmeer, “Family Structure and Child Anemia in Mexico,” Social Science & Medicine 95 (2013).
5   B. Lorntz et al., “Early Childhood Diarrhea Predicts Impaired School Performance.” The Pediatric Infectious Disease Journal 25, no. 6 (2006).
6   J. Hoddinott et al., “Effect of a Nutrition Intervention During Early Childhood on Economic Productivity in Guatemalan Adults,” The Lancet 371, no. 9610 (2008); S. Dercon and A. Sánchez, “Height in Mid Childhood and Psychosocial Competencies in Late Childhood: Evidence from Four Developing Countries,” Economics and Human Biology 11, no. 4 (2013).
7   In the nutrition literature, this type of effect is known as “positive deviance.” See e.g., U. Mackintosh, D. Marsh and D. Schroeder, “Sustained Positive Deviant Child Care Practices and their Effects on Child Growth in Viet Nam,” Food and Nutrition Bulletin 23, Supp 4 (2002); the concept also emerges in and guides other public health interventions, e.g., L. Walker et al., “Applying the Concept of Positive Deviance to Public Health Data: A Tool for Reducing Health Disparities,” Public Health Nursing 24, no. 6 (2007).
8   U. Jonsson, “Ethics and Child Nutrition,” Food and Nutrition Bulletin 16, no. 4 (1995).
9   A. Gage, “Familial and Socioeconomic Influences on Children’s Well-Being: An Examination of Preschool Children in Kenya,” Social Science & Medicine 45, no. 12 (1997).
10   S. Bzostek and A. Beck, “Familial Instability and Young Children’s Physical Health.”
11   D. Umberson, R. Crosnoe, and C. Reczek, “Social Relationships and Health Behavior Across the Life Course,” Annual Review of Sociology 36 (2010); R. Gerson and N. Rappaport, “Traumatic Stress and Posttraumatic Stress Disorder in Youth: Recent Research Findings on Clinical Impact, Assessment, and Treatment,” Journal of Adolescent Health, 52 (2013).
12   P.  Engle, P. Menon and L. Haddad, Care and Nutrition: Concepts and Measurement (Washington DC: IFPRI, 1997).
13   For a discussion of the challenges that family instability poses to parents, see A. Cherlin, The Marriage-Go-Round. New York: Knopf, 2009.
14   A. Gage, A. Sommerfelt, and A. Piani, “Household Structure and Childhood Immunization in Niger and Nigeria,” Demography 34, no. 2 (1997); B. Gorman and J. Braverman, “Family Structure Differences in Health Care Utilization among U.S. Children,” Social Science and Medicine 67, no. 11 (2008).
15   R. Crosnoe et al., “Changes in Young Children’s Family Structures and Child Care Arrangements,” Demography doi: 10.1007/s13524-013-0258-5 (2013); M. Grant and S. Yeatman, “The Impact of Family Transitions on Child Fostering in Rural Malawi,” Demography 51, no. 1 (2014).
16   N. Bar-Yam and L. Darby, Fathers and Breastfeeding: a review of the literature, Journal of Human Lactation, 13, no. 1 (1997); Clark and Hamplova, “Single Motherhood and Child Mortality in sub-Saharan Africa: A Life Course Perspective.”
17   M. McKeever and N. Wolfinger, “Reexamining the Costs of Marital Disruption for Women,” Social Science Quarterly 82, no. 1 (2001).
18   W. Wang, K. Parker and P. Taylor, “Breadwinner Moms,” http://www.pewsocialtrends.org/2013/05/29/breadwinner-moms/, calculations from the current study described below.
19   H. Park, “Single Parenthood and Children’s Reading Performance in Asia,” Journal of Marriage and Family 69, no. 3 (2007);   W. Goode, World Revolution and Family Patterns (Glencoe: Free Press, 1963).
20   W. Goode, World Revolution and Family Patterns (Glencoe: Free Press, 1963).
21   S. McLanahan, “Diverging destinies: How children are faring under the second demographic transition,” Demography 41, no. 4 (2004); E. Thomson et al., “Childbearing Across Partnerships in Australia, the United States, Norway, and Sweden,” Demography doi: 10.1007/s13524-013-0273-6 (2014).
22   C. Lloyd and B. Mensch, “Marriage and Childbirth as Factors in Dropping Out from School: An Analysis of DHS Data from sub-Saharan Africa,” Population Studies 62, no. 1 (2008). The authors explain the low rate of pregnancy-related drop-outs in sub-Saharan Africa in terms of dropouts caused by low socioeconomic status long before risk of pregnancy.
23   E. Zell, personal communication. See also C. Kendall, “Loose Structure of Family in Honduras,” Journal of Comparative Family Studies 14, no. 2 (1983); J. Rowlands, Questioning Empowerment: Working with Women in Honduras (Oxford: Oxfam, 1997).
24   Calculations described below.
25   Central/South American & Caribbean countries: Bolivia (2008), Colombia (2010), Dominican Republic (2007), Haiti (2012), Honduras (2011-12), Peru (2012); African countries: Cameroon (2011), Chad (2004), Congo Democratic Republic (2007), Ethiopia (2011), Ghana (2008), Kenya (2008-09), Nigeria (2008), Tanzania (2010), Uganda (2011); Middle Eastern countries: Azerbaijan (2006), Egypt (2008), Jordan (2009), Morocco (2003-04), Turkey (2003), Uzbekistan (1996); Asian countries: Bangladesh (2011), India (2005-06), Indonesia (2012), Pakistan (2006-07), the Philippines (2008), Vietnam (2002).
26   An analysis of childhood growth based on information in the household questionnaire (a nationally representative sample of children living in households) was compared to that from the individual woman’s questionnaire (a nationally representative sample of children living with reproductive-aged mothers) to determine whether the richer information from the individual interviews could be utilized without biasing our results. The estimates of the effects of the child’s living arrangements (living with only the biological mother versus living with both biological parents) were not statistically different between children living with all mothers and children living with interviewed mothers in any country.
27   Determined using the date of the child’s birth, the date of the mother’s first union, and the number of unions the mother has been in.
28   K. Mahler and J. Rosoff, Into a New World: Young Women’s Sexual and Reproductive Lives (New York: Alan Guttmacher Institute, 1998) concluded that what little data is available from the Middle East supports the claim that abstinence before marriage is commonly practiced.
29   Mothers who are separated from their partners are counted as divorced. Those who simply do not live with their partners but the union is ongoing are either continuously in first union or repartnered.
30   The surveys in Jordan and Turkey did not collect data on recent diarrhea.
31   Stunted growth is height-for-age more than two standard deviations below the reference median of a healthy population. The stunting analysis for Asian countries is based only on Bangladesh and India as height measures were not obtained in the other DHS surveys.
32   P. Kaaresen et al., “A Randomized, Controlled Trial of the Effectiveness of an Early-Intervention Program in Reducing Parenting Stress After Preterm Birth,” Pediatrics 118, no. 1 (2006).
33   DHS provides a relative wealth index based on household assets for each country, but because we were pooling data across countries within major world regions we needed an absolute wealth index to keep the meaning comparable. We used the index developed by Sarah Giroux (personal communication):
1=poor floor, poor drinking water, and poor toilet
2=2 of the following (poor floor, poor drinking water, and poor toilet)
3=1 of the following (poor floor, poor drinking water, and poor toilet)
4=0 or 1 of the following (poor floor, poor drinking water, and poor toilet) and a radio
5=0 or 1 of the following (poor floor, poor drinking water, and poor toilet) and electricity
6=0 or 1 of the following (poor floor, poor drinking water, and poor toilet) and a television
7=0 or 1 of the following (poor floor, poor drinking water, and poor toilet) and a refrigerator
8=0 or 1 of the following (poor floor, poor drinking water, and poor toilet) and a car
34   These variables were obtained from the household roster; note: the roster was not available for Pakistan. For Pakistan, other women was approximated by other reproductive-aged women and children under 5 in the household was obtained by the individual interview. Other men and children 5-15 are omitted from analyses using the pooled sample of Asian countries.
35   The difference in years of education between mothers continuously in their first union and all other categories is statistically significant in every region except that widowed mothers do not have significantly less education in Africa. This is likely because HIV death is not as concentrated among the poor as other causes of death are.
36   Figure 1 shows their educational advantage; if the household asset index described in note 33 is used to measure socioeconomic status, the pattern of the results is almost exactly the same.
37   Urban residence is usually associated with better health outcomes, but here most of that effect is picked up by the sub-national region variables.
38   Mother’s education was insignificant for diarrhea in Asia and the Middle East and also for death in the Middle East; it was significant for all other outcomes in all regions. The household asset index was always statistically significant.
39   N. Alam et al., “The Effect of Divorce on Infant Mortality in a Remote Area of Bangladesh,” Journal of Biosocial Science 33, no. 2 (2001); A. Bhuiya and M. Chowdhury, “The Effect of Divorce on Child Survival in a Rural Area of Bangladesh,” Population Studies 51, no. 1 (1997); R. Sear et al., “The Effects of Kin on Child Mortality in Rural Gambia,” Demography 39, no. 1 (2002).
40   M. Bramlett and S. Blumberg, “Family Structure and Children’s Physical and Mental Health,” Health Affairs 26, no. 2 (2007).
41   P.R. Amato and A. Booth, A Generation At Risk (Cambridge: Harvard University Press, 2000).

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Child Health, Safety, and Nutrition Essay

1372 WordsMay 10th, 20126 Pages

Child Health, Safety and Nutrition
CDCG 110
5-8-2012

What did I learn from this course?

Health, safety and nutrition are three of the most important factors to consider when raising a child. In other words, every child should be raised with proper nutrition, good health and safety as possible, allowing him or her to grow with a great well-being. Something that I've learned about this class is that in today’s fast-paced world where the child’s safety and health issues are rapidly growing, more than fifty sites online present health and safety guidelines for the public to consider. These websites given to us has really opened up a door for me to look into my own life as well as my child's development. Another thing I've learned…show more content…

This class and those three things have taught me about balancing my food choices to keep me healthy and to keep my sugars in check to keep me and my baby safe. I've really appreciated the knowledge from this textbook and through the websites on this matter. There are a lot more things I've

learned through this course, but I really found that the certain things mentioned in the above page have has gave me the knowledge I needed for my own health as well as my family's!
What did I already know that was reinforced in this work?
In the above paragraph I have gained the knowledge on how to balance me and my family's lifestyle. I already knew we needed to be eating health and staying active. It is hard to do so in a busy world. But, this course has definitely reinforced on how to stay healthy and fit and implement new things in my life. This course has also reinforced just as you should get a physical annually, your child needs regular well check-ups. Something further that I have been able to balance and reinforce is getting in a good habit is eating a variety of fruits and vegetables daily. Choosing whole grains as much as possible over refined ones will give your child more nutrients and fiber. Make an effort to avoid foods that are processed, high in sugar or high in saturated fat, all of which can increase risks for health problems such as diabetes. Especially helped reinforce with my diabetes.
Other things that have

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