Global Social Welfare

Preference for Sex of Children Among Women in Nepal Abstract The preference for a son at birth is one of the key issues of demographic studies conducted in less-developed countries; however, exploration of preference for sex of children among women in Nepal is rare. This paper estimates the likelihood of preference for a son or a daughter using the 2016 Nepal Demographic and Health Survey (NDHS) data, which contains a nationally representative sample of 12,862 Nepalese women. A multinomial logistic regression analysis shows that son and daughter preferences vary widely across ethnicities, educational and economic status, and rural-urban region. Regarding ethnic origin, women from the Hill Janajati (the largest ethnic minority group that consists of many sub-ethnic groups) prefer daughters more than the top two caste groups, the Hill Brahman and Chhetri, whereas the Terai Brahman, Terai Dalit, Muslim, and other ethnic minority women prefer sons more than the top two caste groups do. Similarly, less educated, poorer, and rural women prefer a son, unlike more educated, richer, and urban women in general. Women who desire more of either sex end up with more children in their household.

Correlates of Female Sterilization in Bihar: Does Women's Empowerment Matter? Abstract Female sterilization is the most emphasized and utilized method of family planning in India. Recently, Bihar, one of India's most socially and economically disadvantaged states, has garnered national and international attention for government prompted, coercive measures to sterilize impoverished women (MacAskill, 2013; Human Rights Watch, 2012). Using data from the National Family Health Survey (NFHS-3), this study examined the association between factors of women's empowerment and female sterilization controlling for sociodemographic characteristics in the state of Bihar. Logistic regression analysis was restricted to women from Bihar aged 15–49 (N = 1165) who reported using some method of contraception. The strength of association was estimated by calculating the odds ratios (OR) with 95% confidence intervals (CI). Sixty-eight percent of the women in the sample reported being sterilized. The women, on average were 34 years old and 50% of the women reported having no formal education. Controlling for sociodemographic characteristics, women with more than a 10th grade education were 73% less likely to report being sterilized compared to women with no education (OR 0.27; CI 0.14–0.52), controlling for other variables. Additionally, women who delayed marriage were significantly less likely to report being sterilized (OR 0.89; CI 0.85–0.95), controlling for other variables. Women's out-of-home employment and intrahousehold decision-making were not statistically significant correlates of sterilization status. Age and religious affiliation were significant sociodemographic correlates of sterilization. Implications for practice and policy are discussed.

Gaps in Suicide Assessment and Management Among Accident and Emergency Nurses in Kenyatta National Hospital: a Qualitative Study Abstract This qualitative study was conducted using key informant interviews with Accident and Emergency and Mental Health staff at Nairobi's Kenyatta National Hospital to examine the current state of suicide assessment and management care at the Department. The interviews probed whether protocols were in place and if the key personnel were aware of these procedures and to what extent evidence-based protocol was used in managing suicidal patients at A&E. We interviewed eight key informants who rotated in the Accident and Emergency Department and Mental Health Department, and they were interviewed using a semi-structured interview guide. We included clinicians and administrators in addition to the nurses. Using NVivo Pro 11 software, themes and subthemes were derived with the final code system having patient assessment and patient management, as well as protocol and care gaps and further recommendations as the key themes. With regard to patient assessment, all the interviews identified stressful life situations, substance use, and violence as being the dominant presenting complaints in patients with suicidal tendencies who were seen at A&E. Five out of eight interviews with our key respondents mentioned depressive symptoms as a clinical presentation for suicidal patients. Six out of eight respondents also shared that there were no protocols for assessing and managing suicidal patients with some reporting that they used what they learnt in Nursing and Medical School to offer management in that point of time. Most of our respondents mentioned that clinical management of suicidal patients was mostly done with the use of force to deal with violent and resistant patients. Psychological management was essentially an ex post facto issue left to the very few counselors within the Department. Most of our respondents did not have information on their patients after discharge raising questions about patient safety and well-being. Our analyses of these interviews led us to the conclusion that there were significant gaps in assessment as patients were not routinely screened for suicidal ideation despite suicidal intent and psychological problems being undercurrent issues. Psychological management was sparse with most of it being left to very few staff. Training in suicide assessment for all patients and management we felt was critical in increasing the self-efficacy of nurses in Accident and Emergency Department in handling medical emergencies that are prompted due to mental health issues and suicidal and self-harming behaviors.

Adapting a Global Gender-Transformative Violence Prevention Program for the U.S. Community-Based Setting for Work with Young Men Abstract Extensive practice-based evidence from international settings, as well as in-depth evaluations of programs promoting gender equity, have demonstrated effectiveness in reducing perpetration of violence against women and girls. Such "gender-transformative programs" encourage critical analysis of gender norms, challenge homophobia and gender-based harassment, build skills to question harmful masculine norms, interrupt harmful and disrespectful behaviors, and encourage more equitable behaviors. Here we describe the history of a gender-transformative program, "Program H," first developed in Brazil and Mexico, the rationale for and evaluation of this original program, and the processes of adaptation for the US urban community-based setting, and highlight the risks as well as opportunities on the work with young men and boys in the future.

What I Thought I Knew: Parental Involvement in the Sexuality Education of Their Children and Its Role on Sexual Abuse Abstract Sexuality education has been identified as important in the fight against child sexual abuse. Children's knowledge about sexuality determines their ability to identify sexual behaviors that could expose them to sexual abuse. This study was conducted to understand the role of parents in preventing the sexual abuse of their children through sexuality education. A qualitative approach was used to collect data from 19 sexually abused children and 20 parents of victims of child sexual abuse in selected towns in the Ga Community in Ghana via semi-structured interviews. The findings showed that most parents were unable to provide sexuality education to their children due to social taboos and beliefs about sexuality education. The few parents who attempted teaching their children about sexuality used a deterrent approach which yielded negative outcomes. These factors pushed children to depend on their peers and the media for information on sexuality which led to their sexual abuse. The study demonstrates the need for cultural appropriate interventions in engaging parents in sexuality education in preventing children from sexual abuse.

War Violence Exposure, Reintegration Experiences and Intimate Partner Violence Among a Sample of War-Affected Females in Sierra Leone Abstract Although international attention has focused mostly on boys as child soldiers and youth affected by armed conflict, girls account for more than 40 % of this population globally. Primarily recruited and abducted into armed conflict to serve as "wives" and sexual slaves for commanders and other soldiers, girls experienced high rates of rape and sexual abuse. Using data from a longitudinal study conducted in collaboration with a major international Non-Government Organization (NGO) in Sierra Leone, this study examined the contributions of potentially stigmatizing war violence exposures and more recent post-conflict reintegration experiences to IPV. Results indicate the various aspects of wartime violence, this sample of female youth showed the highest rates of ambient wartime violence, victimization, and sexual assault. However, this sample also showed a non-trivial proportion of perpetrating wartime violence. Overall, this sample reported middling levels of community reintegration, and similar average rates of family reintegration. This study indicates a need for war-affected females to have greater access to resources that can empower them post-conflict.

Recent Immigrants' Use of Dental Care and Health Insurance Status in the USA Abstract Background According to existing research, immigrants have poorer oral health than the US-born population. Evidence suggests that immigrants' poor oral health is associated with a lack of health insurance and a lower use of preventive dental services. However, the role of Medicaid coverage on immigrants' use of dental healthcare has not been well investigated. Methods To explore if the use of oral healthcare services increased among immigrants with Medicaid, this study analyzed a sample of 7578 legal immigrants aged between 18 and 65 using the 2003 New Immigrant Survey. Bivariate analyses and multivariate logistic regressions were performed to examine the relationship between immigrants' health insurance status and the use of dental healthcare. Results More than 60% of recent immigrants were not covered by any health insurance, and 56% did not schedule any dental services during the year prior to the survey. The results of the logistic regression revealed that immigrants covered by employment or private insurance were 74.3% more likely to have a regularly scheduled dental service, compared to immigrants who were uninsured. Having Medicaid coverage, however, was either not associated with or had smaller effect size in predicting immigrants' use of dental services using the two analytic samples. The results of an additional bivariate analysis suggested that Medicaid was insufficient in covering dental healthcare expenses. Conclusions This study highlighted the low use of dental services among recent immigrants and the high proportion of them currently uninsured. The study also suggested the need for better coverage of dental healthcare expenses for Medicaid recipients.

Implementing Evidence-Based HIV Prevention for Female Sex Workers in Mexico: Provider Assessments of Feasibility and Acceptability Abstract This study examined service provider perceptions of feasibility and acceptability of implementing evidence-based practices for preventing HIV/AIDS and STIs in female sex workers (FSWs) in Mexico. Semi-structured interviews were conducted with 124 directors, supervisors, and counselors from 12 reproductive health clinics located throughout Mexico participating in a large randomized controlled trial to scale-up the use of a psychoeducational intervention designed to promote FSW condom use and enhance safer sex negotiation skills. Feasibility was based on assessment of personal, organizational and social costs, benefits, and capacity. Costs included anxiety over intervention competency, purchase of condoms and other supplies, expenses of laboratory tests for HIV/STIs, and stigma associated with FSWs. Benefits included increase in personal knowledge and experience, enhanced clinic reputation and service delivery capacity, and increased public health. Capacity was expressed in terms of provider skills to deliver the intervention and additional workload. Acceptability was expressed in terms of provider enthusiasm in delivering these services and FSWs willingness to receive the services. Service provider evaluations of feasibility and acceptability of implementing evidence-based prevention interventions are grounded in local contexts that define costs and benefits of and capacity for implementation and determine features of the intervention and its implementation that are acceptable.

Development and Implementation of a Family Therapy Intervention in Kenya: a Community-Embedded Lay Provider Model Abstract The large burden of mental health disorders among young people worldwide calls for scalable prevention and treatment models that reach children and families in low-resource settings. This paper describes the development of an evidence-informed family therapy intervention designed for lay counselor delivery in low-resource settings and presents findings on the feasibility and acceptability of implementation in Kenya. Qualitative data guided the development of a components-based family therapy that integrates multiple strategies from solution-focused and systems-based therapies, as well as those from parenting skills training and cognitive behavioral therapies. Eight lay counselors delivered the intervention, with 10 families completing treatment. Lay counselors demonstrated adequate fidelity and clinical competency when treating families with a wide range of presenting clinical problems. Unique elements of the implementation model proved feasible and acceptable, including recruiting "natural" lay counselors from communities already engaged in informal counseling for families; participants indicated trust and respect in the counseling relationship that facilitated their participation. Both counselors and families reported positive perceptions of intervention content and strategies, including those least similar to local counseling practices. Results support the potential of this implementation strategy that aims to add evidence-based practices to local practices and routines rather than creating new cadres of lay counselors or health workers. Supervision, provided by psychology student trainees, also proved feasible and mutually beneficial, with phone-based supervision as acceptable as in-person meetings; this suggests the potential feasibility of this model for use in remote locations. Future directions include integrating these delivery approaches into existing social structures to develop and evaluate a comprehensive implementation model for scale-up.

The Next Frontier for Social Development: Deepening Our Understanding, Discovering New Solutions, and Forging Ahead