Global burden of maternal bereavement: indicators of the cumulative prevalence of child loss.

Background: We provide country-level estimates of the cumulative prevalence of mothers bereaved by a child's death in 170 countries and territories.

Methods: We generate indicators of the cumulative prevalence of mothers who have had an infant, under-five-year-old or any-age child ever die by using publicly available survey data in 89 countries and an indirect approach that combines formal kinship models and life-table methods in an additional 81 countries. We label these measures the maternal cumulative prevalence of infant mortality (mIM), under-five mortality (mU5M) and offspring mortality (mOM) and generate prevalence estimates for 20-44-year-old and 45-49-year-old mothers.

The Enduring Case for Fertility Desires.

Persistently high levels of unintended fertility, combined with evidence that over- and underachieved fertility are typical and not exceptional, have prompted researchers to question the utility of fertility desires writ large. In this study, we elaborate this paradox: widespread unintendedness and meaningful, highly predictive fertility desires can and do coexist. Using data from Malawi, we demonstrate the predictive validity of numeric fertility timing desires over both four-month and one-year periods.

Maternal cumulative prevalence measures of child mortality show heavy burden in sub-Saharan Africa.

We advance a set of population-level indicators that quantify the prevalence of mothers who have ever experienced an infant, under 5-y-old child, or any-age child die. The maternal cumulative prevalence of infant mortality (mIM), the maternal cumulative prevalence of under 5 mortality (mU5M), and the maternal cumulative prevalence of offspring mortality (mOM) bring theoretical and practical value to a variety of disciplines. Here we introduce maternal cumulative prevalence measures of mortality for multiple age groups of mothers in 20 sub-Saharan African countries with Demographic and Health Surveys data spanning more than two decades.

Changing Childbearing Norms During an Era of ART Expansion in Malawi, 2009 to 2015.

Community norms shape the childbearing goals and behaviors of persons living with HIV/AIDS (PLWHA) but little is known about how norms around HIV-positive childbearing have changed with expanded access to antiretroviral treatment (ART). We analyze data collected in 2009 and 2015 by the Tsogolo la Thanzi (TLT) project-a longitudinal, population-based study of young adults in southern Malawi. Respondents were asked about the acceptability of childbearing using vignettes that varied a hypothetical couple's HIV status and number of children.

Data Collection as Disruption: Insights from a Longitudinal Study of Young Adulthood.

Research disrupts the social world, often by making respondents aware that they are being observed or by instigating reflection upon particular aspects of life via the very act of asking questions. Building on insights from the first Hawthorne studies, reflexive ethnographers, and methodologists concerned with panel conditioning, we draw on six years of research within a community in southern Malawi to introduce a conceptual framework for theorizing disruption in observational research. We present a series of poignant-yet-typical tales from the field and two additional tools-the refresher-sample-as-comparison and study-focused ethnography-for measuring disruption empirically in a longitudinal study.

Tsogolo la Thanzi: A Longitudinal Study of Young Adults Living in Malawi's HIV Epidemic.

Tsogolo la Thanzi (TLT) was designed to study how young adults navigate sexual relationships and childbearing during a generalized HIV epidemic. TLT began in 2009 with a population-representative sample of 1,505 women and 574 men between the ages of 15 and 25 living in Balaka, southern Malawi, where regional adult HIV prevalence then stood at 15 percent. The first phase (2009-11) included a series of eight interviews, spaced four months apart.

Awareness and perceived fairness of Option B+ in Malawi: A population-level perspective.

Introduction: Policies for rationing antiretroviral therapy (ART) have been subject to on-going ethical debates. Introduced in Malawi in 2011, Option B+ prioritized HIV-positive pregnant women for lifelong ART regardless of the underlying state of their immune system, shifting the logic of allocation away from medical eligibility. Despite the rapid expansion of this policy, we know little about how it has been understood and interpreted by the people it affects.

Ideals as Anchors for Relationship Experiences.

Research on young-adult sexuality in sub-Saharan Africa typically conceptualizes sex as an individual-level risk behavior. We introduce a new approach that connects the conditions surrounding the initiation of sex with subsequent relationship well-being, examines relationships as sequences of interdependent events, and indexes relationship experiences to individually held ideals. New card-sort data from southern Malawi capture young women's relationship experiences and their ideals in a sequential framework.

Brief Report: Health-Seeking Behavior and Symptoms Associated With Early HIV Infection: Results From a Population-Based Cohort in Southern Malawi.

HIV transmission is most likely to occur during the first few months after infection, yet few cases are identified during this period. Using a population-based cohort of young Malawian women, we identify the distinct symptomology and health-seeking behavior marking early HIV infection by comparing it with periods of seronegativity and chronic infection. During early HIV infection, women are more likely to report malaria-like symptoms and visit clinics for malaria care.

Integrating the Demographic and Health Surveys, IPUMS-I, and TerraPopulus to Explore Mortality and Health Outcomes at the District Level in Ghana, Malawi, and Tanzania.

In this paper, we first show how the Demographic and Health Surveys (DHS) can be integrated with other data sources to expand the types of variables available for analysis of population and health outcomes. Second, we demonstrate one particular example of such integration by modelling the social, physical, and built environment determinants of health outcomes at the district level in Ghana, Malawi, and Tanzania. To do so, we created district-level measures of a number of variables from the DHS, and then merged them with district-level data from the IPUMS, an environmental data set called TerraPopulus, and other sources.

Sibling support and the educational prospects of young adults in Malawi.

Background: Extended kin networks are an important social and economic resource in Africa. Existing research has focused primarily on intergenerational ties, but much less is known about "lateral" ties, such as those between siblings. In contexts of high adult mortality (i.

Polygynous contexts, family structure, and infant mortality in sub-saharan Africa.

Contextual characteristics influence infant mortality above and beyond family-level factors. The widespread practice of polygyny is one feature of many sub-Saharan African contexts that may be relevant to understanding patterns of infant mortality. Building on evidence that the prevalence of polygyny reflects broader economic, social, and cultural features and that it has implications for how families engage in the practice, we investigate whether and how the prevalence of polygyny (1) spills over to elevate infant mortality for all families, and (2) conditions the survival disadvantage for children living in polygynous families (i.

Uncertainty and Fertility in a Generalized AIDS Epidemic.

Sociologists widely acknowledge that uncertainty matters for decision making, but they rarely measure it directly. In this article, we demonstrate the importance of theorizing about, measuring, and analyzing uncertainty as experienced by individuals. We adapt a novel probabilistic solicitation technique to measure personal uncertainty about HIV status in a high HIV prevalence area of southern Malawi.

U.S. congregations' provision of programs or activities for people living with HIV/AIDS.

Using data from a nationally representative sample of U.S. congregations, this study estimates the proportion of congregations that provide programs or activities that serve people living with HIV/AIDS (PLWHA) and examines the effects of congregational characteristics on the likelihood of having them.

Religious differences in female genital cutting: a case study from Burkina Faso.

The relationship between religious obligations and female genital cutting is explored using data from Burkina Faso, a religiously and ethnically diverse country where approximately three-quarters of adult women are circumcised. Data from the 2003 Burkina Faso Demographic and Health Survey are used to estimate multilevel models of religious variation in the intergenerational transmission of female genital cutting. Differences between Christians, Muslims, and adherents of traditional religions are reported, along with an assessment of the extent to which individual and community characteristics account for religious differences.

Best-friend reports: a tool for measuring the prevalence of sensitive behaviors.

We introduce the best-friend methodology for using surveys to measure the population prevalence of sensitive behaviors. We demonstrate the effectiveness of this tool by comparing self-reports to best-friend reports of sexual behavior and abortion history among young women in Malawi (n = 1493). Best-friend reports reveal higher and more believable estimates of abortion and multiple sexual partners.

The third therapeutic system: faith healing strategies in the context of a generalized AIDS epidemic.

Faith healing in sub-Saharan Africa has primarily been studied qualitatively among Pentecostal-Charismatic groups, and considered as its own phenomenon with little attention to its relationship to other modes of healing. Using data from Malawi, a religiously diverse African country with high HIV prevalence, we find that faith healing is pervasive across multiple religious traditions. For individuals, attending a faith healing congregation is associated with lower levels of generalized worry about AIDS, and this association is driven by those who switched churches before AIDS became widespread in rural areas.

The AIDS-related activities of religious leaders in Malawi.

The AIDS-related activities of religious leaders in Africa extend far beyond preaching about sexual mortality. This study aims to quantify the involvement of religious leaders in the fight against AIDS and to identify key predictors of the types of prevention strategies they promote. Using data from a random sample of Christian and Muslim leaders in Malawi, I use logistic regression to predict six types of AIDS activities, which correspond to three distinct types: formal messages (i.

The Malawi Religion Project: Data collection and selected analyses.

Scholars have recently become increasingly interested in the role religion plays in the responses to the HIV/AIDS epidemic in sub-Saharan Africa. Here, we present the Malawi Religion Project (MRP), which provides data to examine the relationship between religion and HIV/AIDS through surveys and in-depth interviews with denominational leaders, congregational leaders, and congregation members in three districts of rural Malawi. In the paper, we outline existing perspectives on the religion-HIV/AIDS link, describe the MRP's design, implementation, and subsequent data; provide initial evidence for a series of general research hypotheses; and describe how these data can be used both to extend explorations of these relationships further and as a model for gathering similar data in other contexts.

Religious teachings and influences on the ABCs of HIV prevention in Malawi.

This study examines the relationship between religion and HIV risk behaviors in rural Malawi, giving special attention to the role of religious congregations, the organizations with which rural Africans have most immediate contact. It draws on 2004 data from a household survey in 3 districts (N=3386), and quantitative and qualitative data collected in 2005 from 187 leaders of religious congregations previously identified in the survey. The first aim is descriptive--to identify overall patterns and variations in what religious leaders in rural Malawi teach about HIV and about sexual behavior in light of the epidemic.

US religious congregations and the sponsorship of health-related programs.

Despite consistent evidence that religious congregations provide health-related programs for their members and residents of the local community, little is known about the distribution of congregation-based health programs across the United States. Using a nationally representative sample of US congregations (n=1230) we employ bivariate analysis and logistic regression to identify patterns in the sponsorship of health-related programs by religious congregations; we then propose and test various explanations for these observed patterns. Our findings contradict the impressions given by case studies and the program evaluation literature and suggest: a) that congregation-based health programs may not be serving the neediest communities; and b) that congregations are not taking advantage of mechanisms intended to facilitate the provision of health-related services by religious congregations.

Beyond Denomination: The Relationship between Religion and Family Planning in Rural Malawi.

Despite the centrality of religion and fertility to life in rural Africa, the relationship between the two remains poorly understood. The study presented here uses unique integrated individual and congregational level data from rural Malawi to examine religious influences on contraceptive use. In this religiously diverse population, we find evidence that the particular characteristics of a congregation-leader's positive attitudes toward family planning and discussion of sexual morality, which do not fall along broad denominational lines-are more relevant than denominational categories for predicting women's contraceptive use.