Reproduction in upheaval: Ethnic-specific fertility responses to societal turbulence in Kazakhstan

Sustained and Universal Fertility Recuperation in Kazakhstan

The fertility rates of Kazakhstan have reversed to levels not seen for several decades. The striking fertility increase poses questions regarding the extent to which this new development is shared across socio-demographic groups and the nature of fertility recuperation. The current study employs UNICEF Multiple Indicator Cluster Survey data and event-history modelling to analyse parity progressions to one, two, three, and four children. The results suggest a sustained fertility increase that is not merely associated with the recuperation of delayed first births, but a genuine increase across all birth orders. This pattern is evident for both main ethnicities in Kazakhstan and across educational groups. The gradual increase of higher-order births, especially among ethnic Kazakhs, indicates a reversed fertility transition and also that the previous fertility decline in the 1990s was not part of a general transition towards below-replacement fertility but rather a reflection of economic crisis after the collapse of the Soviet Union.

Group Normative Propensities, Societal Positioning, and Childbearing: Ethno‑linguistic Variation in Completed and Desired Fertility in Transitional Central Asia

Considerable research in western, low-fertility contexts has examined minority-vs.-majority fertility differentials, typically focusing on minority groups' cultural idiosyncrasies and on socioeconomic disadvantages associated with minority status. However, the formation and functioning of ethnic complexities outside the western world often diverge from the standard western model and so may their impact on fertility preferences, behavior, and outcomes. We expand on the previous research by analyzing ethnic variation in completed and desired fertility in the multiethnic transitional setting of Kyrgyzstan, where ethnic groups and their ethnolinguistic subparts are characterized by both different stages of the demographic transition and different positioning in the socioeconomic and political hierarchies. Using combined data from two rounds of a nationally representative survey, we find that ethnic-specific levels of completed fertility generally align with culturally shaped group-level normative propensities. In contrast, in desires to have a(nother) child, the ranking of the ethnic segments is more reflective of their collective societal positioning, with more disadvantaged segments having lower fertility desires, regardless of actual number of children and various other characteristics. We also find that ethnic homophily of respondents' social milieu and their optimism about the future of their ethnic group are positively associated with fertility desires, even though these associations are more potently present among women, compared to men. We relate our findings to the extant scholarship and reflect on their implications for a better understanding of ethno-racial fertility dynamics and differentials in transitional contexts.

The Consequences of the Tajikistani Civil War for Abortion and Miscarriage

Although a great deal of attention is paid to reproductive health during violent conflicts, the literature is sparse on the consequences of conflict for abortion and miscarriage. This research provides an analysis of a recent historical case: the 1992-1997 civil war in Tajikistan, using the female questionnaire of the 2007 Tajik Living Standards Survey to examine a subsample of 1,445 women surveyed who had reached menarche during or after the war and had been pregnant at least once by the time of the survey. The analysis leverages the uneven geographical scope of conflict events during the civil war to pinpoint women's exposure to violence, measured by the Uppsala Conflict Data Program. The results show that for women who had reached menarche during or after the civil war, exposure to conflict events increases the likelihood of ever experiencing miscarriage, but not abortion. Including a spatial lag operator reveals that there were also spillover effects for abortion, in which women who were in a broader region of uncertainty were more likely to induce an abortion. These findings highlight the role of institutional changes in affecting pregnancy loss during and after civil war.

The Influence of In-Group Membership on Trust in Health-Care Professionals in Kazakhstan

Background:

Trust in providers is key to positive health outcomes. However, perceptions of trust in health-care professionals can vary by population. Factors beyond the immediate behaviors of health-care professionals such as group association may influence perceptions of trust.

Objective:

To examine the possible association of in-group membership and levels of trust in health-care professionals in Kazakhstan.

Method:

We used an online survey including the General Trust in Physicians scale along with demographic questions and a question regarding family members as health-care professionals. Bivariate analysis was used to compare the mean differences between general levels of trust and sociodemographic characteristics. Then multivariate analysis was conducted to examine the association between having a family member who is a health-care professional and general level of trust in health-care professionals among Kazakhstani citizens. Statistical tests were 2-sided.

Results:

A total of 497 Kazakhstani participants completed the survey. In adjusted multivariate regression, participants with family members as health-care professionals scored significantly higher on the trust scale (P < .001), and other factors such as language (P < .001) and interaction term of language and education (P< .05) were also shown to be influential in the general level of trust.

Conclusion:

Further examinations of how group membership influences reported trust levels in health-care professionals in Kazakhstan are warranted. Such studies would be beneficial if trust in health-care professionals is to be understood and improved in order to achieve more desirable health outcomes.

The Effects of Conflict on Fertility: Evidence From the Genocide in Rwanda

Our study analyzes the fertility effects of the 1994 genocide in Rwanda. We study the effects of violence on both the duration time to the first birth in the early post-genocide period and on the total number of post-genocide births per woman up to 15 years following the conflict. We use individual-level data from Demographic and Health Surveys, estimating survival and count data models. This article contributes to the literature on the demographic effects of violent conflict by testing two channels through which conflict influences fertility: (1) the type of violence exposure as measured by the death of a child or sibling, and (2) the conflict-induced change in local demographic conditions as captured by the change in the district-level sex ratio. Results indicate the genocide had heterogeneous effects on fertility, depending on the type of violence experienced by the woman, her age cohort, parity, and the time horizon (5, 10, and 15 years after the genocide). There is strong evidence of a child replacement effect. Having experienced the death of a child during the genocide increases both the hazard of having a child in the five years following the genocide and the total number of post-genocide births. Experiencing sibling death during the genocide significantly lowers post-genocide fertility in both the short-run and the long-run. Finally, a reduction in the local sex ratio negatively impacts the hazard of having a child in the five years following the genocide, especially for older women.

Design and measurement in a study of war exposure, health, and aging: protocol for the Vietnam health and aging study

BACKGROUND

Survivors of war throughout the world experience illnesses and injuries that are crucial to understand, given the ongoing treatment and adaptation they demand. In developing countries like Vietnam, where population aging and chronic disease burdens are rapidly rising, aging populations have seen a disproportionate share of armed conflict and related casualties. This paper describes the Vietnam Health and Aging Study (VHAS), a unique resource for investigating mechanisms of association between diverse exposures to armed conflict during the Vietnam War and multiple dimensions of older adult health among survivors of that war.

METHODS

The VHAS utilizes a longitudinal design, the first wave of data collection conducted in 2018 among 2447 older adults. A second wave of follow-up data collection, scheduled to take place in 2021, will examine life course, social relational and health and mortality transitions. The VHAS was conducted in four northern Vietnamese districts purposively selected to represent a spectrum of war exposure as indicated by intensity of bombings. Additionally, VHAS uses random sampling within gender and military service subdomains to permit unique gender-specific analyses of military service, trauma exposure and health. The VHAS' face-to-face interviews include modules detailing war and military service experiences; warzone stressors; and multiple dimensions of health such as chronic disease, functional limitation, disability, health behaviors, cognition and psychological health. Biomarker data collected for the full VHAS sample includes anthropometric and functional tests such as grip strength and blood pressure, hair samples for cortisol assay, and capillary blood samples to assay C-reactive protein, cholesterol, HbA1c, and other markers of interest for cardiovascular and other disease risks and for testing the impact of early life stressors on later life health. Blood samples will also permit epigenetic analysis of biological aging.

DISCUSSION

Future VHAS investigations will examine dynamic linkages between war exposure, mortality and morbidity, while taking into account the selective nature of each of these processes. Longitudinal analyses will examine late-life health transitions and war-related resiliency.

Economic Swings, Political Instability and Migration in Kyrgyzstan

Individual-level migration responses to economic fluctuations and political instability remain poorly understood. Using nationally representative survey data from Kyrgyzstan, we look at variations in levels and propensities of internal and temporary international migration and relate them to changes in the economic and political environment in that Central Asian nation in the first decade of the century. A multinomial event history model predicting yearly risks of both types of migration detects no clear association of internal migration risks with episodes of heightened political instability but shows a decrease in those risks in response to the strongest economic shock of the observation period. In comparison, international migration risks, while also insensitive to political turmoil, appear to increase at the time of the most pronounced economic downturn. The results also point to instructive patterns in migration propensities by type of area of residence, education, gender, and ethnicity. These findings are interpreted in light of complex intersections of demography with politics, economy, and culture in this transitional Eurasian setting.

Between Tradition and Modernity: Marriage Dynamics in Kyrgyzstan

The demographic literature on union formation in post-communist Europe typically documents retreat from marriage and increase in cohabitation. However, sociological and anthropological studies of post-Soviet Central Asia often point to a resurgence of various traditional norms and practices, including those surrounding marriage, that were suppressed under Soviet rule. We engage these two perspectives on union formation by analyzing transition to first marriage in Kyrgyzstan both before and after the collapse of the USSR. We use uniquely detailed marriage histories from a nationally representative survey conducted in the period 2011-2012 to examine the dynamics of traditional marital practices among that country's two main ethnic groups-Kyrgyz and Uzbeks-focusing on trends in arranged marriages and in marriages involving bride kidnapping. The analysis reveals instructive ethnic and period differences but also indicates an overall decline in the risks of both types of traditional marriage practices in the post-Soviet era. In fact, although the decline has characterized all marriage types, it was more substantial for traditional marriages. We interpret these trends as evidence of continuing modernization of nuptiality behavior in the region.

Analysis of economic determinants of fertility in Iran: a multilevel approach

BACKGROUND

During the last three decades, the Total Fertility Rate (TFR) in Iran has fallen considerably; from 6.5 per woman in 1983 to 1.89 in 2010. This paper analyzes the extent to which economic determinants at the micro and macro levels are associated with the number of children in Iranian households.

METHODS

Household data from the 2010 Household Expenditure and Income Survey (HEIS) is linked to provincial data from the 2010 Iran Multiple-Indicator Demographic and Health Survey (IrMIDHS), the National Census of Population and Housing conducted in 1986, 1996, 2006 and 2011, and the 1985-2010 Iran statistical year books. Fertility is measured as the number of children in each household. A random intercept multilevel Poisson regression function is specified based on a collective model of intra-household bargaining power to investigate potential determinants of the number of children in Iranian households.

RESULTS

Ceteris paribus (other things being equal), probability of having more children drops significantly as either real per capita educational expenditure or real total expenditure of each household increase. Both the low- and the high-income households show probabilities of having more children compared to the middle-income households. Living in provinces with either higher average amount of value added of manufacturing establishments or lower average rate of house rent is associated to higher probability of having larger number of children. Higher levels of gender gap indices, resulting in household's wife's limited power over household decision-making, positively affect the probability of having more children.

CONCLUSION

Economic determinants at the micro and macro levels, distribution of intra-household bargaining power between spouses and demographic covariates determined fertility behavior of Iranian households.

A micro-level event-centered approach to investigating armed conflict and population responses

In this article, we construct and test a micro-level event-centered approach to the study of armed conflict and behavioral responses in the general population. Event-centered approaches have been successfully used in the macro-political study of armed conflict but have not yet been adopted in micro-behavioral studies. The micro-level event-centered approach that we advocate here includes decomposition of a conflict into discrete political and violent events, examination of the mechanisms through which they affect behavior, and consideration of differential risks within the population. We focus on two mechanisms: instability and threat of harm. We test this approach empirically in the context of the recent decade-long armed conflict in Nepal, using detailed measurements of conflict-related events and a longitudinal study of first migration, first marriage, and first contraceptive use. Results demonstrate that different conflict-related events independently shaped migration, marriage, and childbearing and that they can simultaneously influence behaviors in opposing directions. We find that violent events increased migration, but political events slowed migration. Both violent and political events increased marriage and contraceptive use net of migration. Overall, this micro-level event-centered approach yields a significant advance for the study of how armed conflict affects civilian behavioral responses.

Maternal health care amid political unrest: the effect of armed conflict on antenatal care utilization in Nepal

Armed conflicts, which primarily occur in low- and middle-income countries, have profound consequences for the health of affected populations, among them a decrease in the utilization of maternal health care services. The quantitative relationship between armed conflict and maternal health care utilization has received limited attention in the public health literature. We evaluate this relationship for a particular type of health care service, antenatal care, in Nepal. Using count regression techniques, household survey data and sub-national conflict data, we find a negative correlation between the number of antenatal care visits and incidents of conflict-related violence within a respondent's village development committee. Specifically, we find that under high-intensity conflict conditions women receive between 0.3 and 1.5 fewer antenatal care check-ups. These findings imply that maternal health care utilization is partially determined by characteristics of the social environment (e.g. political instability) and suggest health care providers need to revise maternal health strategies in conflict-affected areas. Strategies may include decentralization of services, maintaining neutrality among factions, strengthening community-based health services and developing mobile clinics.