Child Wantedness and Low Weight at Birth: Differential Parental Investment among Roma

The impact of welfare on maternal investment and sibling competition: evidence from Serbian Roma communities

Siblings compete for limited parental resources, which can result in a trade-off between family size and child growth outcomes. Welfare incentives may improve parental circumstances in large families by compensating for the additional costs of an extra child and increasing the resources available to a family. The improvements in conditions may influence parents to increase their investment, expecting greater returns from the investment in child survival and development, while in turn increase sibling competition for the investment. This study assessed whether welfare benefits have influenced parental investment trade-offs and competition between siblings among Serbian Roma, a population largely dependent on welfare. Using data from the UNICEF Multiple Indicator Cluster Survey 6, this study assessed the associations between maternal investment, child cash benefits, sibship size, and child anthropometry, as an indicator of health, among 1096 Serbian Roma children aged 0 to 59 months. Living in a small family benefited Roma children, while the incentives increased competition between siblings. Maternal investment was negatively associated with incentives, as the improvements brought about were insufficient to influence a change in maternal perceptions about the local setting uncertainty and thus promote an increase in investment.

Do unwanted children face growth penalties in resource poor environments? Evidence from Roma Settlements in Serbia

In a high fertility context, research on the relationship between parental investment, unwanted births and child nutritional outcomes is limited. The implications may be especially relevant for children coming from the most disadvantaged backgrounds and at increased risk of nutritional deprivation. This study assessed the association between maternal investment, unwanted births disaggregated into mistimed and unwanted children, and child nutritional outcomes in a poor population of Serbian Roma. Multiple Indicator Cluster Surveys rounds 5 and 6 data for Serbian Roma settlements were used to account for the association between two measures of maternal investment: weight at birth and parity, and mistimed and unwanted children, and children height-for-age z-score (HAZ), weight-for-age z score (WAZ) and weight-for- height z-score (WHZ). The sample included 130 children aged 0-24 months. The child variables were age, gender, and birth order, while maternal independent variables included age, literacy and access to improved toilet facility as proxies for socioeconomic status. Children born with low birth weight (lower maternal investment in utero) face a significant deficit in terms of their nutritional outcomes, measured by HAZ and WAZ. The effect was aggravated for height if the child was unwanted while there was a positive relationship between access to improved toilet facility and WHZ. Unwanted children were of higher birth order, with older, higher parity mothers than mistimed children. Many of the Roma children may be at risk of undernutrition, however, Roma children who received lower maternal investment in utero, unwanted and living in poorest households may face additional risk.

A scoping review of literature exploring factors affecting vaccine uptake within Roma communities across Europe

INTRODUCTION

Vaccine hesitancy is described by the WHO as one of the top threats to global health. The trajectory of the current COVID-19 pandemic depends upon the vaccination of a global population; therefore, barriers to routine vaccination within marginalized groups considered vaccine hesitant are of critical importance. Consistently, vaccination levels within Roma communities across Europe rate very poorly in comparison with general population coverage, and a number of measles and hepatitis outbreaks over the past 10 years have included Roma communities. This study aims to identify barriers to Roma vaccination in general with a view to informing analysis of potential low levels of vaccination within Roma communities for COVID-19.

AREAS COVERED

The research question explores factors and barriers affecting general vaccine (non-COVID-19 vaccine) uptake within Roma communities across Europe. This scoping review was conducted using the Arksey & O'Malley framework, complying with PRISMA-SR for Scoping Review guidelines.

EXPERT OPINION

Using Thomson's 5A's Taxonomy, access was identified as the greatest barrier to vaccination within Roma communities. Access factors had the greatest number of references in this scoping review and were considered the most relevant in terms of increasing vaccination uptake. Important access themes identified are health system issues, socioeconomic conditions, and mobility.

Paternal investment, stepfather presence and early child development and growth among Serbian Roma

Research on paternal investment and child growth and development is limited outside of high-income countries. Using nationally representative data from low-resource Serbian Roma communities, this study examined father investment (direct care), its predictors and the associations between paternal investment, stepfather presence and child physical growth and early development. The sample included 1222 children aged 35-59 months, out of which 235 were living with biological fathers. Child outcomes included height-for-age Z-scores, stunting and early child developmental score. Roma paternal investment was relatively low. There was a positive association of father investment and children's height, and no association with developmental score. The presence of father vs. stepfather did not exert any influence on children. Instead, maternal and child characteristics explained both the overall development and height for Roma children. Thus, older children, born to literate, lower parity mothers of higher status and greater investment had better developmental and growth outcomes; girls were the preferred sex, owing to expected fitness benefits. Reverse causality emerged as the most likely pathway through which the cross-sectional association of father direct care with child growth may manifest, such that Roma fathers tend to bias their investment towards taller, more endowed children, because of greater fitness pay-off.

Maternal age at marriage and child nutritional status and development: evidence from Serbian Roma communities

OBJECTIVE

This study aimed to assess whether maternal age at first marriage is associated with nutritional and developmental penalties in Roma children.

DESIGN

Roma nationally representative population-based study. Proxies for child nutritional outcomes included children's individual-level height-for-age z (HAZ) and weight-for-age z (WAZ) scores, HAZ and WAZ scores below two standard deviations from the median of WHO's reference population (children aged 0-59 months), and Early Child Development (children aged 36-59 months). Multiple and logistic regressions were used to estimate the association between maternal age at marriage and the outcomes, and other sociodemographic determinants as possible confounders.

SETTING

Aggregated data from UNICEF's fifth and sixth Multiple Indicator Cluster Surveys for Serbian Roma settlements.

SUBJECTS

Children (n= 2652) aged 0-59 months born to ever-married women aged 15-48.

RESULTS

64% of women married before age 18, 19% of children were stunted, 9% wasted, and Early Child Development score was low. Maternal age at first marriage was not associated with either nutritional status or early development of Roma children. Weight at birth (children aged 0-24) emerged as the main predictor of children's nutritional status. Boys were more likely to be shorter, more stunted and wasted than girls. Child's age, maternal parity and unimproved toilet facility negatively impacted nutritional status, while maternal literacy mitigated against poor nutritional and developmental outcomes.

CONCLUSIONS

Roma children up to 5 years of age bear no negative consequences of maternal early marriage. The underlying determinants of children's wellbeing include improved sanitation, child characteristics, maternal literacy and reproductive behavior, and parental investment.

Stunting, maternal investment, and early child development in Serbian Roma children aged 36-59 months

Stunting has shown negative associations with poor child developmental indicators. However, in poor ethnic minority populations the evidence for associations of anthropometric growth indicators and child development is limited. This study examined associations between stunting, height for age z scores (HAZ) and other determinants, with Early Child Development (ECD) among children in poor Roma communities. Publicly available data from Multiple Indicator Cluster Surveys for Serbian Roma settlements were used to assess a cohort of 1075 Roma children aged 36-59 months. Indicators of child growth and nutrition included children?s HAZ scores and stunting. ECD assessed physical, learning/cognition, literacy/numeracy and socio-emotional developmental domains. Multiple regressions were used to assess the association between HAZ and stunting with ECD, controlling for maternal and child confounders. Sum score for ECD in Roma children was low, and 18% of children were stunted. After adjusting for potential confounders, HAZ and stunting revealed no significant associations with developmental outcomes. Instead, increasing maternal investment was positively associated with overall ECD score and higher scores in each of the individual developmental domains, except socio-emotional. In a low-resource setting, maternal investment appeared a good predictor of child development: it may buffer against the effects of poverty and stimulate child development.