Patriarchy and fertility in Albania

Health literacy and body mass index: a population-based study in a South-Eastern European country

Background

The relationship of health literacy (HL) with objective measures including anthropometric measurements remains an under-researched topic to date.

Objective

To assess the association between body mass index (BMI) and HL among Albanian adults.

Methods

A cross-sectional study was conducted in Tirana, Albania, in 2012–2014 including a population-based sample of 1154 individuals aged ≥18 years. HL was assessed by the use of HLS-EU-Q instrument. Anthropometrics included measurement of weight and height based on which BMI was calculated. Information on socio-demographic characteristics was also collected. Logistic regression was employed to assess the independent association of BMI and HL controlling all socio-demographic factors.

Results

One-fifth of the participants reported an inadequate HL level, whereas almost one-third (31%) reported an excellent HL level. About 41% of study participants were overweight and further 22% were obese. In multivariate analysis, there was evidence of a strong and significant association between BMI and HL: the odds of overweight/obesity were two times higher (OR = 2.0, 95% CI = 1.3–3.1) among inadequate HL individuals compared with excellent HL participants.

Conclusion

Our findings, pertinent to a transitional country in the South East Europe, point to a strong, consistent and highly significant association between BMI and HL, irrespective of a wide array of socio-demographic characteristics.

Fertility and union formation during crisis and societal consolidation in the Western Balkans

Fertility decline in central and eastern Europe (CEE) since the fall of the communist regimes has been driven by both stopping and postponement of childbearing: two processes that have been related to crisis and economic development, respectively. In the Western Balkans these economic and political contexts followed each other in the form of a biphasic transition. I examine whether this sequence triggered fertility responses like those observed elsewhere. Relying on three independent data sources, I cross-validate the levels of, and describe the trends in, union formation and fertility (by birth order) between 1980 and 2010. Results do not reveal widespread declines in fertility to lowest-low levels during the most acute period of crisis. The subsequent postponement of marriage and first birth was also limited, and the two-child family remains the norm. This relative resilience of childbearing patterns compared with other CEE countries is discussed with reference to the institutional context.

The role of migration in the urban transition: a demonstration from Albania

Although natural increase has been recognized as the main driver of postwar urban growth in developing countries, urban transition theory predicts a dominant role for population mobility in the early and late phases of the process. To account for this discrepancy between theory and empirical evidence, I demonstrate the complex role played by internal and international migration in the pattern of urban growth. Using a combination of indirect demographic estimations for postwar Albania, I show that the dominant contribution of natural increase from the 1960s to the 1990s was induced by a limited urban in-migration; this was due to the restrictions on leaving the countryside imposed under communist rule and, thereafter, to the redirection abroad of rural out-migrants. Although young adults in cities also engaged in international movements and significantly reduced their fertility, the indirect effects of rural-to-urban migration attenuated the fall in urban birth rates and postponed demographic aging. In-migrants swelled urban cohorts of reproductive age and delayed the urban fertility transition. Despite a high level of urban natural increase in Albania, I thus conclude that the role of population mobility dominated in the early and most recent phases of urban growth. The results also have implications for our understanding of demographic processes during the second urban transition in developing countries.

The influence of women's empowerment on maternal health care utilization: evidence from Albania

Women in Albania receive antenatal care and postnatal care at lower levels than in other countries in Europe. Moreover, there are large socio-economic and regional disparities in maternal health care use. Previous research in low- and middle-income countries has found that women's status within the household can be a powerful force for improving the health, longevity, and mental and physical capacity of mothers and the well-being of children, but there is very little research on this issue in the Balkans. The aim of this paper is to investigate the influence of women's empowerment within the household on antenatal and postnatal care utilization in Albania. The research questions are explored through the use of bivariate and multivariate analyses based on nationally representative data from the 2008-09 Albania Demographic and Health Survey. The linkages between women's empowerment and maternal health care utilization are analyzed using two types of indicators of women's empowerment: decision making power and attitudes toward domestic violence. The outcome variables are indicators of the utilization of antenatal care and postnatal care. The findings suggest that use of maternal health care services is influenced by women's roles in decision-making and the attitudes of women towards domestic violence, after controlling for a number of socio-economic and demographic factors which are organized at individual, household, and community level. The study results suggest that policy actions that increase women's empowerment at home could be effective in helping assure good maternal health.