A Mixed Methods Exploration of Young Women’s Agency and Mental Health during COVID-19 in Low-Income Communities in Mumbai, India
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ABSTRACT:
SUBMITTER: Brault M
PROVIDER: S-EPMC11354834 | biostudies-literature | 2024 Jul
REPOSITORIES: biostudies-literature
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Project description:This research paper aims to understand the effects of time spent in domestic work, including childcare, on women's mental health in Ghana. The paper adopted a triangulation convergence mixed methods approach. The quantitative information was sourced from two waves (2009/ 2014) of the Ghana Socioeconomic Panel Survey (GSEPS) while qualitative information was obtained from in-depth interviews with couples and key informants from five (5) regions, representing diverse ethnic backgrounds, in Ghana. Employing fixed effects regressions and a multinomial logistic regression model with fixed effects, we find that domestic work contributes to poorer mental health outcomes among women. These results are consistent, even when we correct for potential self-selectivity of women into domestic work. We also examine whether the relationship is differentiated between women of higher and lower socioeconomic status. We find that women from wealthier households who spend increasing time in domestic work have higher odds of mental distress. These results are supported by the qualitative data- women indicate increasing stress levels from domestic work and while some husbands acknowledge the situation of their overburdened wives and make attempts, however minor, to help, others cite social norms and cultural expectations that act as a deterrent to men's assistance with domestic work. Efforts should be made to lessen the effects of social and cultural norms which continue to encourage gendered distributions of domestic work. This may be done through increased education, sensitization and general re-socialization of both men and women about the need for more egalitarian divisions of household work.
| S-EPMC7853525 | biostudies-literature
Project description:ObjectivesThe health and social effects of women's microfinance participation remain debated.MethodsUsing propensity-score methods, we assessed effects of microfinance participation on novel measures of agency; intimate partner violence (IPV) exposure; and depressive symptoms in 930 wives in Matlab, Bangladesh interviewed 11/2018-01/2019.ResultsParticipants, versus non-participants, were married younger (16.7 vs. 17.4 years), more often Muslim (90.7% vs. 86.2%), less schooled (5.4 vs. 6.8 grades), and more often had husbands (27.0% vs. 19.6%) and mothers (63.2% vs. 50.5%) without schooling. Participants and non-participants had similar unadjusted mean scores for prior-week depressive symptoms, prior-year IPV, and intrinsic attitudinal agency (gender-equitable attitudes; non-justification of wife beating). Participants had higher unadjusted mean scores for intrinsic voice/mobility; instrumental agency (using financial services, voice with husband, voice/mobility outside home); and collective agency. Average adjusted treatment effects were non-significant for depressive symptoms, IPV, and attitudinal intrinsic agency, and significantly favorable for other agency outcomes.ConclusionsMicrofinance participation had no adverse health effects and favorable empowerment effects in Bangladeshi wives.Policy implicationsMicrofinance can empower women without adverse health effects. Social-norms programming with men and women may be needed to change gendered expectations about the distribution of unpaid labor and the rights of women.
| S-EPMC7962741 | biostudies-literature
Project description:In India, "non-notified" slums are not officially recognized by city governments; they suffer from insecure tenure and poorer access to basic services than "notified" (government-recognized) slums. We conducted a study in a non-notified slum of about 12,000 people in Mumbai to determine the prevalence of individuals at high risk for having a common mental disorder (i.e., depression and anxiety), to ascertain the impact of mental health on the burden of functional impairment, and to assess the influence of the slum environment on mental health. We gathered qualitative data (six focus group discussions and 40 individual interviews in July-November 2011), with purposively sampled participants, and quantitative data (521 structured surveys in February 2012), with respondents selected using community-level random sampling. For the surveys, we administered the General Health Questionnaire-12 (GHQ) to screen for common mental disorders (CMDs), the WHO Disability Assessment Schedule 2.0 (WHO DAS) to screen for functional impairment, and a slum adversity questionnaire, which we used to create a composite Slum Adversity Index (SAI) score. Twenty-three percent of individuals have a GHQ score≥5, suggesting they are at high risk for having a CMD. Psychological distress is a major contributor to the slum's overall burden of functional impairment. In a multivariable logistic regression model, household income, poverty-related factors, and the SAI score all have strong independent associations with CMD risk. The qualitative findings suggest that non-notified status plays a central role in creating psychological distress-by creating and exacerbating deprivations that serve as sources of stress, by placing slum residents in an inherently antagonistic relationship with the government through the criminalization of basic needs, and by shaping a community identity built on a feeling of social exclusion from the rest of the city.
| S-EPMC4252879 | biostudies-literature
Project description:This paper explores reproductive decision-making among young women in South Africa's informal settlements and considers whether and how agency and social norm theory inform their decisions. Understanding whether, when and how young women make decisions about conception and motherhood is critical for supporting women to avoid unplanned, early motherhood. Qualitative data were collected from 15 young women in informal settlements in eThekwini, South Africa at three time points over 18 months, using in-depth interviews, participant observation and photovoice, and were analysed inductively. When the young women were teenagers and into their early twenties, and had not yet had a child, most paid little attention to whether or not they conceived. This shifted as they grew older and/or after having a first child, at which point many of the women began to express, and sometimes act upon, a greater desire to control whether and when they conceived and delay further pregnancies. At different times in their lives, both social norms and reproductive agency, specifically 'distributed agency' played significant roles in influencing their reproductive decision-making. Social norms held the most influence when they were teenagers and experiencing normative pressures to have a baby while young. As they grew older and/or had a first child they began to assert some agentic control around their reproduction. We therefore recommend that in order to improve the effectiveness of services and interventions supporting young women to delay unplanned pregnancies, programmers, researchers and policy makers must develop a better understanding of the role of social norms and agency at different stages of women's lives.
| S-EPMC7190118 | biostudies-literature
Project description:In India, globalization has caused a nutrition transition from home-cooked foods to processed sugary snacks and drinks, contributing to increased early childhood caries (ECC). This mixed-methods study describes risk factors for ECC and associations with undernutrition in low-income communities in Mumbai. Interviews with mothers of 959 children, ages six-months through six-years, addressed maternal-child nutrition and oral health, and children received dental exams and anthropometric assessments. Focus groups with community health workers and mothers explored experiences and perceptions of oral health, nutrition, and ECC. Descriptive and logistic regression analyses of quantitative data, and content analysis of qualitative data were performed. Eighty percent of children lived 5 min from a junk-food store, over 50% consumed junk-food and sugary tea daily, 50% experienced ECC, 19% had severe deep tooth decay, 27% experienced mouth pain, and 56% experienced chronic and/or acute malnutrition. In children ages 3-6, each additional tooth with deep decay was associated with increased odds of undernutrition (Odds Ratio [OR] 1.10, Confidence Interval [CI] 1.02-1.21). Focus groups identified the junk-food environment, busy family life, and limited dental care as contributors to ECC. Policy interventions include limits on junk-food marketing and incorporating oral health services and counseling on junk-food/sugary drinks into maternal-child health programs.
| S-EPMC7699964 | biostudies-literature
Project description:In disadvantaged neighborhoods such as informal settlements (or "slums" in the Indian context), infrastructural deficits and social conditions have been associated with residents' poor mental health. Within social determinants of health framework, spatial stigma, or negative portrayal and stereotyping of particular neighborhoods, has been identified as a contributor to health deficits, but remains under-examined in public health research and may adversely impact the mental health of slum residents through pathways including disinvestment in infrastructure, internalization, weakened community relations, and discrimination. Based on analyses of individual interviews (n = 40) and focus groups (n = 6) in Kaula Bandar (KB), an informal settlement in Mumbai with a previously described high rate of probable common mental disorders (CMD), this study investigates the association between spatial stigma and mental health. The findings suggest that KB's high rate of CMDs stems, in part, from residents' internalization of spatial stigma, which negatively impacts their self-perceptions and community relations. Employing the concept of stigma-power, this study also reveals that spatial stigma in KB is produced through willful government neglect and disinvestment, including the denial of basic services (e.g., water and sanitation infrastructure, solid waste removal). These findings expand the scope of stigma-power from an individual-level to a community-level process by revealing its enactment through the actions (and inactions) of bureaucratic agencies. This study provides empirical evidence for the mental health impacts of spatial stigma and contributes to understanding a key symbolic pathway by which living in a disadvantaged neighborhood may adversely affect health.
| S-EPMC10358916 | biostudies-literature
Project description:This study looks into the socio-physical liveability through socio-spatiality in low-income settlement archetypes. Paradoxically, recently mushrooming slum rehabilitation housing which have delivered secured tenure to its inhabitants, face threats of being deserted from lack of socio-physical liveability. Recurring of informality issues has advocated to investigate the reasons behind the 'rebound' phenomenon. This study explores the efficacy of socio-spatiality and its linkages with socio-physical liveability, taking Mumbai slum rehabs as case study. A comparative analysis of the current built-environment indicators and liveability status of major informal archetypes was performed, followed by analyses of the socio-physical problems associated with it. A critical evaluation of the rehabilitation housing of Mumbai highlights the problems caused by the current dense built-environment design. Reflecting on global instances, this article demonstrates the significance of socio-spatiality and suggests environmentally sustainable indicator-based built-environment recommendations, which if implemented in the forthcoming slum rehab housing planning, would enhance well-being and liveability among the low-income sector in future. While analysing the 'rebound' phenomenon, this study delivered a heuristics of socio-physical liveability, built-environment and their respective indicators. This method would aid the architects, planners and policymakers in reshaping the forth-coming built-environment while safeguarding the socio-physical liveability of the low-income sector.
| S-EPMC7305060 | biostudies-literature
Project description:Background: Public-private interface agency (PPIA) intervention models in Patna (E. India) and Mumbai (W. India) for pulmonary drug-sensitive (DS) tuberculosis (TB) patients were evaluated over 2 years after maturity to examine effect on reduction of patient pathways and retention. The models engaged private providers, diagnostic facilities and pharmacies into an effective network providing free diagnostic tests and treatment. Methods: A population-based retrospective study was undertaken to assess effectiveness of the PPIA model in care pathways of 64 (Patna) and 86 (Mumbai) patients through in-depth interviews conducted within 6 months of initiation treatments to identify types and facilities accessed, duration to diagnosis and treatment. Median durations based on facilities accessed were statistically analysed. Comparisons were made with baseline values and endline pathways of patients accessing PPIA engaged/non-engaged facilities in private and public sectors. Results: Compared to non-engaged facilities, persons accessing engaged facilities at first point-of-care had shorter pathways (Mumbai: 32 vs 43 days), (Patna: 15 vs 40 days). Duration for first care-seeking was considerably shorter for patients accessing PPIA in Patna and for both engaged and non-engaged private facilities in Mumbai (4 days). Whilst PPIA engaged facilities diagnosed more cases than others, the RNTCP in Mumbai provided diagnosis early. There was good retention of patients by PPIA-engaged (1 st) facilities (90% post-diagnosis in Patna) but this was affected by the hub-spoke referral system in Mumbai (13%). Second diagnosis is a common feature in Mumbai. The spoke-hub model in Mumbai contributed considerably to treatment delay; PPIA-engaged providers were better at retaining patients post treatment initiation 11/25 (44%). Conclusion: PPIA-engaged facilities, accessed at onset, result in marked reduction in pathway durations. Such initiatives should engage a critical mass of competent providers, proximal investigation facilities with enhanced disease awareness and literacy efforts amongst communities. Patient movement should be minimized for early treatment and retention.
| S-EPMC7221294 | biostudies-literature
Project description:Live streaming is a unique form of media that creates a direct line of interaction between streamers and viewers. While previous research has explored the social motivations of those who stream and watch streams in the gaming community, there is a lack of research that investigates intimate self-disclosure in this context, such as discussing sensitive topics like mental health on platforms such as Twitch.tv. This study aims to explore discussions about mental health in gaming live streams to better understand how people perceive discussions of mental health in this new media context. The context of live streaming is particularly interesting as it facilitates social interactions that are masspersonal in nature: the streamer broadcasts to a larger, mostly unknown audience, but can also interact in a personal way with viewers. In this study, we interviewed Twitch viewers about the streamers they view, how and to what extent they discuss mental health on their channels in relation to gaming, how other viewers reacted to these discussions, and what they think about live streams, gaming-focused or otherwise, as a medium for mental health discussions. Through these interviews, our team was able to establish a baseline of user perception of mental health in gaming communities on Twitch that extends our understanding of how social media and live streaming can be used for mental health conversations. Our first research question unraveled that mental health discussions happen in a variety of ways on Twitch, including during gaming streams, Just Chatting talks, and through the stream chat. Our second research question showed that streamers handle mental health conversations on their channels in a variety of ways. These depend on how they have built their channel, which subsequently impacts how viewers perceive mental health. Lastly, we learned that viewers' reactions to mental health discussions depend on their motivations for watching the stream such as learning about the game, being entertained, and more. We found that more discussions about mental health on Twitch led to some viewers being more cautious when talking about mental health to show understanding.
| S-EPMC8007960 | biostudies-literature
Project description:Organ transplantation has become an effective means to extend lives; however, a major obstacle is the lack of availability of cadaveric organs. India has one of the lowest cadaver organ donation rates in the world. If India could increase the donor rate, the demand for many organs could be met. Evidence from high-income countries suggests that an organ donor registry can be a valuable tool for increasing donor rates. The purpose of this study is to determine whether the implementation of an organ donor registry is a feasible and appropriate policy option to enhance cadaver organ donation rates in a lower-income country.This qualitative policy analysis employs semi-structured interviews with physicians, transplant coordinators, and representatives of organ donation advocacy groups in Mumbai. Interviews were designed to better understand current organ donation procedures and explore key informants' perceptions about Indian government health priorities and the likelihood of an organ donor registry in Mumbai. The 3-i framework (ideas, interests, and institutions) is used to examine how government decisions surrounding organ donation policies are shaped.Findings indicate that organ donation in India is a complex issue due to low public awareness, misperceptions of religious doctrines, the need for family consent, and a nation-wide focus on disease control. Key informants cite social, political, and infrastructural barriers to the implementation of an organ donor registry, including widely held myths about organ donation, competing health priorities, and limited hospital infrastructure.At present, both the central government and Maharashtra state government struggle to balance international pressures to improve overall population health with the desire to also enhance individual health. Implementing an organ donor registry in Mumbai is not a feasible or appropriate policy option in India's current political and social environment, as the barriers, identified through the 3-i framework lens, may be too difficult to overcome. Despite the evidence supporting the use of donor registries as a means to enhance organ donation rates, it is clear that context is critical and that it is not always practical to apply evidence-based policy solutions from high-income countries to lower-income settings.
| S-EPMC4712496 | biostudies-other