Background Internal migration is an important part of the transition to adulthood for many young people in sub-Saharan Africa. This study examines how migration, in relation to marriage and parenthood, impacts modern contraceptive use and health facility visits amongst young urban women. Methods We draw on Performance Monitoring for Action (PMA) surveys conducted in Burkina Faso, Côte d’Ivoire, Democratic Republic of Congo, Kenya, Nigeria, and Uganda (2019–2022). Our analysis is unique in being able to adjust for whether women wanted to get pregnant soon. Our sample includes women ages 15–24 years currently residing in urban areas (n = 6,225). We conducted logistic regression models clustered by village level identifier to explore the sequence of life events and the timing of migration in relation to current modern contraceptive use and recent health facility visit, a proxy for engagement with formal health services. Results The timing of migration matters more than the sequence of these life events. Young urban women who experienced both migration and a birth, regardless of the order, had increased contraceptive use and recent health facility visit, compared to women who had only experienced one event or neither. Young women who migrated in the past year had 24% lower odds of using a modern method (Odds Ratio = 0.76; 95% confidence interval 0.63, 0.91), adjusting for demographic factors and adjusting for fertility preference (Wanting to get pregnant soon). Having had a birth was highly significant for health facility visit and among women who had had a birth, those who migrated in the last year had lower odds of a recent visit (OR = 0.68, 95% CI 0.41, 0.89). Results suggest an initially disruptive effect of migration. Discussion Our results suggest young women who recently migrated to urban areas may need additional support in accessing contraception and formal health services for themselves or their children.

Women in Africa may have experienced conflicting pressures during the COVID-19 pandemic. While the unpredictable nature of the pandemic was prompting some women to delay pregnancies, the pandemic was potentially limiting access to reproductive health services due to supply shortages, fears of virus exposure, and mobility restrictions. In this study, we used longitudinal data from Kenya and Burkina Faso and applied a multilevel perspective to better understand the factors contributing to change or persistence in contraceptive use during the early months of the pandemic. We found a marginal increase in contraceptive uptake in the early days of the pandemic. Multilevel logistic regression results revealed that interpersonal trust and accurate knowledge of COVID-19 precautions were associated with a greater likelihood of initiating contraception. These factors appeared to have provided women with confidence to navigate the complicated COVID-19 landscape. At the same time, we observed a decrease in contraceptive use in regions with high COVID-19 cases, suggesting the virus was limiting access to contraception in some contexts. These findings highlighted the need for public health officials to ensure that women have the necessary knowledge and ability to safely access contraception during public health crises, when overall demand for contraception may be increasing.

Niger is highly vulnerable to rainfall variability, often with adverse socioeconomic consequences. This study examined observed subseasonal rainfall variability during Niger’s monsoon season (May to September). Using k-means clustering of dekadal (ten-day) rainfall, a typology was developed for the annual evolution of the monsoon season. Year-to-year rainfall variability for each of the first few dekads of the season is modest, but the middle, or peak of the rainy season demonstrates large interannual variability. Clustering analysis of annual timeseries for each dekad of the season revealed two types of monsoon progression. The distinction between the two types is strongly dependent on differences during the latter half of the season. For the first and third ten-day periods in August, and the first ten days in September, the two groups of years are more distinct. These results imply that while reliable prediction of the timing of anomalous onsets will be challenging, due to the relatively narrow range of uncertainty historically, there are opportunities for further exploration of dynamic and or statistical predictors or precursors using this typology that could potentially provide better information for decision-makers, especially with respect to agriculture.

Although more than half of the world’s population lives in urban areas, there is a dire lack of data on trade, cost, and origin of the food that the urban dwellers rely on. Understanding the impact of escalating water-food systems variability on urban quality of life is critical for designing data systems needed to implement appropriate policies and state-supported interventions in urban areas.

The Trump administration reinstated and expanded the Mexico City Policy (MCP) in 2017 as the Protecting Life in Global Health Assistance (PLGHA) policy, forbidding international organizations recei...

In the context of global warming, individuals may, in their lifetimes, experience the gradual increase in average warming and drying conditions, repeated extreme weather events, or small but significant shifts in seasonal precipitation and temperature. Individual-...

Seasonal shifts in community-level agricultural production and their impact on the severity of the annual hunger season and household coping behaviors are important themes in climate change–health ...

Agricultural production and household food security are hypothesized to play a critical role connecting climate change to downstream effects on women's health, especially in communities dependent on rainfed agriculture. Seasonal variability in agriculture strains food and income resources and makes it a challenging time for households to manage a pregnancy or afford a new child. Yet, there are few direct assessments of the role locally varying agricultural quality plays on women's health, especially reproductive health. In this paper we build on and integrate ideas from past studies focused on climate change and growing season quality in low-income countries with those on reproductive health to examine how variation in local seasonal agricultural quality relates to childbearing goals and family planning use in three countries in sub-Saharan Africa: Burkina Faso, Kenya, and Uganda. We use rich, spatially referenced data from the Performance Monitoring for Action (PMA) individual surveys with detailed information on childbearing preferences and family planning decisions. Building on recent advances in remote monitoring of seasonal agriculture, we construct multiple vegetation measures capturing different dimensions of growing season conditions across varying time frames. Results for the Kenya sample indicate that if the recent growing season is better a woman is more likely to want a child in the future. In Uganda, when the growing season conditions are better, women prefer to shorten the time until their next birth and are also more likely to discontinue using family planning. Additional analyses reveal the importance of education and birth spacing in moderating these findings. Overall, our findings suggest that, in some settings, women strategically respond to growing season conditions by adjusting fertility aspirations or family planning use. This study also highlights the importance of operationalizing agriculture in nuanced ways that align with women's lives to better understand how women are impacted by and respond to seasonal climate conditions.

This study examines how trust was associated with social distancing during the early days of the COVID-19 pandemic in Burkina Faso and Kenya. It fills gaps in previous research on trust and health by 1) simultaneously considering the relationship of individual- and aggregate-level indicators of trust, and 2) evaluating trust in local government and national government separately. Performance Monitoring for Action (PMA) data on COVID-precautionary measures and individual-level trust measures were spatially linked with aggregated trust data from the Afrobarometer to create a multilevel dataset. PMA data show that women in Kenya were generally more likely to report taking COVID-precautionary measures relative to Burkinabé women, although levels of these measures were high in both countries. Hierarchical logistic models for each country show levels of interpersonal trust mattered more in Burkina Faso. Although the association between individual-level trust in government and social distancing was not statistically significant, overall levels of trust in the region where an individual lived were associated with social distancing. We found a significant interaction effect between regional trust in the national government and regional trust in local government: individuals in regions where trust was high in both national and local government were the most likely to socially distance; individuals in regions with low local government trust but high national government trust were less likely to report social distancing. We unpack possible implications of these findings; they point to the importance of a unified government front within African countries in promoting health safety measures during a pandemic.

Soil moisture reflects the amount of water available to crops in the top layer of soil. As such, considering soil moisture provides important insight into water availability and ultimately crop yields in agricultural settings. In studies of climate change, food security, and health, however, soil moisture is rarely empirically considered despite its connection to crop health and yields. In this project, we aim to advance understanding of climate impacts on food security by incorporating soil moisture into quantitative models of child health. Combining spatially referenced health survey data from the Demographic and Health Surveys for 2005 and 2010 in Senegal and 2007, 2011, and 2014 in Bangladesh, with soil moisture data from the Famine Early Warning System Network Land Data Assimilation System, we explore the linkages between sub-annual and sub-seasonal climate conditions and child malnutrition in two rainfed agriculture dependent countries—Bangladesh and Senegal. Results suggest that soil moisture, measured on very short time scales, may be associated with reductions in anthropometric weight-for-height z-scores, but the relationship is highly dependent upon geographic context.

Abstract: Prior evidence suggests an association among food insecurity, poor health, and increased health care spending. In this study, we are using a natural experiment to confirm if longer participation in the Supplemental Nutrition Assistance Program (SNAP) is associated with reduced Medicaid among a highly impoverished group of adults. In 2013, the mandatory work requirements associated with SNAP benefits were lifted for able-bodied adults without dependents (ABAWDs). Using 2013 to 2015 Medicaid and SNAP data of 24,181 Minnesotans aged 18-49, we examined if changes in SNAP enrollment duration affect health care expenditures. In fully adjusted within-participant regression models, for each additional month of SNAP, average annual health care spending was $98.8 lower (95% CI: -131.7, -66.0; p<.001) per person. Our data suggests that allowing ABAWDs to receive SNAP even in months they are not working may be critical to their health as well as cost-effective.

Higher perceived social support has been shown to buffer the impact of negative stressful events like childhood abuse on health outcomes. Yet, the role of perceived social support as a mediator of the association between childhood abuse and pain-related characteristics is not well understood. The present study explored this premise. Patients (n = 1,542) presenting to a tertiary-care, outpatient pain clinic completed a cross-sectional survey consisting of regularly collected clinical data and validated measures. Path analysis suggested that the impact of childhood abuse on sensory and affective pain-related characteristics was partially explained by perceived emotional support. Survivors of childhood abuse display a more complex clinical pain phenotype and this extends to more negative perceptions of social support. Our findings may reflect processes whereby childhood abuse negatively impacts social relationships across the lifespan, and these negative social perceptions and relationships influence sensory and affective components of pain.

The COVID-19 pandemic ushered in a bereavement crisis unparalleled in a generation, with devastating consequences for the mental health of those who lost a loved one to the virus. Using national su...

Acute malnutrition affects a sizeable number of young children around the world, with serious repercussions for mortality and morbidity. Among the top priorities in addressing this problem are to anticipate which children tend to be susceptible and where and when crises of high prevalence rates would be likely to arise. In this article, we highlight the potential role of conflict and climate conditions as risk factors for acute malnutrition, while also assessing other vulnerabilities at the individual- and household-levels. Existing research reflects these features selectively, whereas we incorporate all the features into the same study. The empirical analysis relies on integration of health, conflict, and environmental data at multiple scales of observation to focuses on how local conflict and climate factors relate to an individual child’s health. The centerpiece of the analysis is data from the Demographic and Health Surveys conducted in several different cross-sectional waves covering 2003–2016 in Kenya, Nigeria, and Uganda. The results obtained from multi-level statistical models indicate that in Kenya and Nigeria, conflict is associated with lower weight-for-height scores among children, even after accounting for individual-level and climate factors. In Nigeria and Kenya, conflict lagged 1–3&nbsp;months and occurring within the growing season tends to reduce WHZ scores. In Uganda, however, weight-for-height scores are primarily associated with individual-level and household-level conditions and demonstrate little association with conflict or climate factors. The findings are valuable to guide humanitarian policymakers and practitioners in effective and efficient targeting of attention, interventions, and resources that lessen burdens of acute malnutrition in countries prone to conflict and climate shocks.

Individuals living in every region of the world are increasingly vulnerable to negative health outcomes due to extreme heat exposure. Children, in particular, may face long-term consequences associated with heat stress that affect their educational attainment and later life health and well-being. Retrospective individual-level analyses are useful for determining the effects of extreme heat exposure on health outcomes. Typically, future risk is inferred by extrapolating these effects using future warming scenarios that are applied uniformly over space and time without consideration of topographical or climatological gradients. We propose an alternative approach using a stochastic weather generator. This approach employs a 1 °C warming scenario to produce an ensemble of plausible future weather scenarios, and subsequently a distribution of future health risks. We focus on the effect of global warming on fetal development as measured by birth weight in Ethiopia. We demonstrate that predicted changes in birth weight are sensitive to the evolution of temperatures not quantified in a uniform warming scenario. Distributions of predicted changes in birth weight vary in magnitude and variability depending on geographic and socioeconomic region. We present these distributions alongside results from the uniform warming scenario and discuss the spatiotemporal variability of these predicted changes.

We examine the relationships between climatic conditions, breastfeeding behavior, and maternal time use in Ethiopia. Infant feeding practices are important predictors of child nutrition that may be affected by a number of factors including mother’s time engaging in agricultural labor, food security, cultural beliefs, and antenatal care. We use panel data from the Living Standards Measurement Study to investigate linkages between climatic conditions during a child’s first year of life and year prior to birth and duration of exclusive breastfeeding. We then explore one potential mechanism: women’s agricultural labor. Results indicate that rainfall during the primary agricultural season—kiremt—in a child’s first year of life plays an important role in duration of exclusive breastfeeding. Experiencing 25 cm of average monthly kiremt rainfall, versus 5 cm, is associated with a 20-percentage-point decrease in the likelihood of being exclusively breastfed for the recommended 6 months. More kiremt rainfall is associated with a greater number of days that women spend planting and harvesting, and at high levels of rainfall women with infants do not engage in significantly fewer days of agricultural labor than those without infants. Lastly, we find that during the year before birth, greater rainfall during kiremt as well as the dry season is associated with a lower likelihood of 6 months of exclusive breastfeeding, potentially due to the early introduction of complementary foods. Our findings indicate that agricultural labor demands may in part drive breastfeeding behaviors, leading to “sub-optimal” feeding practices in the short-term, but resulting in improved household food security in the longer-term.

In this project we consider the ways that different livelihood strategies impact the climate-health linkage. Specifically, we build on knowledge of livestock mobility in the Sahel and use remotely sensed-based measures of waterholes with health survey data to investigate the linkages between child health outcomes related to food security. We focus on the landscape characteristics relevant to limitedly studied, but highly climate-vulnerable populations, pastoralists and agro-pastoralists in the Sahel. We combine remotely sensed-based data on surface waterholes and spatially referenced health survey data and use flexible regression modeling techniques to uncover the quantitative relationship between waterhole depth and a child’s height-for-age z-score (HAZ). The results suggest that the water depth level of nearby waterholes does indeed impact a child’s HAZ, even after accounting for other environmental factors. This relationship is impacted, however, by the livelihood practices of the area as well as by the source of household drinking water.

Increased exposure to extreme heat from both climate change and the urban heat island effect—total urban warming—threatens the sustainability of rapidly growing urban settlements worldwide. Extreme heat exposure is highly unequal and severely impacts the urban poor. While previous studies have quantified global exposure to extreme heat, the lack of a globally accurate, fine-resolution temporal analysis of urban exposure crucially limits our ability to deploy adaptations. Here, we estimate daily urban population exposure to extreme heat for 13,115 urban settlements from 1983 to 2016. We harmonize global, fine-resolution (0.05°), daily temperature maxima and relative humidity estimates with geolocated and longitudinal global urban population data. We measure the average annual rate of increase in exposure (person-days/year−1) at the global, regional, national, and municipality levels, separating the contribution to exposure trajectories from urban population growth versus total urban warming. Using a daily maximum wet bulb globe temperature threshold of 30 °C, global exposure increased nearly 200% from 1983 to 2016. Total urban warming elevated the annual increase in exposure by 52% compared to urban population growth alone. Exposure trajectories increased for 46% of urban settlements, which together in 2016 comprised 23% of the planet’s population (1.7 billion people). However, how total urban warming and population growth drove exposure trajectories is spatially heterogeneous. This study reinforces the importance of employing multiple extreme heat exposure metrics to identify local patterns and compare exposure trends across geographies. Our results suggest that previous research underestimates extreme heat exposure, highlighting the urgency for targeted adaptations and early warning systems to reduce harm from urban extreme heat exposure.

This study investigates how two aspects of agricultural production diversity – farm production diversity and composition of production – relate to child height-for-age and weight-for-height in Ethiopia. We use longitudinal data on child anthropometric measurements, household farm production diversity and farm production composition from the Ethiopia Socioeconomic Survey for 2011, 2013, and 2015 available through the World Bank. Using longitudinal fixed effects models, we show that an increase in farm production diversity reduces the risk of chronic food insecurity (child height-for-age) but has no impact on acute measures of food insecurity (child weight-for-height). Results also suggest that, in a context of poor rainfall, more diversity in farm production can adversely impact child height-for-age, although livestock sales might mitigate that detrimental effect. These findings highlight the importance of considering the relationship between farm-level food production and child nutrition in a context of climate change.