‘Pregnancy Has Its Advantages’: The Voices of Street Connected Children and Youth in Eldoret, Kenya

Objective

Little is known about the reproductive health or family planning needs of street-connected children and youth in resource-constrained countries. The study objective was to describe how street-connected children and youth (SCCY) in Eldoret, Kenya, perceive pregnancy.

Methods

This qualitative study was conducted between August 2013 and February 2014. A total of 65 SCCY aged 11–24 years were purposively sampled from the three referral points: 1) A dedicated study clinic for vulnerable children and youth at Moi Teaching and Referral Hospital (MTRH); 2) Primary locations in which street children reside known as “bases/barracks”; and 3) Street youth community-based organizations. In-depth interviews and focus group discussions were audio recorded, transcribed, and translated into English. Content analysis was performed after thematic coding by 4 independent coders.

Results

The majority of SCCY interviewed were male (69%) and sexually active (81.5%). None had gone beyond primary level of education. The strong desire for SCCY to go through conventional life experiences including marriage and child bearing was evident. Sub-themes around desired pregnancies included: sense of identity with other SCCY, sense of hope, male ego, lineage, source of income, and avoiding stigmatization. The desire for children was highly gendered with male SCCY more focused on their social status in the street community, while for females it was primarily for survival on the street. Female SCCY generally lacked agency around reproductive health issues and faced gender-based violence. Abortions (either assisted or self-induced), infanticide, and child abandonment were reported. Respondents described a lucrative market for babies born to SCCY and alleged that healthcare workers were known to abduct these babies following hospital deliveries.

Conclusion

Our findings indicate gender differences in the reasons why SCCY become pregnant and have children. We also noted gender inequalities in reproductive health decisions. SCCY friendly interventions that provide tailored reproductive health services are needed.

Full article at:   http://goo.gl/3F7Dwx

By:  

Juddy Wachira, Violet Naanyu, Paula Braitstein 
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

Allan Kamanda 

Moi Teaching and Referral Hospital, Eldoret, Kenya

Lonnie Embleton, Paula Braitstein 

Dalla Lana School of Public Health, University of Toronto, Ontario, Canada

Violet Naanyu, David Ayuku, Paula Braitstein 

College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya

Paula Braitstein 

Indiana University, Fairbanks School of Public Health, Department of Epidemiology, Indianapolis, Indiana, United States of America

Paula Braitstein 

Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America

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Social & Behavioural Factors in Non-Suspicious Unexpected Death in Infancy; Experience from Metropolitan Police Project Indigo Investigation

Background

Risk factors for Sudden Unexpected Death in Infancy (SUDI) are well described, and such cases are now investigated according to standard protocols. In London, Project Indigo of the Metropolitan Police provides a unique, detailed framework for such data collection. We investigate such data to provide a contemporary account of SUDI in a large city and further link data to publically available datasets to investigate interactions with social factors.

Methods

Retrospective analysis of data routinely collected by the Metropolitan Police Service in all cases of non-suspicious SUDI deaths in London during a six year period.

Results

SUDI deaths are associated with markers of social deprivation in London. A significant proportion of such deaths are associated with potentially modifiable risk factors such as cigarette smoking and co-sleeping, such behaviour also being associated with social factors, including accommodation issues.

Conclusions

Routinely collected data provide valuable insight into patterns and associations of mortality, with SUDI remaining a significant issue in London. Risk factors include social disadvantage, which may manifest in part by affecting behavioural patterns such as co-sleeping and public health interventions to reduce rates require significant social modification.

Below:  Number of deaths occurring each calendar month amongst 477 individuals aged less than two years dying in the Metropolitan police area between 2005 and 2010

Below:   Number of deaths occurring each calendar month amongst 477 individuals aged less than two years dying in the Metropolitan police area between 2005 and 2010, divided into explained and unexplained deaths

Below:  Deaths amongst 477 individuals aged less than two years dying in the Metropolitan police area between 2005 and 2010 arranged by Deprivation level

Below:  Characteristics of Co-sleeping on the occasion of death of 477 individuals aged less than two years dying in the Metropolitan police area between 2005 and 2010. a Co-sleeping ratio and deprivation: Deaths associated with co-sleeping in each Deprivation group (Indices of Multiple Deprivation Score Rank for Lower Layer Super Output Areas (LSOAs)) divided by the total number of deaths in that deprivation group. b Location of co-sleeping. c Individuals co-sleeping. d Reason given for co-sleeping

Full article at:   http://goo.gl/90L3ar

By:  Andrew R. Bamber, Liina Kiho, Sam Upton, Michael Orchard, and Neil J. Sebire

Department of Paediatric Pathology, Camelia Botnar Laboratories, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH UK

Institute of Child Health, University College London, London, UK

Specialist Crime and Operations, SCO17, Metropolitan Police Service, London, UK

Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK

Andrew R. Bamber, Email: ku.ca.lcu@rebmab.a.

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From Right to Sin: Laws on Infanticide in Antiquity

This is the first of three papers investigating changes in infanticide legislation as indicators of the attitude of states towards the neonate. 

In ancient East Asian societies in which the bride's family had to pay an excessive dowry, selective female infanticide was the rule, despite formal interdiction by the law. 

In Greece and Rome children's lives had little value, and the father's rights included killing his own children. 

The proportion of men greatly exceeding that of women found in many cultures and epochs suggests that girls suffered infanticide more often than boys. A kind of social birth, the ritual right to survive, rested on the procedure of name giving in the Roman culture and on the start of oral feeding in the Germanic tradition. 

Legislative efforts to protect the newborn began with Trajan's 'alimentaria' laws in 103 CE and Constantine's laws following his conversion to Christianity in 313 CE. 

Malformed newborns were not regarded as human infants and were usually killed immediately after birth. Infanticide was formally outlawed in 374 CE by Emperor Valentinian.

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By:  Obladen M1.

• 1Department of Neonatology, Charité - University Medicine Berlin, Berlin, Germany. 

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From Sin to Crime: Laws on Infanticide in the Middle Ages

This is the second of three papers investigating the legislative history concerning infanticide. It compares the efforts of various states to protect the newborn infant between 534 and 1532 CE. 

When the Roman Empire collapsed in the 5th century, the jurisdiction of infanticide was relegated to the church, which regarded carnal delicts a sin rather than a crime. The punishment - public penance of the mother for 7-15 years - was milder than that which the murder of an adult would incur. 

The Council of Florence decreed in 1439 that the souls of children who died without having been baptized descend to hell. This turned infanticide from a penitential sin to the most heinous of all crimes. The states passed laws that abominated infanticide even more than the murder of older humans and punished women with ever more cruel forms of execution. Towards the men, however, who usually abandoned the women they had impregnated, the laws were lenient. Churches and society continued to vilify illegitimate birth, thus enhancing rather than preventing infanticide. 

The Habsburg-German legislation of 1532 ordained to torture any woman who had concealed pregnancy and birth and claimed the infant was stillborn. Legislation developed similarly in other countries, albeit at a different speed. 

French (1556) and British (1623) legislation reversed the burden of proof and demanded the death penalty for concealing pregnancy and birth when a dead infant was found.

Purchase full article at:  http://goo.gl/vubgXX

By:  Obladen M1.

• 1Department of Neonatology, Charité - University Medicine Berlin, Berlin, Germany. 

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