Individual and Population Perspectives on Sexual and Reproductive Health in Low and Middle Income Countries

Abstract

This dissertation consists of three papers that explore the social determinants of several sexual and reproductive health outcomes in low and middle income countries. Together, these three papers employ a range of quantitative and qualitative methodologies, and exploit unique datasets to reveal new insight into these topics. The first study presents the results of a qualitative study conducted in Monrovia, Liberia among boys and girls aged 15-17 years living in two urban slums in Monrovia, Liberia. The purpose of this study is to better understand how intrapersonal, interpersonal, family and community factors that shape adolescents’ risk for early sexual initiation and pregnancy or fatherhood. The results of the study point toward the need to elicit youth participation in order to develop an understanding of risk environment that adolescents face, and to the importance of up-stream interventions to improve health outcomes among this vulnerable population. The second paper uses multilevel analysis to explore the residual variance in early adolescent childbearing across 44 low and middle income countries using nationally-representative data. Examining the ecological influences on health outcomes is an area of emerging importance in social science and global health research. This paper is the first to use this approach to quantify the variance in adolescent childbearing at the community and country-level. The results indicate that higher-level social, political, and economic determinants at the country and community levels may influence adolescent childbearing. The third paper in this series explores a chronically understudied area of critical importance to women’s health in low and middle income countries – perinatal mental health. By using data from Ethiopia, India and Vietnam, the results of this paper provide a cross-country comparative perspective that highlights both the heterogeneity and similarities observed. This paper is one of the few papers to explore how socioeconomic adversity, including economic disadvantage and exposure to stressful life events during the prenatal period, relates to the presence of common perinatal mental disorders. While the underlying causes of socioeconomic adversity may be difficult to modify through intervention, this paper examines the potential role of social capital as a way to foster resilience.