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Page 1: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Parallel Session:

Resilience from an international perspective

Facilitator

Maja Haals Brosnan

131

Page 2: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Zambian Perspectives

A participatory contextualisation of youth civic engagement (YCE) from both youth and adult Zambian perspectives

Sheila McArdle

Galway Mayo Institute of Technology

132

Page 3: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

S H E I L A M C A R D L E

B U I L D I N G R E S I L I E N C E , E N H A N C I N G S O C I A L S U P P O R T : W H A T R E S E A R C H T E L L S U S

T U E S D A Y , 6 T H D E C E M B E R 2 0 1 6

C R I N N I

D U B L I N

ZAMBIAN PERSPECTIVES: A PARTICIPATORY CONTEXTUALISATION OF YOUTH CIVIC

ENGAGEMENT FROM BOTH YOUTH AND ADULT ZAMBIAN PERSPECTIVES

Page 4: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

INTRODUCTION

• Overview of the research design and methodology

• Mis-match between adult and youth

understandings of Youth Civic Engagement

• Insights into resilience and risks embedded within

the daily lives of young people within the cultural

context

• Resilience and Youth Civic Engagement

• Questions and answers

Page 5: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

CULTURAL COMPETENCY NORTHERN – SOUTHERN DYNAMICS

• Northern understandings of resilience and risk may

be inappropriate in other cultural contexts…(Ungar, et.al. 2007; Serpell and Jere-Folotiya, 2008)

• The challenge is to create processes which

facilitate the voices of young people to be heard.

Essentially without de-stabilising the very culture that

sustains them in their context.(Mason & Bolzan, 2010, p.136).

Page 6: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

CULTURAL COMPETENCY

• Deference by young people to elders

• Adults main decision-makers

• Gender power imbalances

• Collective communities

• Tribes – 73 different ethnic groups (Translator)

Page 7: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

RESEARCH CONTEXT

Country Zambia,

Central Africa

• Geographical

boundaries

• Lusaka

• Western Province

• Southern Province

Page 8: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

PARTICIPANTS

• Total of six study

sites

• One urban

• One rural

• A total of 68 adults (18 year of age and above)

• A total of 80 young

people (12, 13 and 14

years of age)

Page 9: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

RESEARCH AIM AND OBJECTIVE

Aim: To examine Zambian youth and adult

perspectives of Youth Civic Engagement (YCE).

Objectives:

• To establish local understanding of YCE

• To locally define risk and resilience factors

• To identify risk and resilience factors in relation to

YCE

• To identify resilience factors perceived to be

associated with YCE

Page 10: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

RESEARCH METHODOLOGY TWO STRANDED APPROACH

Strand one: Mapping of Existing

Youth Services

Strand two: Direct work with

community members through

two phases

Phase one:

Contextualisation

Phase two:

Collaborative

review

Existing data bases

Photography Reflective Journal

Page 11: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

RESEARCH PROCESS – PHASE ONE CONTEXTUALISATION

Plenary session

Young males

Adult females

Young females

Adult males

X 6 areas

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RESEARCH PROCESS – PHASE TWO COLLABORATIVE REVIEW

Findings

Young people

Adults

Researcher

X 6 areas

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ZAMBIAN DEFINITIONS OF YCE

Adult Perspective

‘Political engagement’

Youth Perspective

“You engage in not just for yourself, but for the good of others and future generations”

(Craig, YM, SS1)

Page 14: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

MIS-MATCH

• Illuminated adult and youth understandings of a

topic can be quite different.

• Lister et al., (2003 p.235) and Sanders and Munford,

(2008, p.357) both advocate that adult definitions of

YCE are often too restrictive to accommodate

young people’s understandings

• Youth understandings moved the research beyond

political engagement

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TYPES OF YOUTH CIVIC ENGAGEMENT

Civic Social Cultural Political Economic

School: Community: School: Youth: Male activities:

A member of:

Children’s council or

student council

Prefect or monitor

Children’ Rights Club

Debate Club

Science club,

Self-evaluation club

Peer groups

Caring for others

National Independence

Day celebrations

Culture club

Drama club

Poetry club

Dancing singing

Arts club

Youth pressure

groups

Street vending

Farming and labouring.

Crushing stone

Community:

Member of youth

activities, clubs,

scouts/girl guides, red

cross, Youth Alive,

Sport/school activities:

Football, netball, volleyball,

basketball, baseball,

athletics, rugby, tennis and

swimming

Community:

Initiation

ceremonies

Language

Traditional

values

Mainly Adults: Female activities in

public:

Markets, maids, farming

and prostitution

National Youth

Association

Children’s press

bureau

Sport for Action

Home-based games: Hide

and seek, snakes and

ladders, Icienga, Nsolo,

Chase or It, game, football,

chess, draughts, sigi,

padda padda and riding

bicycles

Spirituality/ faith:

Churches of

different faiths

Youth choirs.

Salvation Army

Advocacy by

churches

Female activities in the

home:

Household chores,

caring for siblings.

School:

Anti-AIDs club, Road and

transport agency – road

safety.

Evangelism,

outreach

Scripture Union

YWCA

Rural development

programmes

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Page 17: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

LOCAL DEFINITIONS OF RESILIENCE FACTORS

Adults

• Location specific

• Growing crops

• Educational

attainment

• Business acumen

• Healthy, adequate

wealth and

happiness

Young people

• Self reliance

• To be recognised as

an adult by your

community

Page 18: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

THE ‘DUAL FACTOR’

Five out of six areas named

prostitution by girls as an

activity.

“prostitution begins, poverty,

just trying to get some money, to help the family”

(Ellen, adult woman:SS5)

“ …(young women) see others wearing those nice clothes at the end of it, this person will think that let me be myself and indulge myself in prostitution in order to get clothes or in order to get enough food myself and also lack of parental care”

(Emmanuel, adult male: SS1)

“some girls do something else like going out into night clubs, going with big men, then they are given money which is bad for them. Some of the girls like money, they end up pregnant…”

(Jeff, young male: SS5)

Page 19: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Risk and Resilience Factors at the Micro Level - Individual Risk factors Resilience factors

Individual

characteristics

exacerbating

risk

Being a girl

child

Being an

orphan

A child with

a disability

Being a

street kid

Residing in a

compound

Residing in a

rural area

Peer pressure

Early school leaving

Lack of sponsorship

Examination leakage

Economic activity

Stealing

Gambling

Witchcraft and jealous

Satanism

Exposure to mass media

De-politicisation

Swimming in rivers e.g. drowning,

cholera

Bereavement and limited emotional

and psychological support

Gender specific (Female)

Prostitution

Early pregnancy

Early marriage

Rape

Mother to child transmission of HIV

Not being sent to school

Gender specific (Male)

Drug mis-use

Intrinsic

An inner wisdom

Spirituality

Knowing your own talents

Quick thinking

Extrinsic

An ability to co-operate with

others

Competent at English

Leadership to others

To know ones rights

Literacy skills

Peer pressure

Educational credentials

Economic activity

Page 20: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Risk and Resilience Factors at the Micro Level – Family

Risk Resilience

Family level Fear of speaking with parents Fear of physical punishment Parental lack of knowledge Lack of family support Limited time for parents to speak with

their children about important issues Allocation of household chores Cultural taboos prevent parents from

discussing family planning Human rights vs. traditional values Mass media

Parental support A good home Given responsibility to complete a

task A strong family line or network A positive role model within the

family Allocation of household chores Educated parents Human rights vs. traditional values

Page 21: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Risk and Resilience Factors – Meso Level - Community Risk Resilience

Communitylevel

Lack of employment Examination leakages Corruption Nepotism Tribalism Initiation ceremonies Lack of youth activities Decline of rural areas Zambian culture under threat Human rights vs. traditional values

Access to school Access to the labour market Access to youth activities Access to sporting activities Adult Community members as

mentors/role models Initiation ceremonies Peer mentors Educational credentials Caring for others Involvement in organised religion Hard work ethic Human rights vs. traditional values

Page 22: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Risk and Resilience Factors – Macro Level – Societal

Risk Resilience

Societal level Corruption Inconsistency of youth provision Lack of the right to speech Centralisation Slow implementation of existing

laws that protect children and youth

Gender inequality in the labour market

Lack of employment Exposure to mass media

Equality policy Decentralisation policy Human rights

Risk and Resilience Factors – Macro Level – Global

Global level International conventions vs. traditional values

Removal of NGO Support Government arrangements with

multi-national companies that lead to the denigration of Zambia

Brain Drain

International conventions vs. traditional values

Continent and international co-operation

Page 23: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

RESILIENCE AND EXISTING YOUTH CIVIC ENGAGEMENTS

• The education system plays a pivotal role in providing access to and provision of the majority of YCE opportunities.

• Available out-of-school YCE opportunities tend to be age restrictive catering for youth defined as fifteen to thirty-five years of age.

• Perceived lack of intelligence or lack of economic resources force some young people to leave the education system at approximately 12 years of age

• There is dearth of services targeting young people between the ages of twelve and fourteen years

Page 24: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

YOUTH CIVIC ENGAGEMENT AND RESILIENCE

• Among the six study sites it was unanimously agreed the daily lives of young people would be improved through the provision of more YCE opportunities.

• Young people who are in a position to access YCE opportunities, compared to those who are not, may acquire resilience and other social supports more readily.

• Some young people exhibited empathy and appreciation of other young people’s adaptation and self-generation of resilience within the changing social context. It should not be assumed that all young people have the capacity to create their own sources of resilience

Page 25: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

FACTORS INFLUENCING ACCESS TO RESILIENCE AND

Gender, age, location and socio-economic

background are significant factors restricting access

to the in-school and out-of-school YCE opportunities.

• A large range of social engagement opportunities

are available, but are gender biased towards males

• Religion perceived to be the most equitable YCE

opportunity in the context.

• Restricted access to political engagement

Page 26: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

POLITICAL ENGAGEMENT

Adults“the problem is with the youth, get organised to have a strong voice to reach the government to help you”

(Winston, AM, SS 6)

Pezulani: “…so now it is up to the youth to roar.”

Researcher: “Is there space for young people to do that?”

Pezulani: “Yes the space is there, we seem to be blocking their way”

(Pezulani AM SS 5)

Young people

“We want the government to listen to what we are saying because there are some issues, as children, especially for the girl child is bad, but for our voices to be heard it is not possible as we are not given the opportunity to speak out”

(Kathryn YF, SS5)

Page 27: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

CONCLUSION

The research was underpinned with cultural competency so the research methodology would enable the voices of young people and adults to be heard in the cultural context.

Through the collective research processes the views of young people widened the research beyond the adult understanding of YCE as ‘political’ to include social, cultural, economic and civic. The research dialogues provided unique insights into risk and resilience factors embedded within the daily lives of young people in Zambia.

Gender, age, location and socio-economic background are significant factors restricting access to the in-school and out-of-school YCE opportunities

It also emerged adults verbally encouraged young people to voice and engage politically, but their actions present barriers to restrict youth political engagement.

Page 28: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

REFERENCES

• Bottrell, D. (2009). Understanding ‘marginal’ perspectives. Towards a social theory of resilience. Qualitative social work (8) 321- 337

• Dolan, P., Canavan, J. & Brady, B. (2006). Connecting with practice in the changing landscape of family support training in Child Care in Practice 12 (1), 43 -51.

• Dolan, P. (2008) Prospective possibilities for building resilience in children, their families and communities. Child Care and Practice, 14 (1), 83-91.

• Husain, F. (2006). Cultural competency, cultural sensitivity and family support in Dolan, P., Canavan, J., & Pinkerton, J. (Editors) Family Support as Reflective Practice. London. Jessica Kingsley Publishers Limited.

• Ledwith, M.(2001). Community work as critical pedagogy: Re-envisioning Freire and Gramsci. Community Development Journal 36 (3), 171-182

• Mason, I. & Bozan, N. (2010). Questioning understandings of children’s participation, in Percy-Smith, B. & Thomas, N. (Editors). A handbook of children, young people’s participation. UK. Routledge

• Masten, A. (2001). Ordinary magic: Resilience processes in development. American Psychological Association. 56 (3), 227-238.

• Nsamenang, A.B.(2008). (Mis) understanding early childhood development in Africa. The force of local and global motives in Garcia, M., Pence, A.& Evans,J.(Editors). Africa’s future, Africa’s challenge. USA. The World Bank.

• Percy-Smith, B. & Thomas, N. (2010). Emerging themes and new directions in Percy-Smith, B. & Thomas, N. (Editors). A handbook of children, young people’s participation. UK. Routledge.

• Plan. (2007). Because I am a girl: The state of the world’s girls 2007. Plan UK. Plan• Serpell, R. & Jere-Folotiya, J.(2008) Developmental assessment, cultural context, gender and schooling in Zambia.

International Journal of Psychology. 43 (2) 88-96.• Ungar, M. Brown, M., Liebenberg, L. Othman, R., Kwong, M.W., Armstrong, M. & Gilgun, J. (2007). Unique pathways

to resilience across cultures. Adolescence 42 (166) 287-310.• Ungar, M. (2008) Resilience across culture. British Journal of Social Work. 38 (10), 218-235.

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“I see 6, You see 9”

A reflection on the problematic nature of applying Western child development theory in a universal fashion when providing social supports to young children accessing early

childhood education in India

Sinead Matson, Maynooth University

[email protected]

Page 30: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

https://www.linkedin.com/pulse/69-principle-power-compromise-gert-penne

Page 31: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Why India? Background & Context

20% of the World’s population of children under 9 years of age live in India; 164

million children under the age of six (GOI, 2011).

A noted lack of research in Early Childhood Education in India (UNICEF, 2011)

Since 2010 I have travelled back and forth to a primary school situated in a

marginalised community in India which operates as a charity under a Non-

Government Organisation (NGO). All trips were ‘Voluntourism’ in nature.

I have encountered three ‘Western’ charities (one of which I founded) and their

dealings with the school. Each charity has been heavily influenced by educators:

Early Childhood Education & Care (ECEC) practitioner trainers, Montessori teachers

– both pre-school and primary school, and ECEC practitioners.

I noticed that the higher the number of qualified early childhood professionals on a

trip, the more tensions and frustrations were expressed about local practice in the

early childhood classes. There was an expressed frustration that children were not

playing as their Western training (informed by Western research) dictated was the

way children should learn therefore it was ‘developmentally inappropriate’.

This led me to my current doctoral research study examining the perceived values

and cultural nuances of play in early childhood education with children, their

parents and teachers in a case site in urban India.

Page 32: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

What is the ‘West’?

The ‘West’ could be considered a concept, a way of life and a way of viewing

life. It is problematic to define and means different things to different

people.

It has been described as the Minority World, Developed World, First World

and the Global North.

Said has described the West in its relationship as a contrast to the ‘Other’ or

Orient (Said, 1995)

There is no single ‘Western’ culture but a commonality of historical and

cultural background (Reagan, 1995) which can be traced from ancient Greece

to the contemporary North Atlantic community (Gress, 1998)

“The ‘West’ is no longer a geographical location but a way of looking at the

world” (Berger, 2011)

Labels are problematic given the diverse cultures and backgrounds and

fluidity of identity in the ‘West’ but is used in this instance in it’s contrast to

the majority world.

Page 33: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

So what’s the problem?

Research on the value of play (Gray, 2013; Bodrova, 2008; Lillard et.al,

2013), play as pedagogy (Moyles, 1989; Rogers,2010; Brooker & Edwards,

2010; Bruce, 1997; Nutbrown, 2011) and Developmentally Appropriate

Practice (DAP) (Bredekamp & Copple, 1997; 2000; NAEYC, 2006; Kostelnik,

1998; Taguzi, 2010) in the ‘West’ is problematic when applied universally to

early childhood education supports offered to children in Majority world

countries.

The tensions about the universal application of this research and theory,

particularly in early childhood education services offered to children from

marginalised communities in the majority world whom experience a very

different childhood than that of children in the ‘West’ have been

acknowledged (Viruru, 2001; 2005; Gupta, 2004; 2008; 2011; 2013, Prochner,

2002 and Woodhead, 2003).

It raises questions about the use of the terms ‘developmentally appropriate

practice’ and or its alternative ‘Contextually Appropriate Practice’

(Woodhead, 1996; 1998), the concept of play being the way a child learns

and the ‘normal’ development of a child.

Page 34: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

‘Normal’ development: A deficit model

when applied globally?

“Unfortunately, assumptions about what counts as normal development are frequentlyapplied unqualified within international policy and curriculum development … Thesecultural assumptions are brought into sharp focus when compared with more ethnographicstudies of children’s lives throughout much of the Majority World, highlighting thecircumstances where values for childhood are about early socialisation into work andeconomic contribution rather than about realising individual human potential througheducation”

Woodhead, 2006

“This pressure towards measuring … produces a fictional ‘child’ that is abstracted fromgender, class, racialized and other social axes and divisions (Viruru, 2006). It also createsthe occlusion of the cultural and national frame of individual human development. Thesubscription to a prototypical subject avoids analysis of the evaluation of differentchildhoods in different circumstances and the ways in which the political boundaries ofnational belonging, or exclusion, delimit what kind of childhood is available to be lived.”

Burman, 2010

Page 35: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Using research generated in, or informed by,

the ‘West’ in local supports in the Majority

world .

Western charities, NGO’s and INGO’s can tend to use research, curricula and practices informed by research generated in the ‘West’ (Prochner, 2002; Kostelnik, 1998; Roopnarine et. al., 1998; Penn, 2010) in majority world contexts, which is problematic.

It can give rise to assumptions that children all develop and progress along a linear sequence without paying attention to the impact of the cultural and societal systems the individual child is living and learning in.

It may not be sympathetic to local customs, values and ways of being.

This begs the following questions:

Will social supports operating this model have a lasting impact?

Do social supports operating this model fail children?

Does it run the risk of using a deficit model for evaluating children and their development?

Is it moral or ethical?

Is it the best we have?

In this particular example, is play being commandeered in the service of meeting particular educational outcomes (Viruru, 2005) or economic outcomes (Penn, 2010); thus seeing children as becomings and not beings?

Page 36: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

A (slightly hesitant) argument:

If we use postcolonial theory as a lens through which we view our choices about which research to draw on in assessing what social supports to put in place for children, families and communities in the majority world then we must reject applying universal ‘norms’ and ask local informants. In this light, I would hesitantly argue for local, co-generated research that draws on Vygotsky’s socio-cultural theory and Bronfenbrenner’s bio-ecological systems theory.

I would argue:

In order to understand what childhood is like for a child living in abject poverty in a slum community of urban India we must ask those children living that childhood.

In order to understand the cultural nuances and values communities and families hold in their daily lives we must ask those living in the community and family units.

We must bear witness to how these cultural nuances, values and daily life affect the child and her experience of childhood; we must also check our inherent biases and life experiences.

In order to understand why those values and nuances are held we must look at the wider political sphere and try to decipher the affects on local culture and society.

Page 37: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

So let’s talk!

What are the tensions in researching to inform social supports put in place in

the daily lives of children living in the majority world?

How do we create a bank of research from which to draw from that applies

appropriately to the situations we are going into and will go into?

Are we working with the best tools we have?

Is it good enough?

Page 38: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Making children resilient to poor health: can the number of children in a

family play a role?

Mrinal Chadha

University College Cork

168

Page 39: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Making Children Resilient to Poor Health: Can the Number of Children in a Family Play a Role?

Evidence from India

Mrinal Chadha, Rosemary Murphy, Lee-Ann Burke & Edel Walsh

School of Economics

University College Cork, Ireland

Page 40: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Structure• Introduction

• Rationale

• Data & Methods

• Results

• Conclusion

• References

Page 41: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Introduction

• Under 5 mortality rate in India is staggeringly high (48) compared to developed countries (Ireland & UK- 4) (The World Bank Database, 2016)

• Such high mortality rate is because of avoidable causes which signifies lack of health care access (Million Death Study Collaborators ,2010)

• This study attempts to understand the role played by the number of children in a family to make children resilient to poor health

Page 42: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Introduction

• This has been done by comparing the incidence of medical poverty infamilies with no children, one children, two children and threechildren

• Medical poverty has been defined as a state when a non-poor familyfalls below the poverty line after incurring health expenses (Xu,2005)

Page 43: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Rationale

• Very few studies in the literature on medical poverty, also referred asthe impoverishment effect (Kronenberg and Barros,2014;Xu,2005)

• This is the first study that has attempted to associate medical povertywith the number of children in a family

• This study would provide crucial policy suggestions for framing healthcare policies for the Government of India

Page 44: Parallel Session: Resilience from an international perspective · Parallel Session: Resilience from an international perspective Facilitator Maja Haals Brosnan 131. Zambian Perspectives

Data & Methods

• Household level consumer expenditure data (2011-12) collected by National Sample SurveyOrganization (NSSO), New Delhi (GOI, 2014)

• Sample Size: 101662 households with 58.7% in rural India and 41.3% in urban India(GOI,2014)

• Incidence of Medical Poverty has been estimated using the methodology of Xu(2005)

• Pearson’s Chi-square test has been used to measure association between medical povertyand the number of children in a family

• Sampling weights have been applied to estimate the incidence

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Results: Percentage Increase in the Incidence of Medical Poverty Compared to families with No Children

• The incidence of medicalpoverty has been found toincrease by approx. 23% inthe case of families withthree children compared tofamilies with no children.

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Results: Percentage Increase in the Incidence of Medical Poverty Compared to families with No Children

• The incidence of medical povertyhas been found to increase byapprox. 37% in the case offamilies with three childrencompared to families with nochildren

• In rural India, the incidence ofmedical poverty has not found tobe much different in the case offamilies with no child (5.63%),one child (5.62%), two children(5.14%) and three or morechildren (5.82%)

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Results: Incidence of Medical Poverty by Quintiles

Quintile 1 Quintile 5

No child 10.26% 0.22%

One child 12.96% 0.36%

Two children 12.09% 0.02%

Three or more children 11.80% 0%

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Results- Pearson’s Chi-Square Test

• This suggests that there is a statistical association between a familyfalling in medical poverty and the number of children in a family.

Pearson Chi2(3) P value

India 22.42 0

Rural India 9.58 0.022

Urban India 10.29 0.016

Quintile1 6.3738 0.095

Quintile5 1.5757 0.665

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Summary of Results

• Medical poverty has been found to be a big cause for concern in thecase of families with three or more children in the case of India.

• Irrespective of the location of the family: rural or urban, familieswith three or more children have a higher incidence of medicalpoverty compared to families with no children.

• Children in the poorest 20 percent families are the most vulnerablewhere even raising one child makes a family extremely vulnerable tofall below the poverty line.

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Conclusion

• Making children resilient to poor health would require extra supportfor larger families in India, especially for Urban India

• This support may come in the form of different health care schemesfor larger families or extra financial support from the Indiangovernment

• This study also reflects on the need for urban Indians to have healthinsurance, especially for families with more than two children

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References

• GOI. (2014). Household Consumption of Various Goods and Services in India 2011-12. Report No 558 (68/1.0/2). New Delhi.

• Million Death Study Collaborators. (2010). Causes of neonatal and child mortality in India: a nationally representative mortality survey. The Lancet, 376(9755), 1853-1860.

• Kronenberg, C., and Barros, P. P. (2014). Catastrophic healthcare expenditure–drivers and protection: the Portuguese case. Health Policy, 115(1), 44-51.

• Xu, K. (2005). Distribution of health payments and catastrophic expenditures methodology.

• World Bank. http://data.worldbank.org/indicator/SH.DYN.MORT. Accessed 30/11/2016