| 1. |
- Gustafsson, Cecilia, 1977-
(författare)
-
"For a better life..." : a study on migration and health in Nicaragua
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis explores and analyses the manifold relations between migration and health, what I call the migration-health nexus, in the contemporary Nicaraguan context. The study is based on fieldwork in León and Cuatro Santos and a mixed-methods approach combining qualitative in-depth interviews and quantitative survey data. In the thesis health is “traced” within the migration process; i.e. in places of origin, during travel, at the destination and after return, including the situation and consequences for both migrants and family members to migrants (“left-behinds”). The study shows that migration-health relations in Nicaragua are connected to broader economic, social and political factors and to the country’s historical experiences of colonization, neo-colonization and structural adjustments. Contemporary Nicaraguan migrations are primarily related to the strategies of making a living and the struggle for a better life (i.e. a practice of mobile livelihoods). In the study setting health concerns were both indirectly embedded in people’s mobile livelihoods, as well as directly influencing decisions to move or to stay, and migration involved both advantages and disadvantages for health. Through migration, women could see an end to physical violence and sexual abuse. Internal migrants could improve their access to health care and medicine. Vulnerabilities related to the unpredictable nature conditions could be avoided through moving. And, through the money made from migrant work people’s everyday lives and health could be improved, in terms of better nutrition, housing, and access to education, health care and medicine. However, remittances do not necessarily lead to development, as they are used to compensate for the lacking public sector in Nicaragua. Under these circumstances, I argue that the Nicaraguan population is not guaranteed their social rights of citizenship. I also argue that the negative aspects surrounding migration must be taken into account when discussing the development potentials of migration and remittances. Both internal and international migrants in this study experienced stress while moving to a new place. International migrants had difficulties accessing health care in the destination, particularly those lacking documentation. The separation within families due to migration often caused emotional pain. Family members left behind did not rate their physical health as good as often as non-migrant families. The vulnerability, stress experiences and sufferings of migrants and left-behinds varied, however. I therefore conclude that social differences (in terms of e.g. gender, class, skin colour, and legal immigration status) are key for the enactment of the migration-health nexus, and that an interplay of individual, social and structural factors influence the outcome.
|
|
| 2. |
- Dahlblom, Kjerstin, 1950-
(författare)
-
Home alone : sibling caretakers in León, Nicaragua
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sibling caretaking, although common across time and cultures, has not been well researched from the carer’s point of view. In Nicaragua, ranked as one of the poorest countries in the Americas, sibling caretaking is common. The country’s historical background and its state of chronic poverty, widespread unemployment, loose family structures, and migration and mobility makes of the old practise of shared management child care a necessity. Households headed by sing¬le mothers constitute a particular Nica¬raguan charact¬eristic. Many children are expected to help in their own families and care for their siblings and other children living in their households. In its broadest sense sibling caretaking is a public health concern, and we conducted this study to widen the understanding of the phenomenon as it is represented in a setting undergoing a rapid social transition. The main objectives were to identify, describe and analyse the life situation of sibling caretakers in poor areas in León, Nicaragua, with focus on how they perceived it themselves. A combined qualitative and quantitative methodological design was used, mainly applying an ethnographic approach. A further ambition was to explore involvement of children in a participatory research process in accordance with the ‘Convention on the Rights of the Child’. The overall emotion expressed among the caretakers was pride, even if their situation often was characterized by stress and coping problems. They perceived their work as important for their families and they appreciated to fend for their siblings. Household work and nurturing of siblings were shaping the future lives of the caretakers and constituted part of their socialization. Even if many of these children achieve essential life skills as caretakers, they are at risk of falling behind as they grow older. Their long-term personal development is likely to be hampered by the obligations they have as caretakers. The carers' awareness of missing out on education was the most problematic issue for them. From a societal point of view, caretaking has negative consequences. The individual child is marginalised with limited access to basic education, contributing to overall low educational levels in Nicaragua. While the structuring conditions leading to sibling caretaking may be difficult to change, awareness of how these can affect children might make way for improvements in terms of access to school education and support from the society. The knowledge gained from this study should be further utilised to plan for interventions that take children’s perspectives into consideration.
|
|
| 3. |
- Salazar Torres, Virgilio Mariano, 1976-
(författare)
-
Intimate partner violence in Nicaragua : studies on ending abuse, child growth, and contraception
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Intimate partner violence (IPV) is a pervasive, worldwide public health problem and one of the most common violations of human rights. The aim of this thesis were twofold: (i) to study the process and factors related to ending of IPV of Nicaraguan women and (ii) to examine to what extent IPV exposure is associated with the child linear growth and women’s contraceptive use after pregnancy.Methods: Data were collected from a panel study which followed 398 women who were inquired about their IPV exposure during pregnancy and at follow-up a median of 43 months after delivery. Three hundred seventy five of their children were available for anthropometric assessment. Thirteen in-depth interviews were conducted with women exposed to physical/sexual IPV during pregnancy but not at follow-up. For analysis both quantitative and qualitative methodologies were used.Results: Women experienced four patterns of abuse: never abused, ending abuse, continued abuse, and new abuse. Of the women who experienced any IPV before or during pregnancy, 59% (95% CI 52-65%) reported no abuse at follow-up (135/229). Women exposed to a continued abuse pattern and those exposed to any IPV, emotional or physical IPV at follow-up had higher odds of reversible contraceptive use. Further, exposure to any IPV and controlling behavior by a partner during pregnancy impaired the index child linear growth. Girls whose mothers had low social resources during pregnancy were the most affected. Women felt that being inquired about IPV while pregnant contributed to process of ending the abuse.Ending IPV was experienced as a process with three phases: “I came to a turning point,” “I changed,” and the “Relationship ended or changed.” Successful strategies to ending abuse mainly involved utilizing informal networks. Ending IPV did not always mean ending the relationship. IPV awareness, severity of the abuse, and economic independence were individual factors associated with ending of abuse. At the relationship level, diminishing or no exposure to controlling behavior by their partner was a key element. At the community level, a supportive and less tolerant to IPV environment as well as exposure to IPV inquiry during pregnancy facilitated the process of ending abuse.Conclusion: The study found that IPV exposure is associated with the children’s linear growth and women’s reversible contraceptive use. In addition, it is clear that gender norms regarding IPV are not static and that they play an important role in facilitating the process ending the abuse by increasing abused women’s access to emotional and material support. Our results emphasize the relevance of improving public services response to IPV.
|
|
| 4. |
- Schmeer, Kammi K., et al.
(författare)
-
Maternal resources and household food security : evidence from Nicaragua
- 2015
-
Ingår i: Public Health Nutrition. - 1368-9800 .- 1475-2727. ; 18:16, s. 2915-2924
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Women (especially mothers) are theorized as critical to reducing household food insecurity through their work and caregiver roles. The present study tests these assumptions, assessing how maternal economic and social resources are associated with food insecurity in households with young children. Design: Data from a population-based sample of households was collected in Leon, Nicaragua (n 443). Data include a newly validated measure of household food insecurity (ELCSA), maternal resource measures, and household economic status and demographics. Regression analysis tests the statistical associations (P<0.05) of maternal resources with household, adult-specific and child-specific food insecurity. Setting: Municipality of Leon, Nicaragua. Subjects: Households with children aged 3-11 years in rural and urban Leon. Results: Only 25 % of households with young children were food secure, with 50 % mildly food insecure and 25 % moderately/severely food insecure. When mothers contributed substantially to household income, the odds of moderate/severe household food insecurity were 34 % lower than when their spouse/partner was the main provider. The odds of food insecurity were 60 % lower when mothers managed household money, 48 % lower when mothers had a secondary (v. primary) education, 65 % higher among single mothers and 16 % lower with each indicator of social support. Results were similar for adult-and child-specific food insecurity. Conclusions: This research provides new evidence that maternal economic and social resources are important for reducing household food insecurity and adult- and child-specific food insecurity. Women's social status, social support and access to economic resources need to be enhanced as a part of policies aimed to reduce food insecurity in high-poverty settings.
|
|
| 5. |
- Alm, Erika, 1975, et al.
(författare)
-
Parenting the nation : state violence and reproduction in Nicaragua and Sweden
- 2023
-
Ingår i: Struggles for reproductive justice in the era of anti-genderism and religious fundamentalism. - London : Palgrave Macmillan. - 9783031312595 - 9783031312625 - 9783031312601 ; , s. 213-240
-
Bokkapitel (refereegranskat)abstract
- Reproduction is a core question for the state, a site of struggle between the reproduction of the nation and the reproduction of liveable lives, especially for those citizens whose rights are rarely recognized in the first place. What role does the exceptionalisation of reproductive rights play in the reproduction of the nation-state? Nicaragua and Sweden are countries where debates about reproductive justice highlight tensions in the projection of a state that cares for its citizens. Nicaragua, the second-poorest country in the Western hemisphere with one of the most repressive and punitive legislations on abortion in the world. Sweden with its reputation as a pioneering nation in matters of gender equality and reproductive justice. This chapter draws on a particular formulation of the centrality of the state in theories and practices of reproductive justice: the notion of the state as a parent with a particular responsibility to protect and foster, but also discipline and subjugate, its citizens. Political leaders, Fathers and Mothers of the Nation, form the discourse within which the state regulates its imagined children’s, the citizens, reproductive rights. As such the governance of reproduction is a vital aspect of the political fantasy about the nation-state and its futuriority.
|
|
| 6. |
- Zelaya Blandon, Elmer
(författare)
-
Adolescent pregnancies in Nicaragua. The importance of education
- 1999
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Early adolescent pregnancy implies increased social and medical risks. There is lack of understanding of the mechanisms behind early sexual debut and pregnancy. This contributes to the difficulties to meet the educational and health care needs of adolescents. In Nicaragua, few reproductive health interventions target adolescents and even fewer studies focus on sexual and reproductive health in this age group. Therefore, the aim of this thesis is to analyze the background of adolescent pregnancy in Nicaragua, for future interventions.Focus group discussions and in-depth interviews were carried out with young and adult women and men from different social backgrounds in the city of León. Results were used in the planning of a cross-sectional household study carried out in 1993, covering a population of 43,765 in 50 randomly selected clusters in rural and urban León. Reproductive histories were obtained from all women aged 15 to 49 years (n= 10,867), corresponding to 176281 person years of reproductive life. Random sub-samples of men (n=388) and women (n=413) were interviewed in privacy about their age at sexual debut, contraceptive use and reproductive history. The background to early adolescent pregnancy was further analyzed in a matched case-referent study of girls who got their first pregnancy before 17 years of age (146 cases, 242 randomly selected age-matched referents).Economic deprivation and disturbed family relations with an unsatisfied craving for parental affection influence adolescent sexual behavior. Girls' romanticism, belief in virginity until marriage and the contrasting male machismo culture contribute to a lack of empowerment of adolescents.At 15 years of age, 25% of boys and girls had had their sexual debut, and at 18 years this was the case for 85% of boys and 53% of girls. Among girls, the latency period from sexual debut to the end of first pregnancy was only 22 months, indicating very limited access to contraceptive counseling and services. At 17 years of age, one fourth had become pregnant. Contraceptive use was 54% among sexually active adolescents, aged 15-19 years, pills being the most common method. Among adults, female sterilization was the most common method, followed by Intra Uterine Device (IUD) and pilL Condom use was low as well as the use of traditional methods. Low educational attainment was a strong determinant for lack of contraception.Age at sexual debut and age at first pregnancy had been increasing, and fertility rate had declined in Nicaragua from the 1970s to the 1990s. The increase in women’s education was found to be the strongest explanatory factor behind this transition in fertility. Girls who had successfully completed at least 5 years of schooling had lower risk for early pregnancy. This protective effect of education was found for groups with high as well as low socioeconomic status.The background of adolescent pregnancy consists of a complex interaction of socioeconomic, familial and cultural factors. Lack of political will to challenge current values, religious influence in sexual and educational issues, romanticism and lack of empowerment, especially among adolescent women, are also influencing elements. Contraceptive use is still low among sexually active teenagers in Nicaragua, and pregnancy follows soon after first intercourse. There is a strong need for family life education at schools and health services geared to adolescents. Non-use of contraception is associated with poverty and lack of education. The association between education and fertility decline, and the protective effect of education in preventing early pregnancies, even among poor families, indicates that education is a powerful tool in breaking the vicious cycles of poverty and early pregnancy.
|
|
| 7. |
- Caldera, Trinidad, et al.
(författare)
-
Parasuicide in a low income country : results from a three year hospital surveillance in Nicaragua.
- 2004
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 32:5, s. 349-355
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: A study was undertaken to assess the incidence of parasuicide in Nicaragua, to identify groups at risk, and to describe the characteristics of parasuicides, such as methods used and seasonal and diurnal patterns. Method: All hospital-admitted parasuicide cases in the area of León, Nicaragua, were assessed over a three-year period using standardized instruments. Results: Two hundred and thirty-three parasuicide cases were identified in the catchment area giving a parasuicide rate of 66.3/100,000 inhabitants per year based on the population 10 years and older. Corresponding figure for 15 years and older was 71.3. A majority were females (68.8%), who were significantly younger than the males (mean 20.8 years vs. mean 24.6 years). The highest rates were found in the age group 15 - 19 years with a female rate three times higher than the male rate (302.9 vs. 98.9). Pesticides, a highly lethal substance, were used as method in 19.1% of the attempts. Consistent seasonal variation with peaks in May - June and September - October were found over the years. Among parasuicide cases, 46.5% had been in contact with the healthcare system within 6 months before attempting suicide. Conclusions: Parasuicides represent a significant health problem among young people in Nicaragua. Preventive efforts should be directed especially towards the life situation for young girls, limitation of availability of suicide means, increased awareness in schools concerning suicidal problems, as well as improved management of patients with mental health problems within primary healthcare.
|
|
| 8. |
- Herrera Rodríguez, Andrés, 1966-
(författare)
-
Heaven can wait : studies on suicidal behaviour among young people in Nicaragua
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In developed countries, suicidal behaviour is recognised as a significant public health problem among young people, but there are few studies from developing countries on this subject. The present thesis aims at estimating the extent of the problem and at exploring factors related to suicidal behaviour among young people in a developing country, Nicaragua, using a combined quantitative and qualitative approach. Three studies were conducted between 1999 and 2006. In the first study, all hospital admitted suicide attempt cases in the area of León were assessed over a three year period. Secondly, a qualitative study using individual in-depth interviews was conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. Thirdly, a study using the Attitudes Towards Suicides (ATTS) questionnaire was conducted in a community based sample of 278 young people aged 15-24 years to assess own suicidal behaviours, attitudes towards suicide as well as exposure to suicidal behaviour among significant others. The hospital surveillance showed that suicide attempt rates were highest among females in the age group 15-19 years with a female rate three times that of males (302.9 versus 98.9 per 100,000 inhabits per year). Drug intoxication and pesticides were the most commonly used methods for the attempts. A consistent seasonal variation with peaks in May-June and September-October was found in each of the three years, possibly related to exam periods in schools. Findings in the qualitative approach led to a tentative model for pathways to suicidal behaviour based on four main categories: Structuring conditions, triggering events, emotions and action taken. Dysfunctional families, lack of confidential and trustworthy contacts and interpersonal conflicts followed by emotions of shame and anger were some important components in the model. The community studies showed that suicidal expressions (life-weariness, death wishes, suicidal ideation, suicide plans and suicide attempts) were common among young people where more than 44.8% of males and 47.4% of females reported some kind of suicidal expression. Gender differences were small. Exposure to suicidal behaviour among others was associated with higher levels of self-reported suicidal behaviour. The attitude study showed that boys had less pro-preventive attitudes than girls, possibly indicating their higher risk for completed suicide. Exposure to suicidal behaviour and own suicidal behaviour showed an association with specific patterns of attitudes. The findings should be taken into consideration when planning for prevention of suicidal behaviour among young people in a developing country like Nicaragua.
|
|
| 9. |
- Herrera Rodríguez, Andrés, et al.
(författare)
-
Pathways to suicidal behaviour among adolescent girls in Nicaragua
- 2006
-
Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 62:4, s. 805-814
-
Tidskriftsartikel (refereegranskat)abstract
- Adolescent girls are the most frequent suicide attempters worldwide. However, there is little knowledge about pathways leading to suicidal behaviour among young people, in particular in low-income countries. This study explores the motives and processes related to suicidal behaviour among young girls in Nicaragua. Individual in-depth interviews were conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. The audio-taped interviews lasted 2–4 h and were transcribed, translated into English and coded for content. Grounded theory and content analysis were used to construct a theory of the mechanisms behind their suicidal behaviour. A tentative model exploring pathways to suicidal behaviour is described with four main categories: structuring conditions, triggering events, emotions and actions taken. The model illustrates the dialectic interplay between structure and actions taken. Actions taken were categorized as problem solving or various forms of escape where failure with either of these strategies resulted in a suicide attempt. Dysfunctional families, absent fathers and lack of integration into society were some of the structuring conditions that lead to emotional distress. Abuse, deaths in the family, break-up with boyfriends or suicide among friends acted as triggering events. A striking finding was the obvious narrative competence of the girls. Our findings indicate that suicide prevention programmes for young people must offer support from professionals, independent of their family and social networks. Institutions in the community in contact with young people with suicidal behaviour must develop communicative skills to offer a trusting environment mobilising the resources that young people have.
|
|
| 10. |
- Ellsberg, Mary Carroll
(författare)
-
Candies in hell : research and action on domestic violence against women in Nicaragua
- 2000
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the research was to explore the magnitude and characteristics of domestic violence against women in Leon, Nicaragua. A cross-sectional survey was carried out among a representative sample of 488 women between the ages of 15-49 years. In-depth interviews were performed with women who had experienced violence. Also, participatory techniques were used in 19 focus groups of men and women from diverse sectors of Nicaraguan society to gain an understanding of how Nicaraguans view social and legal sanctions for domestic violence.Among ever-married women (n=360) lifetime prevalence of physical violence was 52%, and current prevalence (during the last 12 months) was 27%. Seventy percent of the violence was classified as severe. No significant differences were found with regard to women's age, educational attainment, or occupation and the prevalence of partner abuse. Significant positive associations were found between the risk of wife abuse and poverty, number of children, history of violence in husband's family, husband's controlling behavior and lack of social networks. Abused women were six times more likely to present emotional distress than non-abused women. Emotional distress was more related to the severity of the abuse than to how long ago it had taken place. A significant positive association was found between wife abuse and problems among the children, including physical abuse. Nearly half of the abused women reported that their children had witnessed the violence. Both the qualitative as well as the quantitative data indicated that abused women frequently experience feelings of shame, isolation and entrapment, which in turn contribute to their difficulty in recognizing the violence and disengaging from the violent relationship. Women in Nicaragua used a variety of strategies to protect themselves from violence and most abused women eventually did leave abusive relationships. Temporary leaving and help seeking were critical steps in the process of overcoming violence. However, many women indicated that they did not receive support for their situation.The results of the prevalence survey were compared to findings from two other population-based studies carried out subsequently in Nicaragua. This comparison suggested that under-reporting is a significant threat to the validity of prevalence research on violence, and underscored the importance of incorporating specific measures to enhance disclosure into the research plan, such as providing more than one opportunity to disclose violence and using behaviorally specific language.Moreover, measures that have been primarily viewed from the perspective of ethics and safety, such as ensuring privacy and confidentiality and providing special training and support for interviewers, may have a significant impact on data quality, due to their effect on the disclosure of violence.The survey results and the narrative analysis suggest that domestic violence is a serious public health problem in Nicaragua. The focus group research found that opinions regarding domestic violence differed sharply between men and women, but that broad sectors of society felt that psychological violence was as serious as physical violence, and that new laws and programs were needed to punish violent offenders and to prevent future violence.The results of the research were discussed widely in Nicaragua, and contributed to the debate on the reform of the Nicaraguan Criminal Code with regard to sanctions for domestic violence and protection for victims of violence.
|
|
