Jugendliche lassen sich erfolgreich zur Gestaltung ihrer unmittelbaren Lebenswelten in Stadt und Land einbeziehen. Wie dies funktionieren kann, zeigt das Projekt des Landesamtes für Umwelt, Landwirtschaft und Geologie zur Jugendbeteiligung an der kommunalen Entwicklung in Erlbach und Markneukirchen. Durch das Büro komet empirica GmbH Leipzig gelang es, in enger Abstimmung mit den Bürgermeistern der Dorf- und Stadtgemeinden und der Demografiebeauftragten von Erlbach zahlreiche Jugendliche an einer kreativen Auseinandersetzung mit dem Thema des demografischen Wandels zu interessieren. Der Bericht dokumentiert den Projektverlauf von den ersten Befragungen, über Projektentwicklung, Pressearbeit bis zu umgesetzten Vorhaben. Als vielversprechend kann die Gründung der jeweiligen Jugendbeiräte gelten. Besonders wertvoll ist dieser Projektbericht sicherlich auch deshalb, weil die praktizierten speziellen Methoden für erfolgreiche Jugendbeteiligung nachvollziehbar aufgezeigt sind und somit die Nachahmung erleichtern.

The post war years have seen a steady flow of inmigration into the rural hinterlands of conurbations, eminating both from the surrounding rural areas and from the urban complexes themselves. By 1981 over one fifth of Britain's population was resident in a rural district, the majority falling within zones close to urban centres. This study, based on one year's participant observation in seven settlements within southern Staffordshire, part of the rural hinterland of the West Midlands Conurbation, and southern Hampshire, adjacent to the Southampton - Portsmouth axis, the South Hampshire Conurbation, assess this process. Using the technique of Cluster Analysis, three broad groupings of settlement are identified: the small agricultural settlement, the urbanised commuter village, and settlements in a process of transition between the two. The development of the case settlements, representatives of these three groupings, is assessed in relation to their historical and geographical context, with emphasis being placed on land tenure and local planning policy. An analysis is undertaken of the "hinterland population", the diverse populations now resident within the rural hinterlands. Nine broad groupings emerge from this population, identifiable with reference to socio-economic characteristics and ways of life, and these are examined in relation to their use, their environments, social networks and patterns of behaviour, and perceptions of their place of residence. These groups are represented in various proportions within each settlement type, in relation to the dominant housing class found there. As a result a variety of community forms are seen to be developing, with a polarisation of settlements along class lines. Running concurrently with this, two theoretical concepts are introduced based on the approach of Symbolic Interactionism. These are the Triadic Relationship, and Place Centredness, which provide a more humanistic framework for the analysis. The inclusion of these concepts enables an assessment to be made of the notions of "rurality" and "truly rural population".

Background: This study explored the differences between the seasonal mortality rates (by age and gender) between the two jurisdictions (the Republic of Ireland (RoI) and Northern Ireland (NI)). The study assessed the relationship between cold temperatures and daily mortality, and assessed for effect modification of the cold weather-mortality relationship by age and gender. Methods: Mortality rates were calculated for each cause-specific mortality group during various seasons in both jurisdictions. A time-stratified case-crossover approach was applied to examine the cold weather-mortality relationship, 1984-2007. The daily mortality risk was explored in association with exposure to daily maximum temperatures on the same day and up to 6 weeks preceding death, during the winter months and extended cold period (October-March), using distributed lag models. Model stratification by age and gender assessed for modification of the cold weather-mortality relationship. Results: The winter mortality rates were significantly greater than the summer rates. NI experienced higher mortality from cardiovascular disease, respiratory disease and stroke. The impact of cold weather in the winter months persisted up to 35 days in the RoI, with a cumulative mortality increase for all-cause of 6.4% (95%CI: 4.8%-7.9%) with regards to every 1oC drop in the daily maximum temperature with similar associations for cardiovascular disease and stroke with twice as much for respiratory diseases. The associations were less pronounced and less persistent in NI. Conclusions: The study observed excess winter mortality. The cold weather-mortality associations increased with age with some suggestion of gender differences. There were strong cold weather-mortality associations in both jurisdictions, with suggestive differences in associations by age and gender. The findings suggest the potential contribution of societal differences, and require further exploration. These findings will hopefully contribute to the current efforts to modify fuel policy and reduce winter mortality in both jurisdictions.

The research conducted in this thesis examines the relationship between forms of worklessness (both active unemployment and inactivity due to sickness and disability) and mortality for working age men. Previous research has shown that being out of work is associated with a greater risk of mortality relative to being in work. However, there remains debate as to whether this association is the result of a causal pathway leading from worklessness to mortality or whether it reflects the ‘selection' of individuals who are already at greater risk of mortality from pre-existing poor health or other characteristics. In the UK, many studies rely on the use of ‘wear-off' periods in which mortality events occurring within five years after the observation of employment status are ignored to allow the confounding effects of selection to diminish. Generally these studies concluded in support of a causal relationship. In contrast, more recent studies making use of innovative methodological designs such as natural experiments and linked register and health datasets have found less evidence for this explanation with many emphasising the role of confounding and selection. The thesis aims to firstly, examine the effectiveness of wear-off periods and secondly, to develop an alternative counterfactual approach to examine the relationship between worklessness (both active unemployment and health related inactivity) and mortality. These questions are addressed in three stand-alone papers. In the first paper, data from the Scottish Longitudinal Study and the England & Wales Longitudinal Study was used in logistic regression models which estimated the odds of death in a given time period after the 1991 Census for those aged 35–64 in 1991. The odds ratios for the different economic positions (in work, unemployed, retired, permanently sick and other inactive) were compared, as well as the changes in risk associated with cumulatively increasing the length of wear-off prior to follow-up. No evidence was found of health related selection for the unemployed in 1991 suggesting that the use of the five year wear-off period in many studies of mortality and unemployment may be an ineffective and unnecessary technique for mitigating the effects of health-related selection. The second paper examined men aged between 35 and 54 who were in work in 1991. Subsequent employment status in 2001 was observed (in work or unemployed) and the relative all-cause mortality risk of unemployment between 2001 and 2007 was estimated. To account for potential selection into unemployment of those in poor health, a counterfactual propensity score matching framework was used to construct unbiased and comparable samples of in work and unemployed individuals. Matching was based on a wide range of explanatory variables including health status prior to year of unemployment (hospital admissions and self-reported limiting long term illness) as well as measures of socio-economic position. The findings showed that unemployment was associated with a doubling (hazard ratio 2.1 95% CI 1.30 - 3.38) of the subsequent risk of mortality from all causes relative to employment. This scale of effect was consistent across different samples and was robust controlling for prior health and socio-demographic characteristics. These findings were interpreted as evidence that the often observed association between unemployment and mortality may contain a causal component. The second paper implemented a similar analytical design to address the lack of evidence for the independent mortality effect of inactivity due to sickness. The results showed that the mortality risk of economic inactivity due to sickness relative to active employment was significant (HR. 3.18, 95% CI 2.53-3.98) and suggest that economic inactivity due to sickness poses a mortality risk that is independent of prior health. The findings could be interpreted in two ways; either economic inactivity due to sickness is worse for health than actively seeking work or previous studies of unemployment and mortality have underestimated the true effect of being out of work generally. Across the three studies, the main contribution of the thesis is to reassert the importance of worklessness as a determinant of individual mortality. In doing so the studies also found little evidence of systematic confounding by either health or other characteristics. The thesis concludes with a comprehensive discussion of the wider implications of the findings in relation to both general methodological issues in observational epidemiology and possible policy interventions that could be implemented to tackle work-related inequalities in male mortality.

Introduction : Cette recherche a pour but d'évaluer les effets du programme de communication sur le changement comportemental de quels acteurs pour promouvoir l'allaitement dans la première heure qui suit l'accouchement chez les mères les plus vulnérables au Niger. Les objectifs consistent à identifier les déterminants de l'allaitement précoce et à élaborer une typologie de stratégies de communication intégrées. Les facteurs de résultat comportemental relatifs à la santé de l'enfant constituent un objet de recherche important en démographie. Toutefois, peu d'études ont abordé l'allaitement postpartum en Afrique Sub-Saharienne. Les interventions de soins de santé néonatale n'ont pas suffisamment été explorées dans la région selon des perspectives démographiques tout en mettant en évidence l'inégalité socio-économique dans la région. Cette thèse est une étude démographique qui a quantifié les pratiques de l'allaitement, qui se caractérise par les information qualitatives et non scientifique dans la plupart des études comportementales, et ce parmi le groupe des mères les plus démunies. Méthodes : L'analyse secondaire des études quantitatives transversales au Niger a été réalisée sur la base de la revue de la littérature sur des études menées en Afrique sub-saharienne. Les enquêtes transversales dont fait l'objet cette recherche sont les suivantes: l'Enquête démographique et de santé (EDS) 2006 Niger, l'EDS 2012 Niger et l'enquête d'évaluation dans les 4 régions de Niger en 2011, le dernier a pour but d'examiner l'impact du programme de communication sur la promotion de soins de santé de l'enfant au niveau familial et communautaire. Pour constituer une population d'étude pour chaque base de donnée, le même critère d'exclusion a été appliqué afin d'inclure les femmes de 15-49 ans, ayant au moins un enfant de moins de 24 mois et qui ont accouché par voie basse. Un échantillon aléatoire stratifié a été tiré pour sélectionner 2091 femmes divisées en deux strates, le groupe d'intervention et le groupe de contrôle. Les outils d'analyse de données ont été le test du chi2 et la régression logistique multivariée. Les variables indépendantes incluent les actions de communication, les statuts démographiques et économiques des mères, les recours aux soins de santé de l'enfant ainsi que les pratiques et infrastructures d'hygiène. Résultats : Le retard de l'allaitement postpartum s'est caractérisé par le niveau de vie des plus démunis au Niger. Quelque soit la vulnérabilité socio-économique, des pratiques d'hygiène ont augmenté la chance de l'initiation de l'allaitement précoce. L'enquête d'évaluation dans les 4 régions de Niger a montré que le lavage des mains et l'utilisation des latrines traditionnelles étaient fortement corrélées avec l'allaitement précoce qui a augmenté respectivement de l'OR à 2.4 (IC 95%: [76; 220]) et à 2.3 (IC 95%: [51; 248]). Les agents de santé des établissements sanitaires, les sages-femmes, ont joué un rôle clef déterminant sur l'allaitement postpartum. Le statut valorisant de sages-femmes impliquées dans le programme de communication était à l'origine d'une hausse significative de l'allaitement précoce. Toutefois, les consultation prénatale (CPN) par les sages femmes a augmenté l'allaitement initial de 52% (IC 95%: [14; 103]) par rapport à celles qui n'ont jamais effectué de CPN. L'enquête d'évaluation ne procure aucune information à savoir si le programme de communication a intégré les accoucheuses traditionnelles afin d'appliquer une approche à base communautaire. Une approche inter-sectorielle qui s'adresse aux multiples dimensions de soins de santé maternelle et infantile a augmenté à 6.9 l'OR de l'allaitement initial (95%CI: [374; 900]). Les visites à domicile par les relais communautaires se sont avérées statistiquement non significatives (IC 95%: [-10; 54]). La promotion par les pairs a réduit le risque de retard de l'initiation de l'allaitement de 100% (IC 95%: [39; 189]). / Introduction. This research aims to evaluate the effects of a behavior change communication program promoting early initiation of breastfeeding within the first hour of birth among the most vulnerable mothers in rural Niger. The main objectives are to identify the social determinants of initial breastfeeding and to examine the typology of integrated communication strategies for the socio-economically vulnerable group of populations. Behavioral child health outcomes have become an important research subject in Demography. However, few studies have examined breastfeeding during the postpartum period in Sub-Saharan Africa (SSA). Very few demographic approaches were applied to evaluate neonatal care by looking into socio-economic inequity in SSA. This thesis quantifies predominantly qualitative information characterizing behavioral studies in breastfeeding among the most deprived population. Methods. This is a secondary analysis of cross-sectional quantitative studies conducted in Niger at different points of time based on a literature review of previous studies conducted in Sub-Saharan Africa. The cross-sectional surveys include: the 2006 Niger Demographic Health Survey (DHS), the 2012 Niger DHS and the post-intervention survey (PIS) conducted in 2011 to evaluate a communication program promoting family and community based child health care in 4 regions of Niger. To constitute a study population for each dataset, the same exclusion criteria were applied to include women aged 15-49 years, having at least one child less than 24 months born with vaginal delivery. The PIS study population, drawn from the original survey with stratified random sampling, was divided into two strata, the intervention and control groups according to exposure to the communication program. Statistical analysis tools were the chi-square test and multivariate logistic regression. Independent variables include behavior change activities, socio-demographic and economic status of mothers, health seeking behavior and hygiene practices. Results. Postpartum breastfeeding is impaired by income poverty in Niger. Regardless of socio-economic vulnerability, hygiene practice increases the chance of early initiation of breastfeeding. Multivariate analysis with the 2011 PIS shows that hand washing and use of a traditional latrine increases by 2.4 (95%CI: 76; 220) and by 2.3 (95%CI: 51; 248) respectively the odds of early initiation of breastfeeding. Government health workers, midwives, play a key role determining mothers' postpartum breastfeeding. Antenatal care (ANC) provided by midwives increases the chance of early breastfeeding that increases by 52% (95%CI: 14, 103) compared to ANC provided by other health professionals among the most deprived group of populations. The PIS does not provide any information to evaluate the role of traditional birth attendants in neonatal care. An inter-sectorial approach addressing multiple dimensions of maternal and child health significantly increases by 6.9 odds (95%CI: 374, 900) early initiation of breastfeeding compared to those who are not reached by the whole integrated KFP promotion. Home visits by community volunteers are not significant (IC 95%: -10; 54). Involvement of mothers as a peer promoting exclusive breastfeeding significantly reduces the risk of delayed initiation of breastfeeding by 2.0 odds (IC 95%: 39; 189). However, the number of exposures to different types of communication strategies does not influence positively early breastfeeding. Conclusions. The impact of community volunteers and health workers is limited with regard to early breastfeeding among the most deprived group of mothers. The model of behavior change communication with participatory peer promotion and a multi-sectorial approach combining optimal hygiene promotion suggests a response to socio-economic disparity.

Concernant près de 7000 personnes en France, la mucoviscidose est une maladie génétique évolutive dont les atteintes sont multiples. Ces dernières décennies, l’amélioration de la prise en charge des malades a permis de faire évoluer leur durée de vie, et donc d’augmenter la part d’adultes dans la population touchée. Cela a naturellement amené à de nouvelles problématiques concernant la vie des malades, notamment en termes de procréation. A partir des données du Registre Français de la Mucoviscidose récoltées entre 1992 et 2011, ce travail avait d’une part pour objectif d’étudier la fécondité de cette population et de mieux cerner les caractéristiques des femmes atteintes de la maladie, et d’autre part d’identifier les interactions se jouant entre la mucoviscidose et la survenue d’une grossesse. Les résultats ont montré un certain décalage entre la fécondité de la population française générale et celle de la population malade, expliqué en partie par la jeunesse des patientes et leurs comportements conjugaux et scolaires. Une étude de leurs caractéristiques a permis de mettre en évidence l’évolution du nombre de femmes suivies chaque année et leur avancée en âge, mais également l’amélioration de leur état de santé et de l’offre de soin qui leur est proposée. Des analyses multi-variées ont permis par la suite de distinguer les caractéristiques les plus prédictives de la survenue d’une première grossesse : si certaines variables médicales apparaissent significatives, la plupart sont d’ordre sociodémographique. Enfin, ces analyses ont pu mettre en avant le fait que l’effet à court terme de la grossesse sur l’état de santé des patientes n’apparait pas de façon évidente, et lorsqu’il apparaît, reste modeste ; mais également que les modalités du déroulé de la grossesse peuvent avoir un impact sur la santé de la mère.Mots clés : Mucoviscidose, grossesse, fécondité, maladie génétique / Cystic fibrosis is a progressive genetic disease with multiple levels of harm that affects nearly 7000 people in France. Over the last decades, health care improvements has led to an increase in patients’ life expectancy and hence the proportion of adults in the affected population. This has naturally led to new issues relative to the life of patients, notably procreation. Data from the French Cystic Fibrosis Register recorded between 1992 and 2011 were used in this work, firstly to study the fertility of that population and to pinpoint the characteristics of female patients, secondly to identify any interaction between cystic fibrosis and the occurrence of pregnancy. Results showed a discrepancy between the fertility of general French population and that of the patients, which is partly explained when considering the young age of the patients and their conjugal and school behaviour. By studying their characteristics, an increase in both the age and the number of women being followed, as well as an improvement in their health and the treatments provided to them are observed. In the following multivariate analyses single out the most predictive characteristics of the occurrence of first pregnancy: while some medical variables appear to be significant, most of those are socio-demographic. Finally, those analyses showed that the short-term effect of pregnancy on the patients’ state of health does not appear to be evident and remains low when it occurs ; however specific modalities or events throughout the course of the pregnancy could have an impact on the mother’s health.

The fertility transition in nineteenth century Europe is one of economic history’s greatest puzzles. There is no consensus in the literature on the causes of this ‘fertility revolution’. Following a critical review of the empirical and theoretical literature, this thesis re-examines the economic correlates of the fertility decline through the analysis of two new datasets from England and France. For the first time, the relationship between wealth and fertility can be studied over the period of the fertility transition. Clear patterns are discovered, namely a strong positive relationship pre-transition which switches to a strongly negative relationship during the onset of the transition. Family limitation is initiated by the richest segments of society. I then introduce a simple model which links fertility and social mobility to levels of economic inequality. I argue that parents are motivated by relative status concerns and the fertility transition is a response to changes in the environment for social mobility, where increased mobility becomes obtainable through fertility limitation. This hypothesis is tested with the new micro data in England and France. Fertility decline is strongly associated with decreased levels of inequality and increased levels of social mobility. The analysis finds strong support for the role of changes in inequality and the environment for social mobility as central factors in our understandings of Europe’s fertility transition.

This thesis consists of three papers that explore variation in individual fertility and fertility preference. The setting for all three papers is the contemporary UK, though the conclusions have utility for a general understanding of human fertility. All three papers are motivated by theories arising from evolutionary biology, principally inclusive fitness theory and life history theory. The first two papers investigate actualised fertility and whether patterns of fertility in contemporary Britain are consistent with inclusive fitness theory. Both papers conduct secondary data analysis of the British Household Panel Study. Inclusive fitness theory predicts that because relatives share genes an individual may obtain fitness benefits by increasing the reproduction of a relative. Results support this hypothesis showing that for contemporary British women kin having more opportunities to influence reproductive decision-making is associated with pro-fitness fertility outcomes. In the first paper I find kin accelerate the transition to first birth, and the second paper shows kin also accelerate the transition to second birth. The final paper tests a different hypothesis derived from evolutionary theory. Life history theory predicts that reproductive strategy should have ‘plasticity’ and be liable to alter as perceived environmental risk changes. This paper uses primary data collected from University students using an internet experiment and finds that priming respondents using preceding questions on mortality does alter reported fertility preferences, though the effects depend upon the priming, fertility preference measure and the sex of the respondent. The paper also has methodological relevance as it demonstrates the potential for ‘context effects’ from preceding questions to influence the reporting of fertility preferences. All three papers present evidence that the incorporation of theories from evolutionary biology have utility in the understanding of contemporary fertility patterns and processes.

The aim of this thesis is to investigate the reasons for the growth of large scale labour migration from Ratnagiri district during the nineteenth century. It is argued firstly that for an understanding of the origins of migration from Ratnagiri it is necessary to investigate the socio-economic structure of the district, since exogenous demand for labour cannot explain many aspects of the pattern of migration from Ratnagiri, nor can it explain the high rate of migration compared to other areas with similar access to labour markets. It is argued that regional and gender patterns of migration from Ratnagiri can be partly explained by the structure of demand for labour within the district; but that the scale of migration can most convincingly be explained in terms of the acute poverty of sections of the rural population. It is argued that this poverty cannot be ascribed to demographic pressure in the early nineteenth century, since population in the district did not rise rapidly until migration was already underway. It is instead suggested that the poverty of many cultivators in the earlier nineteenth century was an outcome of the spread of a village zamindari system in Ratnagiri during the late eighteenth century, the impact of which was intensified by legal changes introduced under British rule; the consequent concentration of landholding in the hands of the village zamindars led to higher exactions on the lower caste cultivators, which stimulated emigration in the mid nineteenth century. Furthermore, it is suggested that the land tenure system was at the root of the problems of agricultural development which the district faced later in the nineteenth century. When population rose In the mid nineteenth century, the extension of cultivation put pressure on the fragile ecology of the district, which led to rapid deforestation and falling yields per acre. it is argued that though cultivation intensified In Ratnagiri during the later nineteenth and early twentieth centuries, the output per head nonetheless probably fell, and the system of land tenure discouraged the adoption of many strategies which might have raised output per head, thus perpetuating the poverty which, it is argued, lay at the root of out-migration from Ratnagiri.

In these papers I discuss the causal estimation of the effects of fertility and fertility planning developments on mother and child outcomes. A number of concerns are raised with existing identification techniques, and alternative methodologies to consistently estimate the effect of interest are proposed. These concerns and new techniques are illustrated using microdata on slightly more than 43,000,000 births ocurring between 1972 and 2013. In the first substantive chapter (written with Sonia Bhalotra), we discuss the validity of the use of twin births in fertility research. We demonstrate that twin births are not random. Successfully taking twins to term depends upon positive maternal health behaviours and investments in the periods preceding birth. We show that this is of considerable concern for estimation techniques which rely on twin births being (conditionally) randomly assigned to identify causal effects. To illustrate, we consider the estimation of the child quantity-quality (QQ) trade-off, and show that existing instrumental variable estimates are inconsistent in the contexts examined. Upon partially correcting for the fact that twin births are not random, a statistically significant QQ trade-off begins to emerge. We close by examining a number of partial identification techniques to bound the true effect of fertility on child outcomes. In the second substantive chapter, I examine the effect of fertility control policies on the fertility decisions and outcomes of women. I consider the case of the emergency contraceptive pill in Chile. The staggered arrival of this technology to Chile over the last decade has resulted in the availability of the first safe and legal post-coital birth control policies. In a context of high teenage pregnancy rates, difference-in-difference (DD) style estimates suggest that this policy has accounted for reductions in short-term teen childbearing by as much as 7%, an effect similar to the arrival of abortion in the USA. This policy is also shown to reduce fetal deaths reported in early gestation with no similar reduction in late gestation: suggestive evidence that an alternative fertility control policy may reduce costly and dangerous illegal abortions. Finally, I turn to the use of DD estimators as a policy-analysis tool. I discuss how such estimators perform in the case of reforms which may not be sharply demarcated to treatment and control clusters, but rather subject to local spillovers or externalities. I propose an extension of the typical DD estimator: a spillover-robust DD estimator. This methodology is applied to estimate the effect of two localised fertility control reforms in Mexico and Chile, where women close to treatment clusters who were not themselves subject to the reform may nonetheless travel to access treatment.