Background Quality antenatal care (ANC) is essential for reducing maternal and neonatal mortality; however, access remains inequitable in Southern Africa. Women's empowerment is increasingly recognized as a key determinant of health-seeking behavior; however, its role in shaping ANC quality has not been adequately examined in the region. Methods This study used cross-sectional Demographic and Health Survey (DHS) data from 2015 to 2023 across seven Southern African countries ( n = 36,671). Women's empowerment was measured using the SWPER Global Index, which covers the domains of attitude toward violence, social independence, and decision-making. Quality ANC was defined as the receipt of four essential services: blood pressure measurement, urine testing, blood testing, and iron supplementation. Hierarchical models were fitted, and the measures of variation and model fit were evaluated. The significance level was set at p < 0.05, with a 95% confidence interval. Results Overall, 45.1% of the women received quality ANC, with wide variation between countries (27.4% in Malawi vs. 92.1% in South Africa). A high level of empowerment against violence and decision-making was observed among the women in most of the countries. Women with high social independence (aOR = 1.12, 95% CI: 1.01–1.24) and strong rejection of gender-based violence (aOR = 1.15, 95% CI: 1.05–1.26) were significantly more likely to receive high-quality ANC. Early ANC initiation, ≥8 visits, and doctor-led care were the most powerful predictors of quality ANC care. Conclusion Women's empowerment, particularly social independence and autonomy from violence, plays a critical role in improving the quality of ANC in Southern Africa. However, persistent socioeconomic and geographic inequities highlight the need for context-specific strategies. Policies that integrate gender equality frameworks with strengthened ANC service delivery, especially in rural and low-performing countries, are essential for achieving maternal health targets.
Background Data exist on adolescents’ screen time behavior, but are lacking on urban–rural differences. We compared daily screen time exposures and associated anthropometric parameters, frequency of outdoor physical activity, and psychological parameters of urban and rural school-going adolescents. Methods This was a cross-sectional study. Using five districts of one of the administrative divisions of a western Indian state as the sampling frame, the first two urban and first two rural schools were selected from a randomly reordered list of schools. We included 627 students from 5th, 7th, and 9th standards as representatives of the adolescent age group (10–19 years). Self-reported outdoor physical activity, psychological assessment using the Strengths and Difficulties Questionnaire (SDQ) and daily time spent on each were recorded. We determined associations between area of residence, frequency of outdoor physical activity, and SDQ scores and screen time using the chi-square test or Fisher’s exact test. Multivariable regression analysis was used to determine the predictors of excessive screen time (>2 h/day). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. Results There were 334 (53.3%) urban and 293 (46.7%) rural students. The mean age was 12.5 ± 1.4 years. Mean daily total screen time was 111.9 ± 71.7 min. Urban compared to rural [121.5 ± 75.9 min vs. 100.9 ± 65.0 min; p = 0.001] and boys compared to girls [122.9 ± 81.9 min vs. 100.9 ± 58.0 min; p < 0.000] had longer total screen time exposure. Being a rural resident was significantly associated with a >2 days/week of outdoor physical activity [78.8% (rural) vs. 35.9% (urban), respectively; OR 6.64, 95% CI 4.64–9.51, p < 0.000]. Students with daily screen time of >2 h had some/high needs on the SDQ hyperactivity scale [11.4% vs. 5.7%; p = 0.022]. Males had significantly higher odds of >2 h of total daily screen time than females (aOR = 1.51, 95% CI 1.05–2.17; p = 0.026). Conclusion The associations between longer screen time exposure and worse physical and psychological factors warrant interventions with special attention to urban–rural differences.
Gauri A. Oka, Ashish S Ranade, Mayur Kiran Shinde et al.
BACKGROUND: Preeclampsia is a leading cause of maternal and neonatal morbidity and mortality worldwide, yet effective pharmacological preventive strategies remain uncertain. Statins, metformin, and vitamin D, alone or combined with omega-3, have been investigated for potential protective effects, but comparative evidence is limited. OBJECTIVE: To compare the effectiveness of statins, metformin, and vitamin D in preventing preeclampsia and related adverse outcomes among high-risk pregnant women. METHODS: A systematic review and network meta-analysis of randomized controlled trials was conducted. PubMed, Scopus, Web of Science, Cochrane, and Epistemonikos were searched from September 11, 2020, to September 11, 2025. Eight trials involving 4,078 high-risk pregnant women were included. Participants were randomized to statins, metformin, or vitamin D at different doses versus placebo. The primary outcome was the incidence of preeclampsia. Secondary outcomes included gestational hypertension, preterm birth, low birth weight, neonatal intensive care unit admission, gestational diabetes, respiratory distress syndrome, and perinatal outcomes. Risk ratios with 95% confidence intervals were calculated, and interventions were ranked using the surface under the cumulative ranking probabilities. RESULTS: Eight randomized controlled trials were analyzed. Compared with placebo, higher-dose vitamin D supplementation showed associations with lower estimated risks of preeclampsia, particularly vitamin D 4,000 IU/day (risk ratio 0.21, 95% confidence interval 0.06-0.72) and 60,000 IU monthly (risk ratio 0.36, 95% confidence interval 0.19-0.70). These relative effects corresponded to approximate absolute risk differences of 8% and 6%, respectively, based on observed baseline risks, and reflect associations rather than proven causality. Estimates were derived from limited direct evidence within sparse networks. These dose-specific vitamin D regimens had the highest probabilistic ranking for preeclampsia within the network, but these rankings should be interpreted as exploratory rather than definitive. Higher-dose vitamin D was also associated with trends toward lower event rates of preterm births and low-birth-weight infants, although estimates were imprecise. Evidence for statins and metformin was inconsistent, with wide confidence intervals. SUCRA rankings suggested vitamin D as the highest relative ranking probability overall intervention within the network, followed by statins; however, these rankings remain exploratory given the limited network structure. These associations were derived from limited direct evidence within sparse networks and should be interpreted cautiously. Probabilistic rankings and SUCRA values reflect relative positioning within the network rather than comparative effectiveness. CONCLUSION: In high-risk pregnancies, higher-dose vitamin D regimens were associated with lower estimated risks of preeclampsia compared with placebo; however, these findings are based on limited, heterogeneous, and partly indirect evidence from sparse networks. The certainty of evidence is low, and the observed effect sizes should not be interpreted as evidence of clinical effectiveness. These findings are best considered hypothesis-generating and are intended to inform the design of future studies rather than guide clinical practice. Evidence for statins and metformin remains limited and inconsistent. Overall, further large, well-designed randomized trials are required before firm clinical recommendations can be made.
Menna Alaa El-Khouly, Mazen Mohammed Mahgoub, Mahmoud E. Abd-Elkareem et al.
Gratitude, one virtue that reflects a person's high moral standards, is a culturally sensitive construct expressed differently across cultural contexts. Definitions and perceptions of gratitude among children may differ from one community to another and from one region of the world to another. This study used a phenomenological design, coupled with the Indigenous standpoint theoretical framework and related participatory methodologies, to understand the virtue of gratitude among children. Conducting a qualitative survey, the authors utilized focus group discussions and key informant interviews to investigate how adolescents and adults from the pastoralist Turkana of northern Kenya and the Amhara of central Ethiopia defined and perceived gratitude in children aged 4–8 years. The authors analyzed the data thematically. The findings indicate that gratitude is defined variously as an innate capacity, an action, an expression of other virtues, and a feeling used to commune with both humans and the spirit world. Thus, gratitude reflects appreciation, thankfulness, and a positive response to acts of generosity or opportunities provided. Participants noted that gratitude manifested in children through their emotional dispositions, social interactions and relationships with others; their moral values; their actions and behaviors; and other positive character virtues. The most frequent recurring theme was defining gratitude as a relational skill used with both people and the spiritual world. These findings have implications for programs that support children developing positive virtues: they should be rooted in local cultural traditions and stress values prioritized by local communities.
Background: Verbal violence by teachers in classroom interactions may affect students’ psychological well-being and learning motivation, particularly in situations characterized by unequal power relations. Objective: This study aims to describe forms of verbal violence committed by an Indonesian language teacher in Class VIII of SMP Negeri 4 Arso, Keerom Regency, and to examine teacher domination through conflictive, competitive, and collaborative speech acts. Methods: This descriptive qualitative single-case study involved one Indonesian language teacher and 83 Class VIII students, consisting of 24 boys and 59 girls. Data were collected through classroom observation, interviews, questionnaires, video recordings, and field notes. The primary data consisted of teacher utterances containing elements of verbal violence and students’ statements related to these experiences. Data were analyzed using the Miles-Huberman interactive model. Results: Thirty verbal utterances were identified. Competitive speech acts were the most frequent, comprising 14 utterances (50%), followed by conflictive speech acts with 13 utterances (43%) and collaborative speech acts with 3 utterances (7%). Teacher domination was manifested through satire, warnings, commands, protests, belittling, mocking, cursing, threatening, demanding, stating, and announcing. Student responses included tolerance, fear, discomfort, and reduced motivation to learn. Conclusion: Teacher verbal violence in this case was predominantly expressed through competitive and conflictive speech acts. The findings emphasize the importance of respectful and child-friendly communication in classroom interactions.
Viksit Bharat 2047 vision focuses on making India a developed, inclusive, and sustainable country by its 100th anniversary of independence. This paper offers a multidimensional and sequential model of incorporating the major pillars of development including human rights, empowerment of women, social development and skill improvement with special emphasis on fempreneurs as the economic growth agents. Gender Equity as underlined in SDG 5- Gender Equality, is a main pillar towards sustainable development since they will be able to enjoy equal rights, opportunities and access to resources as women (Jameel, 2025). It is an important move beyond development to women to development with women where women are seen as the agents of development both economic and social. The availability of good education under SDG 4 Quality Education reinforces this process by empowering women with knowledge, skills and decision-making power, which results in better family and societal performance. This is then illustrated by economic empowerment which is in line with SDG 8 (Decent work and Economic Growth) in which financial independence via fempreneurship, innovation and financial literacy increase the contribution of women to national productivity. As a result, SDG 3 Good Health and Well-being is improved in terms of maternal and child health, which enhances human capital. With the empowerment, women are now actively involved in decision making process, which also consists of reduced inequalities according to SDG 10 Reduced Inequalities. Nevertheless, the key to the development of their full potential lies in reducing social barriers like discrimination and gender-based violence. In this regard, gender equity is relevant in providing inclusive business environments to fempreneurs to ensure sustainable development and social equity. Its effect goes beyond generations, with empowered females investing in education, food, and health of children, so that the development of society is guaranteed in the long term. In summary, gender equity on these SDGs should be enhanced to achieve the Viksit Bharat 2047 vision and create an inclusive, sustainable and resilient country.
Single mothers may simultaneously manage income generation, household responsibilities, parenting, decision-making and emotional support. The present descriptive mixed-method study examined psychological stress, social support, coping mechanisms and mother-child family dynamics among 28 single mothers and their children. The study used a supplied questionnaire consisting of demographic items, five-point mother-reported stress and well-being items, social-support and coping questions, open-ended responses, and a child questionnaire addressing emotional well-being and household dynamics. The recorded findings showed very high endorsement of financial pressure (99%), work-life/personal mental-health balance (99%), sole parenting responsibility (98%), and anxiety/guilt regarding time and resources (98%); loneliness was also highly endorsed (97%). External support was rated moderate by 60% and excellent by 40%. Family/friends were reported as a coping route by 49%, while 50% reported internalising or privately managing stress. From the child perspective, 99% reported very frequent concern about maternal stress and 99% reported very frequent closeness and support from their mothers; 92% reported very frequent comfort in sharing feelings or problems. The findings indicate that substantial maternal burden can coexist with strong mother-child emotional bonds. The study supports family-sensitive interventions that combine psychological support with practical childcare, financial guidance, flexible work arrangements and accessible community networks.
Abstract Parenting in urban informal settlements is shaped by intersecting economic, environmental, and institutional constraints. However, less is known about how young mothers experience and make sense of everyday caregiving under these conditions. This study explored the lived experiences of 20 young mothers aged 18–35 years raising children in Old Fadama and African Eleven, two informal settlements in Accra, Ghana. Guided by Jack’s framework of ecological influences on parenting and using an interpretative phenomenological analysis, the study examined experiences of child health care, housing, and education. Participants described recurrent childhood illness, limited access to formal health services, overcrowded and flood-prone living environments, and financial barriers to children’s schooling. Their accounts suggested that caregiving decisions were shaped by restricted material and institutional options, while mothers continued to negotiate available resources and sustain educational aspirations for their children. Although the two settlements differed as a “slum of hope” and a “slum of despair,” settlement type shaped the intensity of these hardships more than their fundamental characteristics. The study contributes an experience-centered account of parenting under structural constraint and highlights the importance of integrated, context-responsive interventions addressing health care, housing, education and the socioeconomic conditions of young mothers and improve child well-being in marginalized communities.
Portia Nana Ama Brempong, Kingsley Saa‐Touh Mort, Eunice Abbey et al.
This study examines the legacy of Tun Dr. Siti Hasmah Mohamad Ali in Malaysia, focusing on her contributions to rural healthcare, women’s empowerment, and community development. The study was conducted through a qualitative documentary review of academic literature, institutional publications, government reports, and credible historical sources concerning her medical career and public-health activities. Particular attention was given to her early service in Kedah, her work in maternal and child health, her leadership in rural health training, and her broader advocacy for women and community well-being. Historical evidence indicates that her professional career was closely connected with Malaysia’s development of rural health services, particularly services addressing mothers and children. The study also examined contemporary Malaysian statistics to situate her legacy within continuing issues of gender equality, healthcare access, and community development. The findings indicate that her legacy can be understood through the interaction of professional medical service, public-health leadership, women’s participation, and community-oriented development rather than through her public position alone.
This paper joins three arguments that are usually kept apart. Psychoanalysis is mental analysis, the science of why people do what they do. Human action turns on three motives that hold survival value: power, sexual gratification, and security from death. Beneath them sits an older root. The root of all evil is the need for food. When that need, or the sexual drive tied to it, is unchecked, other people are used as means. The use of a person as a means is where torture begins. The night of 3 August 2009, outside the Fiesta Inn hotel in Monterrey, is the case that makes the root visible. Gabriela Rico Jiménez, then 21, was filmed in a manic crisis screaming that they ate humans. This paper does not treat that cry as courtroom proof of a rite, and it does not treat it as empty noise. It reads the cry as the emotional truth of a young woman who had lost an empowered child culture, who did not have the resources for incorruptible caregivers or a secure home, and who was on the mean streets and afraid. The same logic then governs two public reforms. Torture in pornography must be banned, because filmed severe pain inflicted for sexual gratification is consumption of a person. Prisons, for violent law violators, must stop being punishment-as-torture and become psychoanalysis reform schools that still keep people off the street when a court requires it. 1. The three motives Psychoanalysis is too accurate a science to ignore. It asks why people do what they do, not only what they say they are doing. The three main motivations of every human action concern power, sexual gratification, and security from death. These issues hold survival value. A person seeks power so as not to be used. A person seeks sexual gratification because the species continues that way. A person seeks security from death because the organism knows it can end. Civilization is sane only when it meets the third motive without licensing the first two to consume other people. Security from death is not a side interest. It is one of the three motives because it has survival value. A civilization that gives people a real sense of security against death reduces the panic that turns into predation. The contrary condition is the mean street: no secure home, no reliable caregiver, no future that cannot be eaten. That is the condition this paper assigns to Gabriela Rico Jiménez, and to most of humanity when resources fail. 2. The root of all evil is the need for food Food is prior to the three motives and feeds all of them. Hunger is the first taking-in. In the unconscious, food and sex are close, because both are forms of taking or of being taken. Cannibalism is the taboo that names the worst case: another person used up so that someone else can go on. Power is the ability to decide who is eaten. Sexual gratification without a limit is the same taking, moved from the mouth to the body. Security from death is the wish not to be the one consumed. This is why a ban on torture cannot be confined to the police cell. Torture is severe pain or suffering, physical or mental, inflicted on purpose. The United Nations Convention against Torture defines it, for the purposes of that treaty, as such an act done to obtain a confession, to punish, to intimidate, to coerce, or for a reason based on discrimination, when inflicted by or with the consent or acquiescence of a public official or a person acting in an official capacity. It excludes pain arising only from lawful sanctions. That definition was written for state violence. It is not a permission slip for the same acts once they are filmed and sold, and it is not a moral warrant for using a prison as a machine for pain. The treaty marks the floor. It does not mark the ceiling. 3. The case: Gabriela Rico Jiménez, Monterrey, 2009 What the record supports On the night of 3 August 2009, in Monterrey, Nuevo León, a 21-year-old woman, Gabriela Rico Jiménez, was filmed outside the Fiesta Inn hotel in acute distress. She wore a torn shirt. She pleaded for her freedom. She said she had wanted her freedom, that Monterrey had freed her at great cost, that she had been in Mexico City for a year and four months, and that it had begun in mid-2001. She accused young and powerful people of killings. She named Carlos Slim as a man who knew of her situation. She shouted that they had killed Juan Camilo Mouriño, the Mexican official who died in a plane crash in 2008. She screamed that they ate humans, that it was disgusting, that they smelled of human flesh. She spoke of queens, of the Queen of England, of princesses, and of Mickey Mouse, in a rush that listeners have tied to child-taking. Police intervened when she became aggressive. She was arrested. What followed is thinner than the video, and that thinness is part of the sadness. She was taken to a police station. An anonymous account, attributed to a law student interning there, describes a short encounter in which she was full of despair, fear, and anguish, and said that everyone was dead, with talk of underground bases and stolen children. The same account says well-dressed men arrived and that officials later denied she had been there. Reports then place her in a psychiatric facility in Colonia Buenos Aires, in Monterrey, to be held for treatment. Public updates fade after the early 2010s. Some later claims say she was seen alive years afterward, still under care or living privately. Viral posts say she vanished that night and was never seen again, often after calling her a supermodel who had been inside an exclusive elite party and who knew too much. The supermodel label does not hold up. No agency record, runway history, or cover confirms a career of that kind. The elite-party frame is an inference from her own words and from the hotel, not an established fact. Claims that she was killed on a billionaire’s property, moved to a foreign facility, or silenced for naming a rite are not supported by a public record. Mexican mental-health privacy can explain missing updates without proving a disappearance. This paper will not build on those claims. The psychoanalytic reading The reading begins from the scream the video actually centers. Her main attention was cannibalism. They ate humans. That cry works on two levels, and both are required. On the surface she is naming the primal taboo. Cannibalism is the extreme violation of a body, tied to the earliest survival instinct, the acquisition of food. That matches the proposition that the root of all evil is the need for food. On the symbolic level, being eaten is a regression to oral-stage anxiety: total engulfment by a hostile caregiver or a hostile world. In object-relations terms, she places the bad object outside herself, the devouring elite, and yearns for the good object she did not have. That good object, in this framework, is a celibate empowered child culture with robotic parents: caregivers who do not hunger, do not lust, and do not neglect, because they are not corruptible in the human way. Her crisis is therefore not first a lecture on secret societies. It is the loss of an empowered child culture. She did not have the resources for robotic parents and a secure home. Like most of humanity in that condition, she was on the mean streets, and she was afraid. The manic rant about evil is the form the fear took when the ego could no longer hold it. Projection put hunger and predation into queens, billionaires, and cartoon figures of innocence, so that the intolerable fact of her own exposure did not have to be borne alone. Regression returned her to a child calling for rescue. Splitting divided the world into an absolute good, the uncorrupted child culture, and an absolute evil, the people who eat. Sexual encroachment belongs in the same picture, as a layer rather than as a proven charge. Encroachment of that kind is common in hotels and in the circles that use young women as access. Psychoanalysis does not need a verdict to notice the link. Food and sex are both taking-in and being-taken. If the hotel added a sexual threat to the primal one, the cannibalism imagery can carry that threat by displacement. The scream is then also a refusal of sex gratification taken from her body. Her deeper plea is to go back to a celibate empowered child culture, with the future robotic parents she would have had if the resources had existed. The video is a call for help. Whether the threat was real, imagined, or both, the emotional truth is the same. She was signaling, in the only language left at that point, that she wanted to escape predation entirely. A clinical diagnosis is not offered here. The public picture is consistent with a psychotic or manic crisis, possibly worsened by trauma, drugs, or an untreated illness. Psychoanalysis does not have to settle the medical name in order to hear the wish. The wish is safety without consumption. 4. Torture in pornography is the same consumption, sold Gabriela’s scream names the act. Pornography that tortures performs it and distributes it. Severe pain or suffering, physical or mental, is inflicted on purpose so that a viewer can be gratified and a producer can be paid. That is sexual gratification using a person as food. Payment, addiction, trafficking, or fear does not convert the suffering into a neutral product. Consent extracted under those conditions is not the opposite of consumption. It is one of the ways consumption is arranged. People whose motive is unchecked sexual gratification, or power over others, are the least likely to champion a ban. That is not an argument against the ban. It is the reason the ban has to be law rather than a request. The Convention against Torture already refuses state torture. A society that accepts that refusal has no coherent reason to exempt the same severe intentional pain because a camera is running and the motive is sex. Ban torture in pornography. The ban is the point at which the drive for sexual gratification meets the refusal t
