#pro-natal policies

[minnesotafollower]

“Economist” Magazine Also Predicts Lower World Population

Last month this blogger was surprised to learn about forecasted declines in world population and the resulting challenges of coping with such changes.[1] And earlier this week this blogger was also surprised to discover that due to the aging and forecasted retirement of many U.S. primary- care physicians, the U.S. will need to recruit foreign physicians to move to the U.S. and practice here and…

[belladonnafleur]

welp

[truth-has-a-liberal-bias]

On Monday, former president Donald Trump announced his vice presidential running mate: Ohio Senator J.D. Vance.

There are endless reasons why I find this alarming, from Vance’s anti-LGBTQ legislation to his disparaging remarks about DEI initiatives. But I want to focus on an old speech that’s been recirculating since the news broke.

In 2021, Vance spoke at the Intercollegiate Studies Institute’s conference on the Future of American Political Economy, where he blamed "the childless left" for the nation's woes. As a woman who’s intentionally childfree, I am livid over this rhetoric. According to him, we have "no physical commitment to the future of this country."

...

Vance specifically called out several Democrats for not having "a personal and direct stake in [our country] via their own offspring": Alexandria Ocasio-Cortez, Cory Booker, Pete Buttigieg, and Kamala Harris (disregarding that the Vice President is the stepmother of her husband’s two children). Since this speech, Buttigieg and his husband have adopted two children.

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Vance bemoaned the current state of "family formation" and "birth rates" in the US. But in true Republican fashion, he didn't bother exploring why many Americans are having fewer children.

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Did Vance propose sound solutions to the "civilization crisis" like addressing climate change? Of course not. (He doesn’t believe that people contribute to climate change.) Other than praising Hungary's pro-natal policies, the only suggestion he offered was this preposterous idea: "Let’s give votes to all children in this country, but let’s give control over those votes to the parents of the children."

He continued, "Doesn’t this mean that nonparents don’t have as much of a voice as parents? Doesn’t this mean that parents get a bigger say in how democracy functions?" He answered his own questions with a "yes" after admitting "the Atlantic and the Washington Post and all the usual suspects" would criticize him.

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After Vance received blowback for his ludicrous suggestion, he appeared on Tucker Carlson Tonight, where he double downed. "We are effectively run in this country...by a bunch of childless cat ladies who are miserable at their own lives and the choices that they've made, and so they want to make the rest of the country miserable, too. And it's just a basic fact." [...]

[zeldahime]

Zelda Liveblogs a Lancet Paper

Following this post, I am now going to liveblog reading the Lancet paper cited by the Economist article to predict worldwide fertility to drop by 3/4s of its current position if current demographic trends continue. It is an Open Access article, so the entire thing is open for anyone on the internet to read.

Citation:

GBD 2021 Fertility and Forecasting Collaborators (March 20, 2024). Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. The Lancet, 403(10440), 2057-2099. https://doi.org/10.1016/S0140-6736(24)00550-6.

I refuse to use Chicago style. This is mostly because I memorized APA and don't want to learn a new one.

First, my background: I am not a demographer; I am not trained as a demographer; I have studied it auxiliarily to my other academic pursuits. I fall in a sort of educated in-between. I am currently a Master's student in library and information sciences, and my undergraduate degree was in political science, both at USAmerican universities. However, the field of economics is also very close to my heart, and I would have double-majored in it if the opportunity and financial costs had not been too high to justify it. During the five years I was a college drop-out, I studied economics independently, reading broadly within the field and taking non-certificate courses online. I've been taking non-certificate courses in economics through correspondence or online since I was about nine. I'm not an expert! I do, however, think I'm a fairly well-informed amateur.

And a note on language. This paper refers to birthing parents as mothers and to the demographic that gives birth interchangeably as female and women. I acknowledge that this is a cissexist patriarchical viewpoint that erases transmen, nonbinary and intersex people, and probably others I'm not thinking of. For consistency between my reflections and the paper and ease of reading, I will do the same. I'm conscious I'm part of the problem here, but don't see a way around it without making my bits harder to understand than they have to be.

With that out of the way, here we go:

Methodology (Summary)

This is where me not being a demographer is an important thing to know. I neither know nor normally care about the statistical methods used to determine demography, just that the demographers aren't retracting papers over it. However, I do know that in general the CCF50 (total cohort fertility before the age of 50) is a neater and more accurate measurement to build projections on than the TFR (total fertility rate by year) and that's the methodology the paper's authors went with. This is good and promising. TFR for known years and CCF50 projections sounds like a solid method. 👍

We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined.

I'm very hopeful about these forecasts! They'll show a few different hopeful scenarios.

To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline.

This is a very responsible thing for the authors to have done, and I am interested to see how this is reflected in the models.

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Findings (Summary)

During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950,

(Emphasis mine. The numbers in parentheses are the confidence interval.) I think this is the most important takeaway from the whole damn paper. Makes sense, since it's the first line of the findings. If you read nothing else, read these three sentences. Global birthrates are barely above replacement (which, if you recall from my other essay, is generally considered to be ~2.1). To me, this implies lot of problems that traditionally have been considered solvable with population redistribution (meaning, mostly, immigration) may not be solvable that way even if fertility were to stop declining today and hold constant for the rest of the century.

Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa.

Holy shit. I cannot emphasize enough how low a TFR of 1.59 is. This is approximately the current TFR of the United Kingdom, and they're beginning to freak out even though they have relatively easy sources of additional replacement recruitment through the Commonwealth. Imagine that for the whole Earth. With only six countries as a potential source of surplus population to be redistributed.

Funding from the Bill & Melinda Gates Foundation. Makes sense. This is the kind of thing that foundation funds.

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Introduction

Low levels of fertility have the potential over time to result in inverted population pyramids with growing numbers of older people and declining working-age populations. These changes are likely to place increasing burdens on health care and social systems, transform labour and consumer markets, and alter patterns of resource use.

Oh man, I wish I'd gone through this paper earlier, I could have just quoted this bit and been done instead of trying to explain it from scratch! 😂

The UN Population Division estimates of past fertility are not compliant with the Guidelines on Accurate and Transparent Health Estimates Reporting (GATHER) statement in important respects; notably, they do not provide all code for statistical models or explicit details on criteria for exclusion or adjustment of primary data sources. Furthermore, the validity of UN Population Division projections has been questioned due to the assumptions applied in countries experiencing low post-transition fertility dropping below replacement level.

YES GO OFF 👏 The UN Population Division is so much more cagey about their data than the World Bank, it's so annoying, and they keep predicting increases that don't happen. I thought it was so weird as an undergrad but figured it was because of ~bureaucracy~ or privacy laws or whatever. It's nice to be vindicated [redacted] years later.

Our forecasts also suggest that, by 2100, the largest concentrations of livebirths will shift to low-income settings, particularly a subset of countries and territories in sub-Saharan Africa, which are among the most vulnerable to economic and environmental challenges. Extreme shifts in the global distribution of livebirths can be partially ameliorated by improved female education and met need for modern contraception. Outside of this subset of low-income areas, most of the world's countries will experience the repercussions of low fertility, with ageing populations, declining workforces, and inverted population pyramids, which are likely to lead to profound fiscal, economic, and social consequences. National policy makers and the global health community must plan to address these divided sets of demographic challenges emerging worldwide.

This is such an important point for them to make. Demography isn't a vacuum; it has significant real-world effects. By 2100, most babies born will be born in Africa, and we need to plan for that now. By 2100, most countries will not have enough workers, and we need to plan for that now. 2100 is not that far into the future. I, personally, will live to see the beginnings of the effects of this demographic shift, and I'm an adult who pays taxes and has a college degree and shit.

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The Data Sources and Processing section is pretty standard and unremarkable. Good job.

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Fertility Forecasting

We produced forecasts of fertility using an updated modelling framework (appendix 1 section 3) that improved on the methods in the 2020 study by Vollset and colleagues. In our updated methods, we used not only estimates of female educational attainment and contraceptive met need as covariates, but also estimates of under-5 mortality and population density in habitable areas to account for a larger variation in CCF50 across all countries in the sub-models (appendix 1 section 3.1, appendix 2 figure S2). Similar to Vollset and colleagues, we continued to forecast fertility with CCF50 rather than TFR, because modelling in cohort space is more stable than in period space.

Niiiiice. Covariates are things that, well, vary, alongside the thing you're trying to measure. For fertility, the most obvious one might be age of the mother at first birth; if someone is 16 at first birth, she probably will have more kids than someone who is 30 at first birth, for example. This model also includes how much schooling the mother gets, whether she has contraception, the mortality rate (that is, how many of them die) of children under five, and population density! That's a lot of statistical crunching and their model will be more precise for it. Precise isn't the same as accurate, but I think that with the variables they selected, they will travel in the same direction.

What a pretty equation. I don't understand it, but it's got a certain je ne sais quois.

For the education SDG scenario, the forecasts assume that by 2030, all people will have 12 years or more of education by the age of 25 years and then maintains the same rate of change as the reference scenario up to 2100. For the contraceptive met need scenario, to reflect the SDG scenario of universal access, the forecasts assumed a linear increase in contraceptive coverage to reach 100% by 2030 and then stay constant up to 2100.

I love how optimistic these scenarios are 😂 This truly is the best-case scenario for both the education forecast and the contraceptive forecast! I do hope everybody has 12+ years of education and 100% contraceptive coverage by 2030. Make it happen, António!!!!

(Joke explained: António Guterres is the current Secretary-General of the United Nations, and these goals are absolutely not going to be met by 2030.)

In the pro-natal scenario, we assumed a country will introduce pro-natal policies, such as childcare subsidies, extended parental leave, insurance coverage expansion for infertility treatment, 33 and other forms of support for parents to afford high-quality child-care services, once TFR decreases to less than 1·75. We then made three assumptions on the effects of such policies. First, we assumed the full effect of pro-natal policies will be to increase TFR by 0·2. Second, it will take 5 years after the policy is introduced for the full increase in TFR to occur, and TFR will rise linearly over that time span. Last, we assumed that both the policies and the increase in TFR by 0·2 will endure for the remainder of the century.

The pro-natal scenario is also incredibly optimistic. This kind of response simply hasn't happened in any country that's tried pro-natal policies as envisioned by the authors (my reference cases, just off the top of my head: Japan and France).

The optimism makes sense. They represent extreme cases, in order to contrast possible outcomes versus the reference case. This is good practice! It's just also funny.

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Results

The Reference Case

I hate the embedded tables. They have the confidence interval in the same cell as the estimate. How very dare they, that's incredibly inconvenient for me personally.

The chart in Figure 1, however, I think speaks volumes:

It speaks so many volumes that I'm gonna go up and put it above the cut, brb. This chart shows the reference case; that is, it shows the fertility rate if the fertility trends of 1950-2021 continue into the future.

At the national level, estimates of TFR in 2021 ranged from 0·82 (95% UI 0·75–0·89) in South Korea to 6·99 (6·75–7·24) in Chad, with below-replacement levels of fertility (TFR <2·1) in 110 of 204 countries and territories (table 1, figures 2A, 3).

I think this range is neat and goes to show that while the trend is world-wide, it's still not even. Chadian women still give birth to about 7ish kids on average. That's more than 3x replacement, and more than 8.5x the average fertility of South Korea. South Korea is going to have different problems than Chad; Chad probably doesn't have to worry as much about their workforce being unable to sustain a large elderly population. (Don't look so cheerful about it. They've got lots of other stuff to worry about. 😬)

These charts are fascinating to look at to me. I think this really showcases just how dramatic the projected decline is. It's not just the Europe, it's not just wealthy post-industrialized countries, but everywhere. It's in Eswanti, it's in Indonesia, it's in Burkina Faso, it's in China. It really shows just how much Chad is an outlier (adn should still be counted, btw, just because it's an outlier doesn't mean we should discard it; it's dependent on study structure and you can't just throw out entire countries because they have high birth rates on a study of birth rates).

Our estimates indicate that there is approximately a 30-year gap between the time when TFR falls below 2·1 and when the natural rate of population increase turns negative. We forecast that 155 (76·0%) countries and territories will have fertility rates below replacement level in 2050; by 2100, we project this number will increase to 198 (97·1%), with 178 (87·3%) having a negative natural rate of increase (figure 3).

A 30-year gap sounds reasonable. That's about how long it takes for people to have/not have kids, and for their own parents to potentially die, in about equalish numbers (on a global scale, anyway). I do think this gap number is likely to increase as healthcare improves in places that are worse today and as fertility technology increases the age at which people can become pregnant, but 30 is a perfectly respectable number with actual statistical backing.

Alternative scenario fertility forecasts

This is the part I'm really excited about!!!

The first scenario, which assumes meeting the SDG education target by 2030, is estimated to result in global TFRs of 1·65 (95% UI 1·40–1·92) in 2050 and 1·56 (1·26–1·92) in 2100 (table 2). The second scenario, which assumes meeting the SDG contraceptive met need target by 2030, will produce global TFRs of 1·64 (1·39–1·89) in 2050 and 1·52 (1·21–1·87) in 2100. The third scenario, which incorporates pro-natal policy implementation, is forecast to yield global TFRs of 1·93 (1·69–2·19) in 2050 and 1·68 (1·36–2·04) in 2100. The combined scenario, in which all three other alternative scenarios are applied, is projected to result in a global TFR of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100.

So recall the reference scenario projections: 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100.

I find it interesting that all cases are so incredibly close to reference, with overlapping confidence intervals. Functionally, there's not a lot of difference between a TFR of 1.68 and 1.52. They're both still well below replacement. It's about the difference between Sweden (1.67) and Russia (1.51). Russia, you may have noticed, is waging war about it.*

*This is not a stated goal of the Russian Federation in the Ukraine War. This is me personally making an assertion that the shifting demographics of the Russian population, including the below-replacement birthrate beginning to put pressure on their lacking social safety networks, has contributed to the many complicated and interconnected reasons why the Russian Federation invaded Ukraine, but please do not take me to be the final authority on the matter or interpret this statement as implying that demography of all things is the sole or primary reason for the war.

Discussion

The aforementioned changes in fertility over the coming century will have profound effects on populations, economies, geopolitics, food security, health, and the environment, with a clear demographic divide between the impacts on many middle-to-high-income locations versus many low-income locations. For nearly all countries and territories outside of sub-Saharan Africa, sustained low fertility will produce a contracting population with fewer young people relative to older people before the end of the 21st century. These changes in age structure are likely to present considerable economic challenges caused by a growing dependency ratio of older to working-age population and a shrinking labour force. 42 Unless governments identify unforeseen innovations or funding sources that address the challenges of population ageing, this demographic shift will put increasing pressure on national health insurance, social security programmes, and health-care infrastructure. These same programmes will receive less funding as working-age, tax-paying populations decline, further exacerbating the problem.

This is why the Economist article talks about birthrates the way it does. It's not about white babies or whatever people in the notes are sarcastically ascribing to an article they haven't read. It's about the whole world. There are 150 countries outside of the Sub-Saharan Africa region, and 44 of the 46 countries within Sub-Saharan Africa are projected to feel the many or all of the same effects as well.

It's about the way social security nets are structured and how they're going to fail. It's about the way that elderly people are going to be treated by our societies. It's about me, and it's about you, and it's about making sure that there are enough humans to take care of the other humans that need taking care of.

If we don't increase global fertility rates above replacement, which it increasingly looks like we won't, we need other solutions. The fertility one is easy fuckin' pickings compared to a complete overhaul of society, and you saw how little difference it actually makes. So did the authors:

To date, one strategy to reverse declining fertility in low-fertility settings has been to implement pro-natal policies, such as child-related cash transfers and tax incentives, childcare subsidies, extended parental leave, re-employment rights, and other forms of support for parents to care and pay for their children.49, 50 Yet there are few data to show that such policies have led to strong, sustained rebounds in fertility, with empirical evidence suggesting an effect size of no more than 0·2 additional livebirths per female. [...] Moreover, although pro-natal policies primarily aim to increase births, they also offer additional benefits to society, including better quality of life, greater household gender equality (ie, more equal division of household labour),53 higher rates of female labour force participation,54 lower child-care costs,55 and better maternal health outcomes,56 depending on policy design and contextual factors. In the future, it will be beneficial to perform an in-depth analysis on varying impacts of pro-natal policies in selected countries that have a meaningful impact on population. [...] Importantly, low fertility rates and the modest effects that pro-natal policies might have on them should not be used to justify more draconian measures that limit reproductive rights, such as restricting access to modern contraceptives or abortions.

I just want to highlight that the study authors explicitly argue for certain pro-natal policies that increase quality of life and caution against pro-natal policies that limit rights. These people aren't heartless.

They also discuss at some length the implications of the changing distribution of live births, where by the end of the century most live births will take place in the poorest nations, which are also the ones that will be hardest-hit by climate change. These nations already face famines, military rule, civil wars, terrorism, and climate changed-caused severe heatwaves, droughts, and floods. They advise politicians to take this into account when making policy decisions but don't go into what policy decisions should be made, which is wise since they're demographers and not political scientists, but disappointed me, the political scientist reading the demography paper and hoping to find something to criticize.

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My takeaway:

Incredibly interesting paper. As a non-demographer, I think it's very convincing and hope that it sparks a serious conversation about the paths we need to take forward, in our own countries and as a global community. I especially hope that it inspires us to take bold action to drastically change our systems of elder care, which are already being pushed to the limit and will simply break under pressure if fertility rates continue to fall.

[pulsar-1919]

Anti-immigration rioting currently going on in Dublin, I just know people like the Irish Freedom Party (our fairly recent and small right wing party) is going to take advantage of people's anger over today's stabbing and Ashling Murphy's murder to drum up votes, so I took a look through their other policies

They are in favour of 'Itrexit' - Ireland leaving the EU and dropping the euro currency

They are vehemently anti-abortion (their constitution says 'pro-natal' but their leader has been quoted saying 'abortion is a stain on this country'

They are seeking changes to the 1989 hate speech legislation (which isn't even very effective for prosecuting hate crimes) in order to protect free speech - citing that hate speech legislation has been used in other countries against Christian pastors (I smell homophobia and transphobia)

They are pro reunification (and everyone is in theory, of course it would be nice, but right now it would cost the relative peace that Northern Ireland has had in my lifetime)

Reminding people to look beyond one issue before giving a party like this a vote

[beardedmrbean]

Helsingin Sanomat is running a piece on the falling birth rate that has a radical new suggestion: acceptance. Finland's birth rate has dropped significantly since 2010, and currently stands at 1.26 children per woman.

That will cause problems for the pension system and other public services in future, because there will simply be too few taxpayers to fund them.

The reasons are many and varied, but women across the western world are now choosing to have fewer children and changing their minds will be tricky, according to researcher Tarmo Valkonen. One possible solution is that women would accept "worse partners", he says, but few politicians are advocating that.

Instead, increasing the population through pro-natal policies (usually paying families to have children through tax incentives or direct payments) or immigration are the usual solutions.

Valkonen, however, says that Finland should just accept that the working-age population is going to decline and either increase pension contributions or reduce pension payments.

Canada's pension system has automatic rule changes built-in, Valkonen notes, mandating changes when the population structure alters.

Finland is late to start on that path, but he sees few other options. In 2023 the government led by Petteri Orpo (NCP) rejected a suggestion from the Strategic Research Council that it would study the impact of immigration on the public finances.

It was the first time a government had rejected a theme by the council, which operates under the Academy of Finland to seek "concrete solutions to grand challenges that require multidisciplinary approaches".

Valkonen said to HS that perhaps previous research he had co-authored had reached too positive conclusions, and the right-wing government did not want further evidence accumulated on the benefits of immigration to the Finnish state finances.

Either way, his message is that birth rates are unlikely to increase and Finland needs to draw the appropriate conclusions.

Wolting while poor

A letter from a social worker to Helsingin Sanomat last week suggested that Wolt's partnership with payment firm Klarna had led some people into debt problems.

The idea is that people with money troubles may take advantage of the "buy now, pay later" service to order food when they have few other options.

Iltalehti follows up on that by asking debt advisors what they think. Juha Pantzar from Takuusäätiö (the Guarantee Foundation), an association that helps people in debt to find a path out of it, says that it is a growing issue.

He notes that although Wolt orders are not the main reason people end up with debt problems, they are clearly evident in his clients' debt histories.

Klarna-style payments in general, however, are a growing factor in people's indebtedness. At present one third of the foundation's clients have debt problems composed entirely of this type of debt.

Young people are particularly vulnerable, according to Pantzar.

Food prices down

Those struggling to make ends meet will be concerned about recent jumps in the price of food, but Aamulehti says those prices are now stabilising.

The Tampere daily has an in-depth look at food prices, using the index kept by Statistics Finland. Food has gotten 2.7 percent cheaper since a peak in March 2023, but that still feels like a high price level for many.

Over the last couple of years food prices have risen by some 20 percent, and Sari Forsman-Hugg from Pellervo Economic Research (PTT) says there is no going back to that previous price level.

PTT says that the overall price increase next year will amount to around one percent. Coffee, cocoa and orange juice have seen big jumps in wholesale prices, which will affect consumer prices in Finland as well.

[mariacallous]

Who Will Be in South Africa’s Next Government?

It’s official: The African National Congress (ANC) party will need to share power for the first time since apartheid ended in 1994 after losing its parliamentary majority in South Africa’s May 29 national election. The historic loss was in part due to former President Jacob Zuma’s 6-month-old uMkhonto weSizwe (MK) party eating into ANC support. The ANC received 40.2 percent of votes, down more than 17 percentage points compared with the 57.5 percent it secured in the last national election in 2019. It now holds just 159 seats out of 400 in the National Assembly.

The center-right Democratic Alliance (DA) trailed in second place with 21.8 percent of votes (87 seats). Zuma’s MK gained 14.6 percent of votes (58 seats), becoming the third-biggest party in the National Assembly.

In Zuma’s home province of KwaZulu-Natal, the former president rejected the final tally, claiming vote-rigging, and threatened violence if South Africa’s Electoral Commission declared the results on Sunday as planned. “People would be provoked,” he said, referring to the violent riots that gripped the nation when he was sent to jail in July 2021. “Do not start trouble when there is no trouble.” MK won 45.3 percent of votes in KwaZulu-Natal—just under the 50 percent needed to govern the province outright.

Zuma’s earlier conviction means he is barred from taking a seat in the National Assembly, but he is still able to pull the strings from behind the scenes. “Love him or hate him, Zuma is the most consequential South African politician of his generation,” Sisonke Msimang wrote in Foreign Policy prior to the election. Another ANC splinter group, the radical left-wing Economic Freedom Fighters (EFF), dropped to fourth place, with a vote share of 9.5 percent (39 seats).

“We suffered heavily, but we are not out,” ANC Secretary-General Fikile Mbalula said at a press conference on Sunday. “We are talking to everybody. There’s nobody we are not going to talk to.” The ANC now needs to form a coalition with one or more opposition parties and began talks on Monday.

The first option that’s popular with investors is a partnership with the pro-business DA. But factions of the ANC are ideologically opposed to the free market agenda promised by the DA. There’s a high potential for political infighting that could weaken any ability to govern cohesively. The DA does not support racial quotas in the workplace—introduced by the ANC—or the new government-funded national health insurance system.

The DA also opposes setting a minimum wage, which it says contributes to unemployment; meanwhile, the ANC believes a minimum wage shelters low-skilled Black workers from extreme poverty.

EFF leader Julius Malema warned the ANC against forming a coalition that would “reinforce white supremacy” and make it a “puppet of a white imperialist agenda”—referring to the DA, which is perceived as serving the interests of minority white South Africans. But the DA has drawn support from Black and mixed-race voters and is seen by most South Africans as governing the best-run province—the Western Cape and its capital, Cape Town.

In turn, DA leader John Steenhuisen has been open to an ANC partnership from the outset knowing that the party was unlikely to reach more than 22 percent of votes. He called an ANC-MK-EFF coalition a “doomsday” scenario.

An alternative to appease dissenting ANC members would be a coalition with the ANC, DA, and Inkatha Freedom Party (IFP), which draws its support mainly from ethnic Zulus in KwaZulu-Natal. This would give the three parties 66 percent of the national vote and a commanding majority in South Africa’s most populous province, Gauteng.

A coalition between the ANC and the EFF would intensify great-power competition in the region by further antagonizing the United States. The EFF has suggested nationalizing key institutions and redistributing minority white-owned land without compensation. The two parties currently run the Johannesburg city council together but have had violent clashes running Ekurhuleni, a municipality east of Johannesburg.

The EFF and MK advocate similar economic policies, but an alliance between MK and the ANC is at the moment unlikely due to the souring of relations between Zuma and ANC members. Zuma’s party has demanded that President Cyril Ramaphosa step down before any coalition talks, which ANC members have ruled out.

Coalitions have rarely worked in South Africa. Coalition governments that have previously governed major cities such as Johannesburg and Durban have been unsuccessful, as party rivalries often hampered the delivery of basic services. On a national level, this could affect the ability to swiftly introduce new policies and pass budgets to deal with the country’s immediate problems on the economy, energy, and jobs.

“The lack of ideological cohesion among parties has led to the rise of coalition politics in South Africa,” Ebrahim Fakir wrote in Foreign Policy just before the election. “The result is a governmental environment where oversight and accountability are minimal—and where policy implementation is erratic.”

Leaked ANC documents seen by South Africa’s Daily Maverick suggest the party may opt for a minority government with a more stable supply and confidence agreement struck with the DA and IFP, similar to the parliamentary system currently in place in Canada. The arrangement would mean that the parties agree to back the ANC on key policy votes in exchange for concessions on specific policies.

Regardless, experts suggest Ramaphosa’s time in office could be limited. No ANC president has ever served a full second term. Nelson Mandela chose not to run for a second term, while his successors Thabo Mbeki and Zuma were forced to step down as party leader before their final terms ended. Having presided over such a historic defeat for the ANC, pressure may increase on Ramaphosa to step down before his mandate ends.

[tabby-shieldmaiden]

Carnival of Aros June 2023: My Future

This is a piece I wrote for the June 2023 Carnival of Aros, themed around being aromantic in an allonormative world.

CW: this piece will briefly discuss the fact that we live in a queerphobic world, and that anti-autistic ableism is a risk that autistic people may face when entering intimate relationships. It’s all only short mentions, but they’re there.

Carnival of Aros June 2023: My Future

At twenty years old, I will hopefully have a lot more life left to live. Presently, I am thinking about the sort of future I would like to build for myself. Where would I see myself in ten years time, twenty, or even thirty and beyond? Where would I end up? What sort of relationships would I find myself in?

I know roughly what sort of work I would like to try and do. The future is uncertain, but I do hope to fight and push for a better one. But then the question comes to where I see myself in my personal life. And then, that’s when I realise I don’t really have a very good answer. 

In my country, one can only apply for single home ownership once one reaches the age of thirty-five. If not, you can only apply for a home if you are doing it with your biological family, if you are widowed, if you are orphaned, or if you are married. The government is pushing more pro-natal policies in the hopes of bringing up the birth rate. And of course, to a conservative culture like this, that means encouraging as many young people to pair up and marry as soon as possible, and pump out as many children as possible (so long as you can afford it, they would caveat). 

Well, I guess that’s all fine and good, if that’s the life you would want. But, truthfully, it’s not a life for me. 

I don’t think it was ever easy for me to imagine myself as a wife. I’d thought about sex, and I’d thought about a wedding, and I’d entertained the thought of being a mother before. But being a wife? It just… doesn’t seem like a life for me. Since losing connection with the religiosity of my upbringing, connecting with my aromanticism, and thinking more and more about what I would like out of life. Marriage as a lifestyle, if I were to realistically think about it, seems less and less like something I would need out of my life. 

If I were to choose an ideal form of emotional support, one which I would like to give and receive, it would be in the form of a close, tight-knit network of many different friends. All of whom I’m emotionally close with, whom I get to fulfil different emotional needs with. It’s something that still doesn’t seem quite realistic in the world we currently live in though. Where would we all live? Would our families all approve? Would we be able to hold together as a group? Will I be able to find people who want the same things I do? Especially when so many people seem to desire a heterosexual, heteromantic, monogamous marriage. Who could dedicate the same level of emotional support one gives their family or their spouse to their unmarried friend? In the world we live in today, that doesn’t seem to be likely. 

And I could go a conventional route. Find a guy to marry out of convenience. Except… this doesn’t seem fair. There would be a certain type of love that I would be expected to return. A type of love which I fear I don’t have in me to feel or express to another. And it would be hard to find other aromantics. Queerness of any kind isn’t readily embraced by many of the people of this country. Few people would know about aromanticism. As an autistic woman, I already know how risky it is with entering a romantic relationship with someone who does not understand what you are. Someone who would expect you to conform to a certain image, and who may resent you for failing to fulfil that image. I’ve heard the stories, I know the fear. Aromanticism will inevitably complicate matters.

As it is, I nevertheless feel myself inevitably being pushed in the direction of some form of monogamous straight relationship. It may be the fear of being alone forever. It may be the fear of having no one to look after me, should anything happen to me in the future. It may be the fear of being perceived as immature. Mostly though, it may be because when so many forces of society wish for someone to be a certain way, sometimes they give up, and they take the path of least resistance. It’s a wimpy response, but it’s one I sometimes wonder if I will fall into. Sometimes, I wonder if I will really, truly, give up and settle.

It is difficult to push back against the tide, especially when it feels like you’re going at it alone. 

I don’t have very many hopeful thoughts pertaining to my future relationships, or of getting the sort of emotional intimacy I hope to get. Maybe I could fight. Maybe I could work towards a better future. For all queer people, for the next generation. Maybe things would be better for the people of the future.

But for now, it is what it is. I don’t know where my future is headed. But if there is a spark of hope I can hold onto, I certainly wish that that hope will find some way to materialise. 

[incarnation-issues]

are you trans-detrans solidarity stances biased in one direction or another? I imagnie most anyone that brands themself as that title will understandably prioritize pro-transition stances. so I am skeptical someone would actually take on a neutral position that benefits any kind of detransitioner.

Hi, anon. Thank you for your concern. If this post doesn't engage with your question on the axes you were trying to ask about, please re-send a clearer question. I obviously can't tell if my stances are biased, so I'll summarize some of them here and give you some backstory.

I actually am kind of a detransitioner. I'm an AFAB/natal female who used to have a masculine nonbinary identity and stopped, and I still have some unwanted physical effects from having been on testosterone. I just also have a social circle full of trans people, really dislike cishumanism, and am perpetually frustrated with radfems, which is why I put stuff like "highly masculine right-brain systems thinker disconnected from Nature" in my tumblr bio.

(I never took exogenous testosterone, my body was like "hey, want to have a neckbeard and chest hair and horrible acne and a teenage-boy-tier sex drive and a face that people sometimes gender as male if paired with a t-shirt and short hair? no need to go to a doctor, I've got that covered". Now I take spironolactone, which I would recommend with caveats. I spent some time in detransition-oriented social groups, but got frustrated with them for what I saw as denying the realities of biomedical transition and having a cruel attitude towards some transgender women I was and am friends with. Discussing dysphoria with transgender women led me to start antiandrogens, which have done infinitely more for my mental health than any radfem has.)

Some policies I think benefit both groups include:

Not making a big deal about people having nonstandard presentations. If we want to avoid people feeling excess time pressure to transition, and be nice to people who temporarily took hormones they didn't want, we need to fuss less over lasting signs of nonstandard hormones, like breast development and hair pattern changes. Furthermore, if we want youth exploring their gender identities to not feel pressure to take hormones/bind/etc, we need to avoid making fun of youth who want to change their names and pronouns without significant physical changes.

Stop requiring people to give pronouns. Trans people mostly seem to not like it and detrans people seem to mostly not like it. It seems to be by and for DEI teams or something.

Doing more research into long-term health outcomes for people who take or have taken cross-sex hormones. Though this is still IIRC better studied than long-term puberty blocker usage! It is genuinely plausible to me that if a child or teenager wants medication for transition stuff, it's safer for them to be on cross-sex HRT than it is for them to be on puberty blockers.

Make checking sex hormone levels a standard diagnostic for miserable teenagers who hate their appearances. Sometimes these are screwy in ways which cause non-transgender dysphoria. At least in the case of AFABs, spending a month trying spiro probably won't set back their goals if they later turn out to benefit from exogenous androgens.

Policies which are less specific to the case of transgender people and detransitioners below the cut.

In general try to reduce child abuse, especially gendered child abuse, and try to avoid making kids do unpleasant unnecessary stuff, especially if it's gendered. Also, don't judge parents for having gender non-conforming kids.

Build more housing to lower housing costs so it's easier for adults to avoid living with their parents. Bad parents can be a huge stressor.

Full transhumanism now:

Look into synthesizing gametes from regular cells. Sometimes people care about being able to have biokids. If you've had your ovaries removed right now, that's a huge pain.

Solve artificial uteri. The root of sex-based oppression is, well, biological sex, which is rooted in disparate parental investment strategies. Artificial uteri are a step in making it more possible to equalize the costs child production puts on parents.

In general making it easy to change one's body reversibly. Right now that's a pain.

Blah blah full biological immortality and uploading and cognitive enhancements and stuff. Because those are nice things.

[pearcaico]

Inauguração da Confeitaria A Crystal, Na Rua Nova Esquina Com a Rua da Palma, Logo Depois Mudou de Nome Para Confeitaria Glória - Recife Em 1925, Local do Palco do Assassinato de João Pessoa, presidente da Paraíba (1928/1930) - cargo idêntico ao de Governador.

O fim trágico de 3 Joões

A tragédia que se abateu sobre a Paraíba no ano de 1930 envolveu três homens chamados João. E mudou a vida política do país na primeira metade do Século 20.

Mais um relato surge sobre esse episódio, que marcou para sempre a vida da população brasileira. Desta vez, pelas mãos da escritora pernambucana Ana Maria César, com publicação pela Cepe.

João Pessoa, presidente da Paraíba (1928/1930) - cargo idêntico ao de governador - sucedeu João Suassuna. E João Dantas, advogado e militante político, era aliado de Suassuna e fazia oposição a João Pessoa.

Quis o destino que os três Joões se cruzassem num mar de intrigas, desavenças, conflitos e mortes.

Sob o comando de João Pessoa,  a Paraíba passou a conviver com uma reforma tributária que reajustou em até 80% os impostos de tudo quanto era exportado para Recife, Natal e Fortaleza. João Pessoa também baixou um decreto para desarmar os fazendeiros, acusados de acoitar pistoleiros e promover assassinatos indissolúveis. Os dois fatos levaram o coronel Zé Pereira, um dos maiores exportadores de algodão e chefe político de Princesa, a liderar uma revolta popular e decretar o município independente da Paraíba. Criou hino, bandeira e leis próprias.

João Pessoa usou a força policial do estado para combater o levante. Princesa reagiu. E o embate armado não parou mais.

A atuação profissional de João Dantas como advogado do coronel e suas declarações favoráveis à insubordinação de Princesa fizeram dele um inimigo de proa do governo paraibano.  Seu escritório foi arrombado na calmaria de uma madrugada. A invasão foi atribuída pela polícia a ladrões comuns. João Dantas contestou porque desapareceram documentos confidenciais dos seus clientes e cartas íntimas trocadas entre ele e sua namorada, a professora Anayde Beiriz. A correspondência pessoal vazou.  

João Dantas decidiu ir pro Recife preparar sua defesa e torná-la pública por meio de um artigo a ser publicado no Jornal do Commercio. Ao lado do cunhado, o engenheiro Augusto Caldas, foi a um hotel no Centro do Recife entregar o artigo ao amigo João Suassuna, deputado federal pela Paraíba, e pai de uma filharada, entre eles, o futuro escritor Ariano Suassuna.

Do hotel, João Dantas saiu pelas ruas do Centro da capital pernambucana. Tinha lido uma pequena notícia em jornais locais informando que João Pessoa passaria aquele 26 de julho de 1930 no Recife. Com um revólver calibre 32 nos quartos, começou a vasculhar os passos do governante paraibano, que em março daquele mesmo ano tinha disputado a vice-presidência da República na chapa de Getúlio Vargas. Enquanto era procurado por João Dantas, o governante paraibano almoçava no já tradicional Restaurante Leite.  Na sua mesa, Agamenon Magalhães e o usineiro Caio de Lima Cavalcanti. De lá, o trio decidiu tomar um chá na elegante Confeitaria Glória, onde próximo estavam o carro e o motorista do Governo da Paraíba.

Foi nesse momento que João Dantas avistou o carro oficial e logo deduziu onde estava seu arqui-inimigo. Entrou na Confeitaria e disparou três tiros à queima-roupa em João Pessoa. Feridos de raspão por tiros saídos da arma do motorista, João Dantas e seu cunhado foram presos em flagrante.  

A Paraíba se vestiu de luto pra chorar seu morto ilustre. Por uma decisão da família, que morava no Rio de Janeiro, e por uma conveniência política da época, o enterro foi programado para ser lá.  De navio, o corpo saiu do Porto de Cabedelo para a então capital do país. Os getulistas, que não aceitavam a derrota para o paulista Júlio Prestes, usaram com maestria a comoção provocada pelo crime para apressar o projeto em curso de tomada do poder - movimento vitorioso e que ficou conhecido como “Revolução de 30”.

Nas investigações do crime, a polícia pernambucana incluiu o ex-governador paraibano João Suassuna pelo simples fato de, pouco antes de consumar o homicídio, o assassino ter deixado a cargo dele a publicação do artigo.

Ao final, nenhuma culpa foi atribuída ao chefe do clã Suassuna. Mas, isso lhe custou a vida. Pouco mais de dois meses depois daquele 26 de julho sangrento, João Suassuna tombou sem vida ao ser baleado quando passeava pelo Centro do Rio de Janeiro. Preso, o assassino disse que quisera vingar a morte de um irmão, que morrera no levante de Princesa, comandado pelo coronel Zé Pereira. O assassino acreditava que esse conflito poderia ter sido evitado pelo pai do menino Ariano Suassuna, por causa da sua amizade com o coronel. Poucos dias antes, João Dantas apareceu degolado na Casa de Detenção do Recife, ao lado do corpo do cunhado, também ferido mortalmente no pescoço. A família dos dois nunca acreditou na versão oficial de suicídio divulgada pela polícia, definia as duas mortes como assassinatos.

E assim se passaram 91 anos do trágico fim dos três Joões: Pessoa, Dantas e Suassuna.

[zeldahime]

So there's a couple reasons.

First, there's the very valid concern of, essentially, maintaining a labor force that is significantly higher than the number of non-working people. The people who are already born are likely to live into old age and age out of the labor force, and someone needs to care for them. Traditionally, this has been their offspring; more recently, it's been a combination of their offspring + nursing staff. It causes massive problems when the elderly population grows too large as a percentage of the total population. In Japan, 10% of the population is over the age of 80 and nearly a third are over the age of 65; as the Japanese birthrate continues to decline, that percentage will continue to grow. Even with their relatively generous social welfare system, it's already causing cultural and economic problems that the Japanese government is being very slow to address.

I thought this Master's thesis a very good summary of the problems caused by this population imbalance is causing Japan. There's not enough resources to care for the elderly. There's not enough money and there's not enough people. The elderly are dying poorer and lonelier; their adult children, especially their daughters, are working twice as hard and having to be caretaker to both their aging parents and their own children. It's a self-reinforcing cycle, because those adult children delay or forego romantic relationships and childbirths themselves, and when they are old in 30 years, they'll have the same problems, compounded.

In general, in order to maintain a healthy proportion of working-aged people, it's considered advisable to have a fertility rate a little over 2, as a replacement rate. (A little higher than 2, because children and young people do still die, tragically.) This is usually represented as 2.1, but it varies by region.

For what it's worth, I don't read any judgement from the Economist article. They're reporting a fact: the birthrates in wealthy Western countries are low, they're especially low with younger women and are predicted to stay low as they age, and governments are trying to use economic incentives to increase birthrates rather than looking at alternatives to increase the working population such as allowing higher levels of immigration. They're talking like economists, which I know can sound uncompassionate, but it doesn't mean they think 16-year-olds should become baby mills.

This isn't just a problem of wealthy countries, either; fertility is falling in middle- and low-income countries too. Immigration won't fix that. There's going to be a massive demographic crisis in about 50-100 years if current trends continue. I may still be alive in the beginning phases—and if I am, as an elderly person of limited means and no children, I'll definitely suffer it. (This is the Lancet paper cited in the Economist article; I haven't read it quite yet, but I intend to when I get home tonight.)

Yet some considerations should give politicians pause. The extra children produced by targeted policies will probably not turn into the productivity-boosting professionals that governments most desire. Only 8% of the children of American-born non-college-educated parents are themselves expected to obtain a bachelor’s degree, and during his or her adult life the average high-school graduate boosts the public finances by less than a tenth of the net contribution of a college graduate. Therefore the financial benefits of pro-natal policies aimed at working-class women would probably be overwhelmed by their costs, given the expense associated with even well-targeted programmes. The best hope for such policies would lie in boosting the life outcomes of extra children. Early evidence from trials such as the one in Flint and covid-19 assistance programmes suggests that cash transfers lift children’s performance in early schooling and improve access to health care. Another consideration for politicians is the morality of such interventions. Policymakers sought to break the norm of young motherhood for a reason. Each year a woman goes without childbearing, her expected lifetime earnings increase. A first-time American mother in her mid-30s will earn more than twice what she would have earned had she had her first child aged 22. Women who give birth aged 15 to 19 are more likely to develop health problems; their first child is more likely to drop out of high school and to grow up without having both parents at home. In Flint many mothers express regret that they did not manage to “get things sorted” before they started to have children. “Hang on,” says one outside a community centre. “The idea is that I get paid just enough to make me have another kid? But that’s all that changes? Where doing it [raising a kid] right, later on, it’s all me? That doesn’t seem right.” The 26-year-old mother of three leans back, and laughs.

The article concludes with this: the reason birthrates are falling and are not likely to increase any time soon, even with all the interventions being reported upon in this article. It's better for the women and it's better for the children, for women not to have children when they're still very young.

[sztupy]

The paradox of fertility is that it is highest in poor countries, but in the developed countries people cite high costs as one of the main reasons for limiting or not having children. Some governments have attempted to alleviate the problem by subsidising childcare, offering extended parental leave and various tax breaks for families.

Yet while there are signs such measures may have small effects, they are not of the kind that will reverse current trends. Hungary, for example, is estimated to spend 5% of its GDP on pro-natal policies.

As a result the fertility rate has climbed from 1.25 to 1.5, yet that is a long way from replacement level. And given that the Hungarian government is right-wing, populist and anti-immigrant, it has helped foster the belief that pro-natalism is really just another form of pro-nationalism.

[husnaot]

A Course of Bricks, Ticks and Info that will Stick (hopefully) 🧳

The last four years I spent carrying around my eye suitcases (they've upgraded from being eyebags) trying to keep up with the curriculum better be worth whatever is to come in the future.

The University of KwaZulu-Natal (UKZN) is an institution that prides itself on offering a diverse range of courses to complete, good facilities to offer practical experience and great opportunities to network with others through the various events that take place. What it does not account for is the potential burnout that students may be experiencing, as well as the threat of failure that hangs over their heads.

The UKZN OT degree is a four-year degree that includes an Honors year. What the three undergraduate years consist of is various practical blocks focusing on engaging the learner in interventions regarding physical conditions and psychological conditions. While the exposure to these conditions is helpful and good for experiential learning, the environment in which we learn is often quite restricted and limited. (Undergraduate Programmes - Discipline of Occupational Therapy, 2019)

Do I, personally, feel like UKZN OT degree has prepared me for working at a community and primary healthcare level?

No, not at all, and this is my evaluation of it.

Pros:

Comprehensive Understanding of Community Health, at least, in theory:

The curriculum includes modules that focus on community-based questions and practical experience, as well as, primary healthcare. This module is the clinical studies done in first year, along with the OT fundamentals module being incorporated this year. This creates a good theoretical fundation in order to understand the community in terms of the social determinants of health, their assessments and heath promotion stategies. By using tools like the CBR matrix or PESTLE analysis taught in class, my practical group will be able to provide good analysis of the community. (Lysack et al., 1995)

Inter-professional Education and Collaboration (IPE):

IPE is emphasized in every lesson by the lecturers, citing that collaboration between different parts of the health science field will benefit us in the future and will provide a more holistic, conclusive report about the client’s presentation. This prepares OT students to work effectively in multidisciplinary teams (MDTs). (MacQueen et al., 2001)

This was evident on our first Wednesday in the community. Upon reaching the clinic, we had a short meeting with the Community Health Workers (CHWs) about the area and had a short orientation to the area. What we learned was that substance use is a common condition amongst the youth in the community and gained referrals for adult clients as well.

Focus on Advocacy and Policy:

OT education at UKZN includes components that educate students about advocacy for social justice and healthcare policy. This empowers us as the future to the health science field to advocate for improved healthcare services and policies that benefit underserved communities. In this way, UKZN teaches us that we are capable of creating a ripple on the surface of a system that has been running since before we were born, but also that we need to respect the space that the community has given to us.

One of the most important lessons that I have learned is that it is best to communicate with the people you are trying to help instead of making the project independently as it is best to receive some feedback on the activities that will be included in order to make it more client-centred.

Cons:

Limited Exposure to Rural Health Challenges:

 The curriculum often incorporates clinical placements in semi-urban and urban areas. This hands-on experience allows students to apply theoretical knowledge in real-world contexts, develop essential clinical skills, and understand the challenges and dynamics of working in community settings. Despite efforts, there may be limited exposure to the unique challenges faced by rural and remote communities in South Africa. More emphasis on rural health issues and specific strategies for overcoming geographical barriers could better prepare us for practice in these settings. (Harper et al., 2022)

For example, my first psychosocial block was in a private facility. Had I not been placed in a semi-urban area for my second block, the shock of coming to the community for the first time in fourth year would have affected my treatment for the first week as I would still need to become familiar with certain ideas.

In conclusion, the UKZN curriculum for OT provides an idea of what working in the community and in primary healthcare is like and provides essential theoretical information about skills that are needed in community. Due to a lack of experience in different types of areas in the clinical environment in previous blocks and a poor control of who goes to which placement during the three undergraduate years, not everyone is able to have the same exposure to different areas and have never experienced a different sense of community.

There are no words to describe what being part of the community feels like, even if it just for six weeks, therefore, my suggestion is to continue with the exposure to community that the first and third years are currently experiencing as it gives them an idea of how the block will be completed instead of being thrown in the deep end with a heavy suitcase filled with theoretical information that is hard to process, let alone implement in a completely new environment.

But what happens if I let the suitcase fly open?

This is Husna, signing OuT!

References:

Harper, K. J., McAuliffe, K., & Parsons, D. N. (2022). Barriers and facilitating factors influencing implementation of occupational therapy home assessment recommendations: A mixed methods systematic review. Australian occupational therapy journal, 69(5), 599–624. https://doi.org/10.1111/1440-1630.12823

Lysack, C., Stadnyk, R., Paterson, M., McLeod, K., & Krefting, L. (1995). Professional Expertise of Occupational Therapists in Community Practice: Results of an Ontario Survey. Canadian Journal of Occupational Therapy, 62(3), 138–147. https://doi.org/10.1177/000841749506200305

MacQueen, K. M., McLellan, E., Metzger, D. S., Kegeles, S., Strauss, R. P., Scotti, R., Blanchard, L., & Trotter, R. T. (2001). What Is Community? An Evidence-Based Definition for Participatory Public Health. American Journal of Public Health, 91(12), 1929–1938. https://doi.org/10.2105/ajph.91.12.1929

Undergraduate Programmes - Discipline of Occupational Therapy. (2019, July 18). Ot.ukzn.ac.za. https://ot.ukzn.ac.za/undergraduate-programmes/

Picture References:

370+ Muslim Nurse Illustrations, Royalty-Free Vector Graphics & Clip Art - iStock. (n.d.). Www.istockphoto.com. https://www.istockphoto.com/illustrations/muslim-nurse

Andy Milne. (2022, June 6). Teaching Health Advocacy. #Slowchathealth. https://slowchathealth.com/2022/06/06/teaching-health-advocacy/

Interprofessional teamwork: Nursing - Osmosis Video Library. (2022). In osmosis.org. https://www.osmosis.org/learn/Interprofessional_teamwork:_Nursing

The Integrated Urban Development Framework (IUDF) – Cooperative Governance and Traditional Affairs. (2016). Cogta.gov.za. https://www.cogta.gov.za/index.php/the-integrated-urban-development-framework-iudf/

[jhavelikes]

Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world.

Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021 - The Lancet

[phezii]

OT curriculum

Today I will be taking you on a journey of reflecting on the Occupational Therapy (OT) curriculum at the University of KwaZulu-Natal (UKZN) in terms of preparing students for community or Primary Health Care (PHC) practice which entails assessing both its strengths (pros) and weaknesses (cons) that we as students face, (Moodley & Singh, 2018). I will take you through the cons and pros that I can testify to have gone through in the last few years. However, I will first look at what does the curriculum provide to students.

The OT curriculum at UKZN is structured into four distinct parts and takes four years to complete. In the second year, we engage with both psychosocial and physical aspects, focusing primarily on client assessments. Moving into the third year, we initiate interventions for both psychosocial and physical conditions. By the fourth year, we delve into community and pediatric OT. Additionally, there was some exposure to community studies in the first year. In the third and fourth years, we're expected to integrate all four components learned to provide comprehensive interventions for clients. During practical’s we are taken to different hospitals to get exposure to a hospital setting and different diagnosis. Also, during this time we learn to work well with multidisciplinary teams and collaborate with stakeholders of the community, (Naidoo, Van Wyk, & Waggie, 2017).

Other students have observed drawbacks in the UKZN curriculum, such as difficulties arising from rural practice, communication, collaboration, and cultural sensitivity, as well as challenges specific to the occupational therapy curriculum, (Naidoo, Van Wyk, & Waggie, 2017). From my side, I would say the disadvantages differ for all of us as we all come from different settings. For instance, for me working in a rural setting takes me back home where I know that the hospitals barely have resources, and this allows me to think broadly when providing intervention considering the client’s background and using the skills thought at UKZN for making assistive devices and being able to adapt your mind for every setting you may see your clients from. However, my biggest disadvantage would be challenges with the curriculum as there is too much workload and there’s little time to assimilate the knowledge, (Naidoo, Van Wyk, & Joubert, 2017). We are never given much time to consolidate the theory and practical application together before giving a client an intervention. Also, we are not so much about the procedures that one must follow when working under the department of health. I remember this other time when someone asked me about DoH, firstly I did not even know what the abbreviation was for, and I did not know the policies that guide us as health practitioners, (Moodley & Singh, 2018).

All the disadvantages found with the UKZN OT curriculum in turns affects the students as most people do not feel prepared for clinical practice as the confidence in their skills and capabilities is always challenged by the fact that people when providing intervention, the important thing is getting good marks and passing the clinical performance missing out on a chance to learn and gain confidence, (Naidoo et al., 2014).

The advantages and the strengths that the UKZN curriculum has is that students are ready or feel confident to practice in urban hospital and community settings as their clinical reasoning for such settings as urban has improved, (Naidoo, Van Wyk, & Waggie, 2017). The reason for that is because during our practical’s we are placed in urban hospitals and develop mindset for that specific setting forgetting not all communities are like that, however this plays a crucial role for our foundation when learning, as you are exposed to so many resources that the government provides in hospitals. The advantage for me is that during community block we get to work closely with the multidisciplinary team and stakeholders of the community learning inter-professional education as we learn to work closely with people available at the community to provide holistic intervention for the patients. Also, working in clinical setting and doing administrative duties plays a huge role in preparing us when we start working.

I believe that the UKZN OT curriculum still needs to make amendments to how they educate students, and they need to expose students to primary health care systems. This will ensure that people are aware of the role the OT’s play in primary health care, working in groups and providing services for early childhood intervention, (Naidoo et al., 2016).

This year, I think there is a lot of improvements when it comes to the curriculum because we are exposed to the marginalized communities and hospitals with few resources to provide intervention. However, there is lot of improvement to implement.

REFERENCES

Moodley, I., & Singh, S. (2018). Strengths and challenges of community-based clinical training as viewed by academics at the University of KwaZulu-Natal, Durban, South Africa. African Journal of Health Professions Education, 10(2), 129. https://doi.org/10.7196/ajhpe.2018.v10i2.954

Naidoo, D., Van Wyk, J., & Joubert, R. (2017). Community stakeholders’ perspectives on the role of occupational therapy in primary healthcare: Implications for practice. African Journal of Disability, 6. https://doi.org/10.4102/ajod.v6i0.255

Naidoo, D., Van Wyk, J., & Nat, R. J. (2014). Are final year occupational therapy students adequately prepared for clinical practice? A case study in KwaZulu-Natal. South African Journal of Occupational Therapy, 44(3), 24–28. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000300007

Naidoo, D., Van Wyk, J., & Waggie, F. (2017). Occupational therapy graduates’ reflections on their ability to cope with primary healthcare and rural practice during community service. The South African Journal of Occupational Therapy, 47(3), 39–45. https://doi.org/10.17159/2310-3833/2017/v47n3a7

Naidoo, D., Wyk, J. V., & Joubert, R. W. E. (2016). Exploring the occupational therapist’s role in primary health care: Listening to voices of stakeholders. African Journal of Primary Health Care & Family Medicine, 8(1), 9. https://doi.org/10.4102/phcfm.v8i1.1139

[itstheinternetofthings]

the moon comes home once a year

I love January. It is cold and there is nothing happening. I am knitting a very large scarf and listening to podcasts. Today for example I learned that there was a communist dictator in Romania not too long ago. He was shot in the back of the head the year before I was born. He forced a pro-natality policy on the people that led to a generation’s worth of babies being born unwanted or abandoned. I know so little about the world.

I am going on long frigid walks under bare trees revealing sky and building and moon. I am spending long moments watching my cats. I am starting to plan my wedding - pinning dresses to a board, dreaming about autumns and gold rings and veils. I am exercising: a dance class today; boxing last week. My muscles are sore and good.

On Friday Anya came over and we worked from my living room - me tip-tapping my little emails for my little corporate job while she annotated Italo Calvino for illustration and applied to artists residencies. Around 5 Caitlin came over, sweeping in like a sea witch in velvet and bright purple lipstick, wild black hair fanning her shoulders like kelp. She had never been to my house before and I found I was charmed by her precise diction and raucous laugh. It is good to have new New York friends, these art school astrologers.

We were gathering for a full moon ritual. At the appointed time we went deep into Central Park, dark except for street lamps and the moon hiding behind clouds. I brought us to Ladies Pavilion, the blue wrought-iron gazebo next to the Loch where this year I will be married. At Caitlin’s instruction we gathered leaves and twigs and dried baby’s breath from the ground and built a nest under the gazebo. It was beautiful, breathtaking even, in the darkness. My heart was racing - maybe from too much nicotine? - and I tried to breathe slow and steady.

Caitlin tore a paper in thirds and handed us each a piece. There was only one sharpie so we took turns writing our wishes with our phone flashlights. Then we placed the papers in the nest and burned them.

When we looked up, the moon was out from behind the clouds, bright and piercing. Happy birthday moon, we said. Thank you moon, we love you moon. It was exuberant and holy. We talked about our wishes, looking out over the lake, the city blurring in the water’s reflection.

Back at my house we met up with Tina and ordered Vanessa’s Dumplings. Even Anya ate something. We talked for a long time, alcohol and ketamine, feeling subdued and thoughtful. Anya made a fire using torn up things from the recycling as kindling. We talked about sex frankly. We talked about our fears and our sadnesses. It felt good to be honest. It felt good to be trusted. It felt good to be vulnerable, and receive vulnerability in return.

Now it is tonight and I have made shakshuka for dinner. There is a cat on my lap and I am getting sleepy. Things keep going wrong but it doesn’t matter. I am creatively bereft and often depressed. And yet recently I feel a happiness that is not quite delirious but not far from it either. As though this is the life I always wanted for myself. 

I want to make writing a practice again.