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Alayne Adams
Assistant Professor
alayne.adams@columbia.edu
EXPERTISE: social and economic determinants of health and nutrition,
household health and coping, measurement of interpersonal social networks
and community-level social capital, women's micro-credit and health,
participatory methodology, qualitative research and analysis.
Gender inequity, social vulnerability and HIV/AIDS: integrating prevention into BRAC’s poverty eradication activities (PI) -- While the current prevalence of HIV remains low in Bangladesh, a growing epidemic is gathering force in surrounding nations such as India and Pakistan. Fortunately, Bangladesh has taken the impressive step of monitoring HIV/AIDS and related risk behaviour at a very early stage of its epidemic. There remains insufficient appreciation, however, of the extent to which the larger context of social exclusion, gender inequality and poor health underlie the vulnerability of high risk populations and the degree to which they extend risk to the population at large. Of further concern is the fact that both surveillance and prevention efforts have largely concerned urban-based high risk groups, when 80% of the country’s population reside in rural areas where risk behaviours are also widespread. Experience in Africa and South East Asia indicate that HIV spread is strongly linked to rural-urban migration patterns like those found in Bangladesh, whereby migrants retain active connections with their rural domiciles. Experience also suggests that those most at risk are those for whom cultural norms and lack of financial “power” restrict freedom of choice, for those without access to information and social support, and for those who are unable or unwilling to effectively utilize health services. In rural Bangladesh, among the most vulnerable are women, whose social and economic powerlessness is manifested in high rates of domestic violence and lower life expectancy than men.
At this early stage in the epidemic, it is particularly timely to embrace the larger context of risk to HIV as an effective point of entry for primary prevention. In this context, researchers from BRAC, the ICDDR,B Centre for Health and Population and The Mailman School of Public Health at Columbia University, are collaborating around the development of an innovative “best practice model” for integrating HIV prevention activities into BRAC’s rural development program. In particular, this model for prevention moves beyond traditional health sector approaches to the epidemic by taking advantage of the social networks implicit in BRAC’s programmatic activities, and incorporating a strong focus on gender inequalities and gender-based violence—factors known to have fueled the HIV epidemic in many parts of the world. Specifically, the research will involve implementing and evaluating the impact of participatory Gender and HIV education delivered to couples, married women and never-married male and female adolescents by means of picture stories. Based on this evaluation, and related assessments of feasibility and cost, the possibility of scaling-up the intervention to BRAC programme areas nation-wide will be considered. Evaluation findings will serve to inform the content and delivery of this broader effort.
Women's Micro-credit and Health in Bangladesh (PI)-- Throughout the developing world, there is evidence of declining rates of mortality and fertility yet no clear understanding of the factors driving this change, nor the extent to which these health improvements are being experienced equitably by sub-sections of the population. This NIH funded project uses prospective data from Matlab, Bangladesh to explore the role of women's micro-credit in hastening health improvement and lessening health disparity. Its specific aims are to: 1) Consider the various determinants of health change and in particular, the relative importance of women's socioeconomic development versus health-specific interventions in explaining this change; 2) Evaluate socioeconomic and gender disparities in a variety of health outcomes and assess whether these inequities have been increasing or decreasing over the course of the decade; 3) Specify the mechanisms through which women's micro-credit influences health behaviors and outcomes.
The project benefits from collaboration with BRAC, a nation-wide NGO in Bangladesh that focuses on women's micro-credit and poverty alleviation, and the ICDDR,B Center for Health and Population Research, home to the longest established Demographic Surveillance Systems (DSS) in the developing world. Linked to fertility and mortality data provided by the DSS registration system, baseline data were collected prior to the initiation of BRAC's programs in Matlab on a random sample of almost 12,000 households. Using a four-cell sampling frame, this survey was repeated in 1999 to assess the rate and magnitude of health change comparing poor households who received BRAC programs and/or intensive health-specific interventions with equivalent non-recipients. Analyses of survey data are complemented by in-depth qualitative studies that explore the mechanisms of health change at the individual and household level.
Women's Social Networks and Health in Mali (PI)-- This project explores the influence of women's social networks on child health and survival through a comparative investigation of two ethnic groups in Mali, West Africa. Funded by NSF, fieldwork involved the application of questionnaire surveys to a sample of 1000 ever-married women aged 15-49 representing agricultural Bamanan and pastoral Fulbe populations. In-depth qualitative work was also undertaken to gain a more textured understanding of the cultural norms underlying the provision of support and the utilization and continuity of this support both over the lifespan and in the immediate and routine context of women's daily lives. The project has been recognized for its innovative contribution to the conceptualization and measurement of women's social networks in non-western settings. Results demonstrate the important role of social factors in producing health and mediating poverty and its adverse effects - a role that is even more consequential in circumstances where access to quality health care is limited.
Assessing societal vulnerability to seasonal climate variability (Co-PI)-- Seasonal and interannual climate variability have important environmental, socioeconomic and public health consequences that are unequally distributed among and within nations, regions and communities. There is a growing realization that conventional approaches to the study of climatic variation do not adequately take into account the effect of multiple stresses, the role of adaptation strategies and the variation in resilience among affected communities. In collaboration with research scientists at CIESIN and the International Research Institute (IRI) for Climate Prediction, this project aims to develop an analytical framework for vulnerability assessment that facilitates targeted application of forecasts and historical climate data for societal benefit. Underlying this interdisciplinary project is the view that better understanding the determinants of vulnerability to climate risks will enhance capacities to proactively manage climate variability instead of simply using forecasts to react to the next climate induced hazard.
Other Activities-- Consultancy work for UNICEF, UNDP and the Aga Khan Foundation on community participation in health, household health and poverty, the measurement of social capital and the development of participatory methods for community involvement in development project appraisal, action and assessment..
PUBLICATIONS:
Adams A.M., S. Madhavan and D. Simon (2002). Women's social networks and child survival in Mali. Social Science and Medicine 54(2):165-321.
Simon D., A.M. Adams S. and S. Madhavan (2001) Women's social power, child nutrition and poverty in Mali. Forthcoming in Journal of Biosocial Science.
Bhuiya A. M. Chowdhury, F. Ahmed and A.M. Adams (2001). Increasing survival and decreasing inequity: the case of child mortality in Bangladesh. Forthcoming in volume Global Health Equity, eds T.G. Evans, M. Whitehead, Diderichson and A. Bhuiya. Oxford University Press.
Ahmed S.M., A.M. Adams. M. Chowdhury and A. Bhuiya (2001). Gender, socioeconomic development and health seeking behaviour in Bangladesh. Social Science and Medicine. 51: 361-371.
Adams A.M. (1999). Social capital and development assistance in Mali: a cross-cultural case study. Final report to Canadian International Development Agency.
Madhavan S., D. Simon and A.M. Adams (1999). Marital stability and child welfare among the Fulbe of Mali. Paper Presented at the Annual Meetings of the Population Association of America March 24-27, 1999, New York.
Adams A.M., S. Madhavan and D. Simon (1998). Women's social networks and reproductive outcomes in Mali. Paper presented at IUSSP Seminar on Gender Inequalities and Reproductive Health: Changing Priorities in an Era of Social Transformation and Globalisation, Campos de Jordao, Brazil, November 16-19, 1998. Forthcoming in edited volume by same title.
Adams A.M., J. Cekan and R. Sauerborn (1998). A conceptual framework of household coping: reflections from rural West Africa. Africa
68(2).
Ahmed S.M., A.M. Adams, A.M.R. Chowdhury and A. Bhuiya (1998). Chronic energy deficiency in women from Bangladesh: some socio-economic determinants. Journal of Biosocial Science 30: 349-358.
Evans T.G., A.M. Adams, R. Mohammed and A.H. Norris (1998). Demystifying non- participation in micro-credit: a population-based analysis. World Development. 27(2): 419-430.
Adams A.M., T.G. Evans, R. Mohammed and J. Farnsworth (1997). Socioeconomic stratification by wealth ranking: is it valid? World Development 25 (7): 1165-1172.
Ahmed, S.M., A.M. Adams, A.M.R. Chowdhury, A. Bhuiya (1997). Income-earning women from rural Bangladesh: changes in attitude and knowledge. Empowerment 4: 1-12.
Sauerborn, R. and A.M. Adams (1996). Household coping with the economic costs of illness. Social Science and Medicine 43 (3):291-301.
Adams, A.M. (1996). Participatory assessment, analysis and action: a guideline for development workers. Report prepared for UNICEF, Bangladesh.
Evans, T.G., M. Rafi, J. Farnsworth, A.M. Adams, and A.M.R. Chowdhury (1996). Barriers to Participation in BRAC RDP. Harvard Center for Population and Development Studies, Harvard School of Public Health. Working Paper Series No. 96.01.
Adams, A.M. (1995). Seasonal variations in adult energy balance: compromise or adaptation? European Journal of Clinical Nutrition, 49, 809-823.
Adams, A.M. (1994). "Seasonal variations in nutritional risk among children in central Mali." Ecology of Food and Nutrition, 33, 93-106.
Adams, A.M. and S. E. Castle (1994). "Gender relations and household dynamics" In: Population Reconsidered: Health, Empowerment and Rights, edited by G. Sen, A. Germaine and L. Chen. Cambridge: Harvard Center for Population and Development Studies/ Harvard University Press.
Adams, A.M., R. Das Roy and A. Mahbub (1993). "Participatory methods to assess change in health and women's lives" RED Working Paper Series, Dhaka, Bangladesh.
Adams, A.M. (1993). "Food insecurity in Mali: exploring the role of the moral economy." IDS Bulletin: New Approaches to Famine, 24(4):42-51.
Adams, A.M. (1992). "Seasonal food insecurity in the Sahel: nutritional, social and economic risk among Bamana agriculturalists in Mali." Unpublished PhD thesis, London School of Hygiene and Tropical Medicine.
Adams, A.M. (1990). "La Soudure: strategies de survie entreprises par les menages agricoles dans la zone sudanno-sahelienne au Mali." Pop Sahel.
EDUCATION AND TRAINING:
Post-Doc (1995) -- Harvard Center for Population and Development Studies, Harvard School of Public Health; Cambridge Mass. (MacArthur Fellow)
Ph.D. (1992) -- Faculty of Medicine, London School of Hygiene and Tropical Medicine, U.K. (Commonwealth Scholar)
M.Sc. (1987) -- Human Nutrition, London School of Hygiene and Tropical Medicine, U.K. (Commonwealth Scholar)
B.A. (1983) -- Honors in Political Thought and Development Economics, McGill University. (James McGill Scholar)
