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Table 3 Initial and final programme theories

From: Linking political exposures to child and maternal health outcomes: a realist review

Theory # Initial programme theory Final programme theory
1 A more generous welfare state has a beneficial effect on child and maternal health outcomes including infant and maternal mortality (Outcomes) especially in LMECs (Context) by improving the social conditions especially of those who face deprivation and ensuring they have what they need, including through progressive child- and family-facing social policies (Mechanism). A more generous welfare state has a beneficial effect on child and maternal health outcomes including infant and maternal mortality (Outcomes) especially in developed countries (Context) by improving the social conditions especially of those who face deprivation and through progressive social welfare policies (Mechanism).
2 A left-of-centre political tradition has a beneficial effect on child and maternal health outcomes including infant and maternal mortality (Outcomes) especially in LMECs (Context) by generating a greater focus on welfare state measures, especially progressive child- and family-facing policies, to improve the social conditions especially of those who face deprivation in order to ensure they have what they need (Mechanism). A left-of-centre political tradition has a beneficial effect on child mortality and low birth weight (Outcomes) especially in developed countries (Context) by generating a greater focus on welfare state measures, especially progressive child- and family-facing policies, to improve the social conditions especially of those who face deprivation in order to ensure they have what they need (Mechanism).
3 Greater democracy has a beneficial effect on child and maternal health outcomes including infant and maternal mortality (Outcomes) especially in LMECs (Context) by promoting empowerment, acting as a safeguard against despotism and through increased accountability facilitating provision of requisite systems and services including progressive child- and family-facing social policies (Mechanism). Not supported.
4 The introduction of capitalist democracy into a communist autocracy (Context) has a negative short-term effect on child and maternal health outcomes including infant and maternal mortality (Outcomes) by the introduction of marketization and erosion of state networks that support health and minimise health inequalities, such as a roll-back of state-supported progressive child- and family-facing social policies (Mechanism). Not supported.
5 Increased globalisation has a beneficial effect on child and maternal health outcomes including infant and maternal mortality (Outcomes) especially in LMECs (Context) by increasing prosperity resulting from increased trade with more advanced economies leading to more money being available for public services including the provision of progressive child- and family-facing social policies (Mechanism). Not supported.
6 Increased globalisation has a negative effect on child health especially obesity and diseases resulting from obesity (Outcome) especially in LMECs (Context) by encouraging exposure to greater commercial interests such as in the food and drink industry, thereby generating an obesogenic environment and increasing the exposure of children to unhealthy products including food and drink (Mechanism). Increased globalisation has a negative effect on child and infant mortality and youth smoking rates (Outcome) in LMECs (Context) by increased international trade dependency and greater influence of multinational corporations and neoliberally oriented international trade organisations (Mechanism).
  1. LMECs Low- and middle-income countries
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