The long term consequences for women of parental divorce and separation in childhood are explored using data from a national, prospective, longitudinal survey. In comparison with women who suffered no parental loss, parental divorce is associated with lower educational attainment and occupational status, poorer mental health, higher alcohol consumption and higher rates of remarriage. Links with earlier signs of emotional disturbance and current levels of stress are explored.

Research has established that genetic differences among people explain a greater or smaller proportion of the variation in life outcomes in different environmental conditions. This review evaluates the results of recent educationally relevant behavioural genetic studies and meta-analyses in the context of recent trends in income and wealth distribution. The pattern of results suggests that inequality and social policies can have profound effects on the heritability of educational attainment and achievement in a population (Gene–Gini interplay). For example, heritability is generally higher at greater equality levels, suggesting that inequality stifles the expression of educationally relevant genetic propensities. The review concludes with a discussion of the mechanisms of Gene–Gini interplay and what the findings mean for efforts to optimize education for all people.

In a case-control study of low birthweight deliveries, comparison of hospital records with interviews conducted soon after delivery fails to confirm the widely-held view that concurrently recorded medical notes are superior to retrospective interviewing. The overall agreement was very good, with slight under-reporting of past abortions by mothers, and marked relative under-recording in the hospital records of vaginal bleeding and especially vaginal discharge. Generally, the rates of disagreement between interviews and hospital notes were similar for those women who had low birthweight babies and those who had normal birthweight babies, except for one single item. Uncertainty or lack of information occurred in the hospital notes as often as in the interviews.

When different accounts of labour were present within a single set of medical records, the level of internal consistency was examined. There were more definite contradictions within the hospital notes than had been observed between the notes and the interviews. Moreover, a very marked association of within-hospital contradiction with birthweight was found, suggesting a possibility of bias when hospital records are used for the investigation of conditions associated with low birthweight. One should not, however, conclude that hospital notes are necessarily more error-prone than interviews, as many of the within-hospital contradictions reflected diagnostic uncertainty in complicated cases.

Bivariate and multivariate analyses of the influence of demographic and sociocultural factors on contraceptive knowledge, attitudes and practice among currently married respondents in Uganda show that: (1) contraceptive knowledge is widespread, even among women with no education; (ii) the majority of the respondents have favourable attitudes towards contraceptive use; (iii) the level of contraceptive use is low in comparison with knowledge and attitudes. Post-primary education, ethnicity, residence, the presence of the spouse in the household and discussion of family planning with spouse were strong predictors of knowledge and favourable attitudes towards contraception. Secondary or higher education, discussion of family planning with spouse and urban residence strongly influenced contraceptive use, but child mortality did not. The use of condoms as a behavioural change to avoid contracting HIV/AIDS was low. The results suggest that, particularly in rural areas, family planning services are not meeting the needs of potential clients.

Indigenous populations in New World nations share the common experience of culture contact with outsiders and a prolonged history of prejudice and discrimination. This historical reality continues to have profound effects on their well-being, as demonstrated by their relative disadvantages in socioeconomic status on the one hand, and in their delayed demographic and epidemiological transitions on the other. In this study one aspect of aboriginals’ epidemiological situation is examined: their mortality experience between the early 1980s and early 1990s. The groups studied are the Canadian Indians, the American Indians and the New Zealand Maori (data for Australian Aboriginals could not be obtained). Cause-specific death rates of these three minority groups are compared with those of their respective non-indigenous populations using multivariate log-linear competing risks models. The empirical results are consistent with the proposition that the contemporary mortality conditions of these three minorities reflect, in varying degrees, problems associated with poverty, marginalization and social disorganization. Of the three minority groups, the Canadian Indians appear to suffer more from these types of conditions, and the Maori the least.

Exploring fertility preferences in relation to contraceptive use can increase the understanding of future reproductive behaviour and unmet family planning needs. This knowledge can help assist women in meeting their reproductive goals. The influences on the desire for more children and current contraceptive use were examined among 1528 married women of reproductive age in an isolated community in Bali, Indonesia, using multivariate logistic regression analysis. Women who were younger, had fewer living children, had given birth in the past year and had regular access to health services were more likely to desire children. Being older, having fewer living children, not having regular access to health services, having given birth in the past year and having the desire for more children were associated with a lower likelihood of using contraception. Women with regular access to health care are more likely to desire more children, probably because they are confident in their ability to have successful birth outcomes. However, specialized clinics or family planning outreach workers may be required to reduce barriers to service utilization among some groups. The findings of this study identify key target populations for family planning, including older women and postpartum women – groups that may not perceive themselves to be at risk for unintended pregnancy. Meeting unmet need for family planning among these groups could help women meet their fertility goals, as well as reduce maternal morbidity and mortality.

This study examined men's justification of wife beating in relation to their perceived rights and autonomy using a nationally representative sample of 18,047 men in India with childhood exposure to parental violence. Five reasons for wife beating justification, four items of men's perceived rights, and five items of household autonomy were analysed using χ2 test and logistic regression. Among 18,047 participants, 67% justified wife beating. Low education, economic stress and being unmarried were generally more associated with justifying wife beating for all five reasons. Wife's refusal of sex and husband's final say on household autonomy are risk factors. Joint autonomy on household decision making and wife's autonomy on managing her own earnings are protective factors. Perceived relationship rights and autonomy are highly predictive of wife-beating justification for the men who have been exposed to parental violence during childhood. The study has significant implications for public health planners and education strategies.

This study aimed to assess empirically the influence of individual and community (neighbourhood) factors on the use of maternal health care services in India through three outcomes: utilization of full antenatal care (ANC) services, safe delivery and utilization of postnatal care services. Data were from the third round of the National Family Health Survey (2005–06). The study sample constituted ever-married women aged 15–49 from 29 Indian states. Multilevel logistic regression analysis was performed for the three outcomes of interest accounting for individual- and community-level factors associated with the use of maternal health care services. A substantial amount of variation was observed at the community level. About 45%, 51% and 62% of the total variance in the use of full ANC, safe delivery and postnatal care, respectively, could be attributed to differences across the community. There was significant variation in the use of maternal health care services at the individual level, with socioeconomic status and mother's education being the most prominent factors associated with the use of maternal health care services. At the community level, urban residence and poverty concentration were found to be significantly associated with maternal health care service use. The results suggest that an increased focus on community-level interventions could lead to an increase in the utilization of maternal health care services in India.

High body fat in apparently lean individuals is a commonly described phenotype in individuals of Asian descent, but very limited consolidated scientific literature is available on this topic. This phenotype is known as ‘normal-weight obesity’ and may explain the large disparity between the prevalence of obesity (as measured by BMI) and diabetes that occurs in these individuals. Routine use of obesity indicators that best predict body fat content would help to identify these individuals in clinical practice. In this debate, we would like to highlight that even though fat and BMI have a good correlation, as suggested by Kryst et al. (2019), clinicians, public health researchers and policymakers should consider the use of these indicators in conjunction with each other rather than individually. Future research is needed on pathogenic mechanisms, diagnostic modalities and therapeutic options in these individuals which will help to further characterize and manage these patients appropriately.

Sex in man and probably throughout the class mammalia is normally determined by the presence of a Y chromosome (male) or its absence (female). The presence of genetic loci on both the long and the short arm of the X chromosome in double dose appears to be essential for the development of mature functional ovaries in the human female though a single X suffices in the female mouse.

The development of masculine genital anatomy and phenotype is a consequence of prior formation of testes. In the absence of gonads of either kind, female internal and external genitalia are formed but secondary sex development fails. In rare human families a mutant gene suppresses the development of male external genitalia in 46, XY embryos but permits the development of testes and male internal genitalia. The external phenotype is normal female (syndrome of testicular feminization). A sex-linked mutant gene in the mouse has a similar effect.

The locus or loci directly concerned with male development might lie wholly on the Y chromosome or might be located on another chromosome or chromosomes. In the latter case it (or they) must be repressed in the female and normally activated by a locus or loci on the Y chromosome in the male. Present evidence does not permit the exclusion of either possibility.

There is now widespread agreement on the importance of men's role in reproductive decision-making. Several studies have argued that fertility preferences and their translation into behaviour differ between polygamous and monogamous unions. Studies investigating the dominance of men's preferences over women's preferences, in cases of couple disagreement, found mixed evidence of the effect of polygamy. However, an often cited limitation of these studies has been the inability to link husband's intention with each of his wives in a polygamous union. By adding fertility-intention questions to an on-going Demographic Surveillance Site in Karonga District in northern Malawi the fertility preferences and contraceptive use of husbands and wives were investigated. An analysis of the relationship between the level of agreement and disagreement between husbands' and wives' fertility preferences was then performed to gain insight into the reproductive decision-making process of polygamous couples.

Child mortality differentials according to water supply and sanitation in many urban areas of developing countries suggest that access to piped water and toilet facilities can improve the survival chances of children. The central question in this study is whether access to piped water and a flush toilet affects the survival chance of children under five in urban areas of Eritrea. The study uses data collected by the Demographic and Health Survey (DHS) project in Eritrea in 1995. The results show that while the unadjusted effect of household environment (water supply and toilet facility) is large and statistically significant during the post-neonatal and child periods, it is relatively small and statistically insignificant during the neonatal period. The effect of household environment remains substantial during the post-neonatal and child periods, even when other socioeconomic variables are held constant. However, the household environment effect totally disappears during the neonatal period when the socioeconomic factors are controlled for.

Protein energy malnutrition is a major health problem in India and it affects the growth and development of young children. This study investigated the impact of hygiene, housing and sociodemographic variables on acute malnutrition in children aged 5–7, living in urban and rural areas. Ordinal logistic regression analysis showed that the overall prevalence of severe malnutrition was 8·2%. Older age, male sex, mother's poor education, lower family income, higher birth order of the child, use of dung or fire wood as fuel and defecation within the premises were significantly associated with malnutrition. Appropriate intervention programmes should be formulated to educate and support these families.

Around 25% of abortions in South Africa are performed in the second trimester. This study aimed to better understand what doctors, nurses and hospital managers involved in second trimester abortion care thought about these services and how they could be improved. Nineteen in-depth interviews with abortion-related service providers and managers in the Western Cape Province, South Africa, were undertaken. Data were analysed using a thematic analysis approach. Participants expressed resistance to the dilation and evacuation (D&E) procedure, as this required more active provider involvement. Medical abortion was preferred as it required less provider involvement in the abortion process. A shortage of providers willing to perform D&E resulted in most public sector services being outsourced to private sector doctors. Respondents noted an increased demand for services and a concomitant lack of infrastructure, physical space and personnel to respond to these demands, sometimes resulting in fragmented or poor quality care. At medical induction sites, most thought introducing the combined mifepristone–misoprostol regimen would improve service capacity, although they were concerned about cost. Improving contraceptive services was also seen as a much-needed intervention to improve care and prevent abortion. Ongoing training, including values clarification, as well as emotional support and team-building for providers are needed to ensure sustainable, high-quality second trimester abortion services.

Drawing upon data from the third round of the National Family Health Survey (NFHS-3) conducted in India during 2005–06, this study compares the utilization of selected maternal and child health care services between the urban poor and non-poor in India and across selected Indian states. A wealth index was created, separately for urban areas, using Principal Component Analysis to identify the urban poor. The findings suggest that the indicators of maternal and child health care are worse among the urban poor than in their non-poor counterparts. For instance, the levels of antenatal care, safe delivery and childhood vaccinations are much lower among the urban poor than non-poor, especially in socioeconomically disadvantageous states. Among all the maternal and child health care indicators, the non-poor/poor difference is most pronounced for delivery care in the country and across the states. Other than poverty status, utilization of antenatal services by mothers increases the chances of safe delivery and child immunization at both national and sub-national levels. The poverty status of the household emerged as a significant barrier to utilization of health care services in urban India.

People living with HIV and AIDS (PLWHAs) often face stigma and discrimination, especially in developing countries. HIV-related stigma is expressed through social ostracism, personal rejection, direct and indirect discrimination, and denial from families and friends. Consequently, it is associated with reduced adoption of preventive and care behaviours, including condom use, seeking for HIV test and care-seeking behaviour subsequent to diagnosis. Ignorance about the epidemiology of the disease on modes of transmission and prevention aggravates HIV-related stigma in Nigeria. Behaviour change communication activities through mass media have been shown to be an effective approach in improving people's knowledge about the disease. This paper monitors trends in the level of accepting attitudes towards PLWHAs in Nigeria between 2003 and 2007. It also evaluates the impact of exposure to mass media and social support on the levels of accepting attitudes towards PLWHAs. A significant and positive trend was evident between 2003 and 2007 (p<0.0001). Furthermore, exposure to mass media communications on HIV and AIDS issues and social support were significantly related to the reduced stigma and discrimination against PLWHAs (p<0.0001).

In a cross-sectional study of gallstone disease, ascertained by ultrasonography, the prevalence was assessed in relation to clinically diagnosed gallstones in first degree relatives by selected socioeconomic factors. In both sexes, clinically diagnosed gallstones among first degree relatives occurred significantly more frequently among subjects with than among those without gallstone disease. None of the socioeconomic variables was significantly associated with gallstone disease in females. In males gallstone disease was positively associated with longer school education, living alone, and duration of residence in the municipality of Copenhagen.

This study aimed to explore pregnant women's attitudes towards the inclusion of a lay companion as a source of social support during labour and delivery in rural central Ghana. Quantitative demographic and pregnancy-related data were collected from 50 pregnant women presenting for antenatal care at a rural district hospital and analysed using STATA/IC 11.1. Qualitative attitudinal questions were collected from the same women through semi-structured interviews; data were analysed using NVivo 9.0. Twenty-nine out of 50 women (58%) preferred to have a lay companion during facility-based labour and delivery, whereas 21 (42%) preferred to deliver alone with the nurses in a facility. Women desiring a companion were younger, had more antenatal care visits, had greater educational attainment and were likely to be experiencing their first delivery. Women varied in the type of companion they prefer (male partner vs female relative). What was expected in terms of social support differed based upon the type of companion. Male companions were expected to provide emotional support and to ‘witness her pain’. Female companions were expected to provide emotional support as well as instrumental, informational and appraisal support. Three qualitative themes were identified that run counter to the inclusion of a lay helper: fear of an evil-spirited companion, a companion not being necessary or helpful, and being ‘too shy’ of a companion. This research challenges the assumption of a unilateral desire for social support during labour and delivery, and suggests that women differ in the type of companion and type of support they prefer during facility deliveries. Future research is needed to determine the direction of the relationship – whether women desire certain types of support and thus choose companions they believe can meet those needs, or whether women desire a certain companion and adjust their expectations accordingly.

The effects of war-induced anxiety and mental distress on individuals and groups can either be mitigated or exacerbated by ‘humanitarian action’. This paper focuses on two key factors that protect the mental well-being of war-affected populations: organized displacement or assisted relocation; and coordinated humanitarian aid operations that are responsive to local needs. Qualitative data from two internally displaced person (IDP) camps in Eritrea are presented. Analysis of these data serves to substantiate and refine a working hypothesis: that social support of the right type, provided at the right time and level, can mitigate the worst effects of war and displacement on victims/survivors. An integrated model of psychosocial transition is suggested. The implications of this approach for humanitarian policy and practice are discussed in the wider context of current debates and lamentations of the ‘humanitarian idea’.

The biological and social factors which may interact to determine the level and pattern of fertility during the last decades of the reproductive life are complex, and because of the paucity of data, the mechanisms regulating fertility at late ages must in part remain speculative. This review focuses on two major questions. First, why is there a decline of fertility prior to the menopause? Second, why does reproduction cease at the menopause and what factors influence the age at which this occurs?