The latest National Family Health Survey conducted in 2015–16 (NFHS-4) showed that malnutrition and anaemia still pose huge health challenges in India. Data on 651,642 adult non-pregnant women aged 15–49 years were taken from the survey to study the nutritional and anaemia statuses of adult women by Indian zone and state. The relationships of these two variables with the women’s urban/rural place of residence, education level, religion and eating habits, and wealth index of the family, were assessed. Body Mass Index (BMI) and haemoglobin level were used to assess nutritional status and level of anaemia, respectively. The results show that in 2015–16 in India the percentages of underweight and obese/overweight people were 22.4% and 18.4%, respectively. The percentages of undernutrition and overnutrition were more or less same. The percentage of underweight people was higher in the middle belt region of India. Zones with high levels of overweight or obesity were concentrated in the West, North and South zones. A comparison of the two national-level data sets, i.e. NFHS-4 and NFHS-3, showed that the prevalences of undernutrition and anaemia reduced by 13 and 5 percentage points, respectively, from NFHS-3 to NFHS 4, i.e. over the 10-year period from 2004–05 to 2015–16, whereas overnutrition increased by 4 percentage points during this period. Analysis of possible socio-demographic factors and eating habits thought to influence underweight, obesity and anaemia revealed substantive causal relations. More specifically, education and eating habit were found to influence underweight, overweight or obesity and anaemia significantly. The nutritional status of a woman was also found to depend on household income.

This paper examines determinants of one aspect of sexual behaviour – coital frequency – among 2188 married women in the Central African Republic using a secondary analysis of data from the Demographic and Health Survey of 1994–95. Female genital cutting (or circumcision) is practised in the Central African Republic and self-reported circumcision status was included in the questionnaire enabling it to be examined as a possible determinant of coital frequency. Multiple logistic regression was used to find a subset of factors independently associated with coital frequency. Decreased coital frequency was found in those who had longer duration of marriage, those who were not the most recent wife in a polygamous marriage and those who had more surviving children. Coital frequency was higher in more educated women and those not contracepting because they wanted to get pregnant. After adjusting for confounders no association between female genital cutting and coital frequency was found. The extent to which women can control coital frequency in this culture is not known and fertility desires may override any negative effects of circumcision on sexual pleasure. It was therefore not possible to draw conclusions about how female genital cutting affects a woman’s desire for sexual intercourse and consequently there is a need to develop research methods further to investigate this question.

A range of activities are currently underway to improve access to malaria prevention and control interventions. As disease control strategies change over time, it is crucial to understand the health-seeking behaviour and the local socio-cultural context in which the changes in interventions operate. This paper reflects on how people in an area of seasonal malaria perceive the causes and transmission of the disease, and what prevention and treatment measures they practise to cope with the disease. It also highlights some of the challenges of malaria treatment for health care providers. The study was undertaken in 2003 in Adami Tulu District in south-central Ethiopia, where malaria is a major health problem. Pre-tested structured questionnaires and focus group discussions were conducted among men and women. Malaria, locally known as busa, was perceived as the most important cause of ill health in the area. Respondent’s perception and knowledge about the cause and transmission of the disease were relatively high. The newly introduced insecticide-treated nets were not popular in the area, and only 6·4% of households possessed at least one. The results showed that patients use multiple sources of health care for malaria treatment. Public health facilities, private clinics and community health workers were the main providers of malaria treatment. Despite higher treatment costs, people preferred to use private health care providers for malaria treatment due to the higher perceived quality of care they offer. In conclusion, effort in the prevention and control of malaria should be intensified through addressing not only public facilities, but also the private sector and community-based control interventions. Appropriate and relevant information on malaria should be disseminated to the local community. The authors propose the provision of effective antimalarial drugs and malaria prevention tools such as subsidized or free insecticide-treated nets.

The long-term high sex ratio at birth (SRB) is a serious issue in China. In this study, changes in SRB were decomposed into variations in SRB by birth order and compositional changes in female births by birth order. With SRB data from China’s surveys and censuses, and SRB data from South Korea’s vital registration and censuses from 1980–2015, the trend and decomposition results in SRB were compared between China and South Korea, and the decomposition results for urban and rural SRBs, and for provinces, are presented. In both China and South Korea the rise in the SRB was driven by a rise in the SRB at all birth orders, which was only partly counteracted by the change in the distribution of births by order. The overall rise in the SRB ended when there was a decline in the SRB at second birth or above in South Korea. In China the total effect of variations in SRB of all birth orders increased more for the rural population than for the urban population before 2000, resulting in a higher total SRB for rural than urban population. After 2000, the total effect of variations in SRB of all birth orders lowered the total SRB for the rural population, whereas the effect of compositional change increased the total SRB, leading to a very slight rise in the total SRB for the rural population. At the province level, there was no spatial autocorrelation for the changes in total SRB by province, the total effect of variations in SRB of all birth orders or the effect of compositional change. The effect of variations in SRB by birth order accounted for the majority of changes in total SRB in most provinces.

This study investigates the possible effects of pre-term births and low birth weight on infant mortality rates (IMRs) over a 15-year period in Ribeirão Preto, Brazil, based on surveys carried out in 1978/79 and 1994. The 1978/79 survey included 6750 births over a 12-month period and the 1994 survey 2846 births over a 4-month period. Infant deaths were retrieved monthly from the city register. Infant mortality rate decreased from 36·6 to 16·9 deaths per 1000 over 15 years. The decrease in IMR was larger in the 2500–2999 g group than in any other group. The observed falls in IMR were attributable to decreases in birth-weight-specific mortality rates. Likewise, there was a general decrease in IMR in mild, moderate and severe pre-term births. The incidence rate ratio of infant mortality between surveys was 0·46 (95% CI 0·34–0·63); it increased to 0·57 (95% CI 0·35–0·75) when adjusted for birth weight and other factors in the model and rose to 0·69 (95% CI 0·49–0·97) when adjusted for length of gestation and other variables. The increase in pre-term births and low birth weight may have had, at most, a marginal effect on the IMR. Progress in the care of newborns may have decreased the mortality risk, but even mild pre-term birth still has an impact on infant mortality. There is room for further improvement in IMR by tackling the high rates of pre-term birth.

From statistics on Australian confinements during the period 1944–63 it seems that the following conclusions can legitimately be drawn:

(1) The proportion of multiple births increases with increasing age of mother up to about age 37, turns, and decreases thereafter.

(2) The proportion of multiple births increases with increasing age of father up to about age 34–38 and is fairly constant thereafter.

(3) The variation with age of father, however, only arises because of the high correlation with age of mother which is the determining factor.

(4) The proportion of multiple confinements increases with birth order. This effect holds for all ages of mother except those over 40 where there is no significant variation.

(5) The proportion of multiple confinements decreases from the first year of marriage to the second, then increases steadily to a maximum after about 15 years of marriage and then decreases slightly.

(6) The proportion of binovular twins increases steadily with increasing age of mother up to about age 37, turns, and thereafter decreases steadily.

(7) The proportion of monovular twins increases slightly with increasing age of mother up to about age 37 and is fairly constant thereafter.

(8) From the small amount of data it appears that the proportion of triplets also increases with increasing age of mother.

This paper explores a number of socioeconomic factors thought to explain the wide prevalence of undernutrition among rural Bangladeshi women. The 1992 baseline survey data of the BRAC-ICDDR,B Joint Research Project at Matlab were used. Anthropometry was performed on a random sub-sample of 1462 currently married, non-pregnant women between 15 and 49 years of age. Women's nutritional status was defined in terms of Body Mass Index (BMI=wt in kg/ht in m2). Compared with women from better-off households, the mean weight (41.2 vs 43.0 kg; p<0.0001), mid-upper arm circumference (MUAC) (22.1 vs 22.7; p<0.0001), and BMI (18.5 vs 19.1; p<0.0001) of poor women were consistently lower. However, no significant difference in mean height was found between the two groups. The results showed that women aged more than 35 years are twice as likely to have a BMI<18.5 compared with younger women. Both years of schooling received and socioeconomic status are found to be important predictors of women's BMI. Women who have received one or more years of formal education are nearly half as likely to suffer chronic energy deficiency (BMI<18.5) than women with no schooling. Again, better-off women are found to be 0.77 times less likely to have chronic energy deficiency than women from poor households. The implications of these findings in improving the nutritional status of rural Bangladeshi women are discussed.

One hundred and thirty healthy women who were willing to breast-feed their babies were followed during the first postpartum year to assess their fertility, lactation and bleeding pattern and examine possible relationships between these variables. Seventy-five women were in full nursing and 22 in partial nursing at the end of the 6th postpartum month. Five hundred and three woman-months and nine pregnancies were recorded during full nursing between the 2nd and the 6th month after delivery. The cumulative probability of pregnancy at the end of 6 months in all full nursing women and in non-amenorrhoeic full nursing women was 10.0% and 27.2% respectively. The corresponding figure for partial nursing women was 40–5%.

By the end of the first year, the cumulative probability of pregnancy in full nursing women had increased to 33.9%. Except for the bleeding pattern, no differences were found among full nursing women who did or did not become pregnant.

It was concluded that full nursing women living in an urban setting who want to space pregnancies need additional protection at a time that depends upon the level of assurance wanted.

The study objective was to analyse the association between food insecurity and the weight and height status of adolescents from a low-income area in the metropolitan region of Rio de Janeiro, Brazil. The population-based cross-sectional survey included 523 adolescents aged 12–18 years, selected by a three-stage cluster sample. Dietary intake was ascertained with a food frequency questionnaire and family food insecurity was assessed with a validated questionnaire. The analysis estimated weighted means of energy and nutrient intakes by families' socioeconomic characteristics and the association between dietary intake with overweight and stunting. The prevalence of mild family food insecurity was 36%, and 24% of the families reported moderate or severe food insecurity. Overweight prevalence was 24%, and the prevalence of stunting was 9%, with no significant differences between sex or age groups. Family food insecurity was associated with unfavourable socioeconomic characteristics, but there was no association between socioeconomic characteristics (including family food insecurity) and overweight or stunting. Moderate or severe family food insecurity was inversely associated with intake of protein and calcium. In addition, stunting was associated with low calcium and iron intake. The co-existence of family food insecurity with overweight and stunting implies a high nutritional risk for adolescents from poor areas of Rio de Janeiro. Nevertheless, the observed absence of a statistical association between family food insecurity and weight status attests to the complexity of this issue.

Most studies of the association between family structure and risky sexual behaviour among adolescents and young adults have employed a risk perspective which assumes that, compared with other types, two-parent families are protective. Drawing from a positive-oriented approach in this study, it is hypothesized that within each family type some influential factors may mitigate such anticipated deleterious effects of non-intact families and decrease sexual risk-taking. The paper examines specifically the effects of risk and protective factors with an emphasis on family processes associated with resilience, using data from a pooled sample of 1025 females and males aged 12–24 years from Bandjoun (West Cameroon). Findings show that the quality of parent/guardian–youth relationships significantly decreases the odds of risky sexual behaviour by 36%, 65% and 50% in neither-, one- and two-parent families, respectively. For two-parent families only, parental control acts as a significant protective factor; it decreased by 41% the odds of risky sexual behaviour. Programmatically, protective family factors such as parent/guardian–youth interactions need to be promoted to improve the efficiency of reproductive health and HIV interventions in sub-Saharan Africa.

Using data from Wave 1 of the Household Income and Labour Dynamics in Australia (HILDA) survey, this paper analyses the extent to which childlessness among Australian women aged 40–54 years varies according to the size and type of family in which they were brought up, and the level and type of schooling they had. Multilevel logistic analysis shows that having been educated in a non-government school, having stayed at school to year 12, having a small number of siblings, at age 14 having a father who was either dead or absent, at age 14 having a father who was employed in a professional occupation, or being a migrant from North or West Europe, North America, East Asia or South-East Asia, all are significantly associated with higher rates of childlessness among women in the 40–54 years age range. The effects of these early lifecourse variables on marital and socioeconomic status in later life, and hence on childlessness, are also considered. The implications of the findings for fertility trends and for Australia’s public debate are discussed.

Many studies in the last 45 years have shown that women prefer a boy to a girl for their first-born child, suggesting that this preference is universal in Western societies. A careful examination of these studies reveals, however, that the subjects were often women who were not pregnant and/or students. A review of sixteen studies with first-time-pregnant women showed that in most cases the opposite was true, namely, that a girl was desired more often than a boy, especially during the last two decades (from 1981 to 1996). Data concerning expectant fathers, however, indicate that they prefer a boy rather than a girl. A preference for a boy first was also observe for both non-expectant males and females. Women’s preference for a male child decreased and men’s preference increased slightly when the two sub-periods (before 1980 vs after 1981) were compared. A difference between men and women is, however, evident whatever the sub-period: men more often prefer a boy than women. These findings suggest that something specific about being pregnant is related to the preference for a girl first.

On 11th March 2011 a magnitude nine earthquake struck the Tohoku region of Japan. The earthquake resulted in a large tsunami and an accident at the Fukushima Nuclear Power Plant. Previous studies have suggested that demographic indices relating to reproduction and marriage change after such massive disasters (e.g. large earthquakes). The present study investigated whether the number of births, number of marriages and the secondary sex ratio (SSR) changed after the East Japan Earthquake. The monthly number of births (males and females, separately) and marriages in each prefecture in Japan from January 1997 to June 2012 were obtained from the Demographic Survey of Japan. An analysis was performed for three different geographic boundary units: the disaster-stricken area, the non-disaster-stricken area and the whole of Japan. In each unit, the numbers of births and marriages in a given month during the post-disaster period were predicted based on a regression equation estimated by the numbers of births and marriages in that month during the pre-disaster period. The numbers of observed monthly births and marriages during the post-disaster period were compared with the predicted figures. Differences between the observed and predicted numbers were determined by referring to the 95% confidence limits for the predicted mean number. The observed probability of a male birth in a given month during the post-disaster period was compared with a 95% confidence interval of a binominal distribution. In all three boundary units, the number of births was significantly lower than the predicted number by about 3–8% from nine months after the disaster, while the number of marriages in October 2011 was significantly lower than the predicted number by about 25–28%. In October 2011, the SSR in the whole of Japan had decreased from 104.8 (the predicted SSR) to 102.9. The number of births and marriages and the SSR decreased in Japan after the East Japan Earthquake irrespective of locality.

This article explores to what extent married middle-aged individuals in Europeare governed by the risk of experiencing divorce, when shaping their physicalappearance. The main result is that divorce risks, proxied by national divorcerates, are negatively connected to body mass index (BMI) among marriedindividuals but unrelated to BMI among singles. Hence, it seems that marriedpeople in societies where divorce risks are high are more inclined to invest intheir outer appearance. One interpretation is that high divorce rates makemarried people prepare for a potential divorce and future return to the marriagemarket.

Data on patterns of consanguineous marriage were collected from 5340 families resident in eight cities in the Pakistan province of Punjab. To assess whether social and/or occupational class was interacting with con-sanguinity, information also was obtained on the hereditary qaum to which each family belonged. In the present generation 46·5% of all marriages were contracted at the level of second cousin or closer, with an average coefficient of inbreeding (F) of 0·0286, and the results indicated that in each of the seventeen qaums there was strong preference for marriage to a close biological relative. However, significant differences existed in the distribution of consanguineous marriage by qaum membership, which could interfere with the interpretation of studies into the biological effects of inbreeding.

Studies on the causes of maternal mortality in India have focused on institutional deliveries, and the association of socioeconomic and demographic factors with the decline in maternal mortality has not been sufficiently investigated. By using both time series and cross-sectional data, this paper examines the factors associated with the decline in maternal mortality in India. Relative effects estimated by OLS regression analysis reveal that per capita state net domestic product (−1.49611, p<0.05), poverty ratio (0.02426, p<0.05), female literacy rate (−0.05905, p<0.10), infant mortality rate and total fertility rate (0.11755, p<0.05) show statistically significant association with the decline in the maternal mortality ratio in India. The Barro-regression estimate reveals that improvements in economic and demographic conditions such as growth in state income (β=0.35020, p<0.05) and reduction in poverty (β=0.01867, p<0.01) and fertility (β=0.02598, p<0.05) have a greater association with the decline in the maternal mortality ratio in India than institutional deliveries (β=0.00305). The negative β-coefficient (β=−0.69578, p<0.05), showing the effect of the initial maternal mortality ratio on change in maternal mortality ratio in the Barro-regression model, indicates a greater decline in maternal mortality ratio in laggard states compared with advanced states. Overall, comparing the estimates of relative effects, the socioeconomic and demographic factors have a stronger statistically significant association with the maternal mortality ratio than institutional deliveries. Interestingly, the weak association between ‘increase in institutional deliveries' and ‘decline in maternal mortality ratio’ suggests that merely increasing deliveries alone will not help in ensuring maternal survival in India. Quality of services provided by the health facility, birth preparedness and avoiding delay in reaching health facility are also important. Deliveries in health facilities will not necessarily translate into increased survival chances of mothers unless women receive full antenatal care services and delays in reaching health facility are avoided.

Cross-sectional studies in Australia and the Philippines and a longitudinal prospective study in a selected Australian sample of breast-feeding mothers have shown that basal serum prolactin (PRL) concentrations are elevated during 15–21 months of lactational amenorrhoea.

A predictive model of serum PRL levels and return of cyclic ovarian activity during full breast-feeding, partial breast-feeding and weaning has been developed from the results of breast-feeding behaviour and serum PRL, gonadotrophin and oestradiol measurements in 34 mothers breast-feeding on demand for a mean of 67 weeks.

Breast-feeding patterns influence serum PRL levels. Important factors during full breast-feeding are the age of the baby, the longest interval between feeds at night and total 24-hr suckling time, and following the introduction of supplements, the mean interval between feeds, together with the total 24-hr suckling time and the number of solid supplements per day.

The precise mechanisms whereby breast-feeding regulates cyclic ovarian activity remain unknown. Gonadotrophin secretion appears to be quantitatively normal, but qualitative changes, secondary to altered hypothalamic activity, may be the most important factor. A direct inhibitory effect of PRL on ovarian follicular development and steroidogenesis remains possible.

Ovulation with a normal luteal phase is probable for 30% of breast-feeding mothers before the first menses, but is unlikely before 6 months, provided breast-feeding is frequent day and night.

Measurement of serum PRL is a sensitive index of the return of menstruation and fertility during lactation in the population studied.

The term ‘obstetric violence’ has been used to describe the mistreatment, disrespect and abuse or dehumanized care of women during childbirth by health care providers. This is a review of the existing literature in India on violence against women during childbirth. The review used the typology of Bohren et al. (2015). An internet search of PubMed, Google Scholar and JSTOR was conducted using the terms ‘obstetric violence’, ‘mistreatment’, ‘disrespect and abuse’ and ‘dehumanized care’. Studies based on empirical research on women’s experiences during childbirth in health facilities in India were included in the review. The search yielded sixteen studies: one case study, two ethnographic studies, two mixed-methods studies, three cross-sectional qualitative studies, seven cross-sectional quantitative studies and one longitudinal quantitative study. The studies were analysed using the seven categories of mistreatment outlined by Bohren et al. (2015): 1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. An additional category of ‘harmful traditional practices and beliefs’ emerged from the Indian literature, which was also included in the review. Although geographically limited, the selected research highlighted varying prevalences of the different forms of ‘obstetric violence’ in both public and private birth facilities in India. ‘Obstetric violence’ in India was found to be associated with socio-demographic factors, with women of lower social standing experiencing greater levels of mistreatment. In response to this normalized public health issue, a multi-pronged, rights-based framework is proposed that addresses the social, political and structural contexts of ‘obstetric violence’ in India.

The aim of this study was to evaluate the sexual attitudes and behaviours of university students. An anonymous questionnaire was administered to 550 final-year university students aged 20–25 years in Izmir, Turkey. Male students opposed premarital sexual intercourse for both genders more than female students did. The frequency of sexual intercourse among male students (61·2%) was higher than that among female students (18·3%). The mean age of first sexual intercourse was lower among male than among female respondents. The rate of condom use at first sexual intercourse was 47·4%. The frequency of having two or more past sexual partners and masturbation was higher among males than females. It was found that there were culture-specific and gender-dependent differences in sexual attitudes and behaviours of the university students. These results may help in the planning of education and health policies in Turkey.

In a time series study of the USA from 1933 to 1984, fertility rates were associated with the suicide rates of those aged 15–44. The higher the fertility rate the lower the suicide rate for these age groups, for both whites and non-whites, and for both men and women. The results were seen as supporting Durkheim's theory of suicide.