One hundred and fifty-two randomly selected pregnant women were examined and followed up by interviews and psychological tests during pregnancy and after parturition. The present paper is focused upon factors which determine the woman's preference for the sex of her expected child. It was shown that women who already have one or more children generally wanted the expected child to be of the opposite sex to her youngest child. Thus, the main part of the study was limited to eighty-one nulliparous women.

Associations were found between the woman's preference for the sex of the child and several factors such as the sex of her own siblings and her position among them, her education, intelligence and degree of field-dependence indicating immaturity and lack of autonomy.

Several of the findings presented refute the common supposition that nulliparous women generally want to give birth to a son, and that the arrival of a son is more satisfactory. Women wishing for a son were found to be somewhat more field-dependent than other women and somewhat more often reported that they had experienced a range of mental symptoms before the current pregnancy. Women wishing for a boy also reported more mental symptoms during the post-partum period. Moreover, those women who gave birth to a son reperted more symptoms at this time than those who gave birth to a daughter, and paradoxically the most affected were those who had wished for a son and had had their wishes fulfilled. The arrival of a daughter therefore seems to be equally satisfactory to the mother, at least as measured by the criteria used in this investigation.

A sample of 842 rural women from Morocco (Amizmiz, Marrakech) was used to examine the relationship between a number of biosocial variables and fertility patterns. For women still in their reproductive years there were significant correlations between family size and woman's age, age at marriage and years of marriage. Among women with completed families, those with early age at marriage ceased childbearing about 10 years before reaching menopause, while women who married later continued to bear children until the end of their fertile life.

Intimate partner violence is widespread worldwide. While assumed to impact women’s ability to use contraceptive methods, few data are available to support this claim. In this study, eight focus group discussions were conducted to guide questionnaire development and to provide contextual information. Participants were women who were currently using the pill and women who had used the pill previously. In addition, 300 women were interviewed who initiated oral contraceptive pill use between December 1995 and April 1996. Participants were interviewed 3–6 months later to investigate the role intimate partner violence played in covert pill use and pill discontinuation. Special study procedures for asking women questions about violence were employed. Nineteen per cent of the women interviewed were using the pill covertly. The odds of covert pill use were four times higher in El Alto and La Paz than in Santa Cruz. Women who used the pill covertly were more likely to have experienced method-related partner violence (OR=21.27) than women whose partners knew of their pill use. One-third of the women had discontinued pill use at the time of the interview. In the final multivariate analysis, having experienced side-effects (OR=2.37) was a significant predictor of pill discontinuation and method-related partner violence was marginally predictive (OR=1.91; 95% CI 1.0–3.66). While efforts are ongoing to incorporate men into family planning programmes, some male partners oppose, and in some situations violently oppose, contraceptive use. The needs of women with these types of partners must not be overlooked.

India is the highest contributor to child anaemia among developing countries. To see the latest picture of child anaemia in India, data for 6- to 59-month-old children were taken from the fourth round of the National Family Health Survey conducted in 2015–16 (NFHS-4). The study sample consisted of 1,37,347 children. The dependent variable was the anaemia status of the child. The objectives of the study were to assess (i) the distribution of anaemia prevalence by child age group, (ii) the prevalence of child anaemia by zone and state and (iii) the relation of child anaemia prevalence with social, demographic and economic variables, including maternal nutritional status and low birth weight. The study found that in India in 2015–16, 56% of 6- to 59-month-old children were anaemic – a decrease of only 13.5 percentage points since the NFHS-3 study conducted in 2005–06. It is well known that iron supplementation is necessary for child growth and brain development. This study suggests that, in addition, the socioeconomic conditions of households in India need to be improved to prevent child anaemia. Low birth weight and low maternal nutritional status are also responsible for the high prevalence of anaemia among children in India.

This paper is based on a study aimed at understanding the perceptions of men to induced abortion and contraceptive use within marriage in rural Zimbabwe. Two qualitative methods were combined. Men were found to view abortion not as a reproductive health problem for women. Instead, they described abortion as a sign of illicit sexual activity and contraceptive use as a strategy married women use to conceal their involvement in extramarital sexual activity. Men felt anxious and vulnerable for lack of control over women. In the absence of verbal communication on sexual matters, women and men resort to what are called here ‘hide-and-seek’ strategies, where women acquire and use contraceptives secretly while men search for evidence of such use. It is concluded that promoting women’s sexual and reproductive health requires both short- and long-term strategies. The short-term strategy would entail providing women with reproductive technology they can use without risking violence. The long-term strategy would entail understanding men’s concerns and the way these are manifested. In turn this requires the use of methodologies that encourage dialogue with research participants, in order to capture their deep meanings and experiences.

Using nationally representative data, it is shown that marital unions are relatively stable in Nigeria. Remarriage rates are high so little time is lost between unions. Consequently, the fertility of women who have experienced marital disruption is only slightly lower than for those in stable unions. Their slightly lower parity may be a function of a high incidence of reproductive impairment, which is a major reason for divorce and separation in Nigeria.

It has been suggested that parish-based reconstitution studies may underestimate the true age at marriage because they do not normally include data for emigrants who may be expected to behave differently from individuals who remain in their natal parishes. This study uses data from C18-19th parish registers of north-west Germany to estimate the difference in age at marriage between leavers and stayers. The difference is not significant for males; although that for females is significant, it is small and the consequence of failing to include migrants is likely to be negligible for most studies. However, it is shown that there is also an independent effect on age at marriage that is due to the woman's natal social (economic) status; historical demographic studies that ignore this dimension may risk confounding two different effects.

This study evaluated the strength of the independent effects of social position (expressed by educational level) and number of childbirths on body mass index (BMI) variation of Polish adult females. The material comprised 2045 pre-menopausal women aged 35–50, who were healthy and occupationally active inhabitants of the city of Wrocław, Lower Silesia, Poland. Two-way analysis of variance (ANOVA) revealed that both educational level (F=34·7; p=0·0001) and parity (F=5·6; p=0·001) exerted independent significant effects on BMI. The mean BMI of women who had attended basic vocational or trade school at the very most (27·0 kg/m2) was greater than that of women who had completed secondary school education or had graduated from university (25·3 kg/m2). However, it is worthy of note that there were no social differences in BMI values between childless women. Nevertheless, an increasing number of childbirths was essentially related to increasing female BMI in each social group, and this tendency was most marked among women of lower social position. Regardless of educational level, the highest prevalence of obesity (BMI exceeding 30 kg/m2) was found among females with at least three children (15·6% and 26·4% of women from higher or lower social groups, respectively).

This paper addresses the overall performance and inequalities in the immunization of children in Vietnam. Descriptive and logistic analysis of cross-national demographic and health data was used to examine inequality in immunization, identify the most vulnerable groups in immunization coverage, and identify the gap in coverage between hard-to-access people and the remainder of the population. The gap in the coverage was found to occur primarily in vulnerable groups such as the poor minority or poor rural children. No evidence was found of a difference in immunization coverage because of sex or birth order. However, the age of children showed a significant influence on the rate of immunization. Mother’s education and regular watching of television had a significant influence on child immunization. In order to improve child immunization coverage in Vietnam, efforts should be concentrated on poor children from minority groups and those living in rural areas, especially remote ones. Community development, investment for immunization and re-organization of immunization services at the grassroots level are also key factors to remove the barriers to immunization for vulnerable populations in Vietnam.

This study examines the prevalence and determinants of adolescents' unintended pregnancy and induced abortion in Owerri, Nigeria. A pre-coded questionnaire was used to obtain information from 540 female adolescents of mean age 15.8 years. In addition, four FGDs were held with female adolescents in selected localities and in-depth interviews held with fifteen health-care service providers. Almost all the adolescents (99.8%) were Christians, with 70.3% being Catholics and 68.2% living with their parents. Over half (57.2%) of the adolescents had had sex. Contraceptives were rarely used owing to deep-seated cultural values. The data show that 31.6% of those who had ever had sex had an unintended pregnancy. Of these, 78.9% had recurrent pregnancies and 20.2% had an abortion. Of the latter, 41.8% had a recurrent abortion and 72.7% a post-abortion problem, for which 70.2% never sought treatment, increasing the risk of infertility in later life. The abortion seekers mostly went to patent medicine operators. A more acceptable and cost-effective contraceptive campaign involving use of local vernacular and traditional/local opinion leaders should be explored.

Based on evolutionary reasoning, Trivers & Willard (1973) predicted status-biased sex composition and parental investment with son-preferencing effects in higher, and daughter-preferencing effects in lower status groups. Previous research shows mixed results. This study uses event-history methods and Swedish register data to study one possible mechanism in isolation: do parents in different status groups vary in their proclivities to continue fertility based on the sex composition of previous offspring? The results show no support for the Trivers–Willard hypothesis on a wide range of different status indicators. Future research on the stated hypothesis should focus on physiological rather than behavioural mechanisms.

In its recently adopted Global Strategy on Infant and Young Child Feeding, the World Health Assembly called for urgent action in addressing the barriers to optimal feeding practices. This paper examines mothers’ concerns about milk insufficiency as a major contributor to suboptimal infant feeding decisions, using survey data from periurban areas of two Bolivian cities. Mothers in the lowland modernizing city of Santa Cruz were more likely than mothers in the highland traditional city of Cochabamba to express concern about insufficient milk, and also less likely to feed their infants according to international recommendations. Furthermore, perceived milk insufficiency was particularly common among mothers of infants younger than 6 months of age – an age at which infants are particularly vulnerable to the adverse effects of breast-feeding cessation and complementary feeding initiation. The paper concludes with policy, programme and research recommendations to address the critical problem of perceived insufficient breast milk.

Botswana is one of the sub-Saharan countries where actual fertility has declined. This study examines the fertility preferences of both men and women and shows that fertility intentions have a significant influence on future fertility behaviour. Fertility preferences are relatively low and there is no significant difference between those of men and women. Men's preference for sons influences desired family size and eventual fertility. For women as well as men, child survival is an important factor. Women's income is also influential.

This paper reports a pilot study of thirteen children with epilepsy and their families; the parents' efforts to obtain help for the child and the effect of the child's disability on the family relationships are described. About half of the parents did not consult the family doctor immediately after the first appearance of signs of epilepsy (patient delay). About a quarter of the family doctors delayed referral of the patient with epilepsy to the specialist (doctor's delay). Another 3 years passed, on average, before the patient reached a special centre or clinic for epilepsy (specialist delay); in three-quarters of all cases the first step to get there was taken by the parents and not by the specialist and chance plays an important role in determining how the entry into this third echelon is achieved. Reasons for the search for more specialized help were: dissatisfaction with the results of the treatment and the kind of rapport with the second echelon specialist. The out-patient clinic for epilepsy is generally favourably commented on because the expert medical advice is combined with the availability of a social worker, thus offering support with social problems also. As regards the influence of the illness on the family, there is evidence that family life is disrupted to a greater or less extent. The parents experience psychological stress and are generally apprehensive lest something will happen to their child. In a number of cases the relationships between siblings are rather disturbed. The parents, especially mothers, tend to (over-)protect the child with epilepsy. The child with epilepsy has a relatively isolated position in his social environment; he has few informal or formal social contacts with his peer group. The condition epilepsy contributes to a diminution of expectations for the future and curtailment of scholastic behaviour.

The incidence of obesity, defined as the fraction of persons with BMIs exceeding 30·0, was examined in two birth cohorts of 40–50-year-old occupationally active inhabitants of the city of Wrocław, Poland. In both cohorts and both genders obesity increased monotonically with decreasing position on a three-level educational scale. During the 1986–1996 decade obesity increased dramatically among males with trade school education only; concomitant shifts were much smaller or absent in the college-educated groups. The contrast in obesity between the opposite ends of the educational scale has widened markedly in both genders; and the between-gender gap has declined somewhat.

This study examined the nutritional status of mothers in one of the most populous food-insecure zones in southern Ethiopia, the Sidama zone. The study used primary data collected from 1094 households with a child under 24 months located in ten kebeles (the smallest administrative district). Households were selected using multi-stage probability sampling techniques. The mothers' nutritional status was estimated using both body mass index (BMI) and mid-upper-arm circumference (MUAC). The results from the BMI analysis revealed that 28.1% of the women were malnourished (BMI <18.5) and 67.5% were normal (BMI 18.5 to <25.0), while the remaining small proportion (4.5%) fell in the overweight or obese categories. Similarly, the computation of maternal nutritional status by MUAC analysis showed that 31.4% of the women were malnourished (MUAC <22). Further analysis of the main predictors of maternal malnutrition using logistic regression showed that three individual-level variables and three household-level variables predicted maternal malnutrition: woman's age, duration of breast-feeding, literacy status, marital form, land size and intra-household food distribution. The study concludes that maternal malnutrition is a serious problem in the study area and that there are contextual risk factors that could be addressed to partially tackle the problem.

Based on data obtained from the marriage registers of seven Oxfordshire parishes in the Otmoor region, an analysis has been made of the effects of social mobility and marriage exchanges on the relatedness of the five social classes which are recognized by the Registrar General. From a starting position in which it is assumed that there was no relatedness between the classes, it is calculated that under the average social mobility patterns which have characterized the area from 1837 to 1967 the different social classes would come to share 95% of their ancestry in sixteen generations. The marriage movement would produce the same levels of relatedness in twenty generations, and the combined effects of social mobility and marriage produce homogeneity in nine generations. It is further argued that these are maximal estimates but in considering the genetic implications it is noted that, whilst genes which do not affect social mobility and marriage movement are not likely to show social stratification in Otomoor populations, genes affecting behavioural traits may well be heterogeneously distributed.

A significant increase occurred in the initiation and duration of breast-feeding among Honduran women between 1981 and 1987. Changes in population characteristics (e.g. level of education of women) would be expected to lead to a decrease in breast-feeding at each infant age, but these were offset by behavioural changes that led to an increase in the likelihood of initiation and continuation of breast-feeding. An exploration of relevant factors suggests that the PROALMA breast-feeding promotion programme has had a profound effect on the breast-feeding behaviour of Honduran mothers.

With declining levels of international donor funding for financing reproductive health programmes, developing country governments and international donors are looking towards private sector strategies to expand the supply of quality reproductive health services. One of the challenges of a health franchise is to improve the quality of services provided by independent private practitioners. Private providers are more likely to abide by the quality standards set by a franchiser if they see a financial benefit resulting from franchise participation. This study was conducted to measure whether (a) there were improvements in perceived quality of care and perceived access to health facilities once these facilities became part of a franchise and (b) improvements in perceived quality and perceived access were associated with increased client loyalty to franchised clinics. Franchisees were given basic reproductive health training for seven days and services marketing training for two days. Exit interviews were conducted with male and female clients at health facilities. A pre-test measurement was taken in April 2001, prior to the start of project activities. A post-test measurement was taken in February/March 2002, about 9 months after the pre-test. Multilevel regression analysis, which takes the hierarchical structure of the data into account, was used for the analysis. After taking provider-level variation into account and controlling for client characteristics, the analyses showed significant improvements in perceived quality of care and perceived access to services. Private provider participation in a franchise network helps improve client perceptions of quality of, and access to, services. Improvements in client perceptions of quality and access contribute to increased client loyalty to franchised clinics. Once increased client loyalty translates into higher client volumes, providers are likely to see the benefits of franchise participation. In turn, this should lead to increased provider willingness to remain part of the franchise and to abide by the standards of quality set by the franchiser.

Improved child health and survival are considered universal humanitarian goals. In this respect, understanding the nutritional status of children has far-reaching implications for the better development of future generations. The present study assessed, first, the nutritional status of children below 5 years using the three anthropometric measures weight-for-age, height-for-age and weight-for-height in two states of India, Kerala and Goa. Secondly, it examined the confounding factors that influence the nutritional status of children in these states. The NFHS-I data for Kerala and Goa were used. The results showed that the relative prevalence of under-weight and wasting was high in Kerala, but the prevalence of stunting was medium. In Goa, on the other hand, the relative prevalence of wasting and underweight was very high, and that of stunting was high. Both socio-economic and family planning variables were significantly associated with malnutrition in these states, but at varied levels. The study recommends more area-specific policies for the development of nutritional intervention programmes.