Analysis of the 1992 Niger Demographic and Health Survey showed that although roughly two-thirds of both polygamous and monogamous women approve of birth control, polygamous wives are less likely than monogamous wives to discuss family size or birth control with their husband or to plan on using birth control. The study suggests that characteristics of polygamous couples have caused polygamous women to be more resistant to birth control use than monogamous women. The polygamous women tended to be married to older men who had not gone to primary school and who desired more children than monogamous husbands. The influence of marital structure is not significantly associated with intention to use birth control when the husband's age and the wife's ideal number of children were controlled for in the multivariate logistic regression model suggesting that background social factors may be more influential. In fact, educational level and age at first marriage were significantly associated with attitudes towards birth control and also with marital structure.

The objective of this study was to identify the key determinants of condom use with regular and casual partners among youth in Madagascar. Data stem from a reproductive health survey conducted in October–December 2000 among a representative sample of 2440 youth aged 15–24 living in Toamasina province. Following theoretical models of behaviour change, logistic regression was used to assess the effect of AIDS awareness, personal risk perception, condom access, perceived condom effectiveness, self-efficacy and social support on condom use. Among sexually experienced youth, only about four in ten males and two in ten females have ever used condoms. Fewer than 15% of youth used a condom in last intercourse with their regular partner. Whether youth will try condoms appears to depend largely on the perceived effectiveness of condoms for family planning, access to a nearby condom source, parental support for condom use, and patterns of risky sexual behaviour. Young males’ likelihood of using a condom with a regular partner increases significantly if they perceive condoms to be effective for family planning (OR=11·4; p=0·019). For females, it increases with level of self-efficacy (OR=2·1; p=0·042) and having discussed HIV prevention with someone in the last year (OR=2·8; p=0·022). Among males, condom use with casual partners is significantly higher among those who perceive themselves to be at high risk of sexually transmitted infections (OR=2·3; p=0·014), who believe condoms are effective for family planning (OR=2·8; p=0·048), who have good access to condoms (OR=2·9; p=0·002) and who perceive their parents support condom use (OR=1·7; p=0·048). In conclusion, very few youth in Toamasina are using condoms, highlighting the need to continue and expand adolescent reproductive health interventions. In this low HIV prevalence setting, it is important for these programmes to emphasize that condoms are effective for both pregnancy prevention and STI/HIV prevention.

Isolation of human populations, leading to genetic divergence, is well documented in island settlements and religious isolates. Demonstration or measurement of isolation is more difficult in mainstream populations. An attempt has been made to assess such isolation by simple methods of aggregate analysis from readily available data. The limitations of the data and methods of analysis are fully appreciated, but it seems that differences between areas are detectable. Hence the methods, simple as they are, warrant further application to other communities. The analyses, both of surnames and of marriage movement data, indicate limited gene flow in Northumberland in the 18th century. Such gene flow as did occur came mainly from neighbouring communities, and there was very little long-distance inflow. There was thus a high degree of population constancy and localization in Northumberland in the 18th century. This could well be a contributory factor promoting the known genetic variability of the area.

The association between breast-feeding patterns and resumption of menses post-partum was examined in a longitudinal study initiated in March 1976 in Bangladesh. Information on suckling patterns and menstrual status was collected on 148 breast-feeding women who were still amenorrhoeic at 17–25 months post-partum at the beginning of the study. Suckling was measured during an 8-hr period once a month for up to 19 months of follow-up.

A high frequency of suckling was found, even at this late post-partum duration. Total suckling time and the number of suckling episodes declined with the age of the child but the mean duration of each episode did not change. The fact that regression analyses did not show a correlation between suckling patterns and return of menses post-partum may be related to the large individual variations in suckling patterns and in the duration of amenorrhoea in this population, and the need to study suckling patterns for longer than 8 hr per day.

Available data in Uganda indicate a resurgence of malaria morbidity and mortality countrywide. This study assessed the burden of malaria, treatment and prevention practices in order initiate a policy debate on the scaling-up of current interventions. A triangulation of methods using a cross-sectional survey and key informant interviews was used to assess self-reported malaria at a household level in Mukono District, Uganda. A total of 5583 households were surveyed, and a high proportion (2897, 51·9%) reported a person with malaria two weeks prior to the survey. Only 546 households (9·8%) owned and used insecticide-treated nets (ITNs) for malaria prevention. Similarly, only a few households (86, 1·5%) used indoor residual spraying. Self-treatment with home-stocked drugs was high, yet there was low awareness of the effectiveness of expired drugs on malaria treatment. Self-reported malaria was associated with socioeconomic, behavioural and environmental factors, but more especially with household ownership of ITNs. These results will contribute to the current debate on identifying new approaches for scaling-up prevention interventions and effective case management, as well as selection of priority interventions for malaria control in Uganda.

The variables maternal age, paternal age, and birth order are studied for possible effects on the human secondary sex ratio. Several multivariate models are applied to a set of over 1·4 million births to assess the effects of these three highly correlated variables. Also investigated is the polynomial regression model used by Novitski & Kimball (1958) in their approach to the same problem. Analysis of the present data shows a weak and negative association between sex ratio and birth order and the suggestion of a similar association with paternal age.

This study examines sex differences in infant mortality in Spitalfields, London, and the estimated contribution of endogenous and exogenous factors to neonatal and infant mortality using the biometric model from 1750 to 1839. There was a marked decline in the risk of death during infancy and the neonatal period for both sexes during the study period. There was significant excess male infant mortality compared with that of females in the 1750–59 cohort, estimated from baptism and burial registers, but not in later cohorts. Similarly, males had higher neonatal mortality rates than females in 1750–59 but not in later cohorts. Biometric analyses suggest that the observed decrease in neonatal mortality in both sexes was caused by a reduction in both endogenous and exogenous causes of death. The contribution of maternal health and breast-feeding practices to the observed patterns of mortality is discussed in the light of available evidence.

There is now fairly substantial evidence of a socioeconomic gradient in low birth weight for developed countries. The standard summary statistic for this gradient is the concentration index. Using data from the recently published Growing Up in Ireland survey, this paper calculates this index for low birth weight arising from preterm and intrauterine growth retardation. It also carries out a decomposition of this index for the different sources of low birth weight and finds that income inequality appears to be less important for the case of preterm births, while father's education and local environmental conditions appear to be more relevant for intrauterine growth retardation. The application of the standard Blinder–Oaxaca decomposition also indicates that the socioeconomic gradient for low birth weight appears to arise owing to different characteristics between rich and poor, and not because the impact of any given characteristic on low birth weight differs between rich and poor.

Census data were used to investigate the influences of socioeconomic and environmental variables on child mortality rates in southern Brazil. By multivariate logistic regression analysis the effects of correlated factors were distinguished, after adjustment for maternal age and parity. Low family income and, to a lesser degree, low employment status of the head of the family were associated with high child mortality levels. Place of residence, education of the mother and of the head of the family, availability of piped water in the home, access to a toilet and type of housing were all associated with childhood mortality variation, even after allowing for the effects of income and employment. The contributions of the source of the water supply and type of sanitation facilities, however, were less clear and tended to become unimportant after controlling for the socioeconomic variables. There was also no apparent advantage in being covered by government health insurance.

Using cross-sectional, individual-level survey data from Maharashtra, Tamil Nadu and Uttar Pradesh collected under the Indian National Family Health Survey programme of 1992–93, statistical modelling was used to analyse the impact of a range of variables on the survival status of children during their first 2 years of life. Attention was focused on the potential impact of the mother’s autonomy. The strongest predictors of mortality were demographic and biological factors, breast-feeding behaviour, and use and knowledge of health services. Variables that can be interpreted as being related to maternal autonomy, such as the presence of a mother-in-law in the household, did not have a significant direct effect on child survival at the individual level, and their indirect effects were very limited.

Research on informed choice in modern contraceptive method acceptance by young married women is pertinent in the broader context of individual freedom and reproductive rights, especially in countries where women continue to have limited control over their reproductive and contraceptive choices. This study in India asked: (1) is young married women’s acceptance of specific modern contraceptive methods an informed choice? and (2) what are the enablers and barriers to informed choice? The study used data for currently married women aged 15–24 (N = 20,752) from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015–16. A Method Information Index (MII) was calculated as a measure of informed choice from the percentage of users who responded ‘yes’ to all three questions on: whether they were informed about methods other than the one they received, told about the method-specific side-effects, and advised what to do if they experienced side-effects. Binary logistic regression analysis was carried out to examine the adjusted effect of factors associated with the MII separately for female sterilization, the intrauterine device and the oral contraceptive pill, and a combined MII including all three methods plus injectables. One-fifth of the study women used any modern contraceptive method at the time of survey, of which only 36% had fully informed choice. The likelihood of being informed about the methods was significantly higher among those using the oral contraceptive pill (OR: 1.75, CI 1.58–1.94), IUD (OR: 2.23, CI 1.97–2.52) and injectables (OR: 1.37, CI 0.97–1.94) compared with those who were sterilized. Informed choice varied by region and the socioeconomic profile of the users. Inadequately informed choice violates the reproductive rights of young women and might result in higher post-use health problems, discontinuation of and unmet need for contraceptives, unintended pregnancies, induced abortions and regret, adversely affecting women’s health. Training of health/family planning workers in India about the importance of reproductive rights is urgently required to enhance informed contraceptive choice and improve the health of young married women.

This paper reports the findings of longitudinal studies of married primigravidae resident in Aberdeen city:

(1) All 1026 primigravidae delivered in 1949 were followed up 5 years later.

(2) A 1-in-6 random sample of primigravidae delivered 1950–53 (330 women) were studied intensively and followed up at 5 and 10 years.

The findings are biased in favour of families of manual workers because more upper social class families left Aberdeen.

Many primigravidae had no definite ideas on family size but they made up their minds or changed their preferences (sometimes to accommodate to reality) as they gained experience of marriage and motherhood. Most women wanted 2 or 3 children and none wanted more than 4 children.

There were striking differentials in fertility at both 5 and 10 years. Women who were under 20 years of age when they had their first baby, those who conceived prenuptially, and those married to a semi-skilled or unskilled manual worker had the largest families at both 5 and 10 years. At 5 years, although on average such women were having intercourse more frequently, they were the least likely to have been regular users of contraceptives.

Two-thirds of all pregnancies which occurred in the first 5 years were ‘unintended’. Only 15% of couples had used contraceptives regularly from marriage and a further 20% became regular users in the 5 years following the birth of their first child. At the end of the first 5 years, 10% of women already had more children ‘than they felt able to manage without excessive strain’. The number increased in the following years but was modified partly by delegation of responsibility for a few children to other women but more especially by the liberal policy to sterilization pursued in Aberdeen. The repetition of the disadvantages in the childhood environment of the largest families is illustrated. It is argued that ‘the pill’, which was not available to the women in the studies reported, may reduce the number of ‘unintended‘ pregnancies in future, but that sterilization may remain the most satisfactory measure of family limitation in a small group of women whose way of life is not conducive to forward planning and sustained rational behaviour.

Senegal is experiencing a rising obesity epidemic, due to the nutrition transition occurring in most African countries, and driven by sedentary behaviour and high-calorie dietary intake. In addition, the anthropological local drivers of the social valorization of processed high-calorie food and large body sizes could expose the population to obesity risk. This study aimed to determine the impact of these biocultural factors on the nutritional status of Senegalese adults. A mixed methods approach was used, including qualitative and quantitative studies. Between 2011 and 2013, fourteen focus group discussions (n=84) and a cross-sectional quantitative survey (n=313 women; n=284 men) of adults in three different socio-ecological areas of Senegal (rural: n=204; suburban: n=206; urban: n=187) were conducted. Dietary intake (Dietary Diversity Scores), physical activity (International Physical Activity Questionnaire), body weight norms (Body Size Scale), weight and health statuses (anthropometric measures and blood pressure) were measured. Middle-aged and older Senegalese women were found to value overweight/obesity more than younger Senegalese in all regions. In addition, young urban/suburban adults had a tendency for daily snacking whilst urban/suburban adults tended to be less physically active and had higher anthropometric means. A binary logistic regression model showed that being female, older, living in urban/suburban areas and valuing larger body size were independently associated with being overweight/obese, but not high-calorie diet. Univariate analyses showed that lower physical activity and higher socioeconomic status were associated with being overweight/obese. Finally, overweight/obesity, which is low in men, is associated with hypertension in the total sample. The nutrition transition is currently underway in Senegal’s urban/suburban areas, with older women being more affected. Since several specific biocultural factors jointly contribute to this phenomenon, the study’s findings suggest the need for local public health interventions that target women and which account for the anthropological specificities of the Senegalese population.

Sexuality is still a taboo in Middle Eastern countries, and Lebanon is no exception. This study’s objective was to evaluate attitudes towards sexuality and its practice among university students in Lebanon and assess their respective correlates. The cross-sectional study was carried out among students selected from seventeen universities across Lebanon. The participants received a self-administered standardized questionnaire that assessed their attitudes towards sexuality. It included questions on socio-demographic factors, risk-taking, risky behaviours and sexuality-related questions. Among 3384 students, 2700 (79.8%) answered the questions on sexuality. Around 15% had engaged in sexual activity, while 20% were regularly sexually active. Among males, 34.8% had never had sexual activity, 29.9% had tried it and 35.3% were regularly sexually active. Among females the results were respectively 85.1%, 5.3% and 9.6% (p<0.001). Only 36% regularly used condoms during their relationships. A liberal attitude towards sex, male sex, motives for risky behaviours, current cigarette smoking and problematic alcohol consumption were associated with sexual activity. Realizing that risky behaviours are dangerous, health concerns related to sexual relationships and a liberal attitude towards sex were associated with regular condom use. However, being bothered by condoms and female sex were inversely associated with condom use. Finally, participants who had motives for, and those who felt excited about risky behaviours, and those reporting current cigarette and waterpipe smoking and problematic alcohol consumption (β=0.600; p=0.002) embraced a more liberal attitude towards sex. Conversely, females (β=−7.58; p<0.001) and individuals who considered risky behaviours as dangerous reported an unfavourable attitude towards sexuality. A substantial proportion of Lebanese university students have regular sexual activity, but a low percentage use condoms for protection. Interventions are required among males in particular in view of these attitude and behavioural changes towards sexuality.

Reported age at first coitus was shown to be associated with incidence and degree of infertility. Infertility patients reported later first coital ages than gynaecological patients in a sample of 792 women seen in a major infertility service. Among the infertility patients, those who had never conceived presented a later first coital age than those who had previously conceived. Routine gynaecological patients reported the youngest first coital age of the groups studied.

Findings are reported on 100 couples who had requested donor insemination as a means of circumventing male infertility. Twelve couples dropped out, but the remainder were graded for personal acceptability. Forty-six couples were recommended with only minor reservations if any, 40 were seen as unsatisfactory in varying degree, and two were rejected owing to gross marital and sexual problems. In one couple, early marital breakdown after childbirth occurred.

A strong sense of mutual commitment may be the norm in such couples but exchange of affection between partners, as measured by the Ryle marital patterns test, was less vivid than in an earlier study of childless couples waiting to adopt. The infertile husband may be in particular need of emotional support from his wife, and a careful appraisal of the marriage seems warranted before treatment.

Trends in multiple birth rates are thought to have been substantially affected by subfertility treatments in the last 25 years, but there are few quantitative assessments of this. This paper examines trends in twin and higher multiple birth rates separately in Scotland, England and Wales and compares their course with corresponding multiple birth rates in the Oxford Record Linkage Study area, where the proportions following subfertility treatment are documented. National data on prescriptions for subfertility treatments reinforce the view that they have had a major effect on the trends, and currently perhaps 60% of triplet and higher order births and 15% of twins follow their use in Britain.

This paper models the proximate determinants of children born to over 13,000 Ethiopian women and of the women’s stated preferences for additional births using the data from the Ethiopian Demographic and Health Survey 2000. Empirical models for the number of children born to women were estimated using Poisson and ordinal regressions. The results show the importance of variables such as maternal education for smaller family size, and that variables reflecting desired family size are strong predictors of the numbers of children born to women. Secondly, binary logistic models for dichotomous variables for women not wanting more children and if getting pregnant would be a ‘big problem’ showed non-linear effects of the surviving and ‘ideal’ number of children. Moreover, the results indicated a desire on the part of women to limit family size, especially as the number of surviving children increased. Probit models were estimated to address potential endogeneity of certain variables. Overall, the results indicated that counselling couples about small family size and increasing the utilization of health care services can lower fertility in Ethiopia.

This report is based on the findings of an epidemiological study of 29,468 rural, semi-rural and urban inhabitants of the Agra region of Uttar Pradesh. The survey was made in order to find out the prevalence of severe mental disorders and associated conditions in an Indian community. The sampling was purposive and areas selected were contiguous. Census methods were used. All inhabitants were investigated by a team consisting of a psychologist, a statistician, social workers and psychiatrists. After reconnaissance and initial contact by home visits, suspected cases were detected by a searching inquiry and the information so obtained was carefully documented. These cases were subjected to psychiatric examination and abnormal ones identified. Consultation with another psychiatrist was necessary to make a final diagnosis.

The lifetime prevalence rate of schizophrenia was 2·2 per thousand, about the same frequency as found in other parts of the world. The maximum number of cases occurred in males between the ages of 15 and 24 and in females between the ages of 35 and 44. Single people, that is, never married, widowed, divorced or separated suffered significantly much more from the disease than bachelors and married people. A significant relationship was found between schizophrenia and castes in Vaish and Brahmin males as compared with others. The highest rate of schizophrenia was found among people in unremunerative status. Intoxicants were used more by schizophrenics than by normal people. Caste group indulgents had their own preferences in drug use, cannabis indulgence being highest among Brahmins. No association of schizophrenia with residence, educational status or sex was found.

Analysis of British National Child Development Study data corroborates the long held views that first born children tend to get more medical surveillance than those of later birth order, and that there is a direct relationship between achieved family size and social status.