The relationship between the return of menstruation and ovulation and the pattern of breast-feeding was studied in a group of 29 women in a rural area of Mexico; eight non-breast-feeding post-partum women were also studied. The return of ovulation was assessed by weekly determinations of urinary pregnanediol. The number of suckling episodes and supplementary feeds was recorded. The cumulative probability of resumption of menses for the breast-feeders was 28% and 52% at 3 and 6 months, respectively, and for the non-breast-feeders was 75% and 88%. The cumulative probability of ovulation for the breast-feeders was 28%, 66%, 69% and 72% at 3, 6, 9 and 12 months, respectively, and for the non-breast-feeders was 50% and 100% at 3 and 6 months. The earlier the introduction of supplements the earlier the return of ovulation. The nonovulatory subjects maintained a higher frequency of suckling episodes than did the ovulatory subjects. The cumulative probability of pregnancy for the breast-feeders was 3%, 7%, 7% and 10% at 3, 6, 9 and 12 months, respectively, and for the non-breast-feeders was 13%, 38% and 50% at 3, 6 and 9 months.

The study compares biological, socioeconomic and behavioural determinants of low birthweight in Cameroon and the United States. Some factors in low birthweight are found to be cross-national, but others are specific to the setting. Positive risk factors of low birthweight in both countries include unmarried motherhood, female sex, multiple births, and preterm births. Outcome of the previous pregnancy is a positive risk factor in the US, but not in Cameroon. Significant negative risk factors include prenatal care visits (in both countries), mother's education (in the US only), births to mothers aged 20–34 and birth orders of 2 or more (in Cameroon only). Separate analyses of all births and the subsamples of singleton births reveal that estimates for the two groups differ only marginally.

This study examined the variation in weight, height and body mass index of 1048 mothers living in a rural area of Bangladesh in relation to age, education, number of previous pregnancies, number of dead children, religion, family type, family size, and amount of land owned by the household. Multiple regression analysis revealed a positive relationship of education with all three variables. Moslem mothers were on average in better condition than Hindus. The number of dead children showed a negative relationship with height, weight and body mass index.

Data are presented on the social backgrounds and IQs of a sample of scientists, their male sibs and their fathers. The range of IQ in the scientists is similar to the range of scores expected of the higher 25% of a representative general population sample.

The IQs of the scientists showed a positive correlation with social class. Differences in IQ between the scientists and their fathers in each social class are related to the distance the scientists have moved up the social scale. In the twenty-two families in which the IQs of the father and two male sibs are known the upwardly mobile sibs tend to have higher IQs than the non-mobile or downwardly mobile sibs.

In Class II there is evidence that stabilizing selection operates on IQ to maintain the mean IQ level. The effect on social stratification of such selection, together with increased educational opportunity, is discussed.

The aim of this study was to determine the degree to which general body fatness variation, presented by body mass index (BMI), the sum of the three skinfold thicknesses (TST) (triceps, subscapular, abdominal) and percentage of body fat (%FAT), can be explained by socioeconomic status (SES) and lifestyle. The cross-sectional, population-based survey was of 259 healthy working males aged 20–30 from the city of Cracow, Poland. Objective anthropometric measurements, bioelectrical impedance analysis, the results of motor fitness tests and social and lifestyle data from a questionnaire were analysed. The independent variables were: age, socioeconomic status (birthplace, place of residence until the age of 14, social class, educational level and the type of work done) and lifestyle elements (smoking habits, dietary habits, family obesity resemblance, sport activity in the past, leisure time physical activity and level of motor fitness). Three separate full models were created using stepwise straightforward regression with BMI, TST and %FAT as dependent variables. The highest autonomous influence on BMI and %FAT was ascribed to age and family obesity resemblance, whereas variation in TST was explained by level of motor fitness, age, city as a place of residence until the age of 14 and family obesity resemblance. Although the analysed variables explained only from 8% (BMI) to 13% (TST) of body fatness variation, indicating at the same time that most variations are explained by other variables, the impact of lifestyle family-shared factors on body fatness seems to be significant.

This paper discusses ways in which empirical research investigating sexual networks can further understanding of the transmission of HIV in London, using information from a 24-month period of participant observation and 53 open-ended, in-depth interviews with eighteen men and one woman who have direct and indirect sexual links with each other. These interviews enabled the identification of a wider sexual network between 154 participants and contacts during the year August 1994-July 1995. The linked network data help to identify pathways of transmission between individuals who are HIV+ and those who are HIV−, as well as sexual links between ‘older’ and ‘younger’ men, and with male prostitutes. There appears to be considerable on-going transmission of HIV in London. The majority of participants reported having had unprotected anal and/or vaginal sex within a variety of relationships. The implications of these findings for policies designed to prevent the transmission of HIV are discussed.

This is a qualitative, descriptive study to explore gender-related factors that influence health seeking for tuberculosis (TB) care by women in Ebonyi State, Nigeria. In-depth interviews based on interview guides were conducted with participants selected through purposive sampling in communities in the state. The results show that gender relations prohibit women from seeking care for symptoms of TB and other diseases outside their community without their husbands' approval. Gender norms on intra-household resource ownership and control divest women of the power to allocate money for health care seeking. Yet, the same norms place the burden of spending on health care for minor illnesses on women, and such repeated, out-of-pocket expenditures on health care at the village level make it difficult for women to save money for use for health care seeking for major illnesses such as TB, which, even if subsidized, still involves hidden costs such as transport fare. The opening hours of TB clinics do not favour their use by most women as they are open when women are usually engaged in income-generating activities. Attending the clinics may therefore entail opportunity costs for many women. People with chronic, infectious diseases such as TB and HIV are generally stigmatized and avoided. Women suffer more stigma and discrimination than men. Stigma and discrimination make women reluctant to seek care for TB until the disease is advanced. Policies and programmes aimed at increasing women's access to TB services should not only take these gender norms that disempower women into explicit consideration but also include interventions to address them. The programmes should integrate flexible opening hours for TB treatment units, including introduction of evening consultation for women. Interventions should also integrate anti-stigma strategies led by the community members themselves.

This paper assesses the factors influencing mistimed and unwanted pregnancies in Nepal separately using data from the 2011 Nepal Demographic and Health Survey. Women who had given birth within the five years before the survey were interviewed about the intendedness of their last pregnancy. The data were analysed with a chi-squared test, followed by multiple logistic regression analysis. Among the total 5391 participants, 11.29% and 13.13% reported their last pregnancy as mistimed and unwanted respectively. Logistic regression analysis showed that women from the hill region were more likely to report mistimed pregnancy, while women from the Western and Far-Western development regions were less likely to report mistimed pregnancy. Education status was positively correlated with the reporting of mistimed pregnancy. Women involved in agriculture, with full autonomy on household decision, with some exposure to mass media, belonging to higher age group and having third or higher parity were less likely to report mistimed pregnancy. Similarly, women from the Western development region had relatively higher odds of reporting unwanted pregnancy. Women with husbands involved in a paid job had lower odds of unwanted pregnancy. Women’s autonomy was also positively correlated with unwanted pregnancy. Women with the intention to use contraceptive had lower odds of unwanted pregnancy. Interventions targeting the factors identified by this study could be useful in reduction of mistimed and unwanted pregnancies among Nepali women.

Although China’s family planning programme is often referred to in the singular, most notably the One-Child policy, in reality there have been a number of different policies in place simultaneously, targeted at different sub-populations characterized by region and socioeconomic conditions. This study attempted to systematically assess the differential impact of China’s family planning programmes over the past 40 years. The contribution of Parity Progression Ratios to fertility change among different sub-populations exposed to various family planning policies over time was assessed. Cross-sectional birth history data from six consecutive rounds of nationally representative population and family planning surveys from the early 1970s until the mid-2000s were used, covering all geographical regions of China. Four sub-populations exposed to differential family planning regimes were identified. The analyses provide compelling evidence of the influential role of family planning policies in reducing higher Parity Progression Ratios across different sub-populations, particularly in urban China where fertility dropped to replacement level even before the implementation of the One-Child policy. The prevailing socioeconomic conditions in turn have been instrumental in adapting and accelerating family planning policy responses to reducing fertility levels across China.

Continuum of care throughout pregnancy, delivery and post-delivery has proved to be a critical health intervention for improving the health of mothers and their newborn children. Using data from the fourth wave of the National Family Health Survey (NFHS-4) conducted in 2015–16, this study examined the correlates of utilization of maternal health care services and child immunization following the continuum of care approach in India. The study also assessed whether the continuity in utilizing maternal health care services affects the immunization of children. A total of 33,422 survey women aged 15–49 were included in the analysis of maternal health care indicators, and 8246 children aged 12–23 months for the analysis of child immunization. The results indicated that about 19% of the women had completed the maternal health continuum, i.e. received full antenatal care, had an institutional delivery and received postnatal care. Women with a higher level of education and of higher economic status were more likely to have complete continuum of care. Continuity of maternal health care was found to be associated with an increase in the immunization level of children. It was observed that 76% of the children whose mothers had complete continuum of care were fully immunized. Furthermore, the results from propensity score matching revealed that if mothers received continuum of care, the chance of their child being fully immunized increased by 17 percentage points. The results suggest that promotion of the continuum of maternal health care approach could help reduce not only the burden of maternal deaths in India, but also that of child deaths by increasing the immunization level of children.

Information on the current prevalence and types of consanguineous marriages in Malakand District, Khyber Pakhtunkhwa Province (KPK), Pakistan, was collected from 1192 rural couples. Some 66.4% of marriages were between couples related as second cousins or closer (F≥0.0156), equivalent to a mean coefficient of inbreeding (α) of 0.0338. The data suggest that the prevalence of consanguineous unions in Malakand has been increasing during the last decade, in response to the high levels of violence across KPK.

Two American ethnic (sub-cultural) groups of Cuban and Jewish women of comparable socio-economic status were studied in New Jersey, USA in order to show how each of their cultures influences the climacteric. A wide spectrum of cultural variables, associated with each of these ethnic groups, was obtained through a questionnaire about self-image, reproductive history, attitudes toward the menopause, climacteric symptoms, the role of the physician during the climacteric and behaviour, attitudes and feelings about sex. A further differentiation of these variables, associated with each specific ethnic group, yielded an ethnic profile from which ethnic group membership could be predicted.

In all European countries for which data exist, there was a maternal-age-specific decline in dizygotic twinning rates during the 1960s. For most of these countries, this decline continued through the 1970s, but in a few it apparently ceased. The causes of the declines and of their abatement are unknown. However, there were declines in sperm quality during the 1960s and 1970s in some parts of the world, including parts of Europe, and it is speculated here that this decline in sperm quality may be related to the decline in dizygotic twinning.

Studies of school age children who were severely malnourished in infancy have focused primarily on somatic growth and intelligence, but information about behaviour is almost completely lacking. In this study the social behaviour of 71 Jamaican school boys who were severely malnourished in infancy (index subjects) is compared with that of classmates of the same age and sex (comparisons) and also with the nearest sibling of the same sex where available. The child's behaviour in his home setting was assessed through an interview with the child's parent or parent substitute. It was found that the index children differed significantly from their comparisons in several ways. They were less liked by siblings and more unhappy at school. They more often behaved immaturely, were more clumsy and were either more highly active or lethargic. They were also more often withdrawn, solitary or unsociable. Differences between index boys and their siblings were not statistically significant on individual questions but were in the same direction as the index-comparision differences. No relationship was found between the age when admitted to hospital for malnutrition and later behaviour. Examination of the aetiological role of malnutrition and other biological and social factors is the next step in the present study.

The duration of amenorrhoea among a group of chronically malnourished women in a rural area of Bangladesh is examined by application of multivariate hazard models with time-varying covariates, including the influence of maternal nutrition, seasonality and patterns of infant feeding. Both maternal weight at pregnancy termination and the pattern of infant feeding affected the length of post-partum amenorrhoea. Analyses focused on season of birth showed the importance of differences by education in infant feeding.

Fertility levels have dropped substantially in Latin America in recent decades, fuelled by increased contraceptive use and notably a method mix skewed towards female sterilization. This study examined choice of female sterilization in four Latin American countries: Brazil, Colombia, the Dominican Republic and Peru. Data were drawn from national Demographic and Health Surveys conducted in 1995–1996. Discrete-time hazard models were used on the five-year calendar modules of women’s reproductive histories to consider the effects of a number of sociodemographic and contextual determinants as they pertained to status at the moment of the event. The results revealed that the likelihood of a woman’s having undergone contraceptive sterilization was increasing over time in Brazil and Peru, suggesting that the potential for future growth of this method remains strong. A consistent pattern of increased probability of sterilization with higher education was seen across all countries, seemingly dispelling certain controversial claims that the procedure may have been disproportionately performed on the poor. At the same time, the multilevel analytical approach pointed to significant cluster-level random effects, suggesting that there were additional unmeasured contextual influences on women’s propensity to choose sterilization.

Under-five mortality remains a major public health challenge in sub-Saharan Africa. Zimbabwe is one of the countries in the region that failed to achieve Millennium Developmental Goal 4 in 2015. The objective of this study was to examine the extent to which maternal health-seeking behaviour prior to and during pregnancy and post-delivery influences the likelihood of under-five mortality among Zimbabwean children. The study was cross-sectional and data were extracted from the 2010/11 Zimbabwe Demographic and Health Survey (ZDHS). The study sample comprised 5155 children who were born five years preceding the 2010/11 ZDHS to a sample of 4128 women of reproductive age (15–49 years). Cox Proportional Hazard regression modelling was used to examine the relationship between maternal health-seeking behaviour and under-five mortality. The results showed that maternal health-seeking behaviour factors are associated with the risk of dying during childhood. Children born to mothers who had ever used contraceptives (HR: 0.38, CI 0.28–0.51) had a lower risk of dying during childhood compared with children born to mothers who had never used any contraceptive method. The risk of under-five mortality among children who had a postnatal check-up within two months after birth (HR: 0.36, CI 0.23–0.56) was lower than that of children who did not receive postnatal care. Small birth size (HR: 1.70, CI 1.20–2.41) and higher birth order (2+) increased the risk of under-five mortality. Good maternal health-seeking behaviour practices at the three critical stages around childbirth have the potential to reduce under-five mortality. Therefore, public health programmes should focus on influencing health-seeking behaviour among women and removing obstacles to effective maternal health-seeking behaviour in Zimbabwe.

Childbearing postponement is a key demographic change that has been experienced by most European countries. It leads to a late-fertility pattern, with women realizing their reproductive plans preferentially after the age of 30. This may result in a lower fertility level. Since the ideal family size has not changed in most European countries, it has been argued that the end of the postponement transition further depends on the extent to which the lower fertility of younger women is compensated for by an increase in that of older women. Thus, the completion of the transition depends not only on the formation of a late childbearing pattern, but also on the capability of women to realize their reproductive plans if they commence childbearing later in their lives. This study employed a new approach to assess postponement transition based on analysis of the realization of the fertility intentions of women at later childbearing ages using survey panel data. A method that enables the differentiation between transitional and post-transitional cohorts was applied. The investigation was based on a comparison of the postponement transition in Czechia and France, the former being a post-communist and the latter a Western European country. It was found that despite having a similar pattern of fertility timing, Czechia and France underwent differing phases of postponement transition. The Czech population was identified as being transitional since only the ‘transition’ cohorts had completed their fertility during the period under study. These cohorts did not show a significant increase in realization of fertility intentions in later age. In contrast, the post-transitional French population is characterized by higher completed cohort fertility rates amongst women who entered motherhood at the age of 30 and over and by the significantly higher realization of fertility intentions for women aged 30–34 years.

This study investigates inequalities at the province level of the use of modern contraception and the proportion of short birth intervals among women in the DRC using data from the 2007 Demographic and Health Survey. Logistic regression and Bayesian geo-additive models were used. The posterior odds ratio and the associated 95% credible interval (95% CI) were estimated using Markov Chain Monte Carlo (MCMC) techniques. Posterior spatial effects were mapped at the province level with the associated posterior probability maps showing statistical significance at 5%. The overall rates of modern contraception use among the entire sample of women (15–49 years old; N=7172) and youth (15–24 years old; N=1389) were 5.7% and 6.0% respectively. However, there was striking variation in contraceptive use between the two groups across provinces with a clear east-to-west gradient. The highest use in the total sample was in Nord-Kivu (OR 1.32; 95% CI 1.12, 1.55) and Bas Congo provinces (1.47; 1.22, 1.78). For the youth, the highest use was observed in Nord-Kivu (1.19; 0.92, 1.65). In multivariate Bayesian geo-additive regression analyses among the entire sample of women, factors consistently associated with lower use of modern contraception were living in rural areas (0.71; 0.62, 0.82), living in low-income households (0.67; 0.54, 0.80) and having no education (0.83; 0.67, 0.97). For the youth sample, living in low-income households (0.57; 0.41, 0.84) and no breast-feeding (0.64; 0.47, 0.86) were consistently associated with a lower use of modern contraception. The study shows a distinct geographic pattern in the use of modern contraception in youth and the entire sample of women in the DRC, suggesting a potential role for socioeconomic factors, such as accessibility, affordability and availability, as well as environmental factors at the province level beyond individual-level risk factors.

Creating community awareness of reproductive tract infections (RTI), including sexually transmitted infections (STI), and how to prevent them is essential to minimize their spread. Data on people's views about RTI/STI are entirely lacking in Laos. The aim of this study was thus to explore people's perceptions, treatment-seeking behaviour and understanding of information about RTI/STI, in urban and rural communities in two provinces in Laos. Fourteen focus group discussions and 20 in-depth interviews were held with 76 women and 56 men, selected purposively to provide diversity of socio-demographic backgrounds. Qualitative content analysis was employed for the data analysis. The major finding was that both male and female participants had a variety of misconceptions about the causes and symptoms of RTI/STI and their cure, and a reluctance to seek health care, which could cause delay in appropriate diagnosis and treatment. The most common treatment-seeking behaviour was self-medication through private pharmacies, following advice mostly given by friends and drug sellers. The main reasons for not going to health facilities were fear of social discrimination or shyness of genital examination. Complaints were also made about clinicians' negative attitudes towards ‘dirty disease’. Although condom use was mentioned as a way to prevent RTI/STI, an unwillingness to use condoms was commonly expressed. The main media sources of RTI/STI information were radio and television, and access to health information was more difficult in rural areas. The health messages provided were mostly understood, except for some technical terms. The findings indicate that strengthening health education and promotion through interventions at the community level is recommended to improve quality of RTI/STI management. Health education messages should be more accessible in rural areas. There is also an urgent need to improve communication between RTI/STI patients and clinicians.