Kin selection theory predicts that individuals may increase their inclusive fitness by investing in their genetically related kin. In addition, according to the reproductive value hypothesis, individuals may increase their fitness more by investing in their kin in descending rather than ascending order. The present study uses the Generational Transmissions in Finland data collected in 2012 (n=601 women) and analyses whether childless younger women invest more in their kin than younger women with children. The study finds that childless women are more likely than mothers to invest in their nieces and nephews but not their aunts and uncles. Thus the results are in line with the reproductive value prediction.

The effects of initiation of solid and liquid supplementation on resumption of post-partum menstruation are examined, 0using data from a 2-year prospective study of birth interval dynamics from central Java, Indonesia. The sample analysed consisted of 444 women who experienced resumption of menses while breast-feeding, women who were breast-feeding and amenorrhoeic at the end of the study, or women who resumed menstruation or were censored after infant mortality and weaning which preceded the resumption of menses. Multivariate hazard model analysis was used to assess the significance of supplementation, various breast-feeding covariates, and age and parity of the dependent variable. Because the timing of supplementation varies, the supplementation variables were introduced into the analysis as time-varying covariates. For the mothers in the sample, solid and liquid supplementation was initiated at medians of 2·1 and 8·0 months respectively. The former had a significant effect on resumption of menses, while the latter was only marginally significant. Earlier supplementation meant shorter durations of amenorrhoea for the majority of women. However, the effect was not consistent across all categories of women. For the small group of mothers who were low intensity breast-feeders (≤6 minutes per nursing episode) or as low frequency day-time breast-feeders (≤6 nursing episodes per day-time), earlier supplementation had no additional effect on their rate of resumption of menses post-partum.

Infant and child mortality in the West Bank and Gaza Strip has steadily reduced since 1967, even though fertility has remained extremely high. In this paper the determinants of infant and child mortality are discussed, with particular emphasis on the role of consanguineous marriages, short birth spacing and maternal education. It is shown that short birth spacings and type of marriage are more important determinants of infant mortality than maternal education. Moreover, the relative role of consanguineous marriages appears to increase with time.

This paper examines the gender differential in health and its socioeconomic and demographic determinants in the old-age population of India based on the National Sample Survey 60th round data collected in 2004. As in developed countries, older women in India report poorer self-reported health and experience greater immobility compared with men. Stepwise logistic regression analysis shows that the gender differential in health is linked to various socioeconomic and demographic variables and that the gender gap could be narrowed with appropriate policy intervention. Specifically, paying special attention towards improving the socioeconomic status of widowed/separated women could attenuate a substantial portion of the observed gender gap in the health of the old-age population.

The diffusion potential of a targeted HIV/AIDS intervention that enlisted peer educators to disseminate ‘safer sex’ messages and condoms among female commercial sex workers and their clients was evaluated in the Dominican Republic. Levels of interurban interaction potential were ascertained that linked the targeted city of La Romana with the proximate cities of San Pedro de Macoris and Guaymate. Weekly service statistics generated over an 8-month period were analysed to establish activity areas for the peer educators. Data were entered and analysed using a geographic information system and interurban linkages were established. Project outcomes were examined via a series of three cross-sectional Knowledge, Attitudes and Practices (KAP) surveys conducted among convenience samples of commercial sex workers at the start of the intervention and at 4 and 8 months. The results attest to a high degree of interconnectivity between the targeted and proximate cities, and a pattern of interurban mobility that links commercial sex workers, clients and establishments in all three cities. The examination of project outcomes revealed statistically significant changes in condom use in the targeted city of La Romana among commercial sex workers, as well as among their counterparts interviewed in the proximate cities of San Pedro de Macoris and Guaymate. These data suggest a diffusion effect. It is concluded that a targeted intervention may influence proximate cities within a relatively compressed period of time. The findings suggest the importance of considering geographic diffusion principles, such as urban hierarchies, regional nodes and transportation linkages, when designing HIV/AIDS prevention efforts. It also has important implications in the selection of control sites when conducting experimental studies of HIV/AIDS interventions.

The exogenous cycles and population dynamics of the community at Penrith, Cumbria, England, have been studied (1557-1812) using aggregative analysis, family reconstitution and time series analysis. This community was living under marginal conditions for the first 200 years and the evidence presented is of a homeostatic regime where famine, malnutrition and epidemic disease acted to regulate the balance between resources and population size. This provides an ideal historic population for an investigation of the direct and indirect effects of malnutrition. Throughout the period studied, a short wavelength oscillation in grain prices was apparently the major external factor that drove exogenous cycles in mortality, birth rate, and migration. In particular, the different responses of children to variations in food supply are emphasised; fluctuations in poor nutrition correlated significantly with the variations in mortality rates for infants (probably indirectly during pregnancy and directly during the first year of life) and for young children (via susceptibility to lethal infectious diseases). Migratory movements contributed to the maintenance of homeostasis in the population dynamics. A medium wavelength cycle in low winter temperatures was associated with a rise in adult mortality which, in turn, promoted an influx of migrants into this saturated habitat. A model incorporating these interacting associations between vital events and exogenous cycles is presented: grain prices were an important density-dependent factor and constituted the major component of the negative feedback of this population and drove the exogenous, short wavelength mortality cycles. Cycles of births and immigration provide a positive feedback for the build-up of susceptibles and the initiation of smallpox epidemics and increased population size.

This analysis was planned to produce an estimate of the effects of maternal ageing on the risk of stillbirth which would not be confounded by other biological and socio-economic factors. The basic comparison is between late fetal death ratios in second and third births for all women who experienced third single births in California in 1968. The analysis leads to the conclusion that women who experience late fetal deaths initiate more subsequent pregnancies and after shorter intervals than do women who have live births. A sharply lower risk of late fetal death for third birth than for second was found to mask age effects. It is suggested that this reduction in risk reflects the effects of successful diagnosis and treatment of conditions which produce high rates of pregnancy loss.

Diarrhoeal disease is one of the major causes of morbidity and mortality in children and is usually measured at individual level. Shared household attributes, such as improved water supply and sanitation, expose those living in the same household to these same risk factors for diarrhoea. The occurrence of diarrhoea in two or more children in the same household is termed ‘diarrhoea clustering’. The aim of this study was to examine the role of improved water supply and sanitation in the occurrence of diarrhoea, and the clustering of diarrhoea in households, among under-five children in India. Data were taken from the fourth round of the National Family and Health Survey (NFHS-4), a nationally representative survey which interviewed 699,686 women from 601,509 households in the country. If any child was reported to have diarrhoea in a household in the 2 weeks preceding the survey, the household was designated a diarrhoeal household. Household clustering of diarrhoea was defined the occurrence of diarrhoea in more than one child in households with two or more children. The analysis was done at the household level separately for diarrhoeal households and clustering of diarrhoea in households. The presence of clustering was tested using a chi-squared test. The overall prevalences of diarrhoea and clustering of diarrhoea were examined using exogenous variables. Odds ratios, standardized to allow comparison across categories, were computed. The household prevalence of diarrhoea was 12% and that of clustering of diarrhoea was 2.4%. About 6.5% of households contributed 12.6% of the total diarrhoeal cases. Access to safe water and sanitation was shown to have a great impact on reducing diarrhoeal prevalence and clustering across different household groups. Safe water alone had a greater impact on reducing the prevalence in the absence of improved sanitation when compared with the presence of improved sanitation. It may be possible to reduce the prevalence of diarrhoea in households by targeting those households with more than one child in the under-five age group with the provision of safe water and improved sanitation.

Data are presented on the verbal and performance (non-verbal) IQs of a sample of university scientists, their surviving fathers and male sibs.

Although mean IQs differ between scientific disciplines the disciplines do not differentially attract scientists from particular socio-economic classes.

The verbal IQs of both the scientists and their fathers are positively correlated with socio-economic class but only in the fathers' sample is the performance IQ/class correlation significant. The variance of both verbal and performance IQs increases from Class I to Class IIIM. The overall estimate of heritability for the verbal IQ is higher than that for the performance IQ.

Verbal and performance IQs are related to the distance the scientists have moved on the socio-economic scale. The effects of social mobility on the genetic and environmental components of the verbal and performance IQ phenotypic variances are discussed.

A caretaker training programme was carried out in Ugwuogo-Nike, a rural area in south-east Nigeria, based on formative research within the community. A training of trainers workshop was organized for 30 leaders of women groups who subsequently trained other mothers in their group. Community information activities, which lasted for a period of eight months, included the use of posters, drama group and jingles. The programme was evaluated using the quantitative and qualitative methods that were employed at baseline, which included community survey and focus group discussions (FGDs). For the community survey, households with children under five years of age were identified and provided the sampling frame, from which 300 households were chosen using the systematic sampling method. The target population for the FGDs were caretakers of children under five years. Post-intervention evaluation of the programme showed significant (p<0.05) improvements in knowledge, home management of malaria and referral practices for severe malaria. Those who correctly reported that mosquitoes were the cause of malaria rose markedly from 39.7% to 88.7%. Knowledge of symptoms of mild and severe malaria also increased significantly. Only 1.5% of caretakers were aware of the correct dose of anti-malarial before intervention, but this increased to 41.5%. The impact of intervention brought about a dramatic change in the practice of taking severely ill children, especially those with convulsion, to a traditional healer. A minority (6.7%) of caretakers took a severely ill child to a traditional healer as against 60% pre-intervention. There was also a significant increase in use of formal health facilities for the treatment of severely ill children. The study findings support the view that training of mothers to recognize, treat appropriately and refer severe cases of malaria is feasible and may lead to a reduction in the incidence of severe disease.

Marriage-first birth intervals are examined in two historical populations, Quebec (1608–1765) and Haut-Jura (1689–1980), comparing intervals in mothers and daughters, and in sister-sister pairs. The results point to a weak relationship between intervals of mothers and daughters, though it does not attain significance. Shared environment does not seem to be responsible since there is no association between pairs of sisters from the same populations.

The possibility that early nutrition has long term consequences in man has been much debated. There have been limited opportunities to perform formal randomised studies on the effect of early nutrition in man and many studies have been flawed by problems with study design. Infants born preterm are a special group. At the start of this study in 1982 evidence on which to base choice of diet was inconsistent and related only to short term outcome, and diets available for such babies differed greatly in nutrient content. In this group it was both ethical and practical to conduct a formal, randomised trial of early diet and outcome and the results were clearly needed for management decisions.

A long term prospective outcome study was undertaken on 926 preterm infants randomly assigned to the diet received in the neonatal period. Surviving children have been followed at 9 months, 18 months and now 7½–8 years of age. The findings suggest that children fed a nutrient supplemented preterm formula perform better than those fed a standard formula milk, and also that human milk may contain factors which promote brain growth or development. Outcome data from the randomised trials show that a very brief period of dietary manipulation (on average for the first 4 weeks of life) influences later development.

The number of years of schooling and adult social class of 1417 adoptees are found to correlate with the social class of both their biological and adoptive fathers. For female adoptees the effect of both paternal social class values upon own social class appears to be mediated through the influence of the former upon years of schooling. For male adoptees, some residual direct correlations of paternal social class with offspring's social class, independent of years of schooling in the adoptee, are observed.

Results are presented from an analysis of the intervals between births from Imesi, Western Nigeria. The mean interval following births of children who survived to 1 year was 35·03 months, but nearly half this value at 18·8 months following stillbirths or deaths under 1 year. Both these results confirm an early study done in the village (Martin, Morley & Woodland, 1964), and the role of post-partum sexual abstention as an explanation for these results is discussed. Attempts were made to look for effects of birth interval variation on the survival of the following child, but no strong trends emerged. Similarly, analyses of many growth variables by preceding and following birth intervals gave very little evidence of real effects. There were, however, hints of trends which were possibly caused by birth order biases; higher birth orders had been found to have correspondingly higher birth intervals. An intriguing result was that those children who had ever suffered from kwashiorkor showed a significantly higher preceding mean birth interval, and also a higher mean interval to the next birth.

A comparative study of 1100 women aged 25–45 years, users and non-users of modern methods of contraception, in the urban centres of Lahore and Faisalabad was conducted in 1991. The objective of the study was to investigate reproductive behaviour and the extent to which social, cultural and attitudinal variables, such as beliefs and values about family life, religiosity and fatalism, influence the fertility decision-making process. Preferences for smaller families were found to be consistently associated with modern attitudes and behaviour towards family and religious values and obligations. Family income, husband's occupation and religiosity offered no explanation of reproductive behaviour. It is concluded that cultural setting and tradition exert an important influence on reproductive behaviour, independent of economic development.

Age variations in the influences of three sets of proximate factors on child survival in Ondo State, Nigeria, during 1981–86 are described. Biodemographic factors covary very strongly with mortality risks during the first month of life, weakly during months 1–11, and imperceptibly beyond infancy. Microenvironmental factors progressively strongly covary with mortality after the neonatal period, while health services accessibility and care factors broadly covary strongly with mortality throughout early childhood. Patterns in the size of the hypothetical population-level impacts of these factors suggest that promoting assisted use of toilet facilities within households by under-5s and wider provision of dispensaries and hospitals would yield cost-effective and notable reductions in overall childhood mortality levels in the study setting.

The paper aims to provide evidence on consistent condom use dynamics among sex workers in Central America between 1997 and 2000, and to examine the most important predictors of use behaviour important for policy and programme interventions in the region. Data on 3500 sex workers, 1500 from 1997 and 2000 from the year 2000, were analysed. The samples represented sex workers in low socioeconomic neighbourhoods who met their clients at known sex establishments or by the roadside. Sex workers were more likely to have used condoms consistently in 2000 than in 1997 (Odds Ratio (OR)=1·4, p≤0·05). Sex workers who discussed condoms with their partners or lovers used them consistently with all clients more than those who did not (OR=1·3, p≤0·10). Knowledge of condom advantages had a positive influence on consistent use. Sex workers who reported using condoms to prevent pregnancy or STDs used them consistently with all clients more than those who did not (OR=1·2, and 1·3 respectively, p≤0·10). The source of condoms is an important predictor of consistent condom use. Sex workers who bought condoms from health establishments or from brothels used them consistently more than those who did not (both OR=1·3, p≤0·10, and p≤0·05, respectively). Self-efficacy had a positive effect on consistent condom use. Sex workers who reported that they would use condoms even if clients offered to pay more for unprotected sex used them consistently with all clients more than those who did not (OR=1·8, p≤0·001). The findings suggest that having condom skill is positively related to condom use. Sex workers who had all four skills used condoms more consistently than those who had none (OR=1·6, p≤0·01). In order to increase consistent condom use and avert more incidences of HIV/AIDS and other STIs, programme interventions need to use the most efficient way to provide quality information, and provide repeated training on condom negotiation and use skills to sex workers.

Reducing China's population has formerly been considered a good thing because of the perceived environmental and social risks of overpopulation, but it has recently become apparent that the resulting population decline may create problems that will become increasingly serious in the future. The results of a survey of 4600 women in nineteen Chinese provinces in 2005 indicated that young age, high income, high education level, urban location and good employment all decreased a woman's willingness to bear children. The risks created by declining fertility in these groups have been intensified by China's ‘one child’ family planning policy. However, as a result of current trends and China's policies, the country's population will continue to age, leading to social problems and difficulties for sustainable development both in China and around the world. Therefore, China's policy-makers must begin planning to adjust their policy by encouraging women to give birth to more than one child.

There is certainly a growing need to justify the significance of studying health-seeking behaviours for designing advocacy campaigns, lobbying for a policy shift and convincing donors to invest in priority areas. Moreover, policymakers need to be encouraged to design evidence-based policies that take into account information relating to health-promoting, -seeking and -utilization behaviour and the factors determining these behaviours. This paper primarily covers the ‘methodology’ used in the study of health-seeking behaviours and determinants of health services utilization in a predominantly rural district of Pakistan. The paper substantiates that this methodology is comprehensive and reliable, and there is potential for replicating this in similar settings. The approach of Kroeger in his research on the study of health-seeking behaviours, particularly in developing countries, provides the most holistic framework for examining, analysing and interpreting factors and determinants of health-seeking behaviours and health services utilization in developing countries. This study endeavoured to validate Kroeger’s framework in a Pakistani setting, exploring all the factors listed through mixed method research, and qualitative supplemented by representative quantitative enquiry. This approach has also helped in understanding the inter-relationship of various factors and drivers of health-seeking behaviours from all angles.

Skilled delivery care has been targeted in the Sustainable Development Goals to reduce preventable maternal and newborn deaths, which mostly occur because of birthing complications. Birthing complications are more frequent in women with unintended than intended pregnancies, and around 43% of total pregnancies in low- and middle-income countries are unintended. This study quantified the impact of unintended pregnancy on skilled birth attendance and delivery in health care facilities in Bangladesh. Data from 4493 women participating in the cross-sectional 2014 Bangladesh Demographic and Health Survey were analysed. Multilevel logistic regression models were used to assess the association of unintended pregnancy with skilled birth attendance and delivery in a health care facility through skilled providers while adjusting for individual-, household- and community-level factors identified using a directed acyclic graph. Around 26% of women reported that their last pregnancy (occurring within the previous 3 years) that ended with a live birth was unintended at conception. Only 42% reported having a skilled birth attendant present at their last birth and 38% gave birth in a health care facility. Significant differences were found across pregnancy intention. Lower odds of skilled birth attendance (OR, 0.70, 95% CI, 0.52–0.93) and delivery in a health care facility through skilled providers (OR, 0.65, 95% CI, 0.48–0.89) were found among women who had an unwanted pregnancy relative to women who had a wanted pregnancy. However, a mistimed pregnancy was not found to be associated with skilled birth attendance or delivery in health care facility through skilled providers. Increased availability of health care facilities at the community level is required in Bangladesh to ensure skilled delivery care for women with an unwanted pregnancy. Policies are also required to integrate women with an unwanted pregnancy into mainstream health care services through earlier detection and increased awareness in order to reduce the adverse maternal and fetal outcomes associated with lack of quality birthing care.