In-depth interviews were conducted with married Asian women from Indian, Pakistani and Bangladeshi backgrounds, to investigate patterns of contraceptive use and influences on contraceptive decision making. The results show two distinctively different contraceptive ‘lifecycles’. Non-professional women typically have little knowledge about contraception until after their marriage or first birth. Their patterns of contraceptive behaviour show low levels of contraceptive use until after their first birth, when condom use is most prevalent. Non-professional women are influenced by their extended family, religion and cultural expectations on their fertility and family planning decisions. Professional women show an entirely different pattern of contraceptive behaviour. They are more likely to have knowledge about contraception before marriage, use some method of contraception throughout their childbearing years (typically the pill) and cite personal, practical or economic considerations in their fertility decisions rather than religious, cultural or extended family influences.

The prevalence of overweight/obesity is increasing worldwide. Although countries like India are typically thought of as having a high prevalence of undernutrition, significant proportions of overweight/obese now co-exist with the undernourished. This study aims to find the prevalence of overweight/obesity, and its association with socioeconomic change, among Tangkhul women in India. The cross-sectional study was carried out among 346 Tangkhul women aged 20–70 years, who were divided into five 10-year age groups. Mean BMI was found to be lowest among the youngest age group, and it increased with age until the age of 59 and then declined. The prevalence of overweight and obesity was found to be 27.1%, as assessed from the Asian cut-off point. Although the prevalence of obesity (2.0%) was low when compared with Indian non-tribal female populations, the prevalence of overweight (25.1%) was not far behind. Overweight and obesity were found to be associated with age, marital status, physical activity level, lifestyle and improvement in socioeconomic status, especially occupation and income. When compared with urban non-tribal Indian females, who have a higher socioeconomic status, the prevalence of overweight/obesity among Tangkhul females is lower, indicating its association with socioeconomic status. Tangkhul Naga is a population where the majority are believed to be thin traditionally owing to the difficult hilly terrain and their physically active lifestyle. With urbanization and economic development, nutritional transition, improved socioeconomic status and an increasingly sedentary lifestyle have been observed, which have contributed to the increasing prevalence of overweight/obesity among Tangkhul Naga women.

Nearly 33 million female youths have an unmet need for voluntary family planning (FP), meaning they are sexually active and do not want to become pregnant. In Ethiopia, age at marriage remains low: 40% and 14% of young women aged 20–24 were married by the ages of 18 and 15, respectively. Despite increases in FP use by married 15- to 24-year-olds from 5% in 2000 to 37% in 2016, unmet need remains high at 19%. Supply-and-demand factors have been shown to limit FP use, yet little is known about how stigma influences FP use among youth. This study validates an anticipated stigma (expectation of discrimination from others) index and explores its effect on unmet need. A cross-sectional survey was implemented with 15- to 24-year-old female youth in Ethiopia in 2016. The analytic sample included married respondents with a demand (met and unmet need) for FP (n=371). A five-item anticipated stigma index (Cronbach’s α=0.66) was developed using principal component factor analysis. These items related to fear, worry and embarrassment when accessing FP. The findings showed that 30% agreed with at least one anticipated stigma question; 44% had an unmet need; 58% were married before age 18; and 100% could name an FP method and knew where to obtain FP. In multivariate regression models, youth who experienced anticipated stigma were significantly more likely to have an unmet need, and those who lived close to a youth-friendly service (YFS) site were significantly less likely to have an unmet need. Interventions should address anticipated stigma while focusing on social norms that restrict married youth from accessing FP; unmet need may be mitigated in the presence of a YFS; and the anticipated stigma index appears valid and reliable but should be tested in other countries and among different adolescent groups.

This study investigated the association between comprehensive HIV/AIDS knowledge and HIV testing among men in sub-Saharan Africa (SSA). Data were taken from the most recent (2010–2019) Demographic and Health Survey men’s recode files of 29 countries in SSA. A total of 104,398 men who had complete information on all the variables of interest were included in the study. The outcome variable was HIV testing. A multilevel logistic regression analysis was conducted to determine the association between comprehensive HIV/AIDS knowledge and HIV testing. The results of the fixed effects model were presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The average prevalences of HIV testing and comprehensive HIV/AIDS knowledge among men in SSA were 53.5% and 50.8% respectively. Rwanda and Niger recorded the highest (93.6%) and lowest prevalences (9.8%) respectively. The prevalence of comprehensive HIV/AIDS knowledge among men in the 29 countries was 50.8%, with the highest in Rwanda (76.4%) and the lowest in Benin (31.1%). Men who had no comprehensive HIV/AIDS knowledge were less likely to test for HIV compared with those who had comprehensive HIV/AIDS knowledge (AOR=0.59, CI: 0.57–0.60). Men who were older than 20 years, married or cohabiting, with at least secondary education, in the richest wealth quintile, exposed to mass media, used condoms and with multiple sexual partners were more likely to test for HIV. To improve HIV testing among men in SSA, this study recommends that policymakers and stakeholders step up comprehensive HIV/AIDS knowledge sensitization and education using effective tools such as mass media.

Three groups of adolescents are compared with regard to their own considerations of abortion and when they believe abortion is justified. One group of adolescents terminated their pregnancies (n=95), a second became pregnant and carried their pregnancies to term but considered abortion (n=68), and the third also carried their pregnancies to term but did not consider abortion (n=204). The study was carried out between 1995 and 1998 in Fortaleza, Brazil. Adolescents were interviewed at the time of their hospitalization or their first prenatal visit and again at 6 weeks and 1 year post-abortion or postpartum. Friends and family recommended abortion to at least half of the teenagers in each group. Teenagers who aborted were more accepting of abortion than those who did not abort, while those who considered abortion found the practice more justified than those who did not consider abortion. Teenagers who aborted became less accepting a year later, while those who did not consider abortion became more accepting. A better understanding of adolescent attitudes towards abortion and their decision-making process should help adults and professionals meet the needs of adolescents for support in the process and in the reduction of the number of unintended pregnancies in the future.

Reproductive characteristics at high altitude are described based on the reproductive histories of 720 Aymara women, collected in 1998 and 1999 in a group of twelve peasant communities at a mean altitude of 4000 m in the Bolivian Altiplano. The reproductive pattern is shaped by a late onset of childbearing, associated with a rather short reproductive span and large birth intervals. Environmental conditions could explain the particularly late age at menarche of rural girls compared with their urban counterparts, whereas the age at first birth is likely to be under cultural control. The short reproductive span appears to result from a large mean interval between last birth and menopause, which is essentially determined by cultural decisions. The birth intervals, which are longer than in many traditional societies, could be the result of a slower restoration of postpartum fecundability induced by the hard way of life inherent in the Altiplano (including poor sanitary and nutritional conditions and high workload), perhaps aggravated by hypoxia. However, a secular trend in fertility is perceptible, towards earlier menarche, earlier age at first birth, increasing reproductive span and a slight increase in live births and surviving offspring, which is probably the result of a slow improvement in living conditions. The existence of birth control on the one hand, and a total fertility rate averaging six live births among the couples who do not practise contraception on the other, are other arguments against the hypothesis of a low natural fecundity in these Aymara groups.

Childhood adversity has been associated with accelerated menarcheal and reproductive timing in females. The relationship between family- and neighbourhood-level measures of childhood adversity, menarcheal timing and intended reproductive timing was investigated in a sample of 354 English adolescent girls. The data were collected from March to June 2012. In total 90 of the participants had reached menarche. Frequent residential relocations increased the likelihood of reaching menarche (HR 1.11; 95%CI 1.02–1.22). Girls who had moved house one to four times or five or more times, were respectively, more than twice (HR 2.14; 95%CI 1.23–3.73) and more than three times (HR 3.20; 95%CI 1.44–7.10) as likely to have reached menarche than girls who had never moved house. Frequent residential relocations were associated with stepfather co-residence, increased number of half/stepsiblings and reduced feelings of family support. Menarche was also accelerated by the presence of half/stepsisters. There was no relationship between menarcheal timing and intended reproductive timing. Frequent residential relocations may indicate instability in a young person's life, which is often outside of their control. Extending childhood adversity measures to include residential relocations could be important in better understanding the role early life events play in accelerating menarche.

This study examines the effects of birth order and interpregnancy interval on birthweight, gestational age, weight-for-gestational age, infant length, and weight-for-length in a sample of 2063 births from a longitudinal study in the Philippines. First births are the most disadvantaged of any birth order/spacing group. The risks associated with short intervals (<6 months) and high birth order (fifth or higher) are confined to infants who have both attributes; there is no excess risk associated with short previous intervals among lower-order infants, nor for high birth order infants conceived after longer intervals. This pattern is observed for all five birth outcomes and neonatal mortality, and persists in models that control for mother's age, education, smoking, family health history and nutritional status. Since fewer than 2% of births are both short interval and high birth order, the potential reduction in the incidence of low birthweight or neonatal mortality from avoiding this category of high-risk births is quite small (1–2%).

Whilst it is generally accepted that breast-feeding lowers the likelihood of conception, this relationship is not straightforward and there appears to be a wide variation in the effectiveness of the association between individual mother-infant pairs. Up to about 6 months post-partum breast-feeding probably can be used as a family planning method, with up to 98% effectiveness if behavioural guidelines are adhered to (Consensus, 1988). But beyond this time significant variations appear between different countries, and even different communities within countries, which make any overall recommendation impossible. To understand the reasons for variation in the duration of lactational infecundity it is necessary to understand the mechanisms involved, but knowledge of these processes is still far from complete. There are, nevertheless, enough data to indicate that suckling and maternal milk output are intimately linked with the return of fecundity.

Four hundred and sixty-five pregnant women and their newborn babies were studied at a maternal and child health training institute in Dhaka, Bangladesh, between July 2002 and June 2003 with the objective of (1) examining the relationship between birth weight and maternal factors, and, if there was a dose–response relationship between quality of antenatal care and birth weight, (2) predicting the number of antenatal visits required for women with different significant characteristics to reduce the incidence of low-birth-weight babies. The study revealed that 23·2% of the babies were of low birth weight according to the WHO cut-off point of <2500 g. Mean birth weight was 2674·19±425·31 g. A low birth weight was more common in younger (<20 years) and older (≥30 years) mothers, the low-income group and those with little or no education. The mean birth weight of the babies increased with an increase in quality of antenatal care. The babies of the mothers who had 6+ antenatal visits were found to be 727·26 g heavier than those who had 1–3 visits and 325·88 g heavier than those who had 4–5 visits. No significant relationship was found between number of conception, birth-to-conception interval, BMI at first visit, sex of the newborn and birth weight. Further, from multiple regression analysis (stepwise), it was revealed that number of antenatal visits, educational level of the mother and per capita yearly income had independent effects on birth weight after controlling the effect of each variable. Using multiple regression analysis, the estimated number of antenatal visits required to reduce the incidence of low-birth-weight babies for women with no education and below-average per capita income status was 6; the number required for women with no education and above-average per capita income status was 5; and that for women with education and with any category of income status was 4 visits. So there is a need to stratify women according to their income and educational status so that, along with other measures, the required number of antenatal visits can be estimated beforehand to reduce the incidence of low-birth-weight babies.

The object of the study was to investigate the genetic nature of personal preferences in such spheres as food, friendship, art, music, ambition, marriage and so on. The subjects chosen for the research were forty-eight pairs of identical and forty-eight pairs of non-identical twins, divided equally into males and females, with ages ranging between 17 and 40 years. Each subject, individually, was given an oral questionnaire (‘Fads and Fancies’), the answers to which were analysed statistically. The results indicate very little difference between the concordance rates of identical and non-identical twins, suggesting that the issues discussed might not be genetically influenced. One possible reason for such findings could be the unrepresentative nature of the sample.

This paper explores the pathways of the determinants of unfavourable birth outcomes, such as premature birth, the size of the baby at birth, and Caesarean section deliveries, in Kenya using graphical log-linear chain models. The results show that a number of factors that do not have direct associations with unfavourable birth outcomes contribute to these outcomes indirectly through intermediate factors. Marital status, the desirability of a pregnancy, the use of family planning and access to health facilities have no direct associations with poor birth outcomes, such as premature births and the small size of the baby at birth, but are linked to these outcomes through antenatal care. Antenatal care is identified as a central link between various sociodemographic or reproductive factors and birth outcomes.

Twenty-seven voluntarily childless couples who had made early decisions prior to marriage not to have children were compared to 23 couples childless through a series of successive postponements of childbearing. While the two groups differed little on background characteristics, husbands in early deciding relationships were less feminine-oriented and their wives more masculine-oriented than husbands and wives in the postponing group. Early deciding couples revealed higher levels of commitment to their choice, especially being more likely to seek an abortion for any pregnancy or to adopt out any child. A repertory grid measure revealed few differences in perceptions of others by either group of deliberately childless couples.

It is widely believed that people can remember the age at which they first had sexual intercourse. Questions about age at onset are routinely asked in population sexual behaviour surveys and in clinical history-taking. However, there are limited test–retest data, especially with regard to individual differences in unreliable recall. In this study, telephone interviews and follow-ups an average of 15 months later were conducted with 570 non-virgin subjects aged between 28 and 73 years. Test–retest correlations for recalled age at first intercourse were 0·85 for females and 0·91 for males. Consistency was slightly lower among older people and women with a history of sexual abuse. There were no significant associations between consistency of recall and measures of personality, educational background or history of alcohol dependence and depression.

This study uses sets of historical family reconstitutions from all of Quebec and from four villages of the Haut-Jura, France—first marriages of 2226 and 994 women, respectively—to investigate the physiological and social factors affecting age of mother at last birth before and during fertility transition. Age remained high throughout the period covered in Quebec, under ‘natural’ conditions, but showed a steady decline in the French material which extends to late 19th century generations practising family limitation.

Age at marriage had no influence in Quebec; in France, however, women with the most surviving children at age 35 continued childbearing the latest. There was no link between biological ability to achieve a live birth, or in health status or aging rhythm, and age at last birth. Behaviour of mothers and daughters showed no relation. The variability in age at last birth thus appears to be random under natural conditions; with the onset of controls, social differences seem to influence not only the end of childbearing, but all aspects of behaviour governing final family size and child survival.

Caesarean section delivery rates in India have doubled from 9% in 2005–06 to 17% in 2015–16, increasing the clinical and economic burden on the health care system. This study applied multilevel models to assess the role of household- and community-level factors in Caesarean section (CS) deliveries among low-risk women in India using data from Round 4 of the National Family Health Survey (NFHS-4) conducted in 2015–16. The sample size was 59,318 low-risk women who had their last birth in an institution during the 5 years preceding the survey. These women were nested in 57,279 households, which were nested in 22,183 communities, which were further nested in 640 districts in India. Around 21% of the low-risk women and 24% of all women who had delivered in an institution had undergone CS. The CS rates among low-risk women were extremely high in private institutions (40%) and in southern India (43%). The explanatory variables age, education of women, household wealth and number of antenatal visits were significantly positively associated, while women’s parity was negatively associated, with CS delivery among low-risk women. The multilevel analysis suggested that the likelihood of a low-risk woman opting for CS was influenced by a similar decision of another woman from the same household (37%) and/or community (18%). Furthermore, women with low-risk pregnancies from higher educated communities were less likely (OR 0.92) to undergo CS. There is therefore a need for a community-level awareness programme on the risks and benefits of low-risk CS and vaginal delivery, particularly in the southern region of India.

Relationships between migration and fertility are examined, using data from the OPCS Longitudinal Study of England and Wales, including linked information from the 1971 and 1981 Censuses and birth registration data for the period 1971–80. The results showed that the proportion moving between the 1971 Census and the first subsequent birth was higher among tenants than owner occupiers, particularly for women in shared accommodation in 1971. The association between tenure and moving was more consistent than the relationship between moving and the husband's social class. Differences in the proportions moving between the censuses were positively associated with fertility in the same period particularly for women in potentially crowded accommodation in 1971. Moving in 1970–71 was not associated with differences in parity progression ratios 1971–81. There were, however, differences in the timing of births, suggesting that long distance migration was associated with a postponement of the first or second child, probably because both longer distance migration and fertility behaviour are associated with other characteristics such as education.

Women carry the primary responsibility for family planning in most parts of the world, and should be afforded the power of decision-making and control over their fertility. This study seeks to gain insight into Iranian women's perception of the meaning of empowerment in family planning. Using a qualitative study, seven focus group discussions and five individual interviews were conducted with 35 married Iranian women of reproductive age. The data were analysed using a conventional content analysis approach, in which themes and categories were explored to reveal women's experiences of empowerment in family planning. The results demonstrated four main categories: control over fertility plan, participative family planning, maintaining health and access to optimal family planning services. They viewed knowledge of family planning and autonomy of decision-making in fertility issues as essential elements for control of their fertility plan. Participants felt more empowered when joint family planning decisions were made with their partners in an atmosphere of agreement. Therefore, family planning policymakers should plan services with new approaches that focus on women's health and empowerment.

The aim of this study was to examine the gender differential effects of eating habits and physical activity on overweight and obesity among school-aged adolescents in Bangladesh. Nationally representative data extracted from the 2014 Global School-based Student Health Survey (GSHS) were utilized. The survey collected information related to physical and mental health from 2989 school-aged adolescents in Bangladesh. An exploratory data analysis and multivariate logistic regression model were employed in this study. Female adolescents were at a lower risk of being overweight or obese (AOR=0.573) than males, with a prevalence of 7.4% (males: 9.9%). The results showed that high consumption of vegetables (both: AOR=0.454; males: AOR=0.504; females: AOR=0.432), high soft drink consumption (both: AOR=2.357; males: AOR=2.929; females: AOR=1.677), high fast food consumption (both: AOR=2.777; males: AOR=6.064; females: AOR=1.695), sleep disturbance (both: AOR=0.675; males: AOR=0.590; females: AOR=0.555) and regular walking or cycling to school (both: AOR=0.472; males: AOR=0.430; females: AOR=0.557) were vital influencing factors for being overweight or obese among adolescents for both sexes. Sedentary activities during leisure time were also identified as significant predictors of being overweight or obese for males. Regular fruit and vegetable consumption, the avoidance of soft drinks and fast food, an increase in vigorous physical activity, regular attendance at physical education classes and fewer sedentary leisure time activities could all help reduce the risk of being overweight or obese for both sexes.