The effect of nutrition on fertility and its contribution thereby to population dynamics are assessed in three social groups (elite, tradesmen and subsistence) in a marginal, pre-industrial population in northern England. This community was particularly susceptible to fluctuations in the price of grains, which formed their basic foodstuff. The subsistence class, who formed the largest part of the population, had low levels of fertility and small family sizes, but women from all social groups had a characteristic and marked subfecundity in the early part of their reproductive lives. The health and nutrition of the mother during pregnancy was the most important factor in determining fertility and neonatal mortality. Inadequate nutrition had many subtle effects on reproduction which interacted to produce a complex web of events. A population boom occurred during the second half of the 18th century; fertility did not change but there was a marked improvement in infant mortality and it is suggested that the steadily improving nutritional standards of the population, particularly during crucial periods in pregnancy (i.e. the last trimester), probably made the biggest contribution to the improvement in infant mortality and so was probably the major factor in triggering the boom.

Female genital cutting (FGC) is a widespread cultural practice in Africa and the Middle East, with a number of potential adverse health consequences for women. It was hypothesized by Kun (1997) that FGC increases the risk of HIV transmission through a number of different mechanisms. Using the 2003 data from the Kenyan Demographic and Health Survey (KDHS), this study investigates the potential association between FGC and HIV. The 2003 KDHS provides a unique opportunity to link the HIV test results with a large number of demographic, social, economic and behavioural characteristics of women, including women's FGC status. It is hypothesized that FGC increases the risk of HIV infection if HIV/AIDS is present in the community. A multilevel binary logistic regression technique is used to model the HIV status of women, controlling for selected individual characteristics of women and interaction effects. The results demonstrate evidence of a statistically significant association between FGC and HIV, after controlling for the hierarchical structure of the data, potential confounding factors and interaction effects. The results show that women who had had FGC and a younger or the same-age first-union partner have higher odds of being HIV positive than women with a younger or same-age first-union partner but without FGC; whereas women who had had FGC and an older first-union partner have lower odds of being HIV positive than women with an older first-union partner but without FGC. The findings suggest the behavioural pathway of association between FGC and HIV as well as an underlying complex interplay of bio-behavioural and social variables being important in disentangling the association between FGC and HIV.

The age at menarche, body height and weight of the daughters of farmers, farmer–workers and landless villagers in a rural region of Poland were studied. In the period 1967–1977, a time of economic development, a decrease in age at menarche (by 0.74 years) and a secular trend in body height (by 2.4 cm/decade) was observed. In 1977–1987, a period of acute economic crisis, age at menarche increased by 0.16 years and the secular trend in body height was only 1.1 cm/decade. In 1987–2001, age at menarche decreased and body height increased by 0.28 years and 2.9 cm respectively. The percentage of families owning a car, freezer and video increased during this period. These last results are indicative of an improvement in living conditions, but the villagers regard themselves as losers as a result of the political transformation (1989) in Poland.

The hypothesis that measures of sub-adult mortality rates in natural fertility populations are associated with subsistence practices in a selected cross-cultural sample (n=39) was tested. After controlling for both distance from the equator and the general likelihood of cultural similarities between genetically closely related cultures using phylogenetic comparative methods, it was found that dependence on extractive modes of subsistence (hunting, gathering and fishing) was a significant positive correlate of total child mortality (15q0). Both increases in dependence on foraging and permanent settlement were associated with increases in child mortality between pairs of historically related cultures. The results indicated little association between infant mortality (1q0) and either dependence on foraging or settlement.

Some of the literature on the interrelationships between suicidal acts, accidents, surgical operations and other forms of violent experience is reviewed.

It was postulated that persons making suicidal attempts would, more commonly than non-suicidal controls, have encountered violent experiences during their life-time. To test this hypothesis, 50 persons attempting suicide were compared with 50 non-suicidal psychiatric patients and with 50 healthy persons attending a chest clinic. The groups were matched for age, sex and social class.

Using a questionnaire, all relevant data were recorded. Classes of violent experience were graded numerically on a basis of severity and on the degree of responsibility of the person involved. It was found that the suicidal patients had significantly higher violence scores than either control group, a finding which remained significant when previous suicidal attempts were excluded from the score. The possible implications of this finding are discussed.

Although attitudes to premarital sex may be influenced by several factors, the importance of religion to that discourse cannot be underestimated. By providing standards to judge and guide behaviour, religion provides a social control function such that religious persons are expected to act in ways that conform to certain norms. This study investigated the interconnectedness of several dimensions of religion and premarital sexual attitudes among young people in the informal settlements of Nairobi, Kenya. Using reference group as the theoretical base, it was found that those affiliated with Pentecostal/Evangelical faiths had more conservative attitudes towards premarital sex than those of other Christian faiths. Additionally, while a high level of religiosity was found to associate with more conservative views on premarital sex, the effect was more pronounced among Pentecostal groups. The findings are discussed in relation to programmes on adolescent sexuality.

The lactational histories of 500 Sudanese women were studied retrospectively to examine postpartum lactational amenorrhoea as a method of family planning. Particular attention was given to the factors affecting postpartum lactational amenorrhoea, including supplementary feeding and the use of modern contraceptive methods. Breast-feeding was overwhelmingly practised (90%) among this sample, which was roughly representative of the Sudanese population as a whole. The prevalence of amenorrhoea among this group of lactating women was quite high (73%). Duration of lactational amenorrhoea ranged from 2 to 36 months with a median of 12 months.

Introduction of supplementary feeding had little effect on lactational amenorrhoea up to the 9th month of breast-feeding. Beyond the 12th month of breast-feeding, lactational amenorrhoea was significantly prolonged by postponing the introduction of supplementary feeding until the 4th month or later.

Ovulation, and hence conception, during lactational amenorrhoea was unpredictable. It occurred as early as the 3rd or as late as the 36th month postpartum. Conceptions interrupting lactational amenorrhoea soon after delivery (3–9 months) were more frequent among primiparous women. The failure rate of lactational amenorrhoea as a contraceptive was 8·4%. Though extremely high compared to that of the pill, lactational amenorrhoea was more useful as a fertility control mechanism because, in this study, a high proportion of women initiated pill use, but soon discontinued it because of side effects. Modern contraceptive practice was not prevalent. Amenorrhoeic mothers accepted the pill after the 6th month postpartum (41%), compared to lactating mothers whose menses had returned who started it much earlier. Forty-nine percent of the women studied relied completely on the protection of lactational amenorrhoea. Fifty-seven percent of all lactating women who used the combined pill reported a reduction in milk production. There are several policy implications of this study.

In contrast to the extensive knowledge on the association between women’s empowerment and the nutritional status of children under the age of five, relatively little is known about the influence of women’s empowerment on adolescents’ nutritional status. This study aimed to assess the association between women’s empowerment and gender inequalities in adolescent nutritional status. Data were from the Indonesian Family Life Survey (IFLS) covering the period 1997 to 2015, and consisted of 16,683 observations from 13,396 adolescents between the ages of 10 and 19 years born in 6781 families. Three indicators of women’s empowerment were used: mother’s education, mother’s bargaining power and mother’s working status. Multivariate linear regression with robust standard errors was used to examine whether and how these indicators of women’s empowerment influenced adolescent nutritional status. Interaction terms were added to analyse how the association between women’s empowerment and adolescent nutritional status differed by gender. The results showed that mother’s education and mother’s working status were significantly associated with adolescent nutritional status, particularly with height-for-age. Adolescents of well-educated mothers had a higher height-for-age while those who were raised by mothers with a blue-collar job had a lower height-for-age. Although no gender differences were found for height-for-age, gender differences for BMI-for-age were obvious, with boys having a lower BMI-for-age than girls. Interactions between indicators of mother’s empowerment and gender showed that the gender gap in BMI-for-age was smaller for adolescents of more educated mothers. However, further analyses of food consumption patterns showed that boys whose mothers were more educated consumed more fast food and had higher instant noodle consumption than girls, thus suggesting gender bias in new disguise.

The north-western populations of Pakistan in the Federally Administered Tribal Areas (FATA) adjoining the Pakistan–Afghanistan border are an amalgamation of native and migrated Pashtun tribes. These tribal populations are in transition due to war conditions and geo-political turmoil on both sides of the border since the Soviet invasion in 1979. Bio-demographic and epidemiological data for these tribes are scarce. A prospective cross-sectional sample of 967 males was selected from a representative Pashtun population of Bajaur Agency, and information obtained on bio-demographic variables and marital union types. Analysis of these data revealed that consanguinity was 22.34% and the inbreeding coefficient F was calculated to be 0.0134. The inbreeding coefficient was observed to be higher in subjects who were illiterate, had unskilled jobs and who belonged to younger age categories, extended families and the Tarkalani tribe. Further analyses with respect to temporal variables like subject's age, year of marriage and age at marriage revealed that after a transition in marital union types in the early 80s, there has been a declining trend in the rate of consanguineous unions. Further, consanguineous unions in the parental generation were only 5%, but parental marriage types were predictors of subjects' marital union types. The data further establish that, contrary to a general notion about a high consanguinity rate in Pakistan, consanguineous unions are not common in Bajaur Agency and first cousin marriage is not the preferred type. Furthermore, this research shows that there is a great regional variation in the pattern of consanguinity in Pakistan that needs to be documented in order to draw a more comprehensive picture of the inbreeding coefficient in the country.

This study contributes to the dialogue on the prevention of mother-to-child HIV transmission (PMTCT) through the use of HIV and antenatal care (ANC) integrated services. The determinants of antenatal HIV testing in Zimbabwe were explored. Multilevel logistic regression models were applied to data for 8471 women from 406 clusters who gave birth in the 5 years preceding Zimbabwe Demographic and Health Surveys conducted in 2005/6 and 2010/11. The uptake of antenatal HIV testing was found to be determined by a wide range of individual-level factors relating to women’s economic and demographic status, as well as HIV-related factors, including HIV awareness and stigma within the community. Important individual-level enabling and perceived need factors included high socioeconomic status, not having observed HIV-related stigma and knowledge of HIV status (based on a previous HIV test), such that these groups of individuals had a significantly higher likelihood of being tested for HIV during pregnancy than their counterparts of lower socioeconomic status, and who had observed HIV-related stigma or did not know their HIV status. The results further revealed that community HIV awareness is important for improving antenatal HIV testing, while stigma is associated with reduced testing uptake. Most contextual community-level factors were not found to have much effect on the uptake of antenatal HIV testing. Therefore, policies should focus on individual-level predisposing and enabling factors to improve the uptake of antenatal HIV testing in Zimbabwe.

The Sustainable Development Goals (SDGs) are increasingly being used to measure developmental progress among and within countries. Achieving the health-related SDGs remains a primary concern of many developing countries. This study measured the progress in selected health-related indicators of SDGs in the states of India by social and economic groups, and predicted their likely progress by 2030. The health indicators analysed included health outcomes, nutrition, health care utilization and determinants of health. Data from the Census of India, Sample Registration System (SRS), National Family and Health Surveys (NFHSs) and National Sample Survey Organization (NSSO) were used in the analysis. Annual rate of progress (ARP) and the required rate of progress (RRP) were computed for selected indicators over the period 2005–06 to 2015–16. A Composite Index of Health (CIH) was used to understand the state of health of populations. The ARP was higher than the RRP in maternal care and reduction of under-five mortality, while ARP was lower than the RRP in undernutrition and sanitation. The ARP for health-related indicators showed a mixed pattern across religion and caste groups. The ARP for medical assistance at birth and immunization was highest among Scheduled Castes and that for reduction of under-five mortality was highest among Scheduled Tribes. The CIH was lowest in Uttar Pradesh (0.26) and highest in Goa (0.81). The association between the CIH and the Human Development Index (HDI) was significant, suggesting interlinkage between health and development. Notable improvements were observed in maternal and child health and maternal health care utilization across social groups in India over the period 2005–06 to 2015–16, and if the trends continue the country can achieve the SDG target in maternal health by 2030. However, progress in nutrition and other health indicators has been slow and uneven.

This paper investigates the impact on birth intervals of three distinct birth control strategies: stopping childbearing, spacing births and the postponement of further childbearing for reasons unrelated to women's family-building histories. A macro-simulation model of the family-building process is described that incorporates heterogeneity in fecundability. This model is used to demonstrate that the postponement of further childbearing has a distinctive impact on schedules of duration-specific fertility rates that differs from that of both family-size limitation and birth spacing. In particular, the simulation results, supplemented by an analytical exposition, show that reductions in fertility due to spacing are a function of interval duration and its log, while reductions due to postponement are a function of interval duration and its square. This provides a way to test statistically for the presence of, and distinguish between, differential postponement and spacing in regression analyses of birth history data.

The study looks at the effects of maternal sociodemographic characteristics and the quality of the environment on child survival through two intervening variables, breast-feeding and prenatal care. A linear structural equation modelling approach was used to examine infant and child survival based on a weighted sample of 5180 Liberian children aged 0–5 years. The findings confirm previous studies, but also reveal complex relationships of the role of education, maternal age and breast-feeding in enhancing child survival.

The conception rate in Baroda and Manipal, India, is lowest during the hottest weather. The greatest extremes are found in Baroda and, following high summer temperatures, there is a prolongation of low conception rates which may indicate that part or all of the effect is mediated through an effect on scrotal temperature. However, other factors may also be involved and a reduction of coital frequency is likely at extremes of temperature. Seasonal changes in abortion, stillbirths and prematurity are also observed. Changes in spontaneous abortion could be due to heat stress in the mother or possibly to abnormal sperm production at high temperature or to less frequent coitus, leading to embryonic defects.

In a 1982 survey of 250 men living in Khartoum, knowledge of, attitudes towards and use of contraception among Sudanese men were explored. Particular attention was given to attitudes towards male and female sterilization. Although most of the men expressed a desire to have large families, several findings suggest that they felt that they may have to be satisfied with a lower number for economic reasons. Three-fifths of the men with wives of reproductive age wished to use family planning services now but only about one-fifth were currently using an effective method. Almost 60% of the men were interested in learning more about female sterilization and about 50%, more about male sterilization. In general, attitudes towards family planning were more favourable than previously believed by providers of these services. Only 2·8% of these men had obtained services from a family planning clinic, suggesting that the demand currently exceeds the supply.

The cost effectiveness of various modes of family planning service delivery based on the cost per couple-year of protection (CYP) is assessed using 1984 data for 63 projects in ten countries (three each in Africa and Asia, and four in Latin America). More than 4·8 million CYPs were provided through these projects during the year studied. Programmes with the highest volume of services delivered corresponded to lowest average costs: social marketing (2·8 million CYPs) and sterilization projects (960,000 CYPs) cost about $2 per CYP, on average; highest costs were for full service clinics and community-based distribution projects ($13–14 per CYP). Costs of clinics combined with community-based distribution services fell approximately midway between these two extremes.

Postpartum sexual abstinence may be a major determinant of fertility and of maternal and child health in sub-Saharan Africa. This study examines the relationship between ethnicity and abstinence using data from the 1988 Ghana Demographic and Health Survey. There is considerable diversity in the length of abstinence although only for one ethnic group, the Mole-Dagbani and other Ghanaians, is abstinence, both actual and ideal, very long. Respondents in most ethnic groups believe their abstinence to be adequate. A key motivation for abstinence is the unwillingness to have sexual intercourse with nursing mothers. Education, urbanisation, changes in marriage patterns and religious traditions are major factors shaping the ethnic differentials in abstinence. In comparison to breast-feeding, abstinence appears to have relatively little impact on the length of the birth interval and, for Ghana, has relatively few implications for fertility and child health.

This paper evaluates a Singapore experiment to test the Shettles ‘rhythm and douche’ method of sex control. The clinic was set up in the hope that if couples could have the son they desired, they would keep their families small in accordance with the goverment's strong commitment to population control. From March 1975 to July 1977, 10,000 newly-wed women were invited to attend the clinic. A thousand women, not all newlyweds, attended at least once. Of the 31 women who had definite sex preferences, who attempted to follow the method, and who gave birth between March 1975 and November 1977, all wanted boys. By chance alone, one would expect about sixteen to have boys. In fact, fourteen had boys. Only six of the 31 women reported using the method completely correctly.

Women attending the clinic at least once were more likely to have an outside job, to have a husband with a professional or managerial job, and to be of Chinese origin compared with the Singapore population. Clients coming either had fertility problems and had no sex preferences or wanted a boy. Of those coming at least once, 70% had no previous children; the rest had had 403 girls and 58 boys.

To test this sex control technique adequately, one would need a large sample of highly committed couples who are given intensive counselling and follow-up. This particular method appears to be impractical on a mass basis, apart from questions about its effectiveness. Other sex control methods currently under research may prove more practical and effective. A better solution would be to discourage boy preference and improve the opportunities for girls.

This study indicates that urban marital patterns in nine Nigerian cities influence fertility. Fertility is also influenced by age at marriage, region of residence, ethnicity and religion; education and employment lead to marriage delay and tend to conflict with childbearing by enhancing the status of women.

The high variability between centres in the incidence of side effects related to intrauterine devices (IUDs) is taken to indicate the need to direct research attention towards the context in which IUDs are inserted, as opposed to exclusive concern with the nature of the device. This paper considers the significance of psychological factors at the time of insertion in the light of recent studies indicating the benefits of adequate patient preparation.