The 1994 Cairo Conference on Population and Development consensus called for actions that will make family planning programmes oriented to the needs and concerns of women that are served. This paper, based on data from Bangladesh, presents an illustrative analysis of how an outreach programme can be evaluated by this criterion. A scale for perceived service quality is developed from five indicators of desirable characteristics of services. Regression methods are used to assess the impact of outreach service encounters on the perceived quality scale. Econometric methods are used to adjust for endogeneity that arises from the selectivity of outreach encounters and the selective service exposure of contraceptive users. Results show that increasing contact with outreach workers increases client satisfaction with the overall quality of the Bangladesh family planning programme.

This paper proposes a causal model of sexual activity among a randomly selected sample of 305 Junior secondary school girls in Zambia. The results indicate that liberal sexual attitudes influence romantic involvement with boys. Emotional involvement is likely to result in sexual activity. Traditional courtship forms are slowly being replaced by modern patterns of courtship behaviour. Policy and programme implications are discussed.

The aim of this cross-sectional study was to investigate beliefs, attitudes and reproductive behaviours in relation to consanguinity in a population living in the backlands of north-eastern Brazil. Data were collected by face-to-face interview from 147 high school students aged 13–20 years and from 532 elderly individuals aged 60 years and over from Brejo dos Santos in the state of Paraíba in 2017. The frequency of consanguineous marriage was found to have increased over the generations, being 15.9% in the parents of the elderly participants, 17.1% in the elderly participants themselves and 20.5% in their descendants. Although 258 (50.9%) of the elderly interviewees opposed consanguineous union, 341 (65.3%) would approve of the marriage of their children with relatives. Both the young (n=108 or 78.3%) and elderly (n=398 or 80.4%) interviewees believed that consanguineous marriages were no more durable than non-consanguineous marriages (p=0.578). Additionally, 408 (82.4%) of the elderly individuals and 108 (80.6%) of the students recognized that spouses in consanguineous unions experience conflicts, just like other couples do (p=0.625). In both groups, the majority of the participants did not believe that consanguinity increased the risk of having children with disabilities. The regression of the two continuous variables ‘age’ and ‘positive attitudes score’ showed a significant correlation, suggesting that younger individuals are more susceptible to the influence of cultural factors contributing to consanguinity, such as the opinions of their parents and grandparents. The belief that consanguineous unions are more durable showed a significant difference between elderly individuals in consanguineous and non-consanguineous unions (p=0.001); the former were 2.42 more likely to believe that marriages between relatives contributes to marriage durability.

Epidemiological studies have revealed that stressful changes in social environment increase the risk of cardiovascular mortality. In this study, the influence of major negative and positive life changes on serum cholesterol was examined in middle-aged men to determine a possible biochemical link between life changes and cardiovascular mortality. The results showed no influence of negative life changes on serum cholesterols. However, positive life changes significantly predicted a reduction in total and LDL (low-density lipoprotein) cholesterol levels after adjustment for the baseline cardiovascular health status, baseline cholesterol level, diet, body mass index, waist-to-hip ratio and cardiorespiratory fitness. The odds ratio for lowering LDL cholesterol was 5·2 in the men reporting positive events compared with those reporting none. The findings suggest a predictive value of positive life changes for atherogenic lipid profile in middle-aged men.

The risk of developing a major non-communicable disease is critically affected by lifestyle choices. This study examined the consequences of factors that might predict a change in the self-rated health of older adults and aimed to assess their monetary costs. In particular, two predisposing risk factor moderators were studied: high blood pressure and high cholesterol. The effects of these on two serious adverse cardiovascular events – heart attack and stroke – were estimated. Using data from the Survey of Health, Aging and Retirement in Europe (SHARE) carried out in 2014, a two-stage procedure was applied as well as pairwise comparison. The results revealed the significant role of socioeconomic status in health outcomes. Behavioural risk factors were found to be significant predictors for heart attack and stroke. The findings support the claim that variables such as age, wealth and behavioural risk factors are additional predictors of a change in these two diseases. The monetary consequences can reach up to 12.8 thousand Euros for older adults per unit of predisposing risk factor. Since national health budgets are limited, health policies might be prioritized.

Spousal violence against women is a serious public health problem that is prevalent in all societies, with one in three women around the world experiencing violence in their lifetime. This study examined the prevalence of spousal violence, and its determinants, in Afghanistan using data from the 2015 Afghanistan Demographic and Health Survey. Univariate, bivariate and logistic regression statistical techniques were used to assess the association of socioeconomic variables with spousal violence. The study sample comprised 20,827 currently married women aged 15–49. Fifty-two per cent of women reported experiencing some form of violence by their husband. A significant association was found between women’s justification of violence, women’s participation in decision-making in their household (COR=0.476; CI=0.446–0.509) and lower risk of experiencing spousal violence. After adjustment for demographic and socioeconomic factors, women’s participation in all of four household decisions, either alone or jointly, was found to be associated with a lower risk of experiencing spousal violence (AOR=0.472; CI=0.431–0.516). In both the crude and adjusted models, the risk of experiencing spousal violence was high if the husband’s desire for children was different from that of his wife. In the case of inequality in property ownership, the risk of spousal violence was significantly higher (COR=1.263; CI=1.178–1.353; AOR=1.159; CI=1.051–1.278) when women were joint owners of property compared with when they did not own any property. The findings point to an immediate need for legal and social interventions to prevent spousal violence against women, or at least reduce its prevalence, in Afghanistan.

Globally, diarrhoea is the third leading cause of death for under five-children. Women’s empowerment can significantly reduce under-five mortality due to diarrhoea. This study investigated the association between women’s empowerment and childhood diarrhoea in Benin using data from the 2017/18 Benin Demographic and Health Survey. A total of 7979 currently married women were included in the study. A logistic regression model was used to control for possible confounders. The prevalence of diarrhoea among children under five years of age was 13.6%. About 36.3% of the currently married women decided either alone or together with their husband on their own health, purchase of large household items and visiting family/relatives. Close to 65.4% of currently married women disagreed with all five reasons to justify wife-beating. The children of mothers who had decision-making power were less likely to have diarrhoea (aOR = 0.74, 95% CI: 0.57–0.96) than the children of mothers who had no decision-making power. Moreover, the children of mothers who disagreed with all five reasons to justify wife-beating (aOR = 0.79, 95% CI: 0.65–0.96) were less likely to have diarrhoea than the children of mothers who accepted wife-beating as a part of life. Women’s age, educational level, wealth index and region were associated with childhood diarrhoea in Benin. The role of women’s empowerment, as determined by decision-making power and wife-beating attitude, was found to be significantly associated with the risk of childhood diarrhoea in Benin, after adjusting for other variables. Therefore, it is essential for policymakers in Benin to reinforce strategies and interventions focusing on women’s empowerment to avert childhood mortality caused by diarrhoea. This includes improving household economic status, women’s education and decision-making power and enhancing awareness of women’s human and democratic rights.

Uganda has received praise for its success in dealing with the COVID-19 pandemic. This opinion piece uses publically available data from Johns Hopkins University to suggest that it is far from clear whether the Public Health and Social Measures (PHSM) introduced in Uganda influenced the course of the first outbreak. In addition, the analysis of data from the second and third waves in Uganda suggest that government action had little or no effect on these outbreaks. The dominant narrative of successful PHSM, therefore, needs to be reconsidered, and alternative explanations for the low rates of COVID-19-related mortality in the country need to be further understood.

Around 40% of pregnancies worldwide are unintended and a half of those are terminated. Yet, few international comparisons of unintended pregnancy resolution (choosing birth or abortion) exist. This study analysed how parous women’s pregnancy intentions and abortion decisions are associated with their reproductive histories and country contexts using twelve Demographic and Health Surveys representing four context groups: post-Soviet/communist and Asian countries with liberal abortion legislation, and Asian and Latin American countries with restrictive abortion legislation. Similarities were found across contexts: preference to have children of both sexes, space births, stop childbearing after reaching desired family size and an increased likelihood of unintended pregnancy when using less-effective contraceptive methods versus none. Contextual factors most clearly associated with reports of unintended pregnancy resolution were type of abortion legislation and living in post-Soviet/communist contexts. Women’s propensity to report abortions and unintended pregnancy varied by context and the decision-making processes for pregnancy versus fertility management were different.

Age misreporting is a common phenomenon in Demographic and Health Surveys, and there are numerous reasons for this. The trend and pattern of disparity in age heaping vary between countries. The present study assesses age heaping in the selected South Asian countries of Afghanistan, India, Nepal, Bangladesh and Pakistan using data from the most recent round of the Demographic and Health Survey. The respondent sample sizes were 203,703 for Afghanistan, 2,869,043 for India, 49,064 for Nepal, 81,618 for Bangladesh and 100,868 for Pakistan. Age heaping was assessed by respondent’s age, education level, sex and level of education. Whipple’s index was calculated to assess systematic heaping on certain ages as a result of digit preference. Bangladesh, Afghanistan and India showed stronger preference for ages ending with the digits ‘0’ and ‘5’ compared with Pakistan and Nepal among uneducated respondents. On the other hand, strong avoidance of ages ending in the digits ‘1’, ‘4’ and ‘9’ was observed in Bangladesh, Afghanistan and India. However, urban–rural place of residence was not found to be associated with digit preference in the study countries. Among males, age misreporting with the final digits ‘0’ and ‘5’ was highest in Bangladesh, followed by Afghanistan and India, and Nepal showed the least displacement. Strong digit preference and avoidance, and upper age displacement, were witnessed in the surveys conducted in Bangladesh, Afghanistan and India on the parameters of sex and education level. Innovative methods of data collection with the measurement and minimization of errors using statistical techniques should be used to ensure accuracy of age data.

Increasing body of health planning and policy research focused upon unravelling the fundamental drivers of population health and nutrition inequities, such as wealth status, educational status, caste/ethnicity, gender, place of residence, and geographical context, that often interact to produce health inequalities. However, very few studies have employed intersectional framework to explicitly demonstrate how intersecting dimensions of privilege, power, and resources form the burden of anthropometric failures of children among low-and-middle income countries including India. Data on 2,15,554 sampled children below 5 years of age from the National Family Health Survey 2015-2016 were analysed. This study employed intersectional approach to examine caste group inequalities in the anthropometric failure (i.e. moderate stunting, severe stunting, moderate underweight, severe underweight, moderate wasting, severe wasting) among children in India. Descriptive statistics and multinomial logistic regression models were fitted to investigate the heterogeneities in the burden of anthropometric failure across demographic, socioeconomic and contextual factors. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and caste groups with the likelihood of anthropometric failure among children.

More than half of under-5 children suffered from anthropometric failure in India. Net of the demographic and socioeconomic characteristics, children from the disadvantageous caste groups whose mother were illiterate, belonged to economically poor households, resided in the rural areas, and coming from the central and eastern regions experienced disproportionately higher risk of anthropometric failure than their counterparts in India. Concerted policy processes must recognize the existing heterogeneities between and within population groups to improve the precision targeting of the beneficiary and enhance the efficiency of the nutritional program among under-5 children, particularly for the historically marginalized caste groups in India.

A survey of women in two highly developed rural counties of China, Sichuan and Jiangsu Provinces, was carried out in late 1991, to gain information about demographic and economic change between 1980 and 1990. Three separate surveys were conducted: the first a questionnaire administered to married women aged 30–39, eliciting information about childbearing and contraception, as well as the social and economic background of the respondents; the second, focus group interviews emphasizing the motivation for childbearing. Official information about the selected villages, townships and counties was also collected.

National level data in 1987 show that individual reproductive behaviour in China failed to conform to a universal, effectively implemented, population policy. They imply either a spatial range of policies, or great diversity in the demand for children, or perhaps a combination of both.

Such diversity in reproductive behaviour is also found in the study area. The purpose of the analysis was to examine the diversity in reproductive behaviour and contraceptive practice, and to discover whether differentials are influenced by area, or else exist between individuals within areas. If the former, then the explanation may be found in differences in policy formulation and implementation between areas: and if the latter, to demand for children, or else differential application of policy restrictions.

The main findings were that: (1) the explanation of the pattern of fertility and contraceptive use is to be found at the individual level (within locations) rather than in policy differences between administrative units; (2) the association between income and number of children is negative, as is that between income and the propensity for uniparous women to remain unsterilized. The theory that privilege may be exercised to gain concessions from birth planning cadres is therefore not supported; (3) ideal family size differentials are largely absent, showing that social (education) and economic (income, occupation) characteristics are not responsible for differences in reproductive motivations, and implying that the nature of the demand for children is very different from that in most rural areas of the Third World; (4) data on ideal family size by sex of the existing offspring indicate only a weak preference for sons.

The low demand for children, and the weak son preference, may both be explained by the social acceptability of uxorilocal marriages, and of village endogamy, together with the prohibitive costs of children, and especially of sons. This partly results from the expense of education, but most mothers emphasize marriage costs.

It is speculated that the circumstances responsible for the escalating costs of children in the two counties are likely to pertain in growing areas of the country, with the privatization of education and health services, the declining support of collective institutions, and the replacement of this function by kinship networks.

These on-going changes imply that any policy of reproductive restriction for the purposes of population control is likely soon to meet with diminishing resistance; and it may later be rendered unnecessary in the eyes of government officials, as fulfilled reproductive intentions lead to a fertility level below replacement level.

The superiority of men over women in chess has been cited as evidence that there are fundamental differences in male and female intelligence (Howard, 2005a, 2006; Irwing & Lynn, 2005). An alternative interpretation of the difference is that it is due to differential male and female participation rates in chess (Charness & Gerchak, 1996; Bilalić & McLeod, 2006; Chabris & Glickman, in press). This has been dismissed by Howard (2006) on the grounds that changes in the difference in skill level between top male and female players in recent years are not correlated with changing relative participation rates. Here it is shown that Howard’s analysis is misleading. The data are consistent with differential participation rates as the explanation of the gap between the performance of women and men in chess.

The 1981 Bangladesh Contraceptive Prevalence Survey found that 55% of ever-married women had some knowledge of traditional methods of contraception and the overall level of ever use was 23%. There was a positive relationship between use and socioeconomic variables. Current use of traditional methods at 7·7% was only slightly below the figure for modern methods (10·9%). It is suggested that traditional methods still have an important role in family planning and that this should not be disregarded.

Because of the importance of contraceptive behaviour in most societies today a better understanding is needed of the social and behavioural factors affecting contraceptive decisions and choices of individuals and couples. This paper examines the need for longitudinal, theoretically-based studies of contraceptive use dynamics, including the timing, duration and interaction of reproductive events which may be more important than contraceptive technology in the social, cultural and economic context of fertility control. New research methods and appropriate analysis of data are relevant. Consideration of the social context is essential for the formulation and implementation of effective policies relating to the provision of contraceptive services.

Births to women aged 35 years and older are compared with births to women aged 20–34 in three hospitals, one each in Mexico, Egypt and Hungary. In the two developing countries, babies born to the older women had lower rates of survival until hospital discharge, and were more likely to have depressed 5-minute Apgar scores. They were not, however, more likely to be of low birth weight. The differences were statistically significant, and remained when several other variables were controlled. The variables controlled were known to be age-related and to influence pregnancy outcome.

Hungary, the only developed country in the analysis, was quite different. Age had a significant influence on the weight of the infant, but not on survival or Apgar score. It seems therefore that when older women are in general good health and there are no concurrent social risk factors, advanced maternal age does not necessarily increase the risk of an adverse pregnancy outcome.

Infand mortality for the period 1950—70 has been analysied in a North-Swedish isolate, a population characterized by a high incidence of schizopherenic psychoses and other neuorpsychiatric disorders. Infand mortality is higher than in Sweden generally. As many as 45·9% of the deceased infands in the population sccumbed during the first week of their life, compard to 28·1% in the general Swedish population.

The fall in the birth rate in Australia, from 23·6 per 1000 population in 1946 to 19·4 in 1967 is analysed according to various biosocial factors: the age composition of the female population and the age incidence of marriage in relation to it, the timing of births, the size of completed family and the overall effect of the variables.

Estimates of fertility in Protestant Barra and Catholic Harris, islands in the Outer Hebrides, over the period 1856–1985, show that in both islands fertility declined, although marital fertility was generally greater than in Scotland as a whole, and illegitimate fertility was less. However, in Barra during 1966–75 there were pronounced rises in all the indices; illegitimate fertility showed the smallest rise. The publication of the papal encyclical Humanae Vitae may have played a part in this change in fertility, although other, probably local, factors must have been acting, as the first rise in numbers of births occurred before the publication of the encyclical. Other than this transient rise, the religious difference between Harris and Barra had little effect on changes in fertility over the whole period.

Indices of proportions married showed declines until after World War 2, followed by steep increases. The marked decline in fertility in both islands may be due in part to this low nuptiality. In addition, a trend of occupation away from traditional crofting and fishing towards more skilled mercantile and professional employment may have played a role.