Social stratification is an important mechanism of human organization that helps to explain health differences between demographic groups commonly associated with socioeconomic gradients. Individuals, or group of individuals, with similar health profiles may have had different stratification experiences. This is particularly true as social stratification is a significant non-measurable source of systematic unobservable differences in both SES indicators and health statuses of disadvantage. The goal of the present study was to expand the bulk of research that has traditionally treated socioeconomic and demographic characteristics as independent, additive influences on health by examining data from the United States. It is hypothesized that variation in an index of multi-system physiological dysregulation – allostatic load – is associated with social differentiation factors, sorting individuals with similar demographic and socioeconomic characteristics into mutually exclusive econo-demographic classes. The data were from the Longitudinal and Biomarker samples of the national Study of Midlife Development in the US (MIDUS) conducted in 1995 and 2004/2006. Latent class analyses and regression analyses revealed that physiological dysregulation linked to socioeconomic variation among black people, females and older adults are associated with forces of stratification that confound socioeconomic and demographic indicators. In the United States, racial stratification of health is intrinsically related to the degree to which black people in general, and black females in particular, as a group, share an isolated status in society. Findings present evidence that disparities in health emerge from group-differentiation processes to the degree that individuals are distinctly exposed to the ecological, political, social, economic and historical contexts in which social stratification is ingrained. Given that health policies and programmes emanate from said legal and political environments, interventions should target the structural conditions that expose different subgroups to different stress risks in the first place.

Using data from India’s National Family Health Survey, 2005–06 (NFHS-3), this article examines the patterns of relationship between birth order and infant mortality. The analysis controls for a number of variables, including mother’s characteristics such as age at the time of survey, current place of residence (urban/rural), years of schooling, religion, caste, and child’s sex and birth weight. A modest J-shaped relationship between birth order of children and their risk of dying in the neonatal period is found, suggesting that although both first- and last-born children are at a significantly greater risk of dying compared with those in the middle, last-borns (i.e. fourth and higher order births) are at the worst risk. However, in the post-neonatal period first-borns are not as vulnerable, but the risk increases steadily with the addition of successive births and last-borns are at much greater risk, even worse than those in the neonatal period. Although the strength of relationship between birth order and mortality is attenuated after the potential confounders are taken into account, the relationship between the two variables remains curvilinear in the neonatal period and direct in the post-neonatal period. There are marked differences in these patterns by the child’s sex. While female children are less prone to the risk of dying in the neonatal period in comparison with male children, the converse is true in the post-neonatal period. Female children not only run higher risks of dying in the post-neonatal period, but also become progressively more vulnerable with an increase in birth order.

There is now widespread agreement on the importance of men's role in reproductive decision-making. Several studies have argued that fertility preferences and their translation into behaviour differ between polygamous and monogamous unions. Studies investigating the dominance of men's preferences over women's preferences, in cases of couple disagreement, found mixed evidence of the effect of polygamy. However, an often cited limitation of these studies has been the inability to link husband's intention with each of his wives in a polygamous union. By adding fertility-intention questions to an on-going Demographic Surveillance Site in Karonga District in northern Malawi the fertility preferences and contraceptive use of husbands and wives were investigated. An analysis of the relationship between the level of agreement and disagreement between husbands' and wives' fertility preferences was then performed to gain insight into the reproductive decision-making process of polygamous couples.

Drawing upon data from the third round of the National Family Health Survey (NFHS-3) conducted in India during 2005–06, this study compares the utilization of selected maternal and child health care services between the urban poor and non-poor in India and across selected Indian states. A wealth index was created, separately for urban areas, using Principal Component Analysis to identify the urban poor. The findings suggest that the indicators of maternal and child health care are worse among the urban poor than in their non-poor counterparts. For instance, the levels of antenatal care, safe delivery and childhood vaccinations are much lower among the urban poor than non-poor, especially in socioeconomically disadvantageous states. Among all the maternal and child health care indicators, the non-poor/poor difference is most pronounced for delivery care in the country and across the states. Other than poverty status, utilization of antenatal services by mothers increases the chances of safe delivery and child immunization at both national and sub-national levels. The poverty status of the household emerged as a significant barrier to utilization of health care services in urban India.

Protein energy malnutrition is a major health problem in India and it affects the growth and development of young children. This study investigated the impact of hygiene, housing and sociodemographic variables on acute malnutrition in children aged 5–7, living in urban and rural areas. Ordinal logistic regression analysis showed that the overall prevalence of severe malnutrition was 8·2%. Older age, male sex, mother's poor education, lower family income, higher birth order of the child, use of dung or fire wood as fuel and defecation within the premises were significantly associated with malnutrition. Appropriate intervention programmes should be formulated to educate and support these families.

Around 25% of abortions in South Africa are performed in the second trimester. This study aimed to better understand what doctors, nurses and hospital managers involved in second trimester abortion care thought about these services and how they could be improved. Nineteen in-depth interviews with abortion-related service providers and managers in the Western Cape Province, South Africa, were undertaken. Data were analysed using a thematic analysis approach. Participants expressed resistance to the dilation and evacuation (D&E) procedure, as this required more active provider involvement. Medical abortion was preferred as it required less provider involvement in the abortion process. A shortage of providers willing to perform D&E resulted in most public sector services being outsourced to private sector doctors. Respondents noted an increased demand for services and a concomitant lack of infrastructure, physical space and personnel to respond to these demands, sometimes resulting in fragmented or poor quality care. At medical induction sites, most thought introducing the combined mifepristone–misoprostol regimen would improve service capacity, although they were concerned about cost. Improving contraceptive services was also seen as a much-needed intervention to improve care and prevent abortion. Ongoing training, including values clarification, as well as emotional support and team-building for providers are needed to ensure sustainable, high-quality second trimester abortion services.

Sex in man and probably throughout the class mammalia is normally determined by the presence of a Y chromosome (male) or its absence (female). The presence of genetic loci on both the long and the short arm of the X chromosome in double dose appears to be essential for the development of mature functional ovaries in the human female though a single X suffices in the female mouse.

The development of masculine genital anatomy and phenotype is a consequence of prior formation of testes. In the absence of gonads of either kind, female internal and external genitalia are formed but secondary sex development fails. In rare human families a mutant gene suppresses the development of male external genitalia in 46, XY embryos but permits the development of testes and male internal genitalia. The external phenotype is normal female (syndrome of testicular feminization). A sex-linked mutant gene in the mouse has a similar effect.

The locus or loci directly concerned with male development might lie wholly on the Y chromosome or might be located on another chromosome or chromosomes. In the latter case it (or they) must be repressed in the female and normally activated by a locus or loci on the Y chromosome in the male. Present evidence does not permit the exclusion of either possibility.

People living with HIV and AIDS (PLWHAs) often face stigma and discrimination, especially in developing countries. HIV-related stigma is expressed through social ostracism, personal rejection, direct and indirect discrimination, and denial from families and friends. Consequently, it is associated with reduced adoption of preventive and care behaviours, including condom use, seeking for HIV test and care-seeking behaviour subsequent to diagnosis. Ignorance about the epidemiology of the disease on modes of transmission and prevention aggravates HIV-related stigma in Nigeria. Behaviour change communication activities through mass media have been shown to be an effective approach in improving people's knowledge about the disease. This paper monitors trends in the level of accepting attitudes towards PLWHAs in Nigeria between 2003 and 2007. It also evaluates the impact of exposure to mass media and social support on the levels of accepting attitudes towards PLWHAs. A significant and positive trend was evident between 2003 and 2007 (p<0.0001). Furthermore, exposure to mass media communications on HIV and AIDS issues and social support were significantly related to the reduced stigma and discrimination against PLWHAs (p<0.0001).

Tuberculosis (TB) researchers and clinicians, by virtue of the social disease they study, are drawn into an engagement with ways of understanding illness that extend beyond the strictly biomedical model. Primers on social science concepts directly relevant to TB, however, are lacking. The particularities of TB disease mean that certain social science concepts are more relevant than others. Concepts such as structural violence can seem complicated and off-putting. Other concepts, such as gender, can seem so familiar that they are left relatively unexplored. An intimate familiarity with the social dimensions of disease is valuable, particularly for infectious diseases, because the social model is an important complement to the biomedical model. This review article offers an important introduction to a selection of concepts directly relevant to TB from health sociology, medical anthropology and social cognitive theory. The article has pedagogical utility and also serves as a useful refresher for those researchers already engaged in this genre of work. The conceptual tools of health sociology, medical anthropology and social cognitive theory offer insightful ways to examine the social, historical and cultural dimensions of public health. By recognizing cultural experience as a central force shaping human interactions with the world, TB researchers and clinicians develop a more nuanced consideration of how health, illness and medical treatment are understood, interpreted and confronted.

Although the role of testosterone in the aetiology of social dominance is often suggested, surprisingly few studies have addressed the relationship between sex steroid hormones and dominance as a personality trait. In this paper, the relationship between testosterone and dominance is studied in a sample of adolescent boys and girls, taking into account the moderating role of gender ideology and same-sex peer group orientation. A direct association between free testosterone (FT) and dominance was found in girls but not in boys. In boys, masculine ideology moderated the relationship between FT and dominance, while in girls the relationship between FT and dominance was moderated by same-sex peer group affiliation.

The proposed method of bleeding pattern analysis avoids the problem of defining the menstrual cycle. The difficulty of maintaining a cyclical approach becomes acute when methods of fertility regulation are used which are known to disrupt seriously previously experienced bleeding patterns.

By using eight simple measures relating to the pattern of bleeding over a fixed period of time, it is possible to present sensitive indicators previously available but not used. These indicators will permit a more meaningful comparison of data obtained from different groups of women or for the same woman over time. The eight measures relate to the number, average duration and variability of bleeding episodes taking place within a defined period of time; the variability of the bleeding-free interval; the average duration and variability of the bleeding episode and its succeeding bleeding-free interval; and the number of days on which bleeding has occurred.

Agreement was reached by the Workshop participants regarding the terms to be used, the definition of these terms, the statistical approach to be adopted and the analytical procedures to be followed in the analysis of bleeding patterns. It is hoped that this alternative approach to bleeding pattern analysis will assist researchers, clinicians and other investigators in the collection, analysis and interpretation of menstrual bleeding patterns.

An example of this approach is given in the following paper by D. Mayes. This example is based on data in the form of diary cards made available to the Family Planning Research Unit, Exeter University, by John Guillebaud of the Churchill Hospital, Oxford.

In a cross-sectional study of gallstone disease, ascertained by ultrasonography, the prevalence was assessed in relation to clinically diagnosed gallstones in first degree relatives by selected socioeconomic factors. In both sexes, clinically diagnosed gallstones among first degree relatives occurred significantly more frequently among subjects with than among those without gallstone disease. None of the socioeconomic variables was significantly associated with gallstone disease in females. In males gallstone disease was positively associated with longer school education, living alone, and duration of residence in the municipality of Copenhagen.

The biological and social factors which may interact to determine the level and pattern of fertility during the last decades of the reproductive life are complex, and because of the paucity of data, the mechanisms regulating fertility at late ages must in part remain speculative. This review focuses on two major questions. First, why is there a decline of fertility prior to the menopause? Second, why does reproduction cease at the menopause and what factors influence the age at which this occurs?

This study examined the recent level, trends and determinants of consanguineous marriage in Jordan using time-series data from the Jordan Population and Family Health Surveys (JPFHSs). According to the 2012 JPFHS, 35% of all marriages were consanguineous in Jordan in 2012. There has been a declining trend in consanguinity in the country, with the rate decreasing from a level of 57% in 1990. Most consanguineous marriage in 2012 were first cousin marriages, constituting 23% of all marriages and 66% of all consanguineous marriages. The data show that women with a lower age at marriage, older marriage cohort, larger family size, less than secondary level of education, rural place of residence, no employment, no exposure to mass media, a monogamous marriage, a husband with less than higher level of education and lower economic status, and those from the Badia region, were more likely to have a consanguineous marriage. Increasing age at marriage, level of education, urbanization and knowledge about the health consequences of consanguinity, and the ongoing socioeconomic and demographic transition in the country, will be the driving forces for further decline in consanguinity in Jordan.

The origin of values and preferences is an unresolved theoretical question in behavioural and social sciences. The Savanna-IQ Interaction Hypothesis, derived from the Savanna Principle and a theory of the evolution of general intelligence, suggests that more intelligent individuals may be more likely to acquire and espouse evolutionarily novel values and preferences (such as liberalism and atheism and, for men, sexual exclusivity) than less intelligent individuals, but that general intelligence may have no effect on the acquisition and espousal of evolutionarily familiar values. Macro-level analyses show that nations with higher average intelligence are more liberal (have greater highest marginal individual tax rate and, as a result, lower income inequality), less religious (a smaller proportion of the population believes in God or considers themselves religious) and more monogamous. The average intelligence of a population appears to be the strongest predictor of its level of liberalism, atheism and monogamy.

Although Kenya’s fertility rate has declined from 6·7 births per woman in the mid-1980s to 5·4 births per woman in 1993 (NCPD, 1994), population growth is still high, yielding a doubling time of 35 years. This study uses the 1993 Kenya Demographic Health Survey data collected from 1257 couples to examine the socioeconomic and sociodemographic characteristics of married men and women and their communication with their spouses over fertility and family planning decision-making practices. The logistic regression analysis shows that education for both men and women, discussion of fertility and family planning between spouses, male approval of use of contraception and male family size desires are important factors that influence ever-use of family planning.

This study aimed to assess empirically the influence of individual and community (neighbourhood) factors on the use of maternal health care services in India through three outcomes: utilization of full antenatal care (ANC) services, safe delivery and utilization of postnatal care services. Data were from the third round of the National Family Health Survey (2005–06). The study sample constituted ever-married women aged 15–49 from 29 Indian states. Multilevel logistic regression analysis was performed for the three outcomes of interest accounting for individual- and community-level factors associated with the use of maternal health care services. A substantial amount of variation was observed at the community level. About 45%, 51% and 62% of the total variance in the use of full ANC, safe delivery and postnatal care, respectively, could be attributed to differences across the community. There was significant variation in the use of maternal health care services at the individual level, with socioeconomic status and mother's education being the most prominent factors associated with the use of maternal health care services. At the community level, urban residence and poverty concentration were found to be significantly associated with maternal health care service use. The results suggest that an increased focus on community-level interventions could lead to an increase in the utilization of maternal health care services in India.

Exploring fertility preferences in relation to contraceptive use can increase the understanding of future reproductive behaviour and unmet family planning needs. This knowledge can help assist women in meeting their reproductive goals. The influences on the desire for more children and current contraceptive use were examined among 1528 married women of reproductive age in an isolated community in Bali, Indonesia, using multivariate logistic regression analysis. Women who were younger, had fewer living children, had given birth in the past year and had regular access to health services were more likely to desire children. Being older, having fewer living children, not having regular access to health services, having given birth in the past year and having the desire for more children were associated with a lower likelihood of using contraception. Women with regular access to health care are more likely to desire more children, probably because they are confident in their ability to have successful birth outcomes. However, specialized clinics or family planning outreach workers may be required to reduce barriers to service utilization among some groups. The findings of this study identify key target populations for family planning, including older women and postpartum women – groups that may not perceive themselves to be at risk for unintended pregnancy. Meeting unmet need for family planning among these groups could help women meet their fertility goals, as well as reduce maternal morbidity and mortality.

A probabilistic model of the human reproductive process is used to assess the success of hypotheses designed to explain human sex ratio fluctuations. It is shown that theories based on different maturation rates or effective lifetimes of X- and Y-bearing spermatozoa cannot account for many of the major sex ratio fluctuations.

A specific physiological model is proposed, based on differential motility of the two types of spermatozoa in the female reproductive tract, which together with differential fetal mortality, accounts successfully for most of the ratio fluctuations. On this theory the principal factor determining sex ratio is the physiological state of the female reproductive tract which in turn is governed by complex physiological and psychological parameters.

Child mortality differentials according to water supply and sanitation in many urban areas of developing countries suggest that access to piped water and toilet facilities can improve the survival chances of children. The central question in this study is whether access to piped water and a flush toilet affects the survival chance of children under five in urban areas of Eritrea. The study uses data collected by the Demographic and Health Survey (DHS) project in Eritrea in 1995. The results show that while the unadjusted effect of household environment (water supply and toilet facility) is large and statistically significant during the post-neonatal and child periods, it is relatively small and statistically insignificant during the neonatal period. The effect of household environment remains substantial during the post-neonatal and child periods, even when other socioeconomic variables are held constant. However, the household environment effect totally disappears during the neonatal period when the socioeconomic factors are controlled for.