It has been suggested that parish-based reconstitution studies may underestimate the true age at marriage because they do not normally include data for emigrants who may be expected to behave differently from individuals who remain in their natal parishes. This study uses data from C18-19th parish registers of north-west Germany to estimate the difference in age at marriage between leavers and stayers. The difference is not significant for males; although that for females is significant, it is small and the consequence of failing to include migrants is likely to be negligible for most studies. However, it is shown that there is also an independent effect on age at marriage that is due to the woman's natal social (economic) status; historical demographic studies that ignore this dimension may risk confounding two different effects.

This study evaluated the strength of the independent effects of social position (expressed by educational level) and number of childbirths on body mass index (BMI) variation of Polish adult females. The material comprised 2045 pre-menopausal women aged 35–50, who were healthy and occupationally active inhabitants of the city of Wrocław, Lower Silesia, Poland. Two-way analysis of variance (ANOVA) revealed that both educational level (F=34·7; p=0·0001) and parity (F=5·6; p=0·001) exerted independent significant effects on BMI. The mean BMI of women who had attended basic vocational or trade school at the very most (27·0 kg/m2) was greater than that of women who had completed secondary school education or had graduated from university (25·3 kg/m2). However, it is worthy of note that there were no social differences in BMI values between childless women. Nevertheless, an increasing number of childbirths was essentially related to increasing female BMI in each social group, and this tendency was most marked among women of lower social position. Regardless of educational level, the highest prevalence of obesity (BMI exceeding 30 kg/m2) was found among females with at least three children (15·6% and 26·4% of women from higher or lower social groups, respectively).

Early sexual debut is of major concern because it is a correlate for health and economic shocks experienced in adulthood. In South Africa, this concern has provided impetus for research directed at the HIV and AIDS epidemic, teenage pregnancy and the effect of adolescent sexual behaviour on persistence in school. Of interest to the present study is high school completion, which is a well-established empirical barometer of adult socioeconomic opportunities. Using data from the five waves of the Cape Area Panel Study (CAPS), this paper examines the association between sexual behaviours initiated in pre- and early adolescence and high school completion rates. The CAPS study is a longitudinal survey that was designed to investigate young people’s (aged 14–22 years) educational attainment and sexual behaviours in Cape Town, South Africa. The sample was constituted from 3213 individuals who had initiated sex during their teenage years and the analysis was undertaken when the youngest cohort was aged 21, an age at which they should have completed high school if they were on time. Logistic regression models were fitted separately for males and females. Overall, the results reveal that early sexual debut is correlated with long-term negative educational outcomes. Individuals who experience early sexual debut are less likely to complete high school than their counterparts who make their sexual debut later on in life. This effect is worse for Africans, who also disproportionately have an earlier sexual debut than other race groups. Apart from race however, the findings also reinforce the effect of other demographic factors on high school completion, namely, place of residence and family socioeconomic status as measured by parental education and household income. Hence, early sexual debut adds another layer of inequality and worsens the plight of Africans, females, those living in rural areas and those who come from low-income families.

This study examines the prevalence and determinants of adolescents' unintended pregnancy and induced abortion in Owerri, Nigeria. A pre-coded questionnaire was used to obtain information from 540 female adolescents of mean age 15.8 years. In addition, four FGDs were held with female adolescents in selected localities and in-depth interviews held with fifteen health-care service providers. Almost all the adolescents (99.8%) were Christians, with 70.3% being Catholics and 68.2% living with their parents. Over half (57.2%) of the adolescents had had sex. Contraceptives were rarely used owing to deep-seated cultural values. The data show that 31.6% of those who had ever had sex had an unintended pregnancy. Of these, 78.9% had recurrent pregnancies and 20.2% had an abortion. Of the latter, 41.8% had a recurrent abortion and 72.7% a post-abortion problem, for which 70.2% never sought treatment, increasing the risk of infertility in later life. The abortion seekers mostly went to patent medicine operators. A more acceptable and cost-effective contraceptive campaign involving use of local vernacular and traditional/local opinion leaders should be explored.

In its recently adopted Global Strategy on Infant and Young Child Feeding, the World Health Assembly called for urgent action in addressing the barriers to optimal feeding practices. This paper examines mothers’ concerns about milk insufficiency as a major contributor to suboptimal infant feeding decisions, using survey data from periurban areas of two Bolivian cities. Mothers in the lowland modernizing city of Santa Cruz were more likely than mothers in the highland traditional city of Cochabamba to express concern about insufficient milk, and also less likely to feed their infants according to international recommendations. Furthermore, perceived milk insufficiency was particularly common among mothers of infants younger than 6 months of age – an age at which infants are particularly vulnerable to the adverse effects of breast-feeding cessation and complementary feeding initiation. The paper concludes with policy, programme and research recommendations to address the critical problem of perceived insufficient breast milk.

This paper reports a pilot study of thirteen children with epilepsy and their families; the parents' efforts to obtain help for the child and the effect of the child's disability on the family relationships are described. About half of the parents did not consult the family doctor immediately after the first appearance of signs of epilepsy (patient delay). About a quarter of the family doctors delayed referral of the patient with epilepsy to the specialist (doctor's delay). Another 3 years passed, on average, before the patient reached a special centre or clinic for epilepsy (specialist delay); in three-quarters of all cases the first step to get there was taken by the parents and not by the specialist and chance plays an important role in determining how the entry into this third echelon is achieved. Reasons for the search for more specialized help were: dissatisfaction with the results of the treatment and the kind of rapport with the second echelon specialist. The out-patient clinic for epilepsy is generally favourably commented on because the expert medical advice is combined with the availability of a social worker, thus offering support with social problems also. As regards the influence of the illness on the family, there is evidence that family life is disrupted to a greater or less extent. The parents experience psychological stress and are generally apprehensive lest something will happen to their child. In a number of cases the relationships between siblings are rather disturbed. The parents, especially mothers, tend to (over-)protect the child with epilepsy. The child with epilepsy has a relatively isolated position in his social environment; he has few informal or formal social contacts with his peer group. The condition epilepsy contributes to a diminution of expectations for the future and curtailment of scholastic behaviour.

The incidence of obesity, defined as the fraction of persons with BMIs exceeding 30·0, was examined in two birth cohorts of 40–50-year-old occupationally active inhabitants of the city of Wrocław, Poland. In both cohorts and both genders obesity increased monotonically with decreasing position on a three-level educational scale. During the 1986–1996 decade obesity increased dramatically among males with trade school education only; concomitant shifts were much smaller or absent in the college-educated groups. The contrast in obesity between the opposite ends of the educational scale has widened markedly in both genders; and the between-gender gap has declined somewhat.

Botswana is one of the sub-Saharan countries where actual fertility has declined. This study examines the fertility preferences of both men and women and shows that fertility intentions have a significant influence on future fertility behaviour. Fertility preferences are relatively low and there is no significant difference between those of men and women. Men's preference for sons influences desired family size and eventual fertility. For women as well as men, child survival is an important factor. Women's income is also influential.

The status of women, which is relative and multidimensional, has an important bearing on any long-term reduction in fertility. In Indian society, where cohabitation and childbearing are socially sanctioned only after marriage, the length of the first-birth interval affects the completed family size by influencing the spacing and childbearing pattern of a family. This study examines the influence of certain aspects of the status of married women – education, employment, role in family decision making, and age at marriage – along with three socioeconomic variables – per capita income of the family, social position of the household, and the caste system – on the duration of the first-birth interval in an urban Hindu society of the north-east Indian state of Assam. The data were analysed by applying life table and hazard regression techniques. The results indicate that a female's age at marriage, education, current age, role in decision making, and the per capita income of the household are the main covariates that strongly influence the length of the first-birth interval of Hindu females of urban Assam. Of all the covariates studied, a female's education appears to be a key mediating factor, through its influence on her probability of employment outside the home and thereby an earned income and on her role in family decision making. Unlike other Indian communities, the effect of the caste system does not have a significant effect on first-birth timing in this urban Hindu society.

The aim of this study was to assess whether women’s empowerment ensures reduced intimate partner violence (IPV). The differential relationship between women’s empowerment and IPV among married women in Bangladesh was investigated using 2007 Demographic and Health Survey data. Logistic regression models were used to assess whether women’s empowerment had any influence on their likelihood of experiencing IPV while controlling for other covariates. The analyses revealed that older cohorts of women, who were more empowered, were more vulnerable to physical violence than less-empowered, younger women. The likelihood of being affected by physical violence among less-empowered, childless women was greater than that of more-empowered women with only male children. Less-empowered, uneducated women were more likely to experience physical violence than more-empowered, primary-educated women. Less-empowered women who had been married for less than 5 years were more likely to suffer from physical violence than more-empowered women who had been married for more than 19 years. The likelihood of experiencing sexual violence was not found to have any significant association with women’s empowerment. The findings suggest that although women’s empowerment in Bangladesh is gradually improving, some sub-groups of empowered women are still susceptible to IPV.

Based on data obtained from the marriage registers of seven Oxfordshire parishes in the Otmoor region, an analysis has been made of the effects of social mobility and marriage exchanges on the relatedness of the five social classes which are recognized by the Registrar General. From a starting position in which it is assumed that there was no relatedness between the classes, it is calculated that under the average social mobility patterns which have characterized the area from 1837 to 1967 the different social classes would come to share 95% of their ancestry in sixteen generations. The marriage movement would produce the same levels of relatedness in twenty generations, and the combined effects of social mobility and marriage produce homogeneity in nine generations. It is further argued that these are maximal estimates but in considering the genetic implications it is noted that, whilst genes which do not affect social mobility and marriage movement are not likely to show social stratification in Otomoor populations, genes affecting behavioural traits may well be heterogeneously distributed.

This study examined the nutritional status of mothers in one of the most populous food-insecure zones in southern Ethiopia, the Sidama zone. The study used primary data collected from 1094 households with a child under 24 months located in ten kebeles (the smallest administrative district). Households were selected using multi-stage probability sampling techniques. The mothers' nutritional status was estimated using both body mass index (BMI) and mid-upper-arm circumference (MUAC). The results from the BMI analysis revealed that 28.1% of the women were malnourished (BMI <18.5) and 67.5% were normal (BMI 18.5 to <25.0), while the remaining small proportion (4.5%) fell in the overweight or obese categories. Similarly, the computation of maternal nutritional status by MUAC analysis showed that 31.4% of the women were malnourished (MUAC <22). Further analysis of the main predictors of maternal malnutrition using logistic regression showed that three individual-level variables and three household-level variables predicted maternal malnutrition: woman's age, duration of breast-feeding, literacy status, marital form, land size and intra-household food distribution. The study concludes that maternal malnutrition is a serious problem in the study area and that there are contextual risk factors that could be addressed to partially tackle the problem.

Analysis of the 1992 Niger Demographic and Health Survey showed that although roughly two-thirds of both polygamous and monogamous women approve of birth control, polygamous wives are less likely than monogamous wives to discuss family size or birth control with their husband or to plan on using birth control. The study suggests that characteristics of polygamous couples have caused polygamous women to be more resistant to birth control use than monogamous women. The polygamous women tended to be married to older men who had not gone to primary school and who desired more children than monogamous husbands. The influence of marital structure is not significantly associated with intention to use birth control when the husband's age and the wife's ideal number of children were controlled for in the multivariate logistic regression model suggesting that background social factors may be more influential. In fact, educational level and age at first marriage were significantly associated with attitudes towards birth control and also with marital structure.

With declining levels of international donor funding for financing reproductive health programmes, developing country governments and international donors are looking towards private sector strategies to expand the supply of quality reproductive health services. One of the challenges of a health franchise is to improve the quality of services provided by independent private practitioners. Private providers are more likely to abide by the quality standards set by a franchiser if they see a financial benefit resulting from franchise participation. This study was conducted to measure whether (a) there were improvements in perceived quality of care and perceived access to health facilities once these facilities became part of a franchise and (b) improvements in perceived quality and perceived access were associated with increased client loyalty to franchised clinics. Franchisees were given basic reproductive health training for seven days and services marketing training for two days. Exit interviews were conducted with male and female clients at health facilities. A pre-test measurement was taken in April 2001, prior to the start of project activities. A post-test measurement was taken in February/March 2002, about 9 months after the pre-test. Multilevel regression analysis, which takes the hierarchical structure of the data into account, was used for the analysis. After taking provider-level variation into account and controlling for client characteristics, the analyses showed significant improvements in perceived quality of care and perceived access to services. Private provider participation in a franchise network helps improve client perceptions of quality of, and access to, services. Improvements in client perceptions of quality and access contribute to increased client loyalty to franchised clinics. Once increased client loyalty translates into higher client volumes, providers are likely to see the benefits of franchise participation. In turn, this should lead to increased provider willingness to remain part of the franchise and to abide by the standards of quality set by the franchiser.

Improved child health and survival are considered universal humanitarian goals. In this respect, understanding the nutritional status of children has far-reaching implications for the better development of future generations. The present study assessed, first, the nutritional status of children below 5 years using the three anthropometric measures weight-for-age, height-for-age and weight-for-height in two states of India, Kerala and Goa. Secondly, it examined the confounding factors that influence the nutritional status of children in these states. The NFHS-I data for Kerala and Goa were used. The results showed that the relative prevalence of under-weight and wasting was high in Kerala, but the prevalence of stunting was medium. In Goa, on the other hand, the relative prevalence of wasting and underweight was very high, and that of stunting was high. Both socio-economic and family planning variables were significantly associated with malnutrition in these states, but at varied levels. The study recommends more area-specific policies for the development of nutritional intervention programmes.

A significant increase occurred in the initiation and duration of breast-feeding among Honduran women between 1981 and 1987. Changes in population characteristics (e.g. level of education of women) would be expected to lead to a decrease in breast-feeding at each infant age, but these were offset by behavioural changes that led to an increase in the likelihood of initiation and continuation of breast-feeding. An exploration of relevant factors suggests that the PROALMA breast-feeding promotion programme has had a profound effect on the breast-feeding behaviour of Honduran mothers.

Isolation of human populations, leading to genetic divergence, is well documented in island settlements and religious isolates. Demonstration or measurement of isolation is more difficult in mainstream populations. An attempt has been made to assess such isolation by simple methods of aggregate analysis from readily available data. The limitations of the data and methods of analysis are fully appreciated, but it seems that differences between areas are detectable. Hence the methods, simple as they are, warrant further application to other communities. The analyses, both of surnames and of marriage movement data, indicate limited gene flow in Northumberland in the 18th century. Such gene flow as did occur came mainly from neighbouring communities, and there was very little long-distance inflow. There was thus a high degree of population constancy and localization in Northumberland in the 18th century. This could well be a contributory factor promoting the known genetic variability of the area.

The objective of this study was to identify the key determinants of condom use with regular and casual partners among youth in Madagascar. Data stem from a reproductive health survey conducted in October–December 2000 among a representative sample of 2440 youth aged 15–24 living in Toamasina province. Following theoretical models of behaviour change, logistic regression was used to assess the effect of AIDS awareness, personal risk perception, condom access, perceived condom effectiveness, self-efficacy and social support on condom use. Among sexually experienced youth, only about four in ten males and two in ten females have ever used condoms. Fewer than 15% of youth used a condom in last intercourse with their regular partner. Whether youth will try condoms appears to depend largely on the perceived effectiveness of condoms for family planning, access to a nearby condom source, parental support for condom use, and patterns of risky sexual behaviour. Young males’ likelihood of using a condom with a regular partner increases significantly if they perceive condoms to be effective for family planning (OR=11·4; p=0·019). For females, it increases with level of self-efficacy (OR=2·1; p=0·042) and having discussed HIV prevention with someone in the last year (OR=2·8; p=0·022). Among males, condom use with casual partners is significantly higher among those who perceive themselves to be at high risk of sexually transmitted infections (OR=2·3; p=0·014), who believe condoms are effective for family planning (OR=2·8; p=0·048), who have good access to condoms (OR=2·9; p=0·002) and who perceive their parents support condom use (OR=1·7; p=0·048). In conclusion, very few youth in Toamasina are using condoms, highlighting the need to continue and expand adolescent reproductive health interventions. In this low HIV prevalence setting, it is important for these programmes to emphasize that condoms are effective for both pregnancy prevention and STI/HIV prevention.

There is now fairly substantial evidence of a socioeconomic gradient in low birth weight for developed countries. The standard summary statistic for this gradient is the concentration index. Using data from the recently published Growing Up in Ireland survey, this paper calculates this index for low birth weight arising from preterm and intrauterine growth retardation. It also carries out a decomposition of this index for the different sources of low birth weight and finds that income inequality appears to be less important for the case of preterm births, while father's education and local environmental conditions appear to be more relevant for intrauterine growth retardation. The application of the standard Blinder–Oaxaca decomposition also indicates that the socioeconomic gradient for low birth weight appears to arise owing to different characteristics between rich and poor, and not because the impact of any given characteristic on low birth weight differs between rich and poor.

The association between breast-feeding patterns and resumption of menses post-partum was examined in a longitudinal study initiated in March 1976 in Bangladesh. Information on suckling patterns and menstrual status was collected on 148 breast-feeding women who were still amenorrhoeic at 17–25 months post-partum at the beginning of the study. Suckling was measured during an 8-hr period once a month for up to 19 months of follow-up.

A high frequency of suckling was found, even at this late post-partum duration. Total suckling time and the number of suckling episodes declined with the age of the child but the mean duration of each episode did not change. The fact that regression analyses did not show a correlation between suckling patterns and return of menses post-partum may be related to the large individual variations in suckling patterns and in the duration of amenorrhoea in this population, and the need to study suckling patterns for longer than 8 hr per day.