Until recently there has been a paucity of factual data on the effects of the climacteric upon women's sexuality. The basic questions here are: do changes occur in sexual behaviour, sexual interest or responsiveness during the climacteric years? If so, what are the variations and how are they caused?

Two variables used extensively as a measure of sexuality are coital frequency and orgasmic frequency. Kinsey et al. (1953) showed that the degree of sexual activity remained fairly constant in unmarried women up to 55 years of age. By contrast, sexual activity in unmarried men declined gradually from puberty onwards. For married men and women they found that the frequency of sexual outlets declined during the life span. Kinsey et al. emphasized that the decreasing frequency of sexual intercourse and orgasm in marriage does not prove that the sexual capacity of the woman is influenced by her own ageing but could instead be a result of her husband's ageing. These authors were of the opinion that there is little evidence of any ageing in the sexual capacity of the female until late in her life.

This study examines whether mortality of two adjacent siblings in families is age-specific and is modified by the MCH–FP programme and fertility and mortality declines in Matlab, Bangladesh, using data for singleton births during 1977–78, 1985–86 and 1989–90 in the treatment (MCH–FP) and comparison areas. Logistic regression was used to estimate the net effects of survival status of elder siblings on mortality of younger siblings in the neonatal, postneonatal and toddler periods, controlling for birth order, previous birth interval, maternal age, education and religion, household possession of valuable items and sex of the child.

Odds of neonatal and postneonatal deaths of younger siblings were found to be higher if the elder sibling had died at the same age than if the sibling had survived infancy. Toddler mortality was lower if the elder sibling had died in infancy. The association between two siblings' mortality risks did not decline over time in either area. The results suggest that a family history of child deaths by age is important to identify when subsequent infants would be at a higher risk of dying.

A majority of Zambian children live in impoverished communities that lack safe water and proper sanitation, exposing them to urogenital and intestinal helminths. Efforts to mitigate this plight have been implemented through mass drug administration aimed at deworming school-age and under-five children against schistosomiasis and soil-transmitted helminths. However, the disease status of adults living in the same communities as the treated children remains unknown. The aim of this study was to describe the potential contribution of infected adult populations to the transmission of these infections in southern Zambia. A cross-sectional study was conducted in April and May 2013 as part of baseline survey for a larger study in Mazabuka and Siavonga Districts. Stool and urine samples of 2829 adults from five catchment areas were collected and processed using Kato-Katz and urine filtration methods, respectively. Adults from Siavonga had a 13.9% combined prevalence of Schistosoma haematobium and S. mansoni, and 12.1% combined prevalence of Ascaris lumbricoides and hookworm. There was no S. mansoni in Mazabuka, and only a 5.3% prevalence of S. haematobium and 7.4% combined prevalence of A. lumbricoides and hookworm. Additionally, no Trichuris trichiura infections were observed in the two districts. Despite most of these infections being categorized as light intensity, heavy infection intensities were also found for all four parasite species. If this infected adult population is left untreated, the possibility of it acting as a reservoir of infections and ultimately transmitting the infections to treated children remains. Therefore, there is need to consider alternative treatment strategies that incorporate adults, thereby reducing the risk of contaminating the environment and perpetuating transmission to children.

The prevalences of hypertension, diabetes and overweight/obesity are increasing in most developing countries, including Bangladesh. Although earlier studies have investigated the factors associated with these three conditions, little is known about whether socioeconomic status is associated with their co-existence. This cross-sectional study analysed data from the 2011 Bangladesh Demographic and Health Survey. An individual was considered hypertensive, diabetic and overweight/obese if their systolic/diastolic blood pressure, fasting plasma glucose concentration, and body mass index were ≥130/80 mmHg, ≥7 mmol/l and ≥23 kg/m2, respectively. Furthermore, individuals who reported taking anti-hypertensive and anti-diabetic drugs were also considered as hypertensive and diabetic, respectively. Two socioeconomic variables were investigated: education level and household wealth quintile. Descriptive analyses and multilevel logistic regression were conducted. Among the 7932 respondents (50.5% female) aged ≥35 years, the prevalences of hypertension, diabetes, overweight/obesity, any one condition and the co-existence of the three conditions were 48.0%, 11.0%, 25.3%, 60.9% and 3.6%, respectively. In adjusted analysis, individuals with secondary (adjusted odds ratio [AOR]: 1.8, 95% confidence interval [CI]: 1.2–2.8) and college or above (AOR: 3.6; 95% CI: 2.2–5.7) education levels had higher odds of the co-existence of all three conditions compared with those with no formal education. Similarly, compared with the poorest wealth quintile, the richer (AOR: 4.6; 95% CI: 2.2–9.4) and richest (AOR: 11.8; 95% CI: 5.8–24.1) wealth quintiles had higher odds of co-existence of these three conditions. Education and wealth quintile also showed significant relationships with each of the three conditions separately. In conclusion, in Bangladesh, hypertension, diabetes and overweight/obesity are associated with indicators of higher socioeconomic status. These findings highlight the importance of developing healthy lifestyle interventions (e.g. physical exercise and dietary modification) targeting individuals of higher socioeconomic status to minimize the burden of these non-communicable diseases.

The paper looks at the limitations and strengths of using the A-cope questionnaire for measuring strategies for coping with prolonged conflict by Palestinian young people in Gaza. The scale was administered to young people between the ages of 8 and 17. The results show some gender differences in coping strategies. However, some items on the subscales are not relevant for Muslim societies or societies in situations of prolonged conflict. The authors suggest that combining an anthropological contextual perspective and qualitative data with psychological instruments is an effective way of addressing the limitations of using a single quantitative method of assessment in non-Western complex social and cultural settings.

Beliefs about child illness were investigated using semi-structured interviews with mothers and providers in four rural Guatemalan communities. The two most common forms of child illness in Guatemala – diarrhoea and respiratory disease – were focused upon. These illnesses are particularly difficult to prevent and treat, especially with the rudimentary health services available in rural areas of developing countries. Comparisons with other ethnographic studies in Guatemala suggest that some traditional models of illness causation identified in these earlier investigations are relatively unimportant in the communities studied here. This finding, in conjunction with frequent responses related to hygiene and water, suggests that traditional explanations may be co-existing with biomedical views of illness causation to a greater degree today than in the past.

Women who bear a child in their teens differ in their childhood, adolescent and adult experiences from their peers who delay childbearing until later ages. Within the group of teenage mothers the background characteristics associated with and the consequences of pregnancy status at first birth are discussed.

Bangladesh represents one of the few countries in south Asia where the pace of fertility decline has been unprecedented over the last three decades. Although there has been significant reduction in fertility levels at the national level, regional variations continue to persist, especially in Sylhet and Chittagong where the total fertility rates are well above the country average. Using data from three consecutive Bangladesh Demographic and Health Surveys (BDHSs) this paper assesses how fertility patterns in Sylhet and Chittagong differ from the rest of Bangladesh through a marriage cohort analysis of the parity progression ratios, and examines the factors determining the transition rates to higher parity in these two regions. Three cohorts of women are identified: those married during 1965–1974, 1975–84 and 1985–94. The results show that the probability that a woman from the recent cohort in Sylhet or Chittagong who had a third birth will have a fourth birth is nearly twice that of her counterpart in other regions. Social characteristics such as education, occupation, religion and residence have no effect on fertility in Sylhet and Chittagong. Additional period-specific analyses using the 2007 BDHS data show that women in Sylhet are considerably more likely to have a third or fourth birth sooner than those in other divisions, especially Khulna. The findings call for specific family planning policy interventions in Sylhet and Chittagong ensuring gender equity, promoting female education and delaying entry into marriage and childbearing.

The prevalence and determinants of primary caesarean section in Jamaica were estimated from a survey of women aged 14–49 years. Among 2328 women reporting 2395 live hospital births during the period January 1984 to May 1989, the prevalence of caesarean section was 4·1%. Repeat caesarean sections accounted for 1·3% of the hospital births during that period. Of the medical complications studied, prolonged labour and/or cephalopelvic disproportion carried the highest risks of primary caesarean section, followed by breech presentation, maternal diabetes, a high birth-weight baby, maternal hypertension, and a low birth-weight baby. The risk of primary caesarean section increased with maternal age, decreased with parity, was higher for urban than for rural residents, and was higher for births in private versus government hospitals.

Obesity is pandemic, but no consensus has yet emerged regarding appropriate tools for measuring it. Medical research based on populations in the developed world has largely dismissed body mass index (BMI) because it is a weak predictor of some health outcomes. In contrast, social science research still relies on it for its simplicity and ready availability in surveys. This paper uses consistent definitions and measures to select sufficiently good predictors of health and economic outcomes from among the anthropometrics that are considered alternatives to BMI. The results from the Indonesian Family Life Survey indicate that BMI and waist circumference are better predictors than waist-to-height ratio and waist-to-hip ratio. This paper argues that given its advantages, BMI is an adequate measure of obesity for Indonesia and possibly for the developing world. Further, if BMI is to be replaced, waist circumference is preferable to other anthropometrics.

The aim of this study was to examine the positive relationship between religiosity and fertility from the perspective of perceived consequences of parenthood. Previous studies in Germany have found that highly religious people ascribe higher benefits and lower costs to having children. Furthermore, the impact of costs and benefits on fertility is less pronounced among the highly religious. This study tested these mechanisms for fertility intentions and in the context of Poland – a country with a low fertility rate and high religiosity in comparison to other European countries. A sample of 4892 men and women of childbearing age from the second wave of the Polish version of the Generations and Gender Survey conducted in 2014/2015 was used. First, the extent to which perceived costs and benefits mediate the impact of religiosity on fertility intentions was analysed. Second, whether religiosity moderates the impact of perceived costs and benefits on fertility intentions was investigated. The results show that part of the positive effect of religiosity on fertility intentions can be explained by more-religious people seeing higher benefits of having children. Furthermore, but only in the case of women, religiosity moderates the impact of perceived costs on fertility intentions, suggesting that the effect of perceived costs decreases with increasing religiosity.

Summary. With the rapid pace of the nutrition transition worldwide, understanding influences of child feeding practices within a context characterized by the co-existence of overweight and undernutrition in the same population has increasing importance. This qualitative study describes Brazilian mothers’ child feeding practices and their perceptions of their association with child weight status and explores the role of socioeconomic, cultural and organizational factors on these relationships. Forty-one women enrolled in the Family Health/Community Health Workers Programme were selected from rural, urban, coastal and indigenous areas in Ceara State, north-east Brazil, to participate in four focus group discussions. Content analysis identified fourteen emergent themes showing mothers’ child feeding practices in this setting were influenced by economic resources, mothers’ immediate social support networks (e.g. neighbours and family members) and participation in nutrition assistance programmes. Child malnutrition was the most common nutritional concern; nevertheless, mothers were aware of the negative health consequences of obesity but misunderstood its causes (e.g. foods filled with fat would make a person fat; others thought that birth control pills and stimulants given to children were causes of obesity); several reported their own struggles with overweight. Food assistance programmes emerged as an important influence on children’s dietary adequacy, especially among mothers describing dire economic situations. The findings have implications for targeting food assistance as well as health and nutrition education strategies in low-income families undergoing the nutrition transition in north-east Brazil.

According to official census returns from Roman Egypt (first to third centuries CE) preserved on papyrus, 23·5% of all documented marriages in the Arsinoites district in the Fayum (n=102) were between brothers and sisters. In the second century CE, the rates were 37% in the city of Arsinoe and 18·9% in the surrounding villages. Documented pedigrees suggest a minimum mean level of inbreeding equivalent to a coefficient of inbreeding of 0·0975 in second century CE Arsinoe. Undocumented sources of inbreeding and an estimate based on the frequency of close-kin unions (corrected downwards to 30% for Arsinoe) indicate a mean coefficient of inbreeding of F=0·15-0·20 in Arsinoe and of F=0·10-0·15 in the villages at the end of the second century CE. These values are several times as high as any other documented levels of inbreeding. A schematic estimate of inbreeding depression in the offspring of full sibling couples indicates that fertility in these families had to be 20-50% above average to attain reproduction at replacement level. In the absence of information on the amount of genetic load in this population, this estimate may be too high

The basal body temperature was recorded by 1353 healthy fertile women aged 18 to 49 years inclusive through 12,247 cycles. The post-ovulatory (hyperthermic) phase of the cycle was significantly longer by 1·31 days in cycles with a slow or staircase rise of temperature than in cycles with an acute rise. The hyperthermic phase increased in length in a rectilinear fashion from 10 to 13 days as the total cycle length rose from 22 to 29 days; over total cycle lengths from 29 to 33 days the length of the hyperthermic phase remained around 13 days.

The human menstrual cycle is characterized by a series of dynamic hormonal relationships that result in the regular maturation of ovarian follicles, ovulation and corpus luteum formation. As methodology has changed and improved, it has become possible to examine these events in greater detail. The simple analysis of menstrual cycle length, when done with care in a large number of women over long time spans, has revealed much about the fundamental biological rhythm of the menstrual cycle. Of particular interest are the predictable changes in cycle length and variability that occur at different stages of reproductive life (Treloar et al., 1967; Vollman, 1977). Basal body temperature records add another dimension to the analyses of menstrual cycle length because they permit estimation of the length of the pre- and post-ovulatory phases of the menstrual cycle and provide some index of the integrity of corpus luteum function.

Japanese and British 9-year-old children were compared on the standard progressive matrices and twelve reaction time parameters providing measures of simple and complex decision times, movement times and variabilities. The mean of the Japanese children on the progressive matrices exceeded that of the British children by 0·65 SD units and on the decision times component of reaction times by 0·50 SD units, suggesting that the high Japanese mean on psychometric intelligence is largely explicable in terms of the more efficient processing of information at the neurological level. Japanese children also showed faster movement times but, contrary to expectation, had greater variabilities than British children.

Utilization of antenatal care (ANC) services, as part of reproductive health care, presents a lifesaving chance for health promotion and the early diagnosis and treatment of illnesses throughout pregnancy. This study examines the factors associated with the number and timing of ANC visits among married women in Cameroon using data from the 2018 Cameroon Demographic and Health Survey. The outcome variables were number of ANC visits, categorized as <8 visits or ≥8 visits, and the timing of first ANC visit, categorized as ≤3 months (early) or >3 months (late) (as per the new 2016 WHO recommendations). Descriptive statistics and binary logistic regression were used to analyse the data. Crude odds ratios (cOR) and adjusted odds ratios (aOR) and p-values with significance at <0.05 were used to interpret the results. The proportions of women who had ≥8 ANC visits and first ANC visit at ≤3 months gestation were 6.3% and 35.6% respectively. Women aged 35–39 at childbirth (aOR=3.99, 95% CI=1.30–12.23), middle wealth quintile women (aOR=3.22, 95% CI=1.01–10.27), women whose husbands had secondary (aOR=7.00, 95% CI=2.26–21.71) or higher (aOR=16.93, 95% CI=4.91–58.34) education were more likely to have ≥8 ANC visits. Early timing of first ANC visit was low among women with birth order 3–4 (aOR=0.63, 95% CI=0.46–0.85). Conversely, the likelihood of having early ANC visits was high among women whose pregnancies were intended (aOR=1.32, 95% CI=1.01–1.74), the richest women (aOR=3.89, 95% CI=2.30–6.57) and women whose husbands had secondary (aOR=2.41, 95% CI=1.70–3.64) or higher (aOR=3.12, 95% CI=2.40–7.46) education. The study highlights that age at childbirth, wealth, husband’s educational attainment, birth order and pregnancy intention could influence the utilization of ANC services among married women in Cameroon. Hence, to improve attendance and early initiation of ANC, interventions should be targeted at empowering women financially and removing all financial barriers associated with accessing ANC, improving ANC education among women and encouraging male involvement in ANC education.

This study analyses factors associated with the incidence of sterilization regret in the four south Indian states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Using data from the National Family Health Surveys, in all four states the incidence of regret was found to be less than 10% and the factors significantly associated with it were child loss experience and quality of services. Hence, there is a need to improve the quality of services, both in terms of counselling and service provision, and women need to be counselled about the permanent nature of sterilization in order to avoid future regret.

Factors resulting in high risk for cardiovascular disease have been well studied in high income countries, but have been less well researched in low/middle income countries. This is despite robust theoretical evidence of environmental transitions in such countries which could result in biological adaptations that lead to increased hypertension and cardiovascular disease risk. Data from the South African Birth to Twenty cohort, Bone Health sub-sample (n=358, 47% female), were used to model associations between household socioeconomic status (SES) in infancy, household/neighbourhood SES at age 16 years, and systolic blood pressure (multivariate linear regression) and risk for systolic pre-hypertension (binary logistic regression). Bivariate analyses revealed household/neighbourhood SES measures that were significantly associated with increased systolic blood pressure. These significant associations included improved household sanitation in infancy/16 years, caregiver owning the house in infancy and being in a higher tertile (higher SES) of indices measuring school problems/environment or neighbourhood services/problems/crime at 16 years of age. Multivariate analyses adjusted for sex, maternal age, birth weight, parity, smoking, term birth, height/body mass index at 16 years. In adjusted analyses, only one SES variable remained significant for females: those in the middle tertile of the crime prevention index had higher systolic blood pressure (β=3.52, SE=1.61) compared with the highest tertile (i.e. those with the highest crime prevention). In adjusted analyses, no SES variables were significantly associated with the systolic blood pressure of boys, or with the risk of systolic pre-hypertension in either sex. The lack of association between SES and systolic blood pressure/systolic pre-hypertension at age 16 years is consistent with other studies showing an equalization of adolescent health inequalities. Further testing of the association between SES and systolic blood pressure would be recommended in adulthood to see whether the lack of association persists.

Bangladesh has been passing through a crucial phase of fertility transition. The level of fertility declined dramatically during the early 1990s without any remarkable improvement in socioeconomic and health status, and then remained constant at a high level of 3·3, despite the increased use of contraception. Such fertility transition can be traced to variations in one or more of the proximate or direct determinants of fertility. This paper critically analyses the fertility levels in Bangladesh with a view to exploring the possible explanations of fertility decline in the 1990s and then its stabilization. The main focus of the study is to examine the role of the major proximate determinants of fertility in bringing about the change in fertility level in Bangladesh. The data for the study come from a series of nationally representative surveys over the period of 1975 to 1999–2000. The analysis indicates that fertility has temporarily ceased to decline in recent years due to the ‘tempo’ effect of high past fertility, but in general a declining trend in fertility is underway. The analysis suggests that the fall in fertility is consistent with the underlying trends in most important proximate determinants of fertility. In recent years contraception has emerged as the highest fertility reducing factor in Bangladesh and its effect is greatest in middle and older age groups. Although until the early 1990s postpartum lactational infecundability was the most important and strongest fertility reducing factor in Bangladesh, in recent years its fertility inhibiting effect has gradually decreasing owing to the declining trend in the lactational infecundability period. The analysis reveals that although the fertility reducing effect of the marriage pattern is increasing, its effect is offset by the declining trend in the lactational infecundability period. A review of these two variables suggests that their effect cannot be raised much for prevailing socioeconomic and cultural reasons, and any future reduction in fertility in Bangladesh may be largely dependent on increased use of effective birth control methods.