A study was made of 126 new attenders at the Edinburgh FPA clinic for single women during its first year of operation. Nulliparous patients were only half as likely to have been referred from a medical source as the parous patient. The higher the social class the greater the likelihood of discussion about contraception between patient and doctor before a visit to this FPA centre. The study population was geographically very mobile. Higher social classes and students were as likely to report experience of previous sexual intercourse than others. At least 24% of patients had a very limited knowledge of contraceptive methods. Forty per cent of patients returned for a follow-up visit and older women and nulliparous women were less likely to return than others. Although most returning patients had experienced regular sexual intercourse since their first visit, 15% had not found this entirely satisfactory, and 32% had had difficulties with the prescribed method of contraception, chiefly the oral contraceptive. When compared for the same period with the city's other clinic offering contraceptive advice to single women, 24% of all attenders at both clinics had been to the FPA. The proportion of parous women at the FPA was twice that at the Brook Clinic, but Brook patients were much more likely to have already received contraceptive advice from a doctor. Discussion centres on the social-class bias in the population of attenders.

The Second Taiwan IUD Follow-up Survey, reported on here, is a representative sample of all IUD acceptors in Taiwan up to the middle of 1966. The data show that 30 months after insertion, 36% of acceptors are continuing users, on a first segment basis, and that if reinsertions are taken into account, the proportion increases to 45%. Compared with extensive clinic data from the city of Taichung, the island-wide termination rates are about 5% higher at 30 months, for first segments, but the all segment rates show little difference at this duration.

Termination rates by social and demographic characteristics show that these rates decline with increasing age and parity, as expected. Sizable differentials in these rates were also found when acceptors were classified as to their purpose in using an IUD—for limiting or spacing—and as to their desire for more children. These effects were partially independent of age and parity. These ‘motivational’ variables were used in cross-tabulations to show how they might clarify the effect of age and parity, as well as to derive a number of other implications for the evaluation and operation of a family planning programme. The effects of education, urban-rural residence, and prior use of contraception, on IUD termination are studied in some detail by cross-classifying these characteristics with age and with one another.

Lastly, this study presents reinsertion rates in relation to a number of social and demographic factors. The rate of reinsertion is seen to depend on the type of termination and, taking this into account, to be generally inverse to the patterns of termination by social and demographic characteristics.

In a sample of 282 marriages in New Nubia in Egypt, 39% were between first cousins and 21% between less closely related kin. The average number of liveborn offspring in first-cousin marriages was higher than in marriages between more distant relations and unrelated spouses, but the number of deaths among children of first-cousin couples was also higher.

A study has been made from parish records of the patterns of marital movement from 1837 to the present day in the Otmoor region of Oxfordshire. The social classes of brides and grooms have been taken into account.

It is shown that the spatial mobility of the different classes is markedly different, and in the earlier part of the period this difference is evident even on a very local scale. Social class distributions themselves vary according to population size and this variation affects the nature of marital exchange between the different populations in the area. Spatially exogamous as compared with endogamous grooms, however, do not appear to differ in their preferences for the social class of brides. There is marked assortative marriage for social class in Classes II and IV but both brides and grooms of Class III, especially in the present century, choose their partners more or less randomly with respect to social class.

A high incidence of multiple births has been reported in an area of New Britain where there is no evidence that birth control is practised. Analysis failed to confirm Edwards' observation that the average size of the sibship after birth of twins varies with the sex of the twins. Repeated twinning occurred in 14% of women who had given birth to twins. No significant differences were found in birth intervals before and after twins but mothers of twins were more fertile, judged by the total number of pregnancies, than comparable women without twins. Mortality was greater among the twins than among the singletons and was greater among females than among males. The development of health services in the area has reduced mortality significantly.

101,220 births in urban areas and 147,331 in rural areas in India, recorded by interview from a 10% sample of households in 3888 villages and 2357 urban blocks, have been analysed. The overall sex ratio was similar to that found in Europe; the only obvious effect of birth order was an apparent high masculinity of first births in both urban and rural areas (probably artifactual); the distribution of the sexes in families in both areas differed somewhat from the binomial expectation; and there was no association between the sexes of pairs of children from adjacent births, but some in the case of pairs separated by one other birth in urban areas or by two other births in rural areas.

The results of measurements of triceps and subscapular skinfold thicknesses in over 7000 businessmenare presented. Mean subscapular skinfold thickness, taken just below the point of the right shoulder blade, increases, while mean triceps skinfold thickness, taken at the outer side of the upper arm, decreases with age. The evidence suggests that the increase in the subscapular skinfold thickness is a reflection of the increase in weight with age when adjusted for height; on the other hand, the fall in triceps skinfold thickness in the older age groups may be due to a cohort effect. The inference, that the subscapular measurement or perhaps the difference between the two measurements are better indications of obesity in middle-aged businessmen than the triceps measurement, is supported by other published data.

From part of a survey conducted in five European countries, Belgium, France, Great Britain, Italy and West Germany, data are given on the opinions of 4207 fertile married women and their husbands on ideal family size and on whether their existing children were planned or not. Data are tabulated according to the respondents' ages and the number of children in their existing families. Differences and similarities between various countries are discussed.

From 1959 to 1969 the annual number of petitions for divorce in England and Wales increased by 133%, and the rate of divorce per 1000 married population increased by an estimated 100%. Traditional explanations for the historical increase in divorce, relying on such factors as increased legal and financial opportunity, wartime disturbances and demographic changes, seem inappropriate to deal with recent experience, and it is proposed that normative changes are involved. Cohort analysis suggests that the marriages of the 1960s are more vulnerable to early divorce than those of the 1939/45 war, and that this vulnerability was increasing throughout the period. It seems likely that earlier divorce also implies higher proportions ultimately divorcing.

Total marriage breakdown is impossible to quantify because some separations are informal and leave no record. However, a formula is proposed for totalling divorce petitions and matrimonial proceedings in the lower courts to calculate annual numbers of breakdowns newly coming to public notice. Calculations based on this show an increase in annual numbers of 75% over the period, and of 65% in the rate, thus demonstrating that divorce figures alone give a false impression of trends in marriage breakdown. Although the rates and numbers of unrecorded breakdown are unknown, and may be diminishing, it is concluded that breakdown is probably increasing in volume among contemporary marriages. On the basis of speculative estimates it is also suggested that perhaps one sixth to one quarter of contemporary marriages may ultimately experience some form of breakdown.

The question is posed whether the increases shown represent a generational effect, due to pass, or a new pattern of high manifest breakdown rates. On the basis of trends in the indices of various forms of valueorientated personal behaviour (including divorce), it is suggested that from about 1955 onwards new patterns of behaviour began to emerge. The causation of such patterns is attributed to social structural changes developing since the was which have fostered a more permissive approach to personal behaviour. It is concluded that these trends have influenced the norms of marriage behaviour, and that relatively high rates of marriage breakdown will henceforth be an integral feature of social experience.

One hundred and fifty-two randomly selected pregnant women were examined and followed up by interviews and psychological tests during pregnancy and after parturition. The present paper is focused upon factors which determine the woman's preference for the sex of her expected child. It was shown that women who already have one or more children generally wanted the expected child to be of the opposite sex to her youngest child. Thus, the main part of the study was limited to eighty-one nulliparous women.

Associations were found between the woman's preference for the sex of the child and several factors such as the sex of her own siblings and her position among them, her education, intelligence and degree of field-dependence indicating immaturity and lack of autonomy.

Several of the findings presented refute the common supposition that nulliparous women generally want to give birth to a son, and that the arrival of a son is more satisfactory. Women wishing for a son were found to be somewhat more field-dependent than other women and somewhat more often reported that they had experienced a range of mental symptoms before the current pregnancy. Women wishing for a boy also reported more mental symptoms during the post-partum period. Moreover, those women who gave birth to a son reperted more symptoms at this time than those who gave birth to a daughter, and paradoxically the most affected were those who had wished for a son and had had their wishes fulfilled. The arrival of a daughter therefore seems to be equally satisfactory to the mother, at least as measured by the criteria used in this investigation.

A study was made of twinning rates in mothers of different ethnic origin delivered in two hospitals in Ibadan, Nigeria; the great majority were of Western Nigerian origin. The twinning rates in mothers of Western, Eastern, Mid-Western and Northern Nigerian origin were 45, 45, 31 and 21/1000 maternities, respectively. The monozygotic twinning rates determined by sex, placentation, blood groups and other genetically determined markers in the different ethnic groups varied very little, the differences in the overall twinning rates being mainly due to variation in the dizygotic rates. The effect of factors such as hospital selection and maternal age and parity on the observed incidence of twinning is discussed.

Using a large special study population and refined indicators of socio-economic status, the relationship of the live birth sex ratio to socio economic variables is examined. The analyses provide control for the possible confounding effects of race and birth order.

The sex ratio is shown to be significantly and positively associated with socio-economic variables. The relationship is not linear, however, but instead is characterized by an apparent ‘diminishing returns’ curve. The major increase in sex ratio is detected as socio-economic status increases from low to moderate. No significant change occurs between moderate and higher socio-economic levels.

Even after controlling for the significant socio-economic effect, the analyses detect a significant difference between the sex ratios of Whites on the one hand and Negroes and Puerto Ricans on the other.

No significant association between birth order and the sex ratio can be detected in the study population.

The findings relating to marriage and fertility of the National Survey of 1960 Graduates show that highly-educated people are on the whole no exception to the generally observed principle of social and educational endogamy. Those from working-class homes, however, marry overwhelmingly into the middle class, so that marriage here constitutes a means of consolidating newly-won status. Respondents on the whole tended to delay marriage and family building while still engaged in full-time study, but more graduates are ultimately marrying and are doing so at younger ages than ever before. There are also certain consistent differences between the sexes, which indicate that women graduates are much more susceptible than men to the delaying influences on marriage and family building of the continued exposure to higher education.

The title I have been asked to discuss is the Coordination' of Reproductive Processes and this implies that there are many structures and functions to be coordinated. Text-fig. 1 gives a general idea of what these structures and functions are. The basal region of the brain, known as the hypothalamus, is played upon by many stimuli from the external environment acting through different nerve tracts. The hypothalamus in turn regulates, through a system of small vessels, the secretory activity of the anterior pituitary gland, which for the purposes of reproduction secretes two or three gonadotrophic hormones into the bloodstream. These hormones are very largely, if not entirely, responsible for maintaining the activity of the ovary and the testis, and for varying and regulating the processes going on in the gonad. The gonad in turn secretes into the bloodstream simpler steroid hormones, which act upon the reproductive tract and the mammary glands.

This paper consists of an edited translation of the greater part of an article by Dr Braestrup published in Ugeskr. Læger, 1970, 132, 232, under the title ‘Unge modres t'iden oni og benyttelse af antikonception’. In view of the current interest in young mothers, especially unmarried ones, and of the importance of Dr Braestrup's contribution to the subject, it seemed desirable to make available as widely as possible the information contained in her paper. The Executive Editor is grateful to Dr Braestrup for permission to re-publish it in English and for providing the translation.

Summary Information about mothers under the age of 21 years in Copenhagen, in 1959 and 1968, was collected, reviewed and compared. The age distribution of the mothers was similar in the two surveys, but the fathers were younger in 1968. In that year, 84% of the married mothers had been pregnant before marriage; 90% of the married mothers and 35% of the unmarried ones had their own flats.

Knowledge and use of suitable methods of contraception showed a considerable increase during the period. In 1968, 90% of the married mothers and about 62% of the unmarried mothers had made use of contraception before pregnancy. The great majority seeking advice had done so from general practitioners while others, before or after pregnancy, had attended maternity welfare or family planning clinics.

Motivation to employ contraception, however, was only slight and approximately two-thirds of these very young mothers stated that they did not wish to avoid pregnancy. Only 15% of the married and 21% of the unmarried mothers were in favour of free abortion.

Daily records are the only acceptable basis for determining human coital rates. A re-analysis of such data presented by earlier writers and a study of new data suggest that within the intermenstruum (viz. the days on which there is no bleeding) the rate of coitus is highest immediately after menstruation ceases, declines thereafter and is lowest (within the intermenstruum) just before menstruation recurs.

It is not clear whether there is a minor peak around ovulation time, but such a correlation, if it exists, is certainly not very powerful.

The major cause of the higher coital rate after menstruation could be abstinence during menstruation and a post-menstrual feeling of release on the part of the woman.

The fact that coital rates are largely independent of the time of ovulation might be due to their being largely determined by the male. In any case, it provides evidence for Morris's view that human sexuality has important evolutionary functions other than reproduction.

Editorial note. The material presented below was originally recorded in an article by Dr Hall in Cuadernos Medico-Sociales, 10, 1969. This Chilean medical journal is published in Spanish and is relatively inaccessible in Europe. In view of the interest and importance of the attitude of the male to family planning, especially perhaps of the South American male, it seemed desirable to bring Dr Hall's findings to the attention of a wider audience. The paper which follows is a revised version of the original English text from which the Spanish translation was prepared. I am much obliged to Dr Hall for her cooperation.

A survey of 584 men in Santiago and 217 men in an adjacent rural area showed that:

(1) Men were favourable to family planning, both in their own personal relationships and for other adults. In all socio-economic strata, more respondents favoured giving information to men than women. It is suggested that male support be enlisted in efforts to reduce induced abortions.

(2) Men favoured giving contraceptive information to youths of both sexes. The family planning programme, therefore, could provide information to adolescents at a time when attitudes toward sex are developing.

(3) There was wide agreement that family planning education be discussed in schools ‘in accordance with the age of the children.’ There is thus an opportunity for the schools to help children develop a system of values within the framework of widely available effective contraception.