In recent years Vietnam has experienced a high sex ratio at birth (SRB) amidst rapid socioeconomic and demographic changes. However, little is known about the differentials in SRB between maternal socioeconomic and demographic groups. The paper uses data from the annual Population Change Survey (PCS) in 2006 to examine the relationship of the sex ratio of the most recent birth with maternal socioeconomic and demographic characteristics and the number of previous female births. The SRB of Vietnam was significantly high at 111.4 (95% CI 109.7–113.1) for the period 1st April 2000 to 31st March 2006. Multivariate analysis reveals that sex of the most recent birth is strongly related with the number of previous female births. This association is consistent across different socioeconomic and demographic groups of women. Given the high SRB in Vietnam, further research into the reasons for high SRB in these groups is required, as are intervention programmes such as those raising the public awareness of its negative consequences.

From March 2007 to March 2008 a cross-sectional study was conducted in Qatar to estimate the prevalence of consanguinity among Qataris and to assess their knowledge of the risks and their attitudes towards the practice. A secondary objective was to test the acceptability of sixteen Likert-style questions within the Qatari population. Face-to-face interviews using a 70-item structured questionnaire were conducted by three native Arabic-speaking medical students with 362 Qatari employees. Where consanguinity existed between the employee's parents, a diagram of the consanguinal relationship (phylogram) was completed. The response rate was 93%. By phylogram, 22% of participants reported a cousin relationship between their parents (consanguinal relationship) and another 15% reported that their parents were from the same tribe (affinal relationship). With respect to their own marital decision, 68% of the respondents had been married at least once. By phylogram, 35% of these reported a consanguineous relationship (first marriage), 9% reported only an affinal relationship and 56% reported that they were not married to a blood relative. Results on the sixteen Likert-style attitude questions were stratified by consanguinity status of parents and of self. In the stratification by consanguinity status of parents the top five attitudes differed by group but there appeared to be more similarity between the consanguinal and only tribal groups. Attitudinal results were stratified by sex. Results showed that the males had a stronger belief in several of the attitudes than females with the exception of causation of genetic abnormalities and health problems. The phylogram was shown to collect more detailed and explicit data than hard-coding. With respect to knowledge, the results showed that knowledge was imperfect with high proportions of participants not knowing that consanguinity has been implicated in autosomal recessive diseases such as thalassaemia, inborn errors of metabolism, deafness, anomalies of the extremities and specific congenital heart defects. Additionally, a sizeable proportion of the participants did not know that a more distant cousin marriage (e.g. third cousin) theoretically could be a less genetically risky choice to potential offspring than a closer cousin marriage (half-first cousin). These results indicate that more effort needs to be made in developing public health strategies to improve the population's understanding of the cost-benefit analysis involved in contracting consanguineous marriages given the goal of healthy offspring.

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.

Counselling on contraception and contraceptive method provision are key components of post-abortion care (PAC). Some studies have suggested that adolescent PAC patients receive worse care than older women seeking these services. This study aimed to evaluate an intervention whose goal was to improve the counselling and contraceptive uptake of PAC patients, with special attention given to the needs of adolescent patients, in the four public hospitals in the Dominican Republic where PAC services were not being routinely offered. The counselling intervention effort included provider training and the development of adolescent-friendly information, education and communication (IEC) materials. Eighty-eight providers were interviewed at baseline and 6 months after the intervention was implemented. Six months after providers were trained, 140 adolescent PAC patients (≤19 years of age) and 134 older PAC patients (20–35 years) were interviewed about the contraceptive counselling messages and contraceptive methods they received before they were discharged from hospital. The adolescent and older PAC patients were matched on study hospital and time of arrival. Significant improvements were noted in provider knowledge and attitudes. No changes were noted in provider-reported PAC counselling behaviours, with close to 70% of providers reporting they routinely assess patients' fertility intentions, discuss contraception, assess STI/HIV risk and discuss post-abortion complications. Adolescent and older PAC patients reported receiving PAC counselling messages at similar rates. Forty per cent of adolescent PAC patients and 45% of older PAC patients who wanted to delay pregnancy were discharged with a contraceptive method. Adolescents were more likely to receive an injectable contraceptive method whereas older women were discharged with a variety of methods. The PAC counselling intervention increased provider knowledge and improved their attitudes and benefited both adolescent and older patients.

Nearly a quarter of the world's neonatal deaths take place in India. The state of Uttar Pradesh alone accounts for one-quarter of all neonatal deaths in the country. In this study 892 married women aged less than 50 years living in a peri-urban area of Kanpur city in Uttar Pradesh were interviewed. In all, 109 women reported neonatal deaths. Characteristics of the last neonatal deaths of these 109 women were compared with those of the last surviving children. Also, characteristics of women who had a neonatal death were compared with those of 783 women who had no neonatal death. It was found that as compared with neonatal deaths, the last surviving children of the 109 women had: (a) significantly better antenatal tests during pregnancy, intake of iron/folic acid tablets and higher percentage of tetanus toxoid immunization; (b) safer delivery practices such as a higher percentage of institutional delivery, sterilization of instruments and application of antiseptic after removal of umbilical cord; (c) postnatal care, such as application of antiseptic to the navel and postnatal checkups; and (d) higher maternal age and greater birth spacing. Likewise, better antenatal care and safer delivery practices and postnatal care were observed among the 783 women with no neonatal deaths, when compared with women who had experienced neonatal death. The complexities of inter- and intra-household differences in health care are discussed. The paper concludes that to improve child survival general education and awareness regarding safe delivery should be increased. Continuing cultural stigmas and misconceptions about birth practices before, during and after childbirth should be an important part of the awareness campaigns.

Men's participation in perinatal care (PNC) is a promising strategy for improving maternal health. This study aimed to assess the educational needs of men for their participation in PNC. This is a qualitative research study using focus group discussions. These were performed with eight groups of men and women in selected hospitals of Shahid Beheshti Medical Science University, Iran. Data were analysed using qualitative content analysis methodology. The majority of participants gave the ‘emotional support of women’ as the most appropriate form of men's participation in PNC, and the ‘long working hours of men’ as the main barrier. The majority would prefer men's education to be about ‘emotional support’, ‘physiological changes’ and ‘signs of risks’ during pregnancy. The participants emphasized the need to consider couples' requirements when selecting the place, time and duration of education.

Sex ratios at birth are known to change during wars or shortly after. This study investigated changes in sex ratios during the civil war that occurred in Tajikistan after the dismantling of the Soviet Union. This civil war was particularly bloody and long lasting, and had many demographic consequences. According to vital registration data, some 27,000 persons died in excess of previous trends during the civil war period (1992–1997), and total mortality was sometimes estimated to be three times higher by independent observers. Birth rates dropped markedly during the war, and sex ratios at birth increased significantly from 104.6 before the war to 106.9 during the war, to return to baseline values afterwards. The change in sex ratio is investigated according to demographic evidence (migration, delayed marriage, spouse separation), substantiated with qualitative evidence (difficulties with food supply), and compared with patterns found in Europe during World War II, as well as with recent wars in the Middle East.

This study evaluated the prevalence of overweight and obesity in the male Sardinian population (Italy), and verifies that it has increased over the last 30 years. Data were collected during 2003–2004 from military registers in the Archive of the Military District of Cagliari for the years 1969 and 1998. A total of 22,345 forms were analysed from all Sardinia. The conscripts were classified on the basis of their place of residence and socioeconomic status. The overall prevalence of overweight and obesity in Sardinia were 4.33% and 0.55%, respectively, for the conscripts of 1969 and 9.8% and 3% for 1998. Olbia-Tempio (northern Sardinia) was the province with the highest incidence of overweight and obesity in 1969, and Nuoro (central Sardinia) had the highest incidence in 1998. Distribution of body mass index, overweight and obesity across the island showed a statistically significant heterogeneity that strongly decreased from 1969 to 1998. Among the conscripts of 1969, the incidence of overweight and obesity were higher in rural than in urban regions. An opposite trend was observed for the 1998 prevalence, it being more frequent in urban than rural regions. Comparison with other Italian regions was made. The percentages of overweight and obese individuals in Sardinia have markedly increased during the last 30 years, but their low incidence with respect to other Italian populations could be explained by the genetic peculiarity of the island. The change in the internal distribution of obesity clearly reflects socioeconomic changes.

Reducing China's population has formerly been considered a good thing because of the perceived environmental and social risks of overpopulation, but it has recently become apparent that the resulting population decline may create problems that will become increasingly serious in the future. The results of a survey of 4600 women in nineteen Chinese provinces in 2005 indicated that young age, high income, high education level, urban location and good employment all decreased a woman's willingness to bear children. The risks created by declining fertility in these groups have been intensified by China's ‘one child’ family planning policy. However, as a result of current trends and China's policies, the country's population will continue to age, leading to social problems and difficulties for sustainable development both in China and around the world. Therefore, China's policy-makers must begin planning to adjust their policy by encouraging women to give birth to more than one child.

Scientists commonly use world average data on sex ratio at birth for India for want of dependable ones. Here an attempt is made to redress the problem to some extent. It is shown that this ratio has been high in India since the 1950s. The ratio has been strikingly high, even prior to the time of inception of prenatal sex identification technologies. The ratio shows a rising trend due to several biological reasons. In addition, it has been rising sharply for a couple of decades due to some socio-medical factors. The natural sex ratio at birth in India is noticeably higher than the world average.

Although a growing body of research has linked religious involvement with HIV/AIDS protective behaviour in Africa, the focus has mainly been on women. Given the patriarchal nature of African culture, this paper argues for the inclusion of men, a critical group whose sexual behaviours have increasingly been linked to the spread and sustenance of the virus in the region. Drawing on different theoretical discourses and using data from the 2003 Ghana Demographic and Health Survey, this paper examines how religious affiliation influences men's risky sexual behaviours. While the results from the bivariate analysis suggested that Muslims and Traditionalists were significantly less likely to engage in risky sexual behaviour compared with Christians, those differences disappeared once socioeconomic variables were controlled, rendering support for the selectivity thesis. This finding could benefit programmatic and policy formulation regarding AIDS prevention in Ghana.

The aim of this study was to assess the variation in student body height, weight and BMI in relation to several socioeconomic factors. Data (collected in 1998) were obtained through a structured questionnaire from 2800 students (1023 men and 1777 women) from Wrocław Universities, Poland. Information on students' age, reported height and weight and their place of residence prior to starting university, the number of siblings and parents' education were collected. Students with mothers or fathers with higher education had, on average, higher mean heights, but after correcting for other socioeconomic variables only place of residence showed a significant association with height and BMI, with those living in medium or large urban centres having a higher mean height and those living in small or medium urban areas having a lower mean BMI.

This paper examines the experiences of women with infertility in two Nigerian communities with different systems of descent and historically different levels of infertility. First, the paper focuses on the life experiences of individual women across the two communities and second, it compares these experiences with those of their fertile counterparts, in each community. In doing this, women who are childless are distinguished from those with subfertility and compared with high-fertility women. The research is based on interdisciplinary research conducted among the Ijo and Yakurr people of southern Nigeria, which included a survey of approximately 100 childless and subfertile women and a matching sample of 100 fertile women as well as in-depth ethnographic interviews with childless and subfertile women in two communities: Amakiri in Delta State and Lopon in Cross River State. The findings indicate that while there are variations in the extent to which childlessness is considered to be problematic, the necessity for a woman to have a child remains basic in this region.

Excess weight is becoming widespread in Spain due to changes in nutritional habits and lifestyles. Previous studies on this issue have focused on specific Spanish regions, subpopulations or relatively short time spans. This study analysed sex, age and cohort trends in the prevalence of adult overweight and obesity over the last two decades by applying a demographic methodology. Data came from the Spanish National Health Surveys that were held between 1987 and 2006. The respondent's demographic characteristics and self-reported height and weight were aggregated to a single dataset in order to analyse changes in weight and BMI by age and sex, over time and within and between quasi birth-cohorts. After correcting for sample bias and coding errors a total sample of about 100,000 subjects aged 20–79 was obtained. The results show that between 1987 and 2006 adult males and females increased their average weight by 8.2% and 2.8%, respectively. While among younger adults this is partly explained by height increases, prevalence in excess weight increased among 50- to 79-year-old males. Persons of the same 10-year age group but of a more recent 10-year quasi birth-cohort had a BMI that was 0.2–0.8 points higher. BMI increases were lower for women and mainly affected 60–79 year olds. In fact, even decreases were observed for 40- to 49 and 50- to 59-year-old women. Potential explanatory factors are discussed.

Over the past century, the population of Korea has aged rapidly as a result of decreasing fertility and mortality. Furthermore, the percentage of the population aged 65 and older is expected to double from 7% to 14% within 18 years, a much shorter doubling period than in most other developed countries. As Korean society ages, interest in healthy and successful ageing has increased. However, although previous studies have examined various determinants of successful ageing, such as socioeconomic status, gender differences have been neglected. This study investigated gender differences as factors in successful ageing among elderly men and women. Successful ageing has been defined as having high levels of physical and social functioning. Physical functioning includes having no difficulties with activities of daily living (ADL) or instrumental activities of daily living (IADL). Social functioning is defined as participation in at least one of the following social activities: paid work, religious gatherings or volunteer service. Data for this study were obtained from a representative sample of 761 community-living individuals aged 65–84 years (340 males, 421 females); the respondents were interviewed face-to-face as part of the third wave of the Hallym Ageing Study (2007). Socioeconomic status appears to have a greater gender-specific effect on physical functioning than on social functioning. Especially for elderly men, a higher monthly individual income was significantly related to a higher level of physical functioning. Among elderly women, a higher level of education was associated with a higher level of physical functioning. In a major metropolis, elderly men had low social functioning and elderly women had low physical functioning. As Korea's population ages, successful ageing has received much attention. This study shows that policies promoting successful ageing must consider gender differences and associated socioeconomic factors.

Maternal mortality persists in low-income settings despite preventability with skilled birth attendance and emergency obstetric care. Poor access limits the effectiveness of life-saving interventions and is typical of maternal health care in low-income settings. This paper examines access to care in obstetric emergencies from the perspectives of service users, using established and contemporary theoretical frameworks of access and a routine health surveillance method. The implications for health planning are also considered. The final caregivers of 104 women who died during pregnancy or childbirth were interviewed in two rural districts in Indonesia using an adapted verbal autopsy. Qualitative analysis revealed social and economic barriers to access and barriers that arose from the health system itself. Health insurance for the poor was highly problematic. For providers, incomplete reimbursements, and low public pay, acted as disincentives to treat the poor. For users, the schemes were poorly socialized and understood, complicated to use and led to lower quality care. Services, staff, transport, equipment and supplies were also generally unavailable or unaffordable. The multiple barriers to access conferred a cumulative disadvantage that culminated in exclusion. This was reflected in expressions of powerlessness and fatalism regarding the deaths. The analysis suggests that conceiving of access as a structurally determined, complex and dynamic process, and as a reciprocally maintained phenomenon of disadvantaged groups, may provide useful explanatory concepts for health planning. Health planning from this perspective may help to avoid perpetuating exclusion on social and economic grounds, by health systems and services, and help foster a sense of control at the micro-level, among peoples' feelings and behaviours regarding their health. Verbal autopsy surveys provide an opportunity to routinely collect information on the exclusory mechanisms of health systems, important information for equitable health planning.

Using a methodology similar to that proposed by Barro & Sala-i-Martin (1995), it is found that, in the period 1990–2006, there was strong convergence among state-level life expectancy series, but a distancing in life expectancy in the Mexican Republic compared with more developed countries, especially during the new millennium. The interior convergence had taken place at the expense of the exterior; that is, not so much as a result of an improvement in living conditions in the poorer states, but more due to the low performance of the richer states. The causes of this situation are explained using the concept of ‘epidemiological transition’.

The strong association of very low birth weight (VLBW; <1500 g) with infant mortality is well known. There are no data related to VLBW trends in Brazil although findings from some large surveys carried out in small- and medium-sized cities have demonstrated an increase in low birth weight (LBW; <2500 g) rates over the last 30 years. The aim of this study was to evaluate the secular trend of VLBW in the city of Porto Alegre, a large city in a developed area in southern Brazil, and the potential determinants of this trend during the 1990s and early 2000s. This is a registry-based study. Data were obtained from birth certificates of all live births in the city from 1994 to 2005. The variables analysed were: VLBW as the dependent variable and maternal age and schooling, type of delivery, type of hospital, number of live births, gestational age, newborn gender and unemployment rate. The incidence ratio rate (IRR) using Poisson regression was calculated to identify possible trends in VLBW rates. Poisson regressions were performed in order to assess the influence of some independent variables on VLBW. A total of 257,740 singleton newborns were delivered in the city during the period, with a steady reduction in the total number of live births per year from 23,296 in 1994 to 18,325 in 2005. The results showed a small but significant increase in VLBW (p for trend=0.049). There was a significant trend towards adequacy for gestational age per birth weight, suggesting a reduction in rates of intrauterine growth restriction (IUGR) (p<0.001). The findings showed a significant increase of 1% per year in the probability of VLBW. The main risk factors were related to VLBW mothers with low levels of schooling, public hospitals and multiparity and nulliparity. After adjustment, nulliparity remained as a significant risk factor. The interaction between type of hospital and type of delivery indicated that the probability for VLBW was 3.6 times higher (p<0.001) among those born in public hospitals by Caesarean section than those born in private hospitals by vaginal delivery. The results show that southern Brazil is going through a demographic transition characterized by a significant decrease in number of live births associated with a small increase in VLBW rates, a decrease in IUGR rates and stabilization of LBW.

This study assessed gender and rural/urban differences in height and weight, and the prevalence of stunting, underweight and overweight of school-going adolescents in south-west Nigeria, using 2007 WHO reference values for comparison. The influence of sexual maturity and the socio-demographic correlates of growth performance were also examined. In this cross-sectional study, 924 male (51.4%) and 875 female (48.6%) students (1799 in total) aged 10–19 years from eighteen schools in Ibadan (five rural, nine urban public and four urban private) were interviewed and examined. Although males were significantly taller than females (p<0.05), stunting was more pronounced for males, who were 7.5 cm shorter than the 2007 WHO reference, compared with females who were 3.5 cm shorter. Body mass index (BMI) for girls was also greater than for boys (p<0.05). Rural adolescents had lower heights and BMIs compared with those in urban areas. The mean height of male adolescents in rural schools fell below 2 SDs of the 2007 WHO reference between 14 and 17 years, while heights of males and females in private schools were similar to the median 2007 WHO standard. Low height-for-age was observed in 282 adolescents (15.7%), which, after multivariate analysis, was significantly associated with school type, gender, number of mother's children and puberty onset. Adolescents in rural schools were much more likely to be stunted than those in urban private schools (AOR 13.1; 95% CI 5.2–33.2) and males were three times more likely to be stunted compared with females (AOR 3.3; 95% CI 2.4–1.4). Low BMI-for-age was observed in 240 adolescents (18.9%), with correlates similar to stunting. Adolescents at the pre-puberty stage were twice as likely to have low BMI-for-age (OR 2.0; 95% CI 1.6–2.5) than those with signs of puberty. There were 2.3% overweight adolescents, who were significantly more likely to be female, in private school and post-pubertal. Innovative interventions for Nigerian adolescents, especially rural inhabitants and males, are needed to reduce the prevalence of stunting and underweight.

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.