Promoting men’s involvement in antenatal care (ANC) requires an understanding of their views on how they ought to be involved. Their involvement in ANC services can help in reducing delay in deciding to seek care and facilitate women’s access to skilled antenatal services. This study sought to determine men’s views and knowledge on, and challenges to, involvement in ANC services in Tanzania. The cross-sectional study was carried out in four districts of Dodoma Region in November 2014 and June 2016. A multi-stage sampling strategy was used to select the study respondents. Data were collected by interviewing 966 men using a structured questionnaire. Univariate, bivariate and multivariate logistic regression analyses were used to examine the association between men’s involvement in ANC services and their background characteristics. About 63.4% of respondents accompanied their partners to ANC services. Men’s view was that they can be involved through accompanying their partner to ANC clinics and providing money for health services. Men who had poor knowledge on ANC services were two times less likely to be involved in ANC services. Similarly, long waiting times at the antenatal clinics decreased the likelihood of service utilization by their partners. Men from a two-income household were more likely to be involved in ANC services than men from households where the men’s earnings were the only source of income. Challenges encountered by men during attendance at ANC services included: perception of antenatal clinics as places only for women, financial difficulties, influence of peer pressure and lack of time due to occupational demands. There is a need to establish community outreach ANC services that offer couple-friendly services in Tanzania. Also, it is crucial to have a policy for men’s involvement in maternal health care that addresses cultural practices that hinder men’s involvement in ANC services.

As progress to eliminate trachoma is made, addressing hard-to-reach communities becomes of greater significance. Areas in Tanzania, inhabited by the Maasai, remain endemic for trachoma. This study assessed the effectiveness of Mass Drug Administration (MDA) through an ethnographic study of trachoma amongst a Maasai community. The MDA experience in the context of the livelihoods of the Maasai in a changing political economy was explored using participant observation and household interviews. Factors influencing MDA effectiveness within five domains were analysed. 1) Terrain of intervention: Human movement hindered MDA, including seasonal migration, domestic chores, grazing and school. Encounters with wildlife were significant. 2) Socio-cultural factors and community agency: Norms around pregnancy led women to accept the drug but hide refusal to swallow the drug. Timing of Community Drug Distributor (CDD) visits conflicted with livestock grazing. Refusals occurred among the ilmurrani age group and older women. Mistrust significantly hindered uptake of drugs. 3) Strategies and motivation of drug distributors: Maa-speaking CDDs were critical to effective drug delivery. Maasai CDDs, whilst motivated, faced challenges of distances, encounters with wildlife and compensation. 4) Socio-materiality of technology: Decreases in side-effects over years have improved trust in the drug. Restrictions to swallowing drugs and/or water were relevant to post-partum women and the ilmurrani. 5) History and health governance: Whilst perceptions of the programme were positive, communities questioned government priorities for resources for hospitals, medicines, clean water and roads. They complained of a lack of information and involvement of community members in health care services. With elimination in sight, hard-to-reach communities are paramount as these are probably the last foci of infection. Effective delivery of MDA programmes in such communities requires a critical understanding of community experiences and responses that can inform tailored approaches to trachoma control. Application of a critical social science perspective should be embedded in planning and evaluation of all NTD programmes.

Although developing countries are experiencing some of the fastest rises in the prevalence of adult overweight and obesity, little is known about the pace of the problem among young people in transition from adolescence to adulthood. This study examined the trend and associated socio-demographic predictors of overweight/obesity (BMI ≥25kg/m2) from 1993 to 2014 among women aged 15–24 years in Ghana and projected the future prevalence from 2019 to 2040. Descriptive statistics, the arithmetic linear change model, and binary logistic regression were applied to data on women aged 15–24 years from five nationally representative Ghana Demographic and Health Surveys conducted in 1993 (N=488), 1998 (N=517), 2003 (N=1832), 2008 (N=1693) and 2014 (N=1491). Overall, overweight/obesity among women aged 15–24 years almost tripled between the 1993 (6.8%; 95% CI=4.9–9.3) and 2014 (19.5%; 95% CI=17.3–21.2) surveys. Based on the arithmetic linear change model, overweight/obesity is projected to increase linearly to over 35% among the 15–24 year cohort of women by 2040. Age, educational level, wealth status, occupation, type of locality, ethnicity, frequency of viewing TV per week, parity and contraceptive use were found to be significant predictors of overweight/obesity among this sub-group of women. The trend of overweight/obesity demonstrated in this group of women could potentially provide momentum for further increases in the prevalence of overweight/obesity and associated health outcomes in the coming years in Ghana. This underscores the need for urgent national-level public health intervention efforts to curtail the problem.

Maternal education plays a central role in children’s health and nutrition. Living conditions and socioeconomic status are linked with mother’s education, which in turn determines the health and development of a child. The Composite Index of Anthropometric Failure (CIAF) is a single indicator that reflects overall rate of three conventional indices of undernutrition: underweight, stunting and wasting. The study was undertaken among 621 rural Bengalee children (308 boys and 313 girls) aged 3–12 years from the Purba Medinipur district of West Bengal, India. Height (cm) and weight (kg) were recorded and NCHS standard values used to calculate z-scores (<–2SD). The same data were used to calculate CIAF as an indicator of ‘anthropometric failure’ (AF) or undernutrition. The prevalence of AF among the children was 59.40%. Chi-squared analysis was employed to evaluate the significance of differences in the prevalence of CIAF between the sexes and the association between nutritional indicators and socioeconomic parameters in the two sexes. Multiple binary logistic regression (MBLR) analyses (including the forward stepwise method) were also performed. Odds ratios with 95% confidence intervals were used to assess the risk of having AF. Results showed that mother’s education was significantly associated with undernutrition (AF) controlling for the other factors considered. A very high prevalence of undernutrition is persisting in this region of India despite national nutritional supplementation programmes being operational. More attention to the improvement of living conditions and hygiene, and more particularly the education of women, in this population might be effective in attaining improved child growth and health.

From 1989 to 2014, Iran was known as a country with a successful family planning programme, and has experienced a sharp decline in fertility over recent decades. This led to the introduction of pronatalist policies in 2014 and the restriction of family planning services. The aim of this study was to explore men’s views on their access to contraceptive information and services and the socio-cultural barriers to such access in Tehran. The qualitative study was conducted in 2014 using in-depth interviews with 60 married men of varying ages and socioeconomic status from across Tehran. The data were analysed with a basic interpretive approach using MAXQDA10. Although the majority of the men acknowledged the importance of family planning and contraceptive use, they reported that their access to contraceptive information and services was limited. Discussion of sexual matters and contraception among men was identified as being somewhat embarrassing. Three main issues were identified: (1) men’s poor awareness of contraceptive use; (2) men’s poor access to high-quality health care services; and (3) cultural taboos and gender norms as barriers to contraception use by men. Socio-cultural and gender norms were found to significantly affect the men’s contraceptive use. The study results support the growing call for gender-transformative approaches to family planning and reproductive health service delivery in Iran, to involve men and facilitate their greater participation.

Gender disparities are pronounced in Zomba district, Malawi. Among women aged 15–49 years, HIV prevalence is 16.8%, compared with 9.3% among men of the same age. Complex structural factors are associated with risky sexual behaviour leading to HIV infection. This study’s objective was to explore associations between multilevel measures of economic resources and women’s empowerment with risky sexual behaviour among young women in Zomba. Four measures of risky sexual behaviour were examined: ever had sex, condom use and two indices measuring age during sexual activity and partner history. Multilevel regression models and regression models with cluster-robust standard errors were used to estimate associations, stratified by school enrolment status. Among the schoolgirl stratum, the percentage of girls enrolled in school at the community level had protective associations with ever having sex (OR = 0.76; 95% CI: 0.60, 0.96) and condom use (OR = 1.06; 95% CI: 1.01, 1.11). Belief in the right to refuse sex was protective against ever having sex (OR = 0.76; 95% CI: 0.60, 0.96). Participants from households with no secondary school education had higher odds of ever having sex (OR = 1.59; 95% CI: 1.14, 2.22). Among the dropout stratum, participants who had not achieved a secondary school level of education had riskier Age Factor and Partner History Factor scores (β = 0.51; 95% CI: 0.23, 0.79, and β = 0.24; 95% CI: 0.07, 0.41, respectively). Participants from households without a secondary school level of education had riskier Age Factor scores (β = 0.26; 95% CI: 0.03, 0.48). Across strata, the most consistent variables associated with risky sexual behaviour were those related to education, including girl’s level of education, highest level of education of her household of origin and the community percentage of girls enrolled in school. These results suggest that programmes seeking to reduce risky sexual behaviour among young women in Malawi should consider the role of improving access to education at multiple levels.

Post-abortion care (PAC) integrates elements of care that are vital for women’s survival after abortion complications with intervention components that aid women in controlling their fertility, and provides an optimal window of opportunity to help women meet their family planning goals. Yet, incorporating quality family planning services remains a shortcoming of PAC services, particularly in low- and middle-income countries. This paper presents evidence from a mixed method study conducted in Tanzania that aimed at explaining factors that contribute to this challenge. Analysis of data obtained through client exit interviews quantified the level of unmet need for contraception among PAC clients and isolated the factors associated with post-abortion contraceptive uptake. Qualitative data analysis of interviews with a subset of these women explored the multi-level context in which post-abortion pregnancy intentions and contraceptive behaviours are formed. Approximately 30% of women interviewed (N=412) could recall receiving counselling on post-abortion family planning. Nearly two-thirds reported a desire to either space or limit childbearing. Of those who desired to space or limited childbearing, approximately 20% received a contraceptive method before discharge from PAC. The factors significantly associated with post-abortion contraceptive acceptance were completion of primary school, prior use of contraception, receipt of PAC at lower level facilities and recall of post-abortion family planning counselling. Qualitative analysis revealed different layers of contextual influences that shaped women’s fertility desires and contraceptive decision-making during PAC: individual (PAC client), spousal/partner-related, health service-related and societal. While results lend support to the concept that there are opportunities for services to address unmet need for post-abortion family planning, they also attest to the synergistic influences of individual, spousal, organizational and societal factors that influence whether they can be realized during PAC. Several strategies to do so emerged saliently from this analysis. These emphasize customized counselling to enable client–provider communication about fertility preferences, structural intervention aimed at empowering women to assert those objectives in family and health care settings, availability of information and services on post-abortion fertility and contraceptive eligibility in PAC settings and interventions to facilitate constructive spousal communication on family planning and contraceptive use, after abortion and in general.

This study aimed to assess the changes in neonatal and infant mortality rates in Nigeria over the period 1990 to 2018 using Nigerian Demographic and Health Survey (NDHS) data, and assess their socio-demographic determinants using data from the most recent survey conducted in 2018. The infant mortality rate was 87 per 1000 live births in 1990, and this increased to 100 per 1000 live births in 2003 – an increase of around 15% over 13 years. Neonatal and infant mortality rates started to decline steadily thereafter and continued to do so until 2013. After 2013, neonatal morality rose slightly by the year 2018. Information for 27,465 infants under 1 year of age from the NDHS-2018 was analysed using bivariate and multivariate analysis and the Cox proportional hazard technique. In 2018, infant deaths decreased as wealth increased, and the incidence of infant deaths was greater among those of Islam religion than among those of other religions. A negative association was found between infant deaths and the size of a child at birth. Infant mortality was higher in rural than in urban areas, and was higher among male than female children. Both neonatal and infant death rates varied by region and were found to be highest in the North West region and lowest in the South region. An increasing trend was observed in neonatal mortality in the 5-year period from 2013 to 2018. Policy interventions should be focused on the poor classes, women with a birth interval of less than 2 years and those living in the North West region of the country.

Evidence suggests that socio-cultural barriers that limit the ability of women in sub-Saharan Africa to make decisions regarding contraceptive use and childbearing contribute to the slow uptake of contraception in this region. This paper explores factors influencing women’s decisions regarding contraceptive uptake, switching and discontinuation, and the implications of those decisions for family planning programmes. Data were from in-depth interviews that were conducted in 2018 with 42 women who participated in a longitudinal research project implemented in Homa Bay County of Kenya. Participants comprised women who were aged 15–39 years at the time of recruitment into the study and who discontinued using injectables or implants between the first and second rounds of data collection. Data were analysed using an exploratory inductive content analytic approach. The findings show that uptake of contraception was largely driven by concerns about the negative consequences of frequent childbirth on individual health and household socioeconomic well-being. Most women discontinued methods because of dissatisfaction but, instead of abandoning contraception altogether, switched to alternative methods, albeit sometimes less-effective ones. However, some women had difficulties in identifying an appropriate new method after experiencing side-effects, contraceptive failure or stock-out of their current method. Securing the cooperation of sexual partners was an additional problem especially for women whose partners did not support contraception. The findings suggest that concerns about the negative consequences of frequent childbirth outweigh challenges associated with contraceptive use. This presents an opportunity for family planning programmes to improve contraceptive uptake and continuation by addressing the health system challenges related to commodity stock-out and poor quality of care, as well as the concerns of men.

This study examined the nature and correlates of child marriage in eight villages in climate-affected coastal Bangladesh using a mixed-methods approach: focus group discussions and in-depth qualitative interviews of female victims of child marriage as well as quantitative data collected using structured interviews of households. More than two-thirds of the qualitative survey respondents had encountered at least one event of natural disaster before marriage. Quantitative data confirmed significantly higher exposure to flood and river erosion among the coastal population. The quantitative data also suggested a positive association between shocks related to climate events and the incidence of child marriage, while the qualitative data indicated multiple themes related to the causes of child marriage, such as economic vulnerability, coping with risk and patriarchal norms. Yet the qualitative study respondents did not directly refer to natural disasters and climate changes when narrating their marital histories. The qualitative and quantitative evidence does not suggest that dowry-related factors are leading to early marriage. Rather, child marriage appears to be a coping strategy adopted by households in response to their increased vulnerability to natural disasters.

Evolutionary theory posits that grandmothers can increase their inclusive fitness by investing time and resources in their grandchildren. According on the X-linked grandmother hypothesis, the asymmetric inheritance of X-chromosomes should be responsible for the biased effect of the investment by maternal and paternal grandmothers towards granddaughters and grandsons. The British Millennium Cohort Study (n=4445 children) was used to investigate the association between grandmaternal childcare and children’s injuries between the ages of 9 months and 3 years. Support was found for the X-linked grandmother hypothesis predicting that the investment of paternal grandmothers benefits more granddaughters than grandsons, the investment of paternal grandmothers benefits granddaughters more than the investment of maternal grandmothers, and the investment of maternal grandmothers is similarly associated with the injuries of granddaughters and grandsons. However, no support was found for the prediction that maternal grandmothers benefit more grandsons than paternal grandmothers. Thus, some, although not univocal, evidence for the prediction that X-chromosomal relatedness shapes the grandmaternal effect on child outcomes was found.