Using retrospective data from the Urban Integration Survey conducted in 2001 in Nairobi, Kenya, on a sample of 955 women and men aged 25–54, this paper compares factors influencing entry into union formation for men and women. The analysis uses event history methods, specifically Cox Proportional Hazards regression, stratified by age cohort and run separately by sex. The results indicate that delay in union formation is more pronounced for women than for men. Cohabitation without formal marriage is the prominent form of union, especially among the younger generation, and appears to have increased. For men, the timing of union is more dependent upon human capital acquisition than on cultural factors. These findings show that the marriage search model, which was first applied in Western countries, can also hold in cities of developing countries. Nonetheless, neither the search model nor the integration or the independence models apply to women's union formation, which very few exogenous factors can explain.

Research on health care behaviour in sub-Saharan Africa usually considers the mother as the reference in the household when a child is sick. The study of health care management within the family is a key issue for understanding therapeutic rationales. This study was conducted in the region of Fatick in Senegal among 902 children with malaria-related fever. The data were taken from a retrospective quantitative survey conducted in all compounds of the DSS (Demographic Surveillance Site) of Niakhar. The results show that child care-taking is fundamentally a collective process: in 70·9% of out-of-home resorts, the treatment decision was collective. The health care process of 68·1% of morbid episodes involved several individuals. The involvement of the mother, the father and other relatives in the collective management of health care followed different logics. Each care-giver had a specific and complementary function depending on gender norms, intergenerational relations and characteristics of the family unit. Family management of illness aims at optimizing financial and human resources given the economic, logistical and social constraints on health care. Nevertheless, collective management also favoured home-based care, prevented good treatment compliance and delayed the resort to health facilities. These results suggest that health education campaigns should focus on an early involvement of fathers in health care-giving and also on the strengthening of the autonomy of mothers. Mothers’ empowerment should give women more autonomy in their child’s treatment choice. Lastly, there is a need to develop community health facilities and establish shared funding at the community level.

Current research and policies on reproductive behaviours in many East African countries focus primarily on proxy indicators of women’s autonomy, and very little emphasis is placed on direct indicators of women’s autonomy. In this paper, data from the 2002 Eritrea Demographic and Health Survey (EDHS) are used to address some of the most frequently raised questions about the link between women’s autonomy and reproductive behaviour. The results from the multivariate logistic models show that although the relationship between women’s autonomy and reproductive preferences in Eritrea is complex, some clear, broad patterns exist that have implications for theory and policy. First, although the different dimensions of women’s autonomy influence the outcome variables differently in terms of magnitude and statistical significance, most of them have a strong connection; in particular, women’s final say in decisions regarding day-to-day household purchases and spousal communication are significant explanatory variables in fertility preferences and ever-use of modern contraception. Second, many background (proxy) variables, particularly household economic condition and employment, exert a strong and independent influence over fertility preferences and ever-use of contraception regardless of a woman’s autonomy. In their relationship to reproductive behaviours, therefore, employment and economic status cannot be considered as proxies for women’s autonomy in Eritrea. A complete explanation of the relationship between women’s autonomy and reproductive preferences must recognize the effects of both the background and direct autonomy indicators. Interventions are needed to improve women’s decision-making autonomy and strengthen their negotiating capacity on family planning if an increased desire to limit fertility is to be attained.

Intimate partner violence (IPV) is a global public health and gender problem, especially in low-income countries. The study focused on verbal abuse, physical abuse and abuse by restricting food provision to wives by their husbands by victim and perpetrator characteristics, emphasizing the socioeconomic context of rural Bangladesh. Using a cross-sectional household survey of 4411 randomly selected married women of reproductive age, the study found that a majority of the respondents are exposed to verbal abuse (79%), while 41% are exposed to physical abuse. A small proportion (5%) of the women had suffered food-related abuse. Risk factors observed were age of the wife, illiteracy (of both victims and perpetrators), alcohol misuse, dowry management, husband's monetary greed involving parents-in-law, and wife's suspicions concerning husband's extramarital affairs. Well-established risk factors for wife abuse, along with dowry and husband's monetary greed, have a relatively high prevalence in rural Bangladesh.

Crow's index is widely used for indirect quantitative estimation of natural selection using birth and death rates. The present investigation is based on 179 studies among 144 different endogamous communities belonging to nineteen states and six geographical regions of India, categorized into six social groups. These studies appeared in 33 different years over six decades (1956 to 2007). The secular trend in Crow's index (It) and its mortality and fertility components (Im and If) shows a gradual decline in It and radical shift in the relative contributions of Im and If. Before 1990 the opportunity for natural selection was mainly determined by differential pre-reproductive mortality (Im), whereas after 1990 it has been determined by differential fertility (If). To find out the covariates of It, Im and If sixteen socio-demographic variables were considered, and nine were found to be significantly correlated with It: total dependency ratio, decadal growth rate 1991–2001, young age dependency ratio, crude death rate, total fertility rate, child mortality rate, under-5 mortality rate, old age dependency ratio and decadal growth rate 1981–1991. On the basis of multivariate stepwise regression analysis, female literacy emerged as one of the most important predictors of It. The declining trend of It, Im and If shows that the Indian population is passing through the demographic transition.

The private sector in health care in Vietnam has been increasingly competing with the government in primary health care services. However, little is known about the use of skilled birth attendance or about choice of public and private sectors among those who opt for skilled attendants. Using data from the Vietnam 2002 Demographic and Health Survey, this study examines factors related to women’s decision-making of whether to have a skilled birth attendant at a recent childbirth, and if they did, whether it was a public or private sector provider. The study indicates that the use of the private sector for delivery services was significant. Women’s household wealth, education, antenatal care and community’s wealth were positively related to skilled birth attendance, while ethnicity and order of childbirth were negatively related. Order of childbirth was positively associated with skilled birth attendance in the private sector. Among service environment factors, increased access to public sector health centres was associated with an increased likelihood of skilled birth attendance in general, but a lowered chance of that in the private sector. Further studies are needed to assess the current situation in the private sector, the demand for delivery services in the private sector, and its readiness to provide quality services.

Consanguineous marriage is traditionally common throughout Arab countries. This leads to an increased birth prevalence of infants with recessive disorders, congenital malformations, morbidity and mortality. The aim of this study was to evaluate the rate of consanguineous marriage in families with autosomal recessive diseases, and to compare it with the average rate of consanguinity in the Moroccan population. The study was conducted in the Department of Medical Genetics in Rabat on 176 families with autosomal recessive diseases diagnosed and confirmed by clinical, radiological, enzymatic or molecular investigations. The rate of consanguinity was also studied in 852 families who had infants with trisomy 21 confirmed by karyotyping. These families were chosen because: (i) there is no association between trisomy 21 and consanguinity, (ii) these cases are referred from different regions of Morocco and (iii) they concern all social statuses. Among 176 families with autosomal recessive disorders, consanguineous marriages comprised 59.09% of all marriages. The prevalence of consanguinity in Morocco was found to be 15.25% with a mean inbreeding coefficient of 0.0065. The differences in the rates of consanguineous marriages were highly significant when comparing the general population and couples with offspring affected by autosomal recessive conditions. These results place Morocco among the countries in the world with high rates of consanguinity. Autosomal recessive disorders are strongly associated with consanguinity. This study better defines the health risks associated with consanguinity for the development of genetic educational guidelines targeted at the public and the health sector.

Kerala State in India is the most advanced in terms of demographic and epidemiological transition and has the highest proportion of elderly population. The study examines the socio-demographic correlates of health status of elderly persons in Kerala in terms of three components: perceived health status, physical mobility and morbidity level. Overall health status was measured by combining the above three components of health status. Data from the 60th National Sample Survey Organization (NSSO) on Condition and Health Care of the Aged in Kerala in 2004 was used for the study. Significant socio-demographic differentials in health status were noted. While women report less morbidity, perceived well-being and physical mobility was better for men. This anomaly can be explained by variations in the components of socio-demographic factors. The findings call for urgent health care strategies for elderly persons in different socio-demographic groups in transitional Indian states like Kerala.

The resolution of parent–offspring conflict (POC) might sway in favour of the offspring if the parent relies on offspring-supplied information about need. Here, three hypotheses from a resolution model of POC were tested using data on sickness histories and mother–infant interactions from 24 Karo Batak women and their young children from two rural villages in North Sumatra, Indonesia. First, as predicted, offspring with greater need (measured as age and propensity to illness) tended to fuss more often. Second, as expected, observed fussiness predicted the number of suckling occurrences observed during sampling periods. Third, contrary to the prediction, the duration of fussing observed after breast-feeding occurrences was longer than the duration of the breast-feeding occurrences themselves. Parental decisions were made based on offspring-supplied information about need, but offspring failed to garner resources in excess of the parental optimum. This suggests that a POC interpretation is unnecessary to account for these results.

The present paper assesses fetal loss among currently married women in India. In addition, the effects of social, economic, demographic and health factors on fetal loss are studied. The study uses data from the second National Family Health Survey conducted in India during 1998–2000. The results show wide variations in fetal loss (induced abortion, spontaneous abortion and still-birth) measures across the country. The importance of mother’s nutritional status, birth spacing, risky behaviours such as smoking, drinking and chewing tobacco and age at marriage for pregnancy outcomes in India is also discussed. The study results imply a broad understanding of reproductive health in India, and emphasize the importance of widening the scope of community-based reproductive health education programmes to improve the reproductive health of women.

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.

The association between maternal smoking and adverse child health outcomes has not been systematically explored in less developed countries, especially in Nepal where over a quarter of women of reproductive age smoke tobacco products. This study aims to quantify the effect of maternal smoking on acute respiratory infection (ARI) symptoms among children aged below five years, using the 2001 Nepal Demographic and Health Survey. It is hypothesized that children born to mothers who smoke frequently are at higher risk of developing ARI symptoms. Four-level random intercept logistic regression models were used to disentangle the independent effect of maternal smoking on children's ARI symptoms, controlling for potential biological, socioeconomic, seasonal and spatial variables. Maternal smoking status had a significant effect on children's ARI symptoms; the effects were significantly higher (adjusted OR 1.41; 95% CI 1.02–1.96) among those born to mothers who smoked more frequently than their counterparts. Furthermore, a strong spatial pattern was evident in the prevalence of ARI symptoms, after adjusting for maternal smoking and relevant control variables. The findings underscore the importance of designing exclusive public health intervention measures to prevent tobacco smoking within households, for example through awareness campaigns highlighting the adverse effect of maternal smoking on child health.

Health systems in developing countries infrequently implement and evaluate maternal death surveillance. This study identified under-reported and misclassified maternal deaths among women of reproductive age between 1999 and 2004 in a rural service unit in Vellore, India. In-depth interviews, semi-structured interviews and structured questionnaires were used to identify maternal deaths known to health care providers and community leaders who regularly come in contact with pregnant women. Eighteen under-reported and misclassified cases – or 50% of maternal deaths – were reported. These included 29% of abortion-related and 7% of domestic violence-related deaths. Based on this study’s fieldwork, the existing death surveillance system detected 100% of the maternal deaths reported by hospital staff; however, it missed most maternal deaths reported by community workers. The latter are more likely than deaths reported by hospital workers to result from abortion and family violence. The existing surveillance system should be augmented with a community-based death surveillance system. This comprehensive approach identified twice as many maternal deaths than previously recorded and could be applied in other settings. Appropriate public health interventions should be initiated to prevent maternal deaths in this community.

The present study investigates the socioeconomic risk factors of anaemia among women belonging to eastern Indian states. An attempt has been made to find out differences in anaemia related to social class and place of residence, and age and marital status. It was hypothesized that rural women would have a higher prevalence of anaemia compared with their urban counterparts, particularly among the poorest social strata, and that ever-married women would be at elevated risk of anaemia compared with never-married women, particularly in the adolescent age group. Using data from National Family Health Survey-3, 2005–6, a nationally representative cross-sectional survey that provided information on anaemia level among 19,695 women of this region, the present study found that the prevalence of anaemia was high among all women cutting across social class, location and other attributes. In all 47.9% were mildly anaemic (10.0–11.9.9 g/dl), 16.1% were moderately anaemic (7.0–9.9 g/dl) and 1.6% were severely anaemic (<7.0 g/dl). Protective factors include frequent consumption of pulses, milk and milk products, fruits and fish, educational attainment, mass media exposure and high socioeconomic status. Urban poor women and adolescent ever-married women had very high odds of being anaemic. New programme strategies are needed, particularly those that improve iron storage and enhance the overall nutritional status of women throughout the life-cycle.

The present paper examines the association between the type of household and maternal health in India using data from the National Family Health Survey 1998–99. The indicators of maternal health used in the analysis are contraceptive use, visit to obtain antenatal care in the first trimester, safe delivery and nutritional status of women measured in terms of body mass index (BMI). Binary and multinomial logistic regressions are used to establish associations. The type of household is coded into three categories, viz. nuclear household, joint household with in-laws and joint household without in-laws. The other independent variables used in the analysis are age, children ever born, work status, education of women, religion, caste, standard of living, exposure to mass media, women’s autonomy and presence of others at the time of interview. The findings clearly suggest that type of household is significantly associated with the utilization of the above-mentioned services that positively affect maternal health. Women in nuclear households are more likely to utilize these services compared with women in joint households. However, an association between type of household and BMI was not found.

Preference for children of either sex is considered a constraint on fertility decline as it induces many couples to keep adding on surviving children in the hope of having a desired sex composition of children. However, preferences for children of a particular sex may differ in relation to demographic and socioeconomic characteristics of women, traditional values and cultural practices, such as propagating a family name, providing economic advantages, and obtaining a medium of social and economic security in times of illness, unemployment and old age. Utilizing the Pakistan Integrated Household Survey (2001–02), this paper aims at investigating the existence of sex preference and examines sex preference differentials by different attributes of women in Pakistan. The results reveal that there is a desire to have another child in the presence of all children of one sex, either sons or daughters. The desire to have a son with only or mostly daughters, however, is stronger than the desire to have a daughter with only or mostly sons. This behaviour will retard fertility decline unless there is a shift in the desire to have children of both sexes in Pakistan.

Using retrospective individual mortality records of three cohorts of newborns (1954–1958, 1959–1962 and 1963–1967) from a large national fertility survey conducted in 1988 in China, this paper examines the effect of being conceived or born during the 1959–1961 Great Leap Forward Famine on postnatal mortality. The results show strong evidence of a short-term (period) effect of the famine, caused directly by starvation or severe malnutrition during the period of the famine. After controlling for period mortality fluctuation, however, the famine-born cohort does not show higher mortality than either the pre-famine or the post-famine cohort. Aggregate-level cross-temporal comparisons using published cohort population counts from China's 1982 Census, 1990 Census, 1995 micro-Census, 2000 Census and 2005 micro-Census lead to the same conclusion. The relevance of these new findings for the ‘fetal origins’ hypothesis and the selection effect hypothesis is discussed.

From an economic perspective that understood it as a spillover of development, migration is now also the subject of socioeconomic investigation incorporating the problems of assimilation, relative deprivation and isolation. The corollary is an increased emphasis on economic and social understanding of migration and its consequences. This entails studying migration or migrants in terms of factors beyond income. Health outcome is important among these non-income factors but at the same time remains less studied. Although there have been a few influential studies on health issues as linked to migration status, the issue of malnutrition in this context continues to be under-researched. This paper explores, theoretically and empirically, migration status and malnutrition in Mumbai in India. An econometric analysis of Demographic and Health Survey data gives insight into the dynamics of child and maternal undernutrition as mediated by migration status in Mumbai.

Evolutionary theory suggests that maternal grandparents will invest more in their grandchildren than paternal grandparents, due to the difference between the certainty of maternity and the uncertainty of paternity. Most tests of this prediction have tended to use retrospective ratings by grandchildren rather than examining grandparental behaviour. Using a large-scale data set from the UK (n>7000), significant differences are shown between maternal and paternal grandparents in terms of frequencies of contact with their newborn grandchildren, while controlling for a wide range of other variables. Maternal grandparents also provided a significantly wider range of financial benefits than paternal grandparents. Maternal grandparents were also more likely to provide essentials and gifts and extras for the baby. Multiple correspondence analysis showed that contact frequencies systematically related to other measures of grandparental investment, indicating that contact frequencies are a useful proxy measure to examine overall investment. Findings are discussed with reference to the paternity uncertainty hypothesis.

Mongolian fertility decline has received only limited analysis in the demographic literature. Using the 2003 Reproductive Health Survey of Mongolia the classical proximate determinants of fertility framework proposed by Bongaarts is applied here in order to analyse which factors shape period fertility. The results indicate that the fertility-inhibiting effect of contraception contributed to reduce period fertility by 54.2% from its theoretical maximum, while induced abortion accounted for only 6.1% of the reduction in fertility. Compared with previous studies made in the early 1990s, these results show that important changes in the control of reproduction took place in Mongolia during the fertility transition. In order to assess the changes implied by the transition to democracy and market economy, the proximate determinants of fertility are estimated for the year 1994. The results show that the importance of induced abortion in the determination of fertility level has reduced and that the use of modern contraception has increased progressively and contributed most in determining fertility level in 2003.