The primary objective of this report is to use data from a study of infant growth and weaning practices in Kathmandu, Nepal, to investigate universal recommendations about exclusive breast-feeding up to 6 months postpartum. A secondary objective is to demonstrate the complexity of the biocultural nature of infant feeding practices. A sample of 283 children under 5 years of age and their 228 mothers living in a peri-urban district of Kathmandu participated in this study. The children’s height/length and weight were measured three times over 9 months. At each session, a demographic, child health and infant feeding survey was administered; between sessions, in-depth interviews were conducted with mothers regarding infant feeding practices. While a few of the infants under 2 months were receiving non-breast milk foods, at 3 months of age half of the sample had been introduced to non-breast milk foods and by 7 months all infants were eating non-breast milk foods. A comparison of growth indices and velocities between exclusively and partially breast-fed infants from birth to 7 months of age shows no evidence for a difference in nutritional status between the two groups. Although there are cultural rules about breast-feeding that vary by ethnic group, all mothers followed a feeding method that depended on their assessment of whether the child was getting enough breast milk. The conclusion is that exclusive breast-feeding up to 6 months may not be appropriate for all infants. In this sample, breast-feeding duration is not shortened by the early introduction of non-breast milk foods, as the median age of breast-feeding cessation is 36 months. One of the main reasons for severance was the onset of another pregnancy. Investigation of infant feeding practices must be contextualized in the local ecology of the population. While cultural beliefs about breast-feeding are relevant, mothers’ individual assessments of their children’s nutritional needs and demographic events in parents’ lives must also be considered.

This paper uses data collected using in-depth, semi-structured interviews to examine utilization of maternal health care services among two rural and urban populations of Pune and Mumbai in Maharashtra, India. The study aims to identify key social, economic and cultural factors influencing women’s decisions to use maternal health care and the places used for child delivery, whilst considering the accessibility of facilities available in the local area. Socioeconomic status was not found to be a barrier to service use when women perceived the benefits of the service to outweigh the cost, and when the service was within reasonable distance of the respondent’s place of residence. A large number of women perceived private services to be superior to those provided by the government, although cost often meant they were unable to use them. The provision of services did not ensure that women used them; they had to first perceive them to be beneficial to their health and that of their unborn child. Respondents identified the poor quality of services offered at government institutions to be a motivating factor for delivering at home. Thus further investigation is needed into the quality of services provided by government facilities in the area. A number of respondents who had received antenatal care went on to deliver in the home environment without a trained birth attendant. Further research is needed to establish the types of care provided during an antenatal consultation to establish the feasibility of using these visits to encourage women, particularly those with high-risk pregnancies, to be linked to a trained attendant for delivery.

Machado-Joseph Disease (MJD) is an autosomal dominant neurodegenerative disorder of adult onset, associated with the expansion of a (CAG)n tract in the coding region of the causative gene, localized on 14q32.1. Machado-Joseph Disease shows non-Mendelian features typical of other triplet repeat disorders, including clinical heterogeneity, variable age at onset and anticipation. Three phenotypes have been proposed (clinical types 1, 2 and 3). Type 1 is associated with early age at onset and a high repeat number of the CAG sequence, and Types 2 and 3 have later onset and lower numbers of CAG repeats. This paper investigates whether there is selection against the MJD gene, acting through differential survival, nuptiality and fertility associated with clinical type and age at onset. The study sample comprised 40 MJD patients from the Azores (Portugal) having fully documented reproductive histories and known dates of death. The proportion of married patients of each clinical type increased from 0·22 among Type 1 patients, to 0·40 in Type 2 and 0·95 in Type 3. Age at onset and length of survival were also associated with marital status, with the married cases having later mean age at onset and longer mean survival time. In the whole sample, clinical type was associated with fertility, with significantly fewer children born to Type 1 patients. Among married patients clinical type was not associated with age at marriage, reproductive span or number of children. No reduction of fertility was detected among married patients in whom the onset of MJD was below the age of 50. The authors’ interpretation of these results is that the high-repeat CAG haplotypes associated with early age at onset and clinical Type 1 are selected against through reduced survival and fertility. The fertility component of selection is mediated by nuptiality rather than marital fertility.

This paper examines the association of the sociodemographic characteristics of women and the unobserved hospital factors with maternal mortality in Kenya using multilevel logistic regression. The data analysed comprise hospital records for 58,151 obstetric admissions in sixteen public hospitals, consisting of 182 maternal deaths. The results show that the probability of maternal mortality depends on both observed factors that are associated with a particular woman and unobserved factors peculiar to the admitting hospital. The individual characteristics observed to have a significant association with maternal mortality include maternal age, antenatal clinic attendance and educational attainment. The hospital variation is observed to be stronger for women with least favourable sociodemographic characteristics. For example, the risk of maternal death at high-risk hospitals for women aged 35 years and above, who had low levels of education, and did not attend antenatal care is about 280 deaths per 1000 admissions. The risk for similar women at low-risk hospitals is about 4 deaths per 1000. To complement results from the analysis of individual patient records, the paper includes findings from hospital staff reports regarding the maternal mortality situation at the hospitals.

The purpose of this study was to investigate the socioeconomic, biological and behavioural factors influencing low birth weight and prematurity in Botswana. Data were from the Botswana Obstetric Record covering the years 1990 to 1995, and were analysed with both descriptive statistics and multivariate analysis. The study found that the major positive risk factors for low birth weight were: late and less frequent attendance of antenatal care services, having experienced pregnancy termination before, low or no education, unmarried motherhood and place of birth. With regard to prematurity, age, late and less frequent attendance of antenatal care services, unmarried motherhood and place of birth were found to be the major positive risk factors. The importance of early and regular antenatal care attendance, marriage and place of birth cut across both low birth weight and prematurity.

Maternal ages at the first maternity (starting), at the last maternity (stopping) and the lengths of intervals between maternities (spacing) have been studied in the Outer Hebridean islands of Harris and Barra for births between the years of 1855 and 1990, a period during which a considerable ‘fertility transition’ occurred. There was a tendency in each island for increases with time in the ages at starting among less-fecund women (although after 1936 starting ages declined), and highly significant heterogeneity of covariance: adjusted means dependent on the total numbers of maternities experienced. The same result was seen for the ages at stopping. Lengths of reproductive life (the difference between ages at starting and stopping) rose to 1876–1895, and then fell, apart from a short-lived rise in Barra during 1956–1975, possibly due to the papal encyclical Humanae Vitae. Intervals between marriage and first maternity and between successive maternities were studied by hazard function survival analysis. The marriage–first birth interval remained very constant, unaffected by total maternities. The father’s occupation and the mother’s age at first maternity showed no significant relationships. In Barra there was a weak negative relationship with the date of the marriage. For intervals between maternities in both islands, total maternities and the death of a previous infant were associated with shorter, and birth order with longer intervals. In Harris, there were tendencies for intervals to be consistently long or short in families, and for the age of the mother and date at first maternity to be negatively related to the length of the interval. In Barra, a previous multiple birth was followed by a longer interval. The date of the previous maternity, father’s occupation, maternal age at the previous maternity, the sex of the previous child, and the duration of the marriage appeared to have no influence on maternity intervals. Evidence for an effect of economic deprivation during the 19th century on the variables considered was equivocal. During the 20th century, it is suggested that economic depression during the inter-war years, the spread of contraception, and improvements in health care may have acted ‘synergistically’ toproduce the lower ages of childbearing and the shortening of maternity intervals and reproductive lives.

This study investigates seasonality of marriages and reproductive isolation in six long-isolated communities in the central Apennines (Italy). It had two objectives: (1) the identification of an Apennine biodemographic model in comparison with mountain communities of other regions, and with non-Apennine communities in Abruzzo, and (2) to identify the possible effects of the drainage of Lake Fucino (1854–1876) on that area. Marriages in this region show two very stable seasonal patterns: one is typical of sedentary rural societies, with summer migrations and marriages preferentially celebrated in the winter, and the other has marriages that are strongly concentrated in the summer months, i.e. between 75% and 93·5% of marriages were celebrated between June and October in these communities in the 1800s. These were traditionally pastoral communities with winter transhumance of the flocks and their shepherds towards the lowlands of southern Italy. In both groups, restrictions imposed by the Catholic Church do not seem to have affected the timing of marriages. Indeed, economic factors related to work activities seem to have had more influence. Concerning reproductive isolation, the results show high rates of endogamy: between 85% and 98% in both the 19th and 20th centuries. Rates of consanguineous marriages were between 5% and 20%, and those of isonymous marriages rarely exceeded 9%. The coefficient of inbreeding α shows that there was a delayed, limited period of increased consanguinity in the few decades around the turn of the century. This is different from the national situation, and thus could be a consequence of the Lake Fucino drainage.

This study’s first objective was to compare the mean birth weights of homosexual and heterosexual men and women. Its second objective was to investigate whether prior male and female fetuses have different effects on the birth weight of subsequent fetuses. The subjects were 3229 adult men and women (the probands), who weighed at least 2500 g at birth, and whose mothers knew the sex of the child (or fetus) for each pregnancy prior to the proband. Information on birth weight, maternal gravidity and other demographic variables was reported on questionnaires completed by the probands’ mothers. The results confirmed earlier reports that boys with older brothers weigh less at birth than boys with older sisters, but they did not confirm reports that girls with older brothers weigh less than girls with older sisters. The results did not show across-the-board differences in the mean birth weights of homosexual versus heterosexual women or homosexual versus heterosexual men. However, the homosexual males with older brothers weighed about 170 g less at birth than the heterosexual males with older brothers. It is suggested that this pattern of results may reflect a maternal immune response to Y-linked minor histocompatibility antigens (H–Y antigens). According to this hypothesis, when the maternal immune response is mild, it produces only a slightly reduced birth weight, but when it is stronger, it produces a markedly reduced birth weight as well as an increased probability of homosexuality.

Evidence from eleven samples indicates that the mean IQ of third world immigrants in the Netherlands is lower than the Dutch mean by approximately one standard deviation for Surinamese and Antillians, and by approximately one and a half standard deviations for Turks and Moroccans. Since IQ tests provide the best prediction of success in school and organizations, it could be that the immigrants’ lower mean IQ is an important factor in their low status on the Dutch labour market. The IQs of second-generation immigrants are rising.