Data from the District Level Household Survey (2002) conducted by the Reproductive and Child Health Project in India has been used to examine the impact of utilization of antenatal care services on improvement in maternal health in rural areas of Uttar Pradesh, India. Multilevel analysis shows that after controlling for other socioeconomic and demographic factors, utilization of antenatal care services may lead to the utilization of other maternal health related services such as institutional delivery, delivery assisted by trained professionals, seeking advice for pregnancy complications, and seeking advice for post-delivery complications. There is strong clustering of utilization of services within the primary sampling units (i.e. villages) and districts.

There is a strong theoretical and empirical relationship between educational attainment and fertility behaviour. However, a fundamental issue that has largely been neglected is the change in this relationship across cohorts resulting from differential improvement in educational opportunities for women over time and how it relates to fertility transition. Utilizing the 1998 DHS data from Kenya this study examines the differential effect of educational attainment on women’s use of modern contraception and desire for cessation of childbearing across generations. The findings indicate that even after controlling for husband’s education and other relevant factors, a woman’s advanced education is positively associated with use of modern contraception. However, support for a similar hypothesis on a woman’s desire for family limitation was only found among the youngest cohort of women. The results suggest that for Kenya’s incipient fertility transition to be sustained the government needs to continue efforts to improve female education and support access to family planning among younger women.

The aim of this research was to explore people’s knowledge, attitude, behaviour and practice towards HIV/AIDS and sexual activity in rural Kenya, where HIV is widespread. The study community was located in south-eastern Kenya, 50 km north of Mombassa, and had an estimated population of 1500. Subjects aged between 16 and 49 were recruited using a stratified cluster-sampling method and they completed self-administered questionnaires.Almost all respondents knew the word ‘HIV’. Around 50% knew of a person living with HIV. About 80% gave ‘death’ or ‘fear’ as words representing their image of AIDS. With regard to sexual activity, the distribution of answers to the question ‘how many partners have you ever had in your life’ was bimodal in males but had only one peak in females, indicating that some men have a large number of sexual partners in their lifetime. First sexual intercourse was at around 12–13 years for both sexes, but female teenagers were more sexually experienced than their male counterparts.

Malaria remains one of the main causes of mortality among young children in sub-Saharan Africa. In Nigeria traditional healers play an important role in health care delivery and the majority of the population depend on them for most of their ailments. The aim of this study was to investigate the perceptions of traditional healers regarding causes, symptoms, treatment of uncomplicated malaria and referral practices for severe malaria with a view to developing appropriate intervention strategies aimed at improving referral practices for severe malaria. A qualitative study was carried out in Ugwogo-Nike, a rural community in south-east Nigeria, which included in-depth interviews with 23 traditional healers. The traditional healers believed that the treatment of severe malaria, especially convulsions, with herbal remedies was very effective. Some traditional healers were familiar with the signs and symptoms of malaria, but malaria was perceived as an environmentally related disease caused by heat from the scorching sun. The majority of traditional healers believed that convulsions are inherited from parents, while a minority attributed them to evil spirits. Most (16/23) will not refer cases to a health facility because they believe in the efficacy of their herbal remedies. The few that did refer did so after several stages of traditional treatment, which resulted in long delays of about two weeks before appropriate treatment was received. The fact that traditional healers are important providers of treatment for severe malaria, especially convulsions, underlines the need to enlist their support in efforts to improve referral practices for severe malaria.

Contraceptive prevalence has been central to family planning research over the past few decades, but researchers have given surprisingly little consideration to method mix, a proxy for method availability or choice. There is no ‘ideal’ method mix recognized by the international community; however, there may be reason for concern when one or two methods predominate in a given country. In this article method skew is operationally defined as a single method constituting 50% or more of contraceptive use in a given country. Of 96 countries examined in this analysis, 34 have this type of skewed method mix. These 34 countries cluster in three groups: (1) sixteen countries in which traditional methods dominate, most of which are in sub-Saharan Africa; (2) four countries in which female sterilization predominates (India, Brazil, Dominican Republic and Panama); and (3) fourteen countries that rely on a single reversible method (the pill in Algeria, Kuwait, Liberia, Morocco, Sudan and Zimbabwe; the IUD in Cuba, Egypt, Kazakhstan, Kyrgyz Republic, Moldova, Turkmenistan and Uzbekistan; and the injectable in Malawi). A review of available literature on method choice in these countries provides substantial insight into the different patterns of method skew. Method skew in some countries reflects cultural preferences or social norms. Yet it becomes problematic if it stems from restrictive population policies, lack of access to a broad range of methods, or provider bias.

The aim of this study is to analyse the impact of maternal age at first birth on low birth weight, preterm birth and low Apgar scores at one minute and at five minutes among live births delivered to primiparous Brazilian women in the city of São Paulo. Analyses were based on 73,820 birth records from the 1998 birth cohort. Logistic regression was used to assess the association between maternal age and each outcome variable, controlling for the following risk factors: delivery mode, plurality, sex, maternal education, number of prior losses, prenatal care, race, parity and community development. Maternal ages below 20 and above 30 years were significantly associated with the risks of low birth weight and preterm birth, but no association was found between maternal ages and Apgar score, with the exception that ages 15–19 reduced the odds of a low one-minute score. Even though this result seems to be inconsistent, low birth weight, preterm birth and low Apgar scores measure different dimensions of newborn well-being, and the association of each measure with maternal age is expected to diverge.

Neonatal mortality during the first week of life, corresponding to the years 1975–1998, was studied in Spain. The first week of life is the time in which the highest number of deaths occur. The temporal decrease of the neonatal mortality rate (NMR) was modelled according to log10(NMR+1)= 2·784−0·023 per year. This decline cannot be explained by an increase in the mean birth weight (MBW=23440·835−10·107 g per year). From the most frequent of the causes of death to the least were: congenital anomalies, preterm born or low birth weight, respiratory problems, pregnancy difficulties, hypoxaemia/asphyxia, delivery difficulties and infectious diseases. This sequence changed when the specific age at death was considered. The NMR descended evenly for both sexes for the causes indicated above, except for preterm born or low birth weight, in which the male mortality decrease was greater since its rate was more elevated at the beginning of the period studied. For all the causes listed, NMR was more elevated both in urban areas and for males. Early neonatal mortality (first 24 hours) was higher for pregnancy difficulties, preterm born or low birth weight, congenital anomalies and hypoxaemia/asphyxia.

The hypothesis that family size limitation by parents enhances the upward mobility chances of their children in (post)industrial populations has a long-standing record in many disciplines, including sociology and economics, as well as evolutionary anthropology and social biology. Yet the empirical record supporting or contradicting the theory is surprisingly limited. The aim of this contribution is to develop a test of the effect of family size limitation on children’s intergenerational mobility. This test is applied to an urban population in Belgium that was in the process of experiencing its demographic transition, including the decline of fertility, at the end of the 19th century. The results indicate that the effect of family size was strong, even after controlling for parental social status as well as birth order. Surprisingly, the effects of birth order and family size appear to be largely independent.