with a population of over 131 million and a fertility rate of 29·9 per 1000, population growth constitutes a primary threat to continued economic growth and development in bangladesh. one strategy that has been used to cease further increases in fertility in bangladesh involves using family planning outreach workers who travel throughout rural and urban areas educating women regarding contraceptive alternatives. this study uses a longitudinal database to assess the impact of family planning outreach workers’ contact upon contraceptive switching and upon the risk of an unintended pregnancy. using longitudinal data on contraceptive use from the operations research project (orp) of the international centre for diarrhoeal disease research (icddr,b) in bangladesh, multiple decrement life table analysis and multilevel, discrete-time competing risk hazards models were used to estimate the cumulative probabilities of switching to an alternative form of contraceptive use after a woman engaged in a discussion with an outreach worker. after controlling for the effects of socio-demographic and economic characteristics, the analysis revealed that family planning outreach workers’ contact with women significantly decreases the risk of transitioning to the non-use of contraceptives. this contact also reduces the risk of an unintended pregnancy. family planning workers’ contact with women is associated with the increased risk of a woman switching from one modern method to another modern method. the study results indicate that side-effects and other method-related reasons are the two primary reasons for contraceptive discontinuation in rural bangladesh.

some propositions on male and female sexual orientation will be considered. some of these are established; others are more speculative. the aim is to offer some notes towards a coherent, comprehensive theory of sexual orientation. 1. the distinction between butch and femme lesbians seems real rather than a social construct. 2. high levels of prenatal steroid hormones seem to be causally associated with the sexual orientation of butch lesbians. however it is not established whether the causal process operates prenatally or postnatally (or both). this is so because prenatal hormone levels are thought to correlate positively with postnatal hormone levels. and high postnatal hormone levels may facilitate homosexual behaviour as a consequence of sensation-seeking. 3. male bisexuals also are interpreted to have been exposed to high prenatal testosterone levels. but (for reasons similar to those outlined above in regard to butch lesbians) it is unclear whether these have a direct prenatal effect on the brain or whether they are precursors of high postnatal testosterone levels, which are associated with male bisexual orientation by promoting sensation-seeking behaviour. 4. postnatal learning processes seem to be causally involved in the sexual orientation of some femme lesbians and some exclusive male homosexuals. 5. some homosexual men have genes that predispose to their sexual orientation. 6. the same may apply to some lesbians, but such genes have not, as far as i know, been identified. 7. people (of both sexes) who engage in same-sex sexual behaviour may be classified simultaneously in two ways, viz (1) ‘active’ vs ‘passive’ and (2) those who do and those who do not engage (or consider engaging) in sex with members of the opposite sex. ex hypothesi, some of the ‘active’ ones initiate some of the ‘passive’ ones. the active ones are driven more by hormones and the passive ones by psychosocial factors. the active males contain a substantial proportion of self-identified bisexuals; and the active females a substantial proportion of self-identified butches. 8. these two active categories (butch lesbians and male bisexuals) share a number of endocrinological, psychological, morphological and behavioural features vis-à-vis their exclusively homosexual and heterosexual peers. methods of testing some of these ideas are presented.

the paper discusses factors associated with sexual risk behaviour, i.e. failure to use condoms consistently during sexual intercourse, among unmarried sexually experienced youths in south africa. data from the ‘transitions to adulthood in the context of aids in south africa’ surveys of 1999 and 2001 were analysed to identify factors associated with high sexual risk behaviour among the youth. the multinomial regression models for male and female youths were fitted separately for the 1999 and 2001 data sets. the results show increasingly consistent use of condoms during sexual intercourse and that high sexual risk behaviour among youths is predominantly determined by social factors such as ‘ever-pregnant’ or ‘ever made pregnant’, ‘ever given something for sex’, age of sexual partner, currently in school, pressured by friends to have sex, peer influence on safe sex and education level for males. there is evidence that availability of contraception information is important in strategic interventions that seek to change the sexual behaviour of the youth in south africa.

this paper explores client satisfaction with abortion care, looking at overall satisfaction and satisfaction with hygiene, comfort and courtesy. the analysis aimed to determine whether client satisfaction was related to the characteristics of the client, in order to guide quality improvement efforts. the analysis is a secondary analysis of data collected in a survey of 489 abortion clients who attended a limited number of hospitals in three cities in russia. the data were analysed using logistic regression. client characteristics, in general, did not affect overall satisfaction though there were significant differences in overall satisfaction for unmarried versus married women (or=0·29, ci=0·13, 0·63). similarly, most characteristics of the abortion visit were not related to client satisfaction, although women who were awake for the procedure were less likely to be satisfied (or=0·37, ci=0·16, 0·89). information provided to abortion clients about self-care was the most important predictor of overall satisfaction for abortion clients (or=3·55, ci=1·64, 7·69). this suggests that improving the information provided to clients, through training providers and other staff, is important in these settings.

as the largest labour flow in human history, the recent rise in migration in china has opened up unprecedented opportunities for millions of chinese to rearrange their lives. at the same time, this process has also posed great challenges to chinese migrants, especially female migrants, who not only face a bias against ‘outsiders’ but also have a greater need for reproductive health-related services in their migratory destinations. based on data collected via multiple sources in shanghai, china’s largest metropolis, this study profiles the changing characteristics of female migrants, presents data on self-reported symptoms of reproductive health-related problems and knowledge on reproductive health issues, compares maternal and child health measures between migrants and local residents, and examines factors related to reproductive health knowledge and migrants’ access to health care in urban china. results of this study show a relatively low level of self-reported reproductive health problems among female migrants, coupled with a relatively high level of ignorance in knowledge related to std. both self-reported health status and knowledge of reproductive health are related to migrants’ educational attainment and length of stay in the urban destination. this study also finds ample evidence that female migrants’ access to urban health care is limited by a number of institutional barriers.

the objective of the study was to investigate the relationship between childhood iq of parents and characteristics of their adult offspring. it was a prospective family cohort study linked to a mental ability survey of the parents and set in renfrew and paisley in scotland. participants were 1921-born men and women who took part in the scottish mental survey in 1932 and the renfrew/paisley study in the 1970s, and whose offspring took part in the midspan family study in 1996. there were 286 offspring from 179 families. parental iq was related to some, but not all characteristics of offspring. greater parental iq was associated with taller offspring. parental iq was inversely related to number of cigarettes smoked by offspring. higher parental iq was associated with better education, offspring social class and offspring deprivation category. there were no significant relationships between parental iq and offspring systolic blood pressure, diastolic blood pressure, cholesterol, glucose, lung function, weight, body mass index, waist hip ratio, housing, alcohol consumption, marital status, car use and exercise. structural equation modelling showed parental iq associated with offspring education directly and mediated via parental social class. offspring education was associated with offspring smoking and social class. the smoking finding may have implications for targeting of health education.

primary research on hiv/aids in india has predominantly focused on known risk groups such as sex workers, sti clinic attendees and long-distance truck drivers, and has largely been undertaken in urban areas. there is evidence of hiv spreading to rural areas but very little is known about the context of the infection or about issues relating to health and social impact on people living with hiv/aids. in-depth interviews with nineteen men and women infected with hiv who live in rural areas were used to collect experiences of testing and treatment, the social impacts of living with hiv and differential impacts on women and men. eight focus group discussions with groups drawn from the general population in the four villages were used to provide an analysis of community level views about hiv/aids. while men reported contracting hiv from sex workers in the cities, women considered their husbands to be the source of their infection. correct knowledge about hiv transmission co-existed with misconceptions. men and women tested for hiv reported inadequate counselling and sought treatment from traditional healers as well as professionals. owing to the general pattern of husbands being the first to contract hiv women faced a substantial burden, with few resources remaining for their own or their children’s care after meeting the needs of sick husbands. stigma and social isolation following widowhood were common, with an enforced return to the natal home. implications for potential educational and service interventions are discussed within the context of gender and social relations.

evolutionary biologists mostly assume that polygyny increases sexual dimorphism in size because, under polygyny, larger males monopolize mating opportunities and pass on their ‘large male’ genes to their sons. available data on parent–child correlations in height among humans (homo sapiens) do not support the crucial assumption that height is transmitted along sex lines. this paper instead suggests that human sexual dimorphism in size emerged, not because men got taller, but because women got shorter by undergoing early menarche in response to polygyny. it further speculates that, rather than genetically transmitted, the sexual dimorphism may emerge anew in each generation in response to the degree of polygyny in society. the analysis of comparative data supports the prediction that polygyny reduces women’s height, but has no effect on men’s, and is consistent with the speculation that the origin of human sexual dimorphism in size may be cultural, not genetic.