The aim of this study was to evaluate the sexual attitudes and behaviours of university students. An anonymous questionnaire was administered to 550 final-year university students aged 20–25 years in Izmir, Turkey. Male students opposed premarital sexual intercourse for both genders more than female students did. The frequency of sexual intercourse among male students (61·2%) was higher than that among female students (18·3%). The mean age of first sexual intercourse was lower among male than among female respondents. The rate of condom use at first sexual intercourse was 47·4%. The frequency of having two or more past sexual partners and masturbation was higher among males than females. It was found that there were culture-specific and gender-dependent differences in sexual attitudes and behaviours of the university students. These results may help in the planning of education and health policies in Turkey.

Ethnicity has been found to be a significant indicator of social position, and many studies have also established that ethnicity is a significant determinant of contraceptive use. This study aims to examine whether ethnicity is an important predictor of unmet need for contraception. Analysis was based on data for 4343 ever-married women drawn from the 2007 Zambia Demographic and Health Survey. Descriptive analysis indicates that in all ethnic groups except the Barotse and Tonga, women aged 15–49 years were married at an average age below 18. The highest mean number of children among the ethnic groups was 6.7, among the Bemba; the lowest was 5.9, among the Barotse. The highest proportion of women with an unmet need for contraception resided in the Eastern region. Multivariate logistic analyses reveal that children ever-born and region of residence were the most important predictors of unmet need for spacing, whereas for unmet need for limiting predictors were age at first marriage and partner's desire for children. Moreover, unmet need for spacing and limiting among women with secondary or higher education was significantly lower (47% and 50%, respectively) compared with those with no education. Ethnicity was not a significant predictor of unmet need for contraception. The findings stress the need for programmes aimed at enhancing the socioeconomic status of women.

This study examined the relationship between Intimate Partner Violence (IPV) and unintended pregnancy among young women in South Asia using Demographic and Health Survey data from India (2005–2006), Bangladesh (2007) and Nepal (2011). The respondents were adolescent and young adult married women aged 15–24 years who had at least one childbirth in the five years preceding the survey. Bivariate and stepwise multivariate logistic regression analyses were performed to assess the relationship between IPV and unintended pregnancy. Thirty-eight per cent of the respondents in India, 52% in Bangladesh and 28% in Nepal reported having experienced physical or sexual IPV. Those who reported physical or sexual IPV had higher odds of unintended pregnancy (1.36 in India and 1.99 in Bangladesh). The findings indicate that IPV is a risk factor for unintended pregnancy among adolescent and young adult married women. Along with violence prevention programmes, a more responsive and youth-friendly health system needs to be in place to provide health care services to young women in these countries.

Using data from the 1988 Ghana Demographic and Health Survey, this study examines couples' demographic and socioeconomic characteristics in the context of their attitudes towards family planning, and the impact of these factors on the use of contraceptives. The characteristics of the husbands and their influence on wives' behaviour illustrate the role of intra-household relations between men and women and their effect on fertility-related behaviour in patriarchal African societies.

Understanding the level, trend, geographical variations and determinants of use of modern family planning (FP) plays a major role in designing effective interventions leading to increased usage. This study assessed these characteristics of FP use in Nigeria using data from the 2003, 2005 and 2007 National HIV/AIDS and Reproductive Health Survey, a national population-based household survey. A Bayesian geo-additive procedure was used, which provides flexible modelling of non-linear and spatial effects at a highly disaggregated level of states. The findings reveal considerable geographical variation in the use of modern FP in Nigeria, with a distinct north–south divide. Furthermore, a significant trend in the use of modern FP was evident, with an increase between 2003 and 2005 followed by a decline between 2005 and 2007. The effect of respondent's age was non-linear, and use of modern FP was found to differ significantly between never-married and currently/formerly married respondents. Awareness of FP methods and knowledge of where to get/buy FP services/methods were found to be significantly associated with usage. The findings provide policymakers with tools to prioritize the use of scarce resources for implementing FP and reproductive health interventions.

The aim of this analysis was to examine the effects on stature in two nationally representative samples of Polish 19-year-old conscripts of maternal and paternal education level, and of degree of urbanization, before and after the economic transition of 1990. Data were from two national surveys of 19-year-old Polish conscripts: 27,236 in 1986 and 28,151 in 2001. In addition to taking height measurements, each subject was asked about the socioeconomic background of their families, including paternal and maternal education, and the name of the locality of residence. The net effect of each of these social factors on stature was determined using four-factor analysis of variance. The secular trend towards increased stature of Polish conscripts has slowed down from a rate 2·1 cm per decade across the period 1965–1986 to 1·5 cm per decade between 1986 and 2001. In both cohorts, mean statures increase with increasing size of locality of residence, paternal education and maternal education. The effect of each of these three social factors on conscript height is highly significant in both cohorts. However, the effect of maternal education has increased substantially while that of size of locality of residence and paternal education diminished between 1986 and 2001. These results imply that the influence of parental education on child growth cannot be due solely to a relationship between education and income, but is also perhaps a reflection of household financial management which benefits child health and growth by better educated parents, regardless of level of income. In addition they suggest that, irrespective of whether there are one or two breadwinners in the family, it is the mother, more so than the father, who is principally responsible for the extent to which such management best favours child health and growth. The asymmetry between the importance of maternal as against paternal education for child growth, clearly seen in the 1986 cohort, became more accentuated in 2001, after the abrupt transition from a command to a free-market economy in the early 1990s.

It is well established that, in general, pregnancies at advanced maternal ages or of advanced birth order are at greater risk of aborting spontaneously. It does not follow that each individual woman, as she proceeds through her reproductive life, becomes steadily more prone to abort. The present paper attempts to analyse evidence on how individual women's abortion probabilities vary during their reproductive lives. Statistical examination of the data suggests that:

1. A spontaneous abortion in a given birth rank is more likely than a live birth in the same rank to be followed by a further pregnancy. Abortion-prone women have more pregnancies than other women.

2. There is no significant overall tendency for spontaneous abortions to appear early or late in sibships even when account is taken of the reproductive compensation reported above.

3. Pathological examination of spontaneously aborted fetuses suggests that more (perhaps many more) than 10% of spontaneous abortions (e.g. those associated with trisomy and maternal isoimmunization) are causally associated with advanced maternal age or birth order.

4. The mean maternal age of spontaneously aborted fetuses which fail to grow in culture is higher than that of fetuses which are successfully cultured.

One would infer:

A. (from suggestions 1 and 2 above) that reproductive compensation (rather than a real birth order effect) is a major reason why abortion rates are higher at higher maternal ages and higher birth ranks;

B. (from suggestions 2 and 3 above) that there must be another group of abortions, roughly equal in number, which are causally associated with low maternal age or early birth order.

Little is known about this second group of reproductive casualties (those associated with low birth order or maternal age), but it is suggested that some have CNS malformations. I have made similar suggestions in regard to stillbirth and neonatal death.

This paper evaluates the influence of breast-feeding on infectious and allergic diseases in infants and children through an analysis of data from a large national sample of US children. It controls for a large number of maternal and child health, demographic, and socioeconomic variables which have been shown to affect feeding patterns, and it includes several aspects of the feeding pattern in addition to breast-feeding. The results suggest that breast-feeding provides some protection against pneumonia and otitis media in the United States while early introduction of formula may have a separate and negative effect.

The present study makes use of nationwide individual-level vital registration data on the single live births occurring in Greece in 2006 to explore associations of socio-demographic factors with adverse pregnancy outcomes, using multinomial logistic regression models. The findings indicate that important risk factors associated with low birth weight preterm and intra-uterine growth retarded births (IUGR) include female sex, primiparity, age of mother over 35, illegitimacy and prior history of stillbirths, infant and child deaths. These constitute risk factors for normal weight preterm births as well, though associations with sex and primiparity in this case point to the opposite direction. Residing in large metropolitan areas is related to a greater risk of an IUGR birth. Among Greek women, educational attainment has a protective effect while housewife status is linked to higher chances of an IUGR birth. For immigrant mothers however, the opposite holds. The study also shows that normal weight preterm births form a distinct group.

Mass media play an important role in changing body image. This study aimed to determine the role of media (magazines and television) in body weight concern among university females in five Arab countries. A total sample of 1134 female university students was selected at convenience from universities in five Arab countries: Bahrain, Egypt, Jordan, Oman and Syria. The females' ages ranged from 17 to 32. A pre-tested questionnaire was used to assess the exposure to mass media regarding weight concerns. For the variables on exposure to mass media, girls were divided into two groups: infrequently exposed and frequently exposed. In general, the females who were exposed to mass media had a greater risk of having dieted to lose weight and changing their ideas of a perfect body shape than those who were not exposed or infrequently exposed. The association of exposure to magazines with having dieted to lose weight was only significant among females in Bahrain (p<0.044), Egypt (p<0.001) and Jordan (p<0.001). Exposure to television had a weaker association than exposure to magazines with body weight concerns of females. The association of exposure to television with females' idea of a perfect body shape was only statistically significant in females in Egypt (p<0.019) and Oman (p<0.019). The pressure from mass media on the body weight concern of female university students may lead these women to practise unhealthy weight control diets.

Much of our understanding of the biological differences between races has come with the development of human genetics. Surveys have established the frequencies of genetic characters known to be under the control of single genes and independent of environmental modification; comparisons of these frequencies in different populations have led to the resolution of many of the earlier outstanding problems of affinities between races and, with the support of experimental and associated investigations, to the identification and measurement of the processes that have given rise to race formation. With this information we can begin to appreciate the extent to which apparent differences are due to racial heritage and to environmental influences.

Lymphatic filariasis is one of several neglected tropical diseases with severely disabling and stigmatizing manifestations that are referred to as ‘neglected diseases of poverty’. It is a mosquito-borne disease found endemically and exclusively in low-income contexts where, concomitantly, general public health care is often deeply troubled and fails to meet the basic health needs of impoverished populations. This presents particular challenges for the implementation of mass drug administration (MDA), which currently is the principal means of control and eventual elimination. Several MDA programmes face the dilemma that they are unable to attain and maintain the required drug coverage across target groups. In recognition of this, a qualitative study was conducted in the Morogoro and Lindi regions of Tanzania to gain an understanding of community experiences with, and perceptions of, the MDA campaign implemented in 2011 by the National Lymphatic Filariasis Elimination Programme. The study revealed a wide variation of perceptions and experiences regarding the aim, rationale and justification of MDA. There were positive sentiments about the usefulness of the drugs, but many study participants were sceptical about the manner in which MDA is implemented. People were particularly disappointed with the limited attempts by implementers to share information and mobilize residents. In addition, negative sentiments towards MDA for lymphatic filariasis reflected a general feeling of desertion and marginalization by the health care system and political authorities. However, the results suggest that if the communities are brought on board with genuine respect for their integrity and informed self-determination, there is scope for major improvements in community support for MDA-based control activities.

This paper explores the inter-relationships between impairment and disability in a sample of 119 teenagers in relation to their psychological adjustment and quality of social life. Poor psychological adjustment and extreme social isolation are associated not so much with individual functional limitations as with particular configurations of impairments and disabilities. It seems that social handicap is not a direct consequence of any impairment or disability but arises generally from severe functional loss and is shaped by dependency on others, restricted choices, physical barriers and adverse reactions of others.

Season of birth has been shown to correlate with many aspects of somatic and mental disorders, development and social adaptation (so-called ‘birth-date effects’). In a sample of young Swedish men, corresponding roughly to a one-year birth cohort, the results of intelligence tests, psychologists’ ratings of psychological function, school achievement, body height, weight and self-reported health during childhood, were found to be correlated with month of birth, and – more strongly – father’s socioeconomic status. The results were more favourable for men who were born during March–May (the period of highest birth rate), and whose fathers were of higher socioeconomic status, than for those born in November and December (the period of lowest birth rate), and whose fathers were in the lower socioeconomic group. It seems reasonable to conclude, from this study and previously reported findings, that these so-called ‘birth-date effects’ are determined by varying and often interacting biological and psychosocial factors. Among these factors, the light-induced entrainment of circadian and annual rhythms in the fetus and/or infant seems to be of pivotal importance. The organization of children into one-year age classes therefore produces an unfair lack of equality of possibilities.

This study examines fertility decline that is larger than expected on the basis of recorded increases in contraceptive prevalence in Ghana. The primary sources of data are three Demographic and Health Surveys (DHS) conducted in the country in 1988, 1993 and 1998. First, the trend in fertility and contraceptive prevalence in Ghana is considered and compared with the trend that would be expected on the basis of prior research. Next, an attempt is made to uncover the explanation behind this unexpected trend. Measures of the quality of the survey data are looked at, as well as trends in the proximate determinants of fertility: contraceptive use, marriage and sexual activity, postpartum insusceptibility and induced abortion. Finally, evidence is presented that couples adjust their coital frequency in accordance with their fertility preferences, behaviour that would influence fertility rates but would not be captured by conventional measures of the proximate determinants of fertility.

Maternal mortality persists in low-income settings despite preventability with skilled birth attendance and emergency obstetric care. Poor access limits the effectiveness of life-saving interventions and is typical of maternal health care in low-income settings. This paper examines access to care in obstetric emergencies from the perspectives of service users, using established and contemporary theoretical frameworks of access and a routine health surveillance method. The implications for health planning are also considered. The final caregivers of 104 women who died during pregnancy or childbirth were interviewed in two rural districts in Indonesia using an adapted verbal autopsy. Qualitative analysis revealed social and economic barriers to access and barriers that arose from the health system itself. Health insurance for the poor was highly problematic. For providers, incomplete reimbursements, and low public pay, acted as disincentives to treat the poor. For users, the schemes were poorly socialized and understood, complicated to use and led to lower quality care. Services, staff, transport, equipment and supplies were also generally unavailable or unaffordable. The multiple barriers to access conferred a cumulative disadvantage that culminated in exclusion. This was reflected in expressions of powerlessness and fatalism regarding the deaths. The analysis suggests that conceiving of access as a structurally determined, complex and dynamic process, and as a reciprocally maintained phenomenon of disadvantaged groups, may provide useful explanatory concepts for health planning. Health planning from this perspective may help to avoid perpetuating exclusion on social and economic grounds, by health systems and services, and help foster a sense of control at the micro-level, among peoples' feelings and behaviours regarding their health. Verbal autopsy surveys provide an opportunity to routinely collect information on the exclusory mechanisms of health systems, important information for equitable health planning.

In South Africa, disability grant allocation has been under review and tensions are evident in government rhetoric stressing welfare provision on the one hand, and encouraging ‘rationalization’ on the other. This ambiguity is traced down to the level of grant negotiations between doctors and ‘clients’ in a psychiatry clinic in Khayelitsha. Here ‘having nerves’ embodies the distress associated with harsh circumstances and is deemed by supplicants as sufficient to secure a grant. The paper illustrates how national discourses influence the presentation and experience of suffering and the way in which doctors mediate diagnoses. The implications of local understandings of ‘health citizenship’ for expectations of the post-apartheid state are explored.

Childhood excess weight is probably associated with, or reflected in, parental attitudes. The objective of this study was to study the relationships between childhood excess weight and parental attitudes. The study subjects were 53 boys and 56 girls, aged 6–10, regularly attending schools in Porto Alegre, south Brazil, and one of their parents or caregivers. Attitudes of the parents or caregivers were assessed by the Child Feeding Questionnaire (CFD). Weight and height of the children were measured, parents self-reported their weight and height and body mass indexes were calculated for both. The WHO criteria for overweight and obesity were used for the adults. The CDC criteria for overweight and risk for overweight were used for the corresponding children. Boys presented excess weight more often than girls. The parents of children with excess weight showed higher scores for perceived child weight, concern about child weight, restriction and monitoring. In logistic regression, excess weight in children was associated with perceived child weight, restriction and male sex; pressure to eat was negatively associated with excess BMI. In Porto Alegre, south Brazil, excess body weight in children aged 6–10 is associated with parental perceived child weight and concern about it, monitoring and restriction; being a boy increases the odds of being overweight.

Many studies have suggested that following the experience of ‘stressful’ life events the risks of accidents, myocardial infarctions and other diseases are elevated. In the OPCS Longitudinal Study, routinely collected data on deaths, and deaths of a spouse occurring in a 1% sample of the population of England and Wales in the period 1971–81 are linked together, and with 1971 Census records of sample members. The timing and patterns of death following the very stressful event of conjugal bereavement may thus be analysed.

Overall the mortality of widowers was about 10% in excess of that in all males in the sample whereas that of widows was only slightly raised. Some increases in death rates shortly after widow(er)hood are observed. Unusually, these increases in all-cause mortality rates are more marked in widows than in widowers, with a two-fold increase in mortality from all causes in the first month after widowhood. Marked peaks of post-bereavement mortality from accidents and violent causes are clear in both sexes. Possible explanations for the increased mortality rates are examined.

This study used data from a community-based survey to examine women’s experiences of abortion in Nigeria. Fourteen per cent of respondents reported that they had ever tried to terminate a pregnancy, and 10% had obtained an abortion. The majority of women who sought an abortion did so early in the pregnancy. Forty-two per cent of women who obtained an abortion used the services of a non-professional provider, a quarter experienced complications and 9% sought treatment for complications from their abortions. Roughly half of the women who obtained an abortion used a method other than D&C or MVA. The abortion prevalence and conditions under which women sought abortions varied by women’s socio-demographic characteristics. Because abortion is illegal in Nigeria except to save the woman’s life, many women take significant risks to terminate unwanted pregnancies. Reducing the incidence of unwanted pregnancy and unsafe abortion can significantly impact the reproductive health of women in Nigeria.