Female genital mutilation (FGM) is very pervasive in Africa, with significant regional variations in the prevalence of this traditional practice. This study examined the linkages between FGM and multiple sexual partnership in Mali and Sierra Leone – two African countries with a high prevalence of FGM. Data were from the 2018 Mali and 2013 Sierra Leone Demographic and Health Surveys, and the study sample comprised 4750 women from Mali and 16,614 from Sierra Leone. Multilevel logistic regression was used for the data analysis, with reported adjusted odds ratios (aOR) and associated 95% confidence intervals. In Mali, women who had not undergone FGM were less likely to have multiple sexual partners (aOR=0.60, CI=0.38–0.96) compared with those who had undergone FGM. In Sierra Leone, women who had undergone FGM (aOR=1.15, CI=1.02–1.30) were more likely to have multiple sexual partners compared with those who had not undergone FGM. Age, level of education, wealth quintile, sex of household head, community socioeconomic status, mass media exposure, and community literacy level were found to be associated with the likelihood of multiple sexual partnership among women in Mali and Sierra Leone. Comprehensive, age-group-based risk-reduction strategies, such as abstinence education and decision-making skills (assertiveness) training, are needed to reduce girls’ and young women’s engagement in multiple sexual partnerships. Policy interventions, such as anti-FGM legislation and initiatives like the ‘Schooling for the Female Child’ initiative aimed at reducing social inequality among girls and women, might help decrease FGM and the likelihood of health-compromising behaviours like multiple sexual partnership.

The importance of childhood immunization for healthy child growth and development is well recognized and is considered to be the best and most cost-effective lifesaver. Low socioeconomic status has been shown to be associated with low child immunization and health care utilization, but the inequalities in immunization coverage due to social and economic factors are poorly understood. This study aimed to explore the association between child immunization coverage and various socioeconomic factors and to quantify their contributions to generating inequalities in immunization coverage in India. The study data are from the National Family Health Survey-4 conducted in 2015–16. The association between socioeconomic determinants and child full immunization coverage was estimated using the χ2 test and binary logistic regression. Concentration indices were estimated to measure the magnitude of inequality, and these were further decomposed to explain the contribution of different socioeconomic factors to the total disparity in full immunization coverage. The results showed that the uptake of immunization in 2015–16 was highly associated with mother’s educational status and household wealth. The concentration index decomposition revealed that inequality (immunization disadvantage) was highest among poorer economic groups and among children whose mothers were illiterate. The overall concentration index value indicates that the weaker socioeconomic groups in India are more disadvantaged in terms of immunization interventions. The results offer insight into the dynamics of the variation in immunization coverage in India and help identify vulnerable populations that should be targeted to decrease socioeconomic inequalities in the country.

Amidst persistently high unintended pregnancy rates and lags in contraceptive use, novel methodological approaches may prove useful in investigating sexual and reproductive health outcomes in the Philippines. Systematic Anomalous Case Analysis (SACA) – a mixed-methods technique – was employed to examine predictors of women’s lifetime contraceptive use. First, multivariable, longitudinal Poisson regression models predicted fertility and sexual debut using the 1998–2009 Cebu Longitudinal Health and Nutrition Surveys (CLHNS), then regression outliers and normative cases were used to identify 48 participants for in-depth interviews (2013–2014) for further examination. Qualitative findings from 24 women highlighted ‘control over life circumstances’ was critical, prompting the addition of two items to the original quantitative models predicting any contraceptive use (n=532). Each of the items, ‘what happens to [them] is their own doing’ and ‘[I] do not [have] enough control over direction life is taking [me]’, significantly and independently predicted any contraceptive use (aOR: 2.37 (CI: 1.24–4.55) and aOR: 0.46 (CI: 0.28–0.77), respectively). The findings demonstrate the utility of SACA to improve the understanding and measurement of sexual and reproductive health outcomes and underscore the importance of integrating psychosocial constructs into existing models of fertility and reproductive behaviour in the Philippines to improve sexual and reproductive health outcomes.

While population ageing is rising, the educational composition of the elderly remains rather heterogeneous. This study assesses the educational differences in future population ageing in Asia and Europe, and how future population ageing in Asia and Europe would change if the educational composition of its populations changed. A comparative population ageing measure (the Comparative Prospective Old-Age Threshold [CPOAT]) was used, which recalculates old-age thresholds after accounting for differences in life expectancy, and the likelihood of adults surviving to higher ages. Combined data from projected age- and sex-specific life-tables (from the United Nations) and projected age- and sex-specific survival ratios by different levels of education (from the Wittgenstein Centre for Demography and Global Human Capital) were used to construct projected life-tables (2015–2020, …, 2045–2050) by educational level and sex for different regions of Asia and Europe. Based on these life-tables, future comparative prospective old-age thresholds by educational level and sex were calculated. It was found that in both Asia and Europe, and among both men and women, the projected old-age thresholds are higher for higher educated people than for less-educated people. While Europe has a larger projected share of elderly in the population than Asia, Europe’s older population is better educated. In alternative future scenarios in which populations hypothetically have higher levels of education, the projected shares of elderly in the population decrease across all regions of Asia and Europe, but more so in Asia. The results highlight the effectiveness of investing in education as a policy response to the challenges associated with population ageing in Asia and Europe. Such investments are more effective in the Asian regions, where the educational infrastructure is less developed.

Adult height is a summary measure of health and net nutrition in early childhood. This study examines the association between height and quality-of-life outcomes in older adults (50+) in India. Cross-sectional data from Wave 1 of the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) conducted in 2007 were analysed. The association between height and quality of life was assessed using bivariate and multivariate logistic and linear regression models. The mean WHO quality-of-life score (WHO-QoL) increased from 45.2 among the older adults in the lowest height quintile to 53.2 for those in the highest height quintile. However, the prevalence of self-rated poor quality of life declined from 16.4% in the lowest height quintile to 6.1% in the highest height quintile. In the fully adjusted regression model, height was found to be positively associated with quality-of-life outcomes among both men and women, independent of socioeconomic and physical health confounders. The association was particularly strong for women. Women in the highest height quintile had a 2.65 point higher WHO-QoL score than those in the lowest height quintile. Similarly, the likelihood of reporting a poor quality of life was lower among women in the highest height quintile. Furthermore, measures of economic status, handgrip strength, cognitive ability and poor self-rated health were significantly associated with WHO-QoL and self-rated poor quality of life. Overall, this study revealed a significant association between height and quality of life among older adults in India, suggesting a significant role of childhood circumstances in quality of life in later life.

Neonatal mortality is one of the leading causes of under-five mortality globally, with the majority of these deaths occurring in low- and middle-income countries. In Ghana, there is a belief in an array of newborn conditions, called Asram, that are thought to have a spiritual, rather than physical, cause. These conditions are predominantly managed by traditional healers as they are considered unable to be treated by allopathic medical providers. Through a series of semi-structured qualitative interviews of medical providers in Kumasi, Ghana, conducted in July–August 2018, this study sought to elucidate perspectives of allopathic medical providers about Asram, including the perceived implications of traditional newborn care patterns on newborn health and higher-level neonatal care. Twenty health care providers participated and represented a tertiary care hospital and a district hospital. Medical providers were universally aware of Asram but varied on the latitude they gave this belief system within the arena of newborn care. Some providers rationalized the existence of Asram in the backdrop of high neonatal mortality rates and long-standing belief systems. Others highlighted their frustration with Asram, citing delays in care and complications due to traditional medical treatments. Providers utilized varying approaches to bridge culture gaps with families in their care and emphasized the importance of open communication with the shared goal of improved newborn health and survival. This study describes the importance of providers being aware of socio-cultural constructs within which pregnant women operate and suggests a focus on the shared goal of timely and effective newborn care in Ghana.

This paper examines the sequential impact of components of maternal and child health care on the continuum of care in India using data from the Indian National Family Health Surveys conducted in 2005–06 and 2015–16. Continuum of care (CoC) for maternal and child health is defined in this paper as the sequential uptake of three key maternal services (antenatal care, institutional delivery and postnatal care for the mother). Women who received all three services were classified as full CoC recipients. Characteristics odd ratios for achieving CoC were estimated by mother’s place of residence, household wealth status, mother’s education, birth order and child full vaccination. Odds ratios were computed to understand the relative impact of each preceding service utilization on the odds of subsequent service uptake. At national level, 30.5% and 55.5% of women achieved full CoC in 2005–06 and 2015–16, respectively, and the overall progress of CoC over the 10-year period was 25.5 percentage points, with significant variation across states and socioeconomic groups. Full CoC improved from 7.5% to 32.4% among the poorest women, whereas among the richest women it improved from 70.5% to 75.1%. Similarly, among uneducated women full CoC improved from 11.7% to 35.9% as against 75.1% to 80.5% among educated mothers over the same period. Furthermore, greater CoC was observed among parity one women. The conditionality between various components of CoC indicated that at national level the odds of having an institutional delivery with antenatal care were 9 times higher in the earlier period as against 4.5 times higher in the more recent period. Furthermore, women who had institutional deliveries complied more with mother’s postnatal care compared with women who did not have institutional deliveries. This again helps increase the likelihood of a child receiving full vaccination.

There has been a drastic decline in the child sex ratio (number of females per 1000 males between ages 0 and 4) in India and many of its states. This study aimed to examine if prenatal factors, such as change in sex ratio at birth, or postnatal factors, such as change in relative mortality of females and males, contribute to this more by analysing the dynamics of the child sex ratio. Changes in the child sex ratio during 2001–2011 were decomposed into a ‘fertility’ component attributable to prenatal sex selection and a ‘mortality’ component attributable to sex differentials in postnatal survival at the country as well as the state level. Between the prenatal factor and the postnatal factor, the contribution of the latter to the declining child sex ratio has been greater than the former in India as a whole and in most of the states. By focusing on both prenatal and postnatal factors, the imbalance in the child sex ratio in the country can be reduced to a large extent.

The multiple realities around the sexual and reproductive health of Ghanaian adolescents are explored in this paper. Female and male adolescents (aged 10–19 years, N=298) participated in 40 focus group discussions in 20 communities. A comparative inductive approach has been used to present, analyse and document the sexual and reproductive realities of adolescents in their communities. The findings reveal commonalities as well as differences in the realities among participants. Common realities, regardless of age and sex, were teenage pregnancy and abortion, sexual violence (defilement, rape and coercive sex) and parental neglect. These aside, there were divergent realities for older adolescent girls in particular, e.g. lack of access to contraceptives and understanding of the fertility cycle, and the influences and pressures of social media and varied notions about sexual harassment between female and male adolescents. The findings, overall, underscore the complexity and nuanced lives of adolescents in traversing the sexual and reproductive maturation processes. These events unfold in communities where adolescents are ‘required’ to be silent and ‘play’ innocent regardless of their daily struggles, compounded by limited opportunities to learn and unlearn embedded norms about sexual and reproductive functioning. Some implications for sexual health promotion programmes are outlined.

The co-existence of under- and overweight at population level around the globe is well documented. However, this has yet to be explored using suitable statistical techniques in the context of Bangladesh. This study aimed to examine the prevalence and risk factors for being underweight and overweight or obese compared with normal weight in ever-married non-pregnant women aged 15–49 years in Bangladesh using data from the most recent Bangladesh Demographic and Health Survey conducted in 2014. Multilevel multinomial logistic regression (MLMLR) and quantile regression models were fitted to examine the associations of socioeconomic and individual-, household- and community-level factors on the nutritional status of women as measured by BMI. Overall, the prevalences of underweight, normal weight, overweight and obese women were 19%, 58%, 19% and 4%, respectively, in 2014. The MLMLR analysis revealed that women of young age, widowed/divorced/separated, having a larger family size and children aged ≤5 years in the household, currently amenorrhoeic and members of non-government organizations were at significantly increased risk of being underweight; those of older age, having higher parity, more educated, frequently watched TV and non-poor were more likely to be overweight or obese relative to normal BMI. Women from more affluent communities and urban areas were more likely to be overweight or obese relative to normal BMI than their counterparts from less-affluent and rural communities. Women’s nutritional status was found to be heterogeneous across the regions of the country. The findings indicate that, along with individual-level factors, community-level characteristics are also important in explaining women’s BMI in Bangladesh. The issue of under- and overweight or obesity among women in Bangladesh requires the immediate adoption of a public health policy for its mitigation. When developing intervention programmes, important determinants and uniform development of regions should be taken into consideration to combat the dual burden of under- and overweight among women in Bangladesh.

After a universal two-child policy was introduced in China in 2016, studies have been published using women’s fertility intentions to forecast future births; however, the recommended algorithms need to be improved. In this study, an algorithm based on the method of limiting factors is developed to retrospectively forecast annual births in Xi’an City in the first three years of policy implementation, i.e. 2016–2018. The 2015 Xi’an Fertility Survey (sample: 560 one-child mothers) showed that 17% of mothers intended to have a second child, 30% were undecided and 53% did not intend to do so at the end of 2015. The low forecast variant based on the updated algorithm indicates that there would be a baby boom in 2016–2018, but the annual births would increase by 13% at most. The forecasting results are basically consistent with the official reports on annual births. This study emphasizes the importance of appropriately adjusting all fertility intentions in birth forecasting, helps to understand women’s fertility behaviour and evaluate the effects of implementing the universal two-child policy, and has important implications for China’s population and family planning work.

In October 2015, the Chinese Government announced that the one-child policy had finally been replaced by a universal two-child policy. China’s universal two-child policy is highly significant because, for the first time in 36 years, no one in an urban city is restricted to having just one child. This cross-sectional study was conducted to explore future fertility intentions and factors influencing individual reproductive behaviour (whether to have two children) in Dalian City. A total of 1370 respondents were interviewed. The respondents’ mean ideal number of children was only 1.73, and urban respondents’ sex preference was symmetrical. A total of 19.0% of the respondents were unmarried, 64.5% were married and had childbearing experience and only 6.3% of married respondents had two children. Among the 1370 participants, 30.4% stated that they would have a second child, while 69.6% refused to have a second child in the future. Binary logistic regression analysis (Model 1) showed that the following characteristics were associated with having only one child in the future: being female, being older, having a lower education level, being born in Dalian, having a lower family income and reporting one child as the ideal number of children. Model 2 (comprising only respondents with childbearing experience) showed that respondents who were female, had a lower family income and were unable to obtain additional financial support from parents were more likely to intend to stick at one child. In addition, respondents’ ideal number of children and childbearing experiences had a significant influence on future fertility intentions. These results suggest that fertility intentions and reproductive behaviours are still below those needed for replacement level fertility in Dalian City. China’s policymakers should pay more attention to these factors (socioeconomic characteristics, economic factors, desired number of children and childbearing experiences) and try to increase individual reproductive behaviour.