The 1994 Cairo Conference on Population and Development consensus called for actions that will make family planning programmes oriented to the needs and concerns of women that are served. This paper, based on data from Bangladesh, presents an illustrative analysis of how an outreach programme can be evaluated by this criterion. A scale for perceived service quality is developed from five indicators of desirable characteristics of services. Regression methods are used to assess the impact of outreach service encounters on the perceived quality scale. Econometric methods are used to adjust for endogeneity that arises from the selectivity of outreach encounters and the selective service exposure of contraceptive users. Results show that increasing contact with outreach workers increases client satisfaction with the overall quality of the Bangladesh family planning programme.

The possible differential effects of ABO blood group materno-paternal (fetal) incompatibility on completed reproductive performance were investigated on a sample of 100 couples (100 fathers and 100 mothers) from three villages in the Jind district of Haryana state, India. The average number of live births per mating couple was slightly higher for the incompatible matings (5·32) than the compatible ones (5·05). This advantage was offset by higher postnatal mortality in the former. Consequently, the average number of living children in the compatible matings (4·64) was higher than in the incompatible ones (4·18). With reference to individual ABO matings, the index of relative fertility (Irf) was the highest in A×AB followed by B×A type of incompatible matings. No decrease in live births in O×A and O×B incompatible matings was observed compared with their reciprocal compatible ones, i.e. A×O and B×O matings, as has been hypothesized in previous studies. The total pregnancy wastage was substantially higher in ABO-incompatible matings (24·59%) than compatible matings (8·45%). About 71% of the postnatal deaths took place within one year of the birth in the case of incompatible matings compared with 50% in the case of compatible matings. The study supports the hypothesis that selection is operative at the ABO locus as revealed by the measures of selection intensity. The loss of fitness in the present sample was associated with differential mortality. There were no differences in the proportions of average number of male live births in the compatible (0·55) and incompatible matings (0·58). However, in the individual mating types, there was some evidence of higher or lower proportions of male live births.

The mental state of people affected by war and other disasters has been a subject of special interest to academic researchers and practitioners in humanitarian assistance and public health for over two decades. The last decade in particular has seen a rise in the number of papers published in scholarly journals around the Post-Traumatic Stress Disorder (PTSD) debate. Anthropologists have rarely engaged in this debate. Nevertheless, some of the most illuminating contributions have come from socio-medical anthropology (Last, 2000).

The objective of this study was to evaluate trends in the availability of socially marketed condoms in urban Tanzania, and to assess the effect of changes in the social marketing programme’s strategy for distributing condoms to retail outlets. Three retail outlet surveys conducted in urban Tanzania in 1996/97, 1998 and 1999 were analysed. Multiple Classification Analysis (MCA) was used to determine changes in availability of condoms, after adjusting for differences in the composition of the samples. Consistent with the changes in the condom social marketing distribution system, the proportion of condom outlets that were supplied by wholesalers increased from 42% in 1997 to 60% in 1999. The increasing use of wholesalers allowed sales agents to devote more time to opening new outlets. Hence, the percentage of outlets that had been solicited to sell condoms by social marketing condom sales persons increased from 14% in 1997 to 25% in 1999. Following these changes in the distribution system, the percentage of outlets selling socially marketed condoms increased from 25% to 32% between 1997 and 1998, and stabilized at that level. More detailed examination showed that availability of socially marketed condoms increased significantly in most non-traditional outlets, and in all regions of the country. In conclusion, distribution survey data indicate that changes in the distribution system increased the role of wholesalers, and enabled sales teams to allocate more time to soliciting new condom outlets. Concurrent with these changes, the availability of socially marketed condoms in non-traditional retail outlets increased significantly. Regular monitoring of condom availability can ensure that any emerging supply problems are identified and remedied quickly.

The purpose of the research reported here is to examine the connection between contraception and those aspects of a woman’s position that are related to her marriage. The research was conducted in two villages among the Pare of northern Tanzania where a shift from hoe cultivation as primary occupation to wage labour has brought about major changes in social relations. The major hypothesis is that a change from a ‘traditional’ marital union to a ‘companionate’ marriage is instrumental in the acceptance of contraception and in lowering fertility. The latter type of relationship between marital partners is related to the status of women. The research methodology consisted of a combination of an ethnographic study, demographic surveys and in-depth interviews. Findings show that approximately half of the women in this community ever used contraception. Of current users, a third are sterilized and half are using a modern reversible method. The determining factor for using modern reversible methods is the nature of the conjugal union.

This paper examines incorrect use of oral contraceptives (OCs) in rural Bangladesh by using data from an OC compliance survey. Of the 1031 current users of OCs interviewed, about 13% took their pills out of sequence, while 17% left incorrect intervals between pill packs. Forty per cent of the women reported missing one active pill during the 6 months prior to the survey, and 74% of them took correct action with the missed pill. Of the women who missed two active pills (16%), only 9% took correct action. Multivariate analyses revealed that women’s education and their husbands’ support helped protect against taking incorrect action with a missed pill. The fieldworker’s contact was found to protect against leaving an incorrect interval between pill packs. Women who had membership of non-government organizations were less likely to interrupt their pill use, and more likely to take their pill out of sequence. The present study underscores the need for providing women with more support in their pill use, and advocates that service providers should be the focal point of efforts. Husbands’ support is essential to improve the pill-taking behaviour of Bangladeshi women.

Contraceptive failure rates for modern methods including sterilization are reported to be high in China, but little is known about the consequence of contraceptive failure and characteristics of women who decide to have an abortion if a contraceptive failure occurs. Using 6225 contraceptive failures from the 1988 Chinese Two-per-Thousand Fertility Survey, this study examines the resolution of contraceptive failure and assesses the impact of some women’s sociodemographic characteristics on the decision to terminate contraceptive failure in abortion. This study has three important findings: (1) The abortion rate was 50·1%, 75·3% and 80·2% for IUD, condom and pill failures, respectively; (2) The abortion rates differed by contraceptive method and women’s social and demographic characteristics. In particular, a woman with just one child was most likely to have the contraceptive failure aborted; (3) Some women experienced repeated abortions because of contraceptive failure. The results suggest that abortion was a backup method if contraception failed in China and the correlates of aborting an unwanted pregnancy reflect the strong impact of the Chinese family planning programme.

Differences in the prevalence of obesity between adjacent regions are quite common, but usually unexplained. This study examined whether birth place, selective migration, intelligence or education – which are both inversely and possibly causally related to obesity – are determinants of such differences. This population-based case-control study (case-cohort design) took place in the greater Copenhagen area (region 1) and surrounding provincial areas of Zealand (region 2), Denmark. A total of 2948 men with a median age of 19 years from two draft board regions during 1966–1977 were examined. The odds ratio (OR) for being obese (defined as body mass index ≥31 kg/m2) was investigated using multiple logistic regression analyses. The OR for being obese in region 2 compared with region 1 was 1·74 (1·50–2·03). Adjustment for birth place, intelligence test score and educational level reduced the OR to 1·42 (1·10–1·82). The OR for being obese for those born in region 2 compared with region 1 was 1·71 (1·46–2·01). Adjustments for intelligence test score, educational level and examination region reduced this OR to 1·13 (0·87–1·46). Irrespective of birth place, men examined in region 2 had a higher OR for being obese than those examined in region 1; this effect was most pronounced for those born in region 2 and examined in either region 1 or 2, with an OR of 1·06 (0·71–1·57) and 1·87 (1·58–2·22) respectively. In conclusion, the regional differences in the prevalence of obesity could not be explained by birth place or later selective migration, but educational level and intelligence test score did explain some of the difference.

Researchers in psychology have focused a great deal of attention on the potential greater predisposition to achievement among first-born children relative to their siblings. Focusing on the United States as an example, a time series of the first birth ratio is used to show how the changing prevalence of first births relative to higher order births has altered the composition of birth cohorts, and the ratio is decomposed into four factors. Results show that the ratio increased significantly in the 1960s and early 1970s, but changed only slightly in the following decades. While more recent birth cohorts are composed of larger proportions of first-born children, the majority of children are still born as siblings. Contrary to expectations, the primary source of change was the proportion childless rather than decreasing higher order birth rates.

This paper describes a pilot study assessing the psychosocial impact of political violence in the Peruvian Andes, utilizing a collaborative approach with local professionals and communities. The study team prioritized dialogue and information exchange with the local professional community and villagers participating in the assessment in order to raise awareness of psychosocial issues and provide education and support. Participation in the pilot study had positive therapeutic effects for villagers, and inspired ongoing discussion groups to address psychosocial problems in communities. This paper also describes a psychosocial assessment strategy utilizing qualitative methods and an adaptation of the Harvard Trauma Questionnaire in collaboration with Andean villagers. Usefulness and limitations of the data will be reviewed, in terms of cultural and context relevance, usefulness for informing interventions, and comparisons with ethnographic methodologies and other survey instruments.

This study investigated the importance of socioeconomic factors such as education, income, religion, family structure and residence in explaining the increased risk of mortality among vulnerable populations aged less than 20 years in Rio de Janeiro, Brazil. Data used were from the 1991 Brazilian Demographic Census and comprised 121,060 women aged 15–49 residing in Rio de Janeiro. Two alternative statistical methods were used to calculate the risk of death: the widely used Brass method (an indirect estimate which assesses population risks) and a case-control study (which assesses individual risks). The study also focused on the importance of indicators of human and social capital, the lack of which may explain the higher risk of death among children and adolescents. Lack of education was found to be a major determinant of mortality at young ages. Residence in a favela (shantytown), families in which mothers were the head of the family, and a lower median level of income were found to be significant determinants of mortality among vulnerable populations in Brazil. However, religion was not found to be as important a predictor of high mortality.

Due to their effect on maternal testosterone levels, sons are said to have reduced maternal longevity in pre-industrial humans. This analysis, using information from a Flemish agricultural village in the 18th–20th centuries, confirms the presence of a negative effect of sons on maternal longevity. However, the effect is mainly observed for mothers belonging to the least privileged social group and for sons surviving their fifth birthday. Both findings make the above-mentioned biological explanation relative. However, a plausible alternative, social interpretation is male-dominated intra-household resource competition. It is reasonable to assume that only sons above a certain age are able to claim a serious amount of resources and that competition is strongest within the least privileged social group.

Studies have documented substantial increases in obesity throughout most of the industrialized world in recent decades. The majority of explanations for these increases have centred around environmental factors such as the increasing availability of high-fat, high-carbohydrate foods and sedentary lifestyles. This study sought to determine if genetic factors might be contributing to the increases in the proportions of North Americans who are obese and overweight. The body mass index (BMI) for a large sample of two generations of United States and Canadian subjects was correlated with family fertility indicators. Small but highly significant positive correlations were found between the BMIs of family members and their reproduction rates, especially in the case of women. For instance, mothers in the sample (most of whom were born in the 1940s and 50s) who were in the normal or below normal range had an average of 4·3 siblings and 3·2 children, compared with 4·8 siblings and 3·5 children for mothers who were overweight or obese. When combined with evidence from twin and adoption studies indicating that genes make substantial contributions to obesity, this study suggests that recent increases in obesity are partially the result of overweight and obese women having more children than is true for average and underweight women. It is speculated that improvements in medical treatments for conditions associated with obesity – particularly diabetes and heart disease – are making it possible for overweight women to live longer and to be more fertile than was true historically.

Within seven years after the end of the Nicaraguan civil war in 1990, forced migrants, whose lives had been most disrupted by the conflict, were self-settled in a squatter community in the capital city of Managua and lived in extreme poverty with minimal health, education, security and social service supports. Compared with voluntary migrant neighbours, whose lives had been less affected by the conflict, forced migrants exhibited equal clinically significant symptoms of physical and mental health and psychosocial maladaptation. These findings run counter to generally held theory and assumptions about the negative long-lasting effects of the trauma and stress of war, forced migration and resettlement. Explanations are offered to explain the discrepancies between theory and the study findings as well as the dominance of poverty and socioeconomic status. Implications are also drawn for increasing social support and other durable forms of assistance that emerge from the study as important to meeting the needs of equally poor and unhealthy forced and voluntary migrants in proliferating squatter communities throughout the Third World.

A birth order and sexual orientation relationship has been demonstrated numerous times in men, but a related variable, parental age (i.e. age of parents when the participant was born), has been less studied and has demonstrated contradictory results. In this research, the relations among birth order, parental age and sexual orientation were examined in a national probability sample of the US (Kessler, 1994; Kessler et al., 1994) and in a Canadian sample of homosexual and heterosexual men closely matched on demographic characteristics (Blanchard & Bogaert, 1996a). In both studies, an interaction between birth order and parental age was observed in men, such that there was positive association between number of older siblings and the likelihood of homosexuality, but this association weakened with increasing parental age. No significant effects were observed for women. The results are discussed in relation to recent theories of the birth order/sexual orientation relationship.

Kuwait is a high fertility country where the average number of desired children still exceeds 5. However, fertility behaviour is beginning to show a noticeable change and the current TFR is about 4·2 children. In order to understand the decline in fertility, the impact of perceived benefits and costs of children on Kuwaiti women’s desired and achieved fertility is analysed. Data from a nationally representative survey of Kuwaiti households held in 1999 are used. Bivariate analyses show that the mean desired number of children is significantly higher among those who rank higher on the perceived value of children, and lower among those who are concerned about the cost of raising children. Achieved fertility (children ever born) shows a similar pattern. In the multivariate analysis, however, large family values emerge as the only significant predictor of (higher) desired as well as achieved fertility, net of the respondent’s demographic and socioeconomic characteristics. The sociocultural, economic and political contexts that shape the mother’s perceptions of the benefits and costs of children are analysed and it is concluded that the need for children as social and national capital is currently the most important driving force behind fertility desires and behaviour.

This paper explores the pathways of the determinants of unfavourable birth outcomes, such as premature birth, the size of the baby at birth, and Caesarean section deliveries, in Kenya using graphical log-linear chain models. The results show that a number of factors that do not have direct associations with unfavourable birth outcomes contribute to these outcomes indirectly through intermediate factors. Marital status, the desirability of a pregnancy, the use of family planning and access to health facilities have no direct associations with poor birth outcomes, such as premature births and the small size of the baby at birth, but are linked to these outcomes through antenatal care. Antenatal care is identified as a central link between various sociodemographic or reproductive factors and birth outcomes.

The paper looks at the limitations and strengths of using the A-cope questionnaire for measuring strategies for coping with prolonged conflict by Palestinian young people in Gaza. The scale was administered to young people between the ages of 8 and 17. The results show some gender differences in coping strategies. However, some items on the subscales are not relevant for Muslim societies or societies in situations of prolonged conflict. The authors suggest that combining an anthropological contextual perspective and qualitative data with psychological instruments is an effective way of addressing the limitations of using a single quantitative method of assessment in non-Western complex social and cultural settings.

The Old Order Amish are a healthy and well-nourished natural fertility population, so that the timing of births is not influenced by behaviours to limit family size, undernutrition or disease. The present study examines the monthly distribution of 8160 births occurring between 1920 and 1991 in the Geauga Settlement in north-east Ohio, USA. The monthly distribution of births in the Geauga Settlement is bimodal, with a major peak extending from August to October, a minor peak in February, and a major trough from April to June. This pattern is almost identical to the pattern found in the US in 1943. The monthly distribution of first births appears to be influenced to some extent by a highly significant seasonal pattern of weddings. The pattern of births in the Old Order Amish is consistent with the hypothesis that the spring trough in US births is at least partially caused by a decrease in coital frequency and/or a decrease in fecundability as a result of hot summer temperatures but is not consistent with the hypothesis that the fall peak in US births is primarily due to an increase in coital frequency during the Thanksgiving and Christmas holiday seasons.