Almost 30% of the world’s stunted children reside in India. This study examined sibling linkage in childhood stunting by assessing the extent of clustering of stunted children born to the same mother. Data were taken from 225,002 children under the age of five from the Indian National Family and Health Survey (NFHS)-4 conducted in 2015–16. States with high fertility and lower socioeconomic development displayed higher clustering of childhood stunting among siblings. Simulating removal of this clustered burden showed an almost 10 percentage point reduction in stunting in India. Multinomial regression analysis highlighted that the propensity to have multiple stunted births was higher among less-educated women, scheduled caste/tribes and poor households. The multilevel model results indicated that the odds of stunting for the index child increased by 1.93 if the older sibling was stunted. The odds of the index child being stunted if the previous child was stunted were high, irrespective of the differences in state-level public health performances and political commitments. Although socioeconomic correlates play a crucial role in determining child stunting status, they also act as proxies for poor-quality intra-generational health. Clustering of stunting among siblings is an indicator of both genetic and environmental association with the height-for-age (HAZ) of children. Mothers with repeated stunted births should be prioritized and monitored over a substantial part of their lives. Inclusion of multiple child beneficiaries in nutrition policies and revisiting the ‘one size fits all’ concept at the micro level, owing to the substantial village/ward-level variation, might be an effective policy measure.

Research on informed choice in modern contraceptive method acceptance by young married women is pertinent in the broader context of individual freedom and reproductive rights, especially in countries where women continue to have limited control over their reproductive and contraceptive choices. This study in India asked: (1) is young married women’s acceptance of specific modern contraceptive methods an informed choice? and (2) what are the enablers and barriers to informed choice? The study used data for currently married women aged 15–24 (N = 20,752) from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015–16. A Method Information Index (MII) was calculated as a measure of informed choice from the percentage of users who responded ‘yes’ to all three questions on: whether they were informed about methods other than the one they received, told about the method-specific side-effects, and advised what to do if they experienced side-effects. Binary logistic regression analysis was carried out to examine the adjusted effect of factors associated with the MII separately for female sterilization, the intrauterine device and the oral contraceptive pill, and a combined MII including all three methods plus injectables. One-fifth of the study women used any modern contraceptive method at the time of survey, of which only 36% had fully informed choice. The likelihood of being informed about the methods was significantly higher among those using the oral contraceptive pill (OR: 1.75, CI 1.58–1.94), IUD (OR: 2.23, CI 1.97–2.52) and injectables (OR: 1.37, CI 0.97–1.94) compared with those who were sterilized. Informed choice varied by region and the socioeconomic profile of the users. Inadequately informed choice violates the reproductive rights of young women and might result in higher post-use health problems, discontinuation of and unmet need for contraceptives, unintended pregnancies, induced abortions and regret, adversely affecting women’s health. Training of health/family planning workers in India about the importance of reproductive rights is urgently required to enhance informed contraceptive choice and improve the health of young married women.

Unsafe abortions remain a considerable public health problem and continue to be a leading cause of maternal morbidity and mortality throughout the world. This study assessed whether women’s choice of type of health care facility for abortion in India varied by their socio-demographic and economic characteristics, and aimed to determine the significant predictors of choice of health care facility. Data were taken from the 2015–16 Indian National Family and Health Survey (NFHS-4). The study sample included women aged 15–49 years, irrespective of their marital status, who had terminated their last pregnancy by induced abortion in the five years before the survey (N = 6876). A bivariate analysis was carried out to assess the pattern in the choice of health care facility type for an abortion, and a multinomial logistic regression model was fitted to assess the predictors affecting the choice of health care facility type for an abortion. The results showed that, at the time of the 2015–16 survey, women in India went to private facilities more than public facilities for abortion care, irrespective of their age, distance to facility and financial constraints. The probability of visiting a private facility increased with women’s age, gestational age and the wealth quintile. A wide variation in choice of health facility for abortion care by socioeconomic characteristics was observed.

Since the implementation of the National Health Mission (NHM) in India there has been a noticeable improvement in the utilization of maternal care, namely antenatal care (ANC), skilled birth attendants (SBA) and postnatal care (PNC) in the country. The increase in utilization of these services is expected to reduce inequality across geographies and population sub-groups, but little is known about the extent of inequality in maternal care use across socioeconomic groups over time. Using data from the last two rounds of National Family Health Surveys conducted in 2005–06 and 2015–16, this study examined the extent of inequality in utilization of full ANC, SBA and PNC in India and its states. Descriptive statistics were used, a concentration index was computed and decomposition analyses performed to understand the pattern and change of inequality in use of maternal care. The results suggest that the gap in maternal care utilization across socioeconomic groups has reduced over time. The concentration index for SBA showed a decline from 0.49 in 2005–06 to 0.08 by 2015–16, while that of PNC declined from 0.36 to 0.13 over the same period. The reduction in inequality in utilization of full PNC was the least. The results of the decomposition analysis revealed that urban residence, education and belonging to Scheduled Caste and Scheduled Tribes positively contributed to the inequality. Based on these findings, it is suggested that the Janani Suraksha Yojana and Janani Sishu Suraksha Karyakaram schemes be continued and strengthened for poor mothers to reduce maternal health inequality, particularly in full ANC and PNC.

Maternal education plays a central role in children’s health, but there has been little research comparing the role of maternal education across health outcomes. It is important to distinguish child health outcomes from medical care outcomes. Health outcomes such as short-term morbidity and stunting are multifactorial in origin and determined by a range of factors not necessarily under a mother’s control. Mother’s education, given the necessary structural factors such as medical centres, is likely to lead to increased access to, and uptake of, medical services. Using data from the 2004–05 India Human Development Survey, eight separate logistic regressions were carried out on 11,026 women of reproductive age and their last-born child under five years of age. The results showed that maternal education had the strongest association with medical care, immunization (except polio) and iron supplementation for pregnant mothers, moderate association with underweight and weak association with short-term diseases and stunting. In addition, the study investigated whether maternal education impacts child health and medical care outcomes through the intervening roles of empowerment and human, social and cultural capital. These intervening linkages were found to be missing for short-term diseases and stunting, bolstering the argument that the influence of maternal education is limited for these outcomes.

Voluntary counselling and testing (VCT) for HIV has been promoted as a strategy to prevent HIV pandemics by changing sexual behaviour. Despite the provision of VCT in countries with generalized or high-burden epidemics, including Nigeria, the extent of its influence on behavioural change remains a conjecture. The main objective of this study was to examine the influence of HIV VCT on sexual behaviour changes among youths in Nigeria. The study utilized 2013 Nigeria Demographic and Health Survey (NDHS) data. Data were analysed from a nationally representative sample drawn from 8046 females and 6031 males aged 15–24 giving a total sample of 14,077 never-married youths. Descriptive and analytical analyses were carried out, including multivariate logistic regression. The study found a low uptake of HIV VCT and regional variation in behavioural changes between female and male youths. Voluntary HIV counselling and testing was found to be a protective factor for condom use at last sex for female youths, but significantly reduced the likelihood of primary sexual abstinence for both females and males, as well as having a single sexual partner for female youths. After controlling HIV VCT with other variables, certain socioeconomic factors were found to be significantly associated with behavioural changes. Thus, the attitudes of most Nigerian youths towards voluntary HIV counselling and testing needs to be improved through socioeconomic factors for healthy sexual activity. To achieve this, government and non-governmental organizations, as well as religious leaders and policymakers, should engage in appropriate and long-term activities directed at the sexual health needs of never-married youths, through voluntary HIV counselling and testing, to encourage them to change their sexual behaviour.

Human anthropometric traits, while significantly determined by genetic factors, are also affected by an individual’s early life environment. An adult’s body height is a valid indicator of their living conditions in childhood. Parental education has been shown to be one of the key covariates of individuals’ health and height, both in childhood and adulthood. Parental functional literacy has been demonstrated to be another important determinant of child health, but this has largely been overlooked in studies on height. The objective of this study was to analyse the associations between parents’ education, their functional literacy and their children’s adult body height. The study used data for 39,240 individuals from the 2016 wave of the nationally representative Life in Transition Survey (LITS) conducted in 34 countries in Southern and Eastern Europe, the Middle East and Central Asia. Using linear and Poisson models, regression adjustment treatment estimators and multilevel mixed-effects linear regressions, the study analysed the links between mother’s and father’s educational attainment, parental functional literacy, measured by the number of books in the childhood home, and children’s adult height. The models also included other individual and contextual covariates of height. The results demonstrated that mother’s educational attainment and parental functional literacy have independent associations with children’s adult body height. Sufficient literacy skills of the parent may have a positive effect on children’s growth even if parental education is low. These associations remained significant across time. The study also provides evidence of a widening of the height gap for men born in the period just before and after systemic transition in post-socialist societies, which may suggest an increase in social differences in early living standards.

This paper presents an analysis of trends in sexual activity by marital status and age, and their associations with contraceptive use. Understanding levels of, and trends in, sexual activity is important for assessing the needs for family planning services and for analysing commonly used family planning indicators. Data were taken from 220 Demographic and Health Surveys (DHSs) and 62 Multiple Indicator Cluster Surveys (MICSs) to provide insights into sexual activity by marital status and age in a total of 94 countries in different regions of the world. The results show the sensitivity of the indicator with respect to the definition of currently sexually active, based on the timing of last sexual intercourse (during the last 4 weeks, 3 months, or 1 year). Substantial diversity in sexual activity by marital status and age was demonstrated across countries. The proportion of married women reporting recent sexual activity (sexual intercourse during the last 4 weeks) ranged from 50% to 90%. The proportion of unmarried women reporting recent sexual activity did not exceed 50% in any of the 94 countries with available data, but showed substantial regional differences: it appeared to be rare in Asia and extremely varied within Africa, Europe and Latin America and the Caribbean. Among married women, sexual activity did not vary much by age group, while for unmarried women, there was an inverted U-pattern by age, with the youngest age group (15–19 years old) having the lowest proportion sexually active. The proportion of women who reported currently using contraception and reported not being sexually active varied by the contraceptive method used and was overall much greater among unmarried women. The evidence presented in this paper can be used to improve family planning policies and programmes to serve the diverse needs, for example regarding method choice and service provision, of unmarried women.

Women tend to under-report or misreport their abortion experiences, mainly because abortion is considered a sensitive issue for cultural, religious, political or other reasons in many countries across the world. Turkey, where induced abortion is an increasingly sensitive issue due to intense statements against induced abortion on religious grounds by influential politicians, and a hidden agenda to prohibit the practice, especially in public health facilities, in recent years, is no exception. This study focused on the increase in level of misreporting of induced abortion in Turkey and its link to social desirability bias using pooled data from 1993 and 2013 Turkish Demographic and Health Surveys. A probabilistic classification model was used to classify women’s reported abortions. The findings confirmed that the level of misreporting of induced abortions has increased from 18% to 53% among all terminated pregnancies over the period 1993–2013 in Turkey. This marked increase, especially among women in the lower socioeconomic sections of society, may be largely associated with the prevailing political environment, and increase in social stigmatization against induced abortion in Turkey over recent decades.

The positive effect of women’s empowerment on the use of contraceptives is well established. However, the reverse effect, i.e. the potential effect of use of contraceptives on women’s empowerment, is relatively unexplored. This study examined the direct impact of contraceptive use on women’s empowerment in currently married women aged 15–49 years in India using data from the National Family Health Survey-4 conducted in 2015–16. A two-stage least squares (2SLS) regression model was used to account for the issue of endogeneity that appears in a general logit model. The use of contraceptives by the sample women was found to be associated with greater women’s empowerment in terms of both their mobility and decision-making power. The pathways to greater women’s empowerment are often presumed to be factors such as changing perception of their domestic role and sense of control over their own body. While these are integral, this paper highlights how the possible control over family size and birth interval through use of contraception may also be critical pathways to increasing women’s empowerment.

The interval between successive pregnancies (birth interval) is one of the main indexes used to evaluate the health of a mother and her child. This study evaluated birth intervals in Iran using data from the Iranian Multiple Indicators Demographic and Health Survey (IrMIDHS) conducted in 2010–2011. A total of 20,093 married Iranian women aged 15–54 years from the whole country constituted the study sample. Based on the nature of sampling and the unobserved population heterogeneity for birth intervals in each city and province, a multilevel survival frailty model was applied. Data were analysed for women’s first three birth intervals. The median first and second birth intervals were 30.3 and 39.7 months respectively. Higher education, Caesarean delivery, contraceptive use and exposure to public mass media were found to decrease the hazard rate ratio (HRR) of giving birth. Meanwhile, higher monthly income increased the hazard of giving birth. The results suggest that public mass media can play an effective role in encouraging women to have the recommended birth interval. Furthermore, increasing family income could encourage Iranian couples to decrease the time to their next birth.

The Nutrition Transition model posits that vegetable oils, animal source foods (ASFs) and caloric sweeteners contribute to increases in adiposity and hence body mass index. Body mass index (BMI) is increasing more rapidly among Latin American populations of low versus high socioeconomic status (SES). The objectives of this study among Costa Rican women were to: (1) compare indicators of adiposity and dietary intake by SES and (2) evaluate the relationship between intake of foods high in vegetable oils, ASFs or caloric sweeteners and body fatness. This cross-sectional study, conducted in 2014–2015, included 128 low-, middle- and high-SES non-pregnant, non-lactating women aged between 25 and 45 years with 1–4 live births. Anthropometry was used to assess BMI, body composition and body fat distribution. Dietary recalls (n = 379) were used to assess dietary intake. Percentage body fat was greater in low- versus high-SES women (31.5 ± 3.9 vs 28.2 ± 4.7%). Skinfold measurements at four sites on the upper and lower body were greater in low- versus high-SES women. Body mass index did not vary in low- versus high-SES women. Intake frequency of foods high in vegetable oils was greater in low- and middle- (1.8 and 1.8 times/day, respectively) versus high- (1.1 times/day) SES women. For individual foods, intake frequency varied significantly by SES for high-fat condiments, fried vegetables, dairy, sweetened coffee/tea and pastries and desserts. Intake frequency of Nutrition Transition food categories was not associated with percentage body fat after adjustment for energy intake. Indicators of body composition provide additional information beyond BMI that are useful in understanding SES–adiposity associations in Latin America. Approaches to understanding diet and adiposity in Latin America that focus on vegetable oils, ASFs and caloric sweeteners should consider within-country variation in the pace of the Nutrition Transition, especially when explaining variation in adiposity by SES.

This study explores the link between height and earnings, using data from the Russian Longitudinal Monitoring Survey for the year 2015 (24th wave). The dependent variable was average monthly income and the key independent variable was self-reported height, measured in centimetres. The empirical model also included a rich vector of personal and job-related factors that have been shown to be associated with earnings in the relevant literature. Sequential multiple regression and one-way analyses of variance (ANOVA) were used to analyse the data. The results suggest that height is a significant predictor of earnings in Russia. The results were found to be robust for a set of controls and tests.

Unwanted and mistimed pregnancies impose threats on the health and well-being of the mother and child and limit the acquisition of optimal sexual and reproductive health services, especially in resource-constrained settings like the Democratic Republic of Congo (DRC). This study aimed to determine the prevalence and correlates of mistimed and unwanted pregnancies among women in the DRC. Data were drawn from the 2013–14 DRC Demographic Health Survey (EDS-RDC II). Bivariate and multivariate logistic regression analysis was performed to identify correlates of mistimed and unwanted pregnancies. Sequential logistic regression modelling including distal (place of residence), intermediate (socio-demographic and socioeconomic factors) and proximal (reproductive health and family planning) factors was performed using multivariate analysis. More than a quarter (28%) of pregnancies were reported as unintended (23% mistimed and 5% unwanted). Women who wanted no more children (aOR 1.21; CI: 1.01, 1.44) had less than 24 months of birth spacing (aOR 2.14; CI: 1.80, 2.54) and those who intended to use a family planning method (aOR 1.24; CI: 1.01, 1.52) reported more often that their last pregnancy was mistimed. Women with five or more children (aOR 2.13; CI: 1.30, 3.49), those wanting no more children (aOR 13.07; CI: 9.59, 17.81) and those with more than 48 months of birth spacing (aOR 2.31; CI: 1.26, 4.23) were more likely to report their last pregnancy as unwanted. The high rate of unintended pregnancies in the DRC shows the urgency to act on the fertility behaviour of women. The associated intermediate factors for mistimed and unwanted pregnancy indicate the need to accelerate family planning programmes, particularly for women of high parity and those who want no more children. Likewise, health promotion measures at the grassroots level to ensure women’s empowerment and increase women’s autonomy in health care are necessary to address the social factors associated with mistimed pregnancy.

Cross-generational sexual relationships are a major route of transmitting HIV and STI between older and younger generations. However, previous research has focused mainly on the young women in these relationships. This study examined the characteristics of men engaging in non-marital sexual relationships with girls aged 15–19 in Nigeria. The data were drawn from the 2013 Nigeria Demographic and Health Survey, and the analysis was restricted to a sub-sample of 7557 men aged 30–49 who were sexually active in the 12 months prior to the survey. Data analysis was carried out using frequency distributions, chi-squared tests of association and binary logistic regression. It was found that 9.5% of men aged 30–49 reported engaging in cross-generational sexual relationships. Also, being older (OR = 0.35), married (OR = 0.37), having secondary or higher education (OR = 0.70; 0.59) and having sexual debut between ages 18 and 30 (OR = 0.73) were associated with a lower likelihood of having cross-generational sexual relationships. However, Muslim men (OR = 2.10), men from Igbo (OR = 1.90), Hausa/Fulani (OR = 8.47) and Northern and Southern minority tribes (OR = 4.73; 2.49), men living in rural areas (OR = 1.34), men who were over the age of 30 at sexual debut (OR = 2.67) and those with 2–4 and 5 or more lifetime sexual partners (OR = 1.43; 1.58) were significantly more likely to engage in cross-generational sexual relationships. Addressing the challenges of cross-generational sexual relationships can be an effective strategy to reduce the menace of HIV and STI transmission. Men who have low education, those aged 30–34 years, those who initiated sex at an older age, rural dwellers and those who have had several lifetime sexual partners need to be targeted while designing and implementing programmes and policies to reduce cross-generational sexual relationships in Nigeria. These interventions must also take into account the religious and cultural attitudes towards cross-generational sexual relationships, and further investigations should identify men’s motives for engaging in the practice.

From an evolutionary perspective, childlessness may be considered a failure, as it implies that there will be no direct transmission of one’s genetic material to later generations. It is also a pressing social issue, because in many contemporary advanced societies, levels of childlessness have increased, and particularly so among men. The absence of a partner is naturally a fundamental determinant of childlessness. Empirical evidence on how childlessness relates to individuals’ partnership histories is nevertheless limited. This issue was analysed with Finnish population register data, which allow the complete cohabitation and marriage histories of individuals from age 18 years to be observed. For women and men born between 1969 and 1971, logistic regression models were estimated for childlessness at age 40 by partnership histories in terms of various stages in the process of union formation and dissolution, and accounting for several socioeconomic variables. A strong link between union histories and childlessness was found, with short partnership spells raising the risk of not becoming a parent. Later age when leaving the parental home raised female childlessness, while a short first-union duration related more strongly to male childlessness. These findings may be considered as providing insights into how specific life-history strategies affect reproductive outcomes, and highlight the need to develop new approaches to understand this feature of social inequality.

Little is known about intimate partner abuse (IPA) among couples during pregnancy in Iran. This study aimed to compare the rates of IPA by pregnant women towards their husbands (perpetration), and women’s experience of IPA from their husbands (victimization) and determine the predictors of the two behaviours. The cross-sectional study was conducted on 525 pregnant women at 24–30 weeks of gestation visiting governmental health care centres/posts in Tabriz, Iran, in 2014. The study sample was selected using random cluster sampling. The Revised Conflict Tactics Scale (CTS2) was used to assess IPA perpetration and victimization. The McNemar test was employed to compare the prevalences of IPA perpetration and victimization, and adjusted logistic regression was utilized to determine the socio-demographic predictors of overall IPA perpetration and victimization. The overall rates of women’s reported abuse of their husbands (perpetration) and women’s experience of abuse from their husbands (victimization) were 70% and 67%, respectively, but the difference was not statistically significant (p=0.086). The prevalence of psychological aggression perpetrated by women towards their husbands was significantly higher than that experienced by the women from their husbands (65% vs 58%, p<0.001). The prevalences of sexual coercion (15% vs 30%) and injury (8% vs 16%) perpetrated by women on their husbands were significantly lower those they experienced by the women from their husbands (p<0.001). There was no statistically significant difference between the prevalence of perpetration of physical violence towards husbands by women (19%) and that experienced by women from their husbands (22%) (p=0.072). Women’s and husbands’ satisfaction with their own occupations were predictors of both perpetration and victimization of IPA. The observed high rates of IPA perpetration by, women and victimization of, women during pregnancy, and the significantly higher rate of violence towards women compared with that perpetrated by women, especially for sexual coercion and injury, require health policymakers and care providers to make serious efforts to identify such violence, and take appropriate measures to reduce it, during pregnancy in women in Iran.

Socioeconomic changes occurring over time influence the lifestyle choices of a population, and these can significantly affect children’s body weight and composition. The aim of this study was to assess the changes in prevalence of overweight, obesity and adiposity in pre-school children in Poland between 2008 and 2018. Body height, body weight and subscapular and triceps skinfolds were measured in 2167 children aged 3–7 years from Kraków. Body mass index and adiposity (percentage body fat, %BF) were calculated for the children, who were then categorized as underweight, normal weight, overweight or obese according to Cole’s cut-off points. Adiposity was categorized according to the z-scores for %BF as low (<−1), normal (−1 to 1) or high (>1). Differences between cohorts were analysed using the chi-squared test. Only the decrease in the prevalence of obesity in 5-year-old girls was found to be statistically significant. However, some overall tendencies were noted. Decreases in the prevalence of underweight, overweight and obesity were observed for both sexes, as well as in the incidence of high adiposity in boys and low adiposity in girls. Increases in the prevalence of high adiposity in girls and low adiposity in boys were also noted. There was no significant change in the prevalence of overweight and obesity among pre-school children over the study decade, and the visible tendencies included decreases in the prevalence of excess body weight and adiposity as well as underweight and low body fat. Also, the visible trends in adiposity were mostly negative. Further studies should, however, also consider the levels of physical fitness and activity of children, as these have a crucial influence on the measured characteristics.

This study examined the pattern of economic disparity in the modern contraceptive prevalence rate (mCPR) among women receiving contraceptives from the public and private health sectors in India, using data from all four rounds of the National Family Health Survey conducted between 1992–93 and 2015–16. The mCPR was measured for currently married women aged 15–49 years. A concentration index was calculated and a pooled binary logistic regression analysis conducted to assess economic disparity (by household wealth quintiles) in modern contraceptive use between the public and private health sectors. The analyses were stratified by rural–urban place of residence. The results indicated that mCPR had increased in India over time. However, in 2015–16 only half of women – 48% (33% from the public sector, 12% from the private sector, 3% from other sources) – were using any modern contraceptive in India. Over time, the economic disparity in modern contraceptive use reduced across both public and private health sectors. However, the extent of the disparity was greater when women obtained the services from the private sector: the value of the concentration index for mCPR was 0.429 when obtained from the private sector and 0.133 when from the public sector in 2015–16. Multivariate analysis confirmed a similar pattern of the economic disparity across public and private sectors. Economic disparity in the mCPR has reduced considerably in India. While the economic disparity in 2015–16 was minimal among those accessing contraceptives from the public sector, it continued to exist among those receiving services from the private sector. While taking appropriate steps to plan and monitor private sector services for family planning, continued and increased engagement of public providers in the family planning programme in India is required to further reduce the economic disparity among those accessing contraceptive services from the private sector.

The main aim of this study was to test whether perception of partner infidelity prompts people to adopt behaviour that is meant to compensate for the increased risk of infection posed by their partner’s infidelity; or whether it prompts people to engage in behaviour that magnifies the risk associated with partner infidelity. Data used were derived from the fourth and latest Botswana AIDS Impact Survey (BAIS IV) conducted in 2013. The sample consisted of 6985 people aged 10–34 years. Logistic regression analysis was used to identify factors associated with perception of partner infidelity and sexual risk behaviours. Perception of partner infidelity with the current and most recent partner was 39.6% while perception of partner infidelity with other previous sexual partners was 79.9%. The main socio-demographic factors associated with perception of partner infidelity were being a man, being single and having secondary education, while sexual risk behaviours associated with perception of partner infidelity were having multiple sexual partners and being involved in multiple concurrent sexual partnerships. These relationships were statistically significant at the 5% level. Botswana’s HIV prevention strategies should seek to improve partner communication within relationships in order to enhance people’s confidence and skills so as to minimize perceptions of infidelity.