The private sector in health care in Vietnam has been increasingly competing with the government in primary health care services. However, little is known about the use of skilled birth attendance or about choice of public and private sectors among those who opt for skilled attendants. Using data from the Vietnam 2002 Demographic and Health Survey, this study examines factors related to women’s decision-making of whether to have a skilled birth attendant at a recent childbirth, and if they did, whether it was a public or private sector provider. The study indicates that the use of the private sector for delivery services was significant. Women’s household wealth, education, antenatal care and community’s wealth were positively related to skilled birth attendance, while ethnicity and order of childbirth were negatively related. Order of childbirth was positively associated with skilled birth attendance in the private sector. Among service environment factors, increased access to public sector health centres was associated with an increased likelihood of skilled birth attendance in general, but a lowered chance of that in the private sector. Further studies are needed to assess the current situation in the private sector, the demand for delivery services in the private sector, and its readiness to provide quality services.

The present paper assesses fetal loss among currently married women in India. In addition, the effects of social, economic, demographic and health factors on fetal loss are studied. The study uses data from the second National Family Health Survey conducted in India during 1998–2000. The results show wide variations in fetal loss (induced abortion, spontaneous abortion and still-birth) measures across the country. The importance of mother’s nutritional status, birth spacing, risky behaviours such as smoking, drinking and chewing tobacco and age at marriage for pregnancy outcomes in India is also discussed. The study results imply a broad understanding of reproductive health in India, and emphasize the importance of widening the scope of community-based reproductive health education programmes to improve the reproductive health of women.

The present paper examines the association between the type of household and maternal health in India using data from the National Family Health Survey 1998–99. The indicators of maternal health used in the analysis are contraceptive use, visit to obtain antenatal care in the first trimester, safe delivery and nutritional status of women measured in terms of body mass index (BMI). Binary and multinomial logistic regressions are used to establish associations. The type of household is coded into three categories, viz. nuclear household, joint household with in-laws and joint household without in-laws. The other independent variables used in the analysis are age, children ever born, work status, education of women, religion, caste, standard of living, exposure to mass media, women’s autonomy and presence of others at the time of interview. The findings clearly suggest that type of household is significantly associated with the utilization of the above-mentioned services that positively affect maternal health. Women in nuclear households are more likely to utilize these services compared with women in joint households. However, an association between type of household and BMI was not found.

Evolutionary theory suggests that maternal grandparents will invest more in their grandchildren than paternal grandparents, due to the difference between the certainty of maternity and the uncertainty of paternity. Most tests of this prediction have tended to use retrospective ratings by grandchildren rather than examining grandparental behaviour. Using a large-scale data set from the UK (n>7000), significant differences are shown between maternal and paternal grandparents in terms of frequencies of contact with their newborn grandchildren, while controlling for a wide range of other variables. Maternal grandparents also provided a significantly wider range of financial benefits than paternal grandparents. Maternal grandparents were also more likely to provide essentials and gifts and extras for the baby. Multiple correspondence analysis showed that contact frequencies systematically related to other measures of grandparental investment, indicating that contact frequencies are a useful proxy measure to examine overall investment. Findings are discussed with reference to the paternity uncertainty hypothesis.

This paper examines the trends in utilization of five indicators of reproductive and child health services, namely, childhood immunization, medical assistance at delivery, antenatal care, contraceptive use and unmet need for contraception, by wealth index of the household in India and two disparate states, Uttar Pradesh and Maharashtra. The data from three rounds of the National Family and Health Survey conducted during 1992–2005 are analysed. The wealth index is computed using principal component derived weights from a set of consumer durables, land size, housing quality and water and sanitation facilities of the household, and classified into quintiles for all three rounds. Bivariate analyses, rich–poor ratio and concentration index are used to understand the trends in utilization of, and inequality in, reproductive and child health services. The results indicate huge disparities in utilization of these services, largely to the disadvantage of the poor. Utilization of basic childhood immunization among the poorest and the poor stagnated in India, as well as in both states, during 1998–2005 compared with 1992–1998. The use of maternal care services such as medical assistance at delivery and antenatal care remained at a low level among the poor over this period. However, contraceptive use increased relatively faster among the poor, even with higher unmet need. Of all these services, the inequality in medical assistance at delivery is consistently large, while that of contraceptive use is small. The state-level differences in service coverage by wealth quintiles over time are large.

In this study, sex ratios at birth (male/female births) were found to vary according to family composition. Using Demographic and Health Survey (DHS) maternity histories from sub-Saharan Africa, the study shows that the sex ratio at birth increases with the number of previous male births and decreases with the number of previous female births. For families with only males, the sex ratio increases from 1·046 for the first birth to 1·083 for the 8th birth. For families with only females, the sex ratio decreases from 1·046 for the first birth to 0·942 for the 8th birth. The differences were highly significant when tested with a linear logistic model (p=0·018 for males; p=1·85✕10−11 for females). The effect was not symmetrical, and was found to be significantly stronger for females. These effects could be reproduced assuming a strong heterogeneity between couples. The distribution of sex ratios was fitted with an asymmetrical log-gamma function, which revealed a wide range of variation in the sex ratio between 0·50 and 1·30, and a peak around 1·14. The results and their implications are discussed in the light of former findings in France and in the United States of America.

The timing of transitions to sexual activity, marriage and childbearing in sub-Saharan Africa is undergoing profound changes. This study investigates the determinants of adolescent transitions in South Nyanza, a socioeconomically deprived setting in Kenya where adolescent reproductive health is a particular concern. The analysis is based on Cox regression of timing of first sexual intercourse, first marriage and first pregnancy, using data from a survey of 1247 females aged 12–19 years. The results show that higher household socioeconomic status and educational attainment are associated with delayed onset of all three transition events. Furthermore, mother’s higher educational attainment is protective for initiation of sexual intercourse while rural residence is protective for pregnancy experience. Other protective factors include communication with parents or with fellow girlfriends. However, discussing sexual matters with boyfriends, high internal locus of control, and gender bias are associated with early onset of the three transition events.