This paper explores the importance of gender differences in the impact of tropical diseases on women. Malaria and schistosomiasis are used as examples but most of the observations also apply to other diseases endemic to developing countries. The distinction between sex and gender is discussed and evidence of sex and gender differences in the determinants and consequences of malaria and schistosomiasis, particularly their economic, social and personal dimensions, is reviewed. Issues on which research and intervention studies are needed are identified.

Birth interval is a major determinant of rates of fertility, and is also a measure of parental investment in a child. In this paper the length of the birth interval in a traditional African population is analysed by sex of children. Birth intervals after the birth of a boy were significantly longer than after the birth of a girl, indicating higher parental investment in boys. However, in women of high parity, this differential disappeared. Birth intervals for women with no son were shorter than for those with at least one son. All these results are compatible with an evolutionary analysis of reproductive decision-making. First born sons have particularly high reproductive success, daughters have average reproductive success and late born sons have low reproductive success. The birth interval follows a similar trend, suggesting that longer birth intervals represent higher maternal investment in children of high reproductive potential.

Serum prolactin has been measured in single blood samples collected within the first 22 post-partum months from 97 nursing mothers from an urban area (Bukavu) of Zaïre. Nursing mothers are hyperprolactinemic, higher serum prolactin levels being associated with more frequent suckling episodes per day. Furthermore, serum prolactin declines rapidly in mothers who are giving the breast less than four times per day: the levels are within the normal range found in non-lactating women after the 6th post-partum month. Among mothers giving the breast more than six times per day, serum prolactin does not decline significantly during the 1st post-partum year.

Previous lactation experiences do not facilitate the effect of nursing on prolactin secretion during subsequent lactations.

Urine was collected at weekly intervals at weekly intervals for three or more months from 139 menstruant women aged 40–55 years. Menstrual cycles were classed as ovulatory if the 24-hr pregnanediol output was > 5 μmol on a single occasion, or if the total excreted on 2 days 1 week apart was > 7 μmol. Of the 81 women who reported no change in menstrual frequency, 95% ovulated in every cycle. Only 34% of the 53 with a recent history of oligomenorrhoea ovulated without fail. Ovalation occurred in 93% of all 21–35-day menstrual cycles, in 55% of 36–50-day cycles, in 40% of 51–75-day cycles and in 17% of those lasting > 76 days. Pregnanediol increases suggestive of ovulation and followed by menstruation were observed on 31 occasions after amenorrhoea of from 2 to 6 months' duration.

The purpose of this study was to validate the self-reported body height and weight of adult Japanese women. The subjects were women, aged 20–42 years, who participated in a survey on eating disorders in women in 1995. Physically measured height and weight data were obtained for 368 (89·8%) of the 469 women who self-reported their height and weight. The report-based heights and weights were compared with the measured values. The correlation coefficients for height and weight were 0·990 and 0·963 (p<0·0001), respectively. Mean reported height was 0·1 cm shorter and mean reported weight 0·2 kg lighter than the measured values. Shorter women tended to report a taller height than their actual height, and heavier women to report a lower weight than their actual weight. Despite these limitations, the self-reported heights and weights of adult Japanese women were precise and accurate, and their use in epidemiological surveys is considered acceptable.

This paper examines age patterns of first marriage and motherhood and covariates of early marriage, delayed consummation of marriage and early motherhood in Nepal using data from the 2000 Nepal Adolescent and Young Adult Survey (NAYA). Both unmarried and married male and female youths (age 14–22) were included in the survey. The analysis is based on 2800 urban youths and 5075 rural youths with complete information on the variables examined. Proportional hazard models are used to estimate covariates of early marriage and early motherhood, and logistic regression models are used to estimate covariates of delayed consummation of marriage. The results show that early marriage and early motherhood are quite common among Nepalese women, especially in rural areas. Early marriage is much less common among men. Delayed consummation of marriage is common among very young brides, especially in rural areas. The main covariates associated with early marriage and early motherhood are respondent’s education, region of residence and ethnicity. The main covariates of delayed consummation of marriage are age at first marriage, region of residence and ethnicity. The study highlights the need to focus on less educated female youths in the Terai region in order to reduce the reproductive and child health risks associated with early marriage and early childbearing.

In Australia, Belgium, Denmark, England and Wales, Holland, Italy, New Zealand, Norway, Scotland, Sweden and Switzerland there was a substantial decline in dizygotic twinning rates during the 1960s. In Portugal, Spain and Japan there was a lesser decline and in the US there was little change. In many of the countries for which evidence is available, it seems that these declines all started at about the same time in the late 1950s. It has been suggested that the recent decline in Scotland occurred mainly in middle class women; in contrast it is suggested here that the earlier decline in the US during the years 1933–58 was more characteristic of lower class women. For England and Wales and for Scotland, the recent decline (unlike that in the US 1933–58) occurred about equally in young and older women, so that the causes of the declines in the US in 1933–58 and in other countries at present may be different. In the absence of hard evidence, it is speculated that the current declines may be due to hormonal or pesticidal substances widely used in agriculture.

Monozygotic twinning rates have shown no similar trend so that pregnancy wastage does not seem to be implicated.

Dietary diversity is associated with household or individual food availability and intake of nutrients from different food groups and is an important component of nutritional outcome. This study examined the Nutrient Adequacy Ratio (NAR) and the Mean Adequacy Ratio (MAR) of three dietary diversity indices and their relationship with the nutritional status of adolescents and adults in rural regions of two states in India, Wardha district in Maharashtra and Koraput district in Odisha, in 2014. Individual dietary diversity was calculated using 24-hour diet recall (FS24hr) data and household dietary diversity was measured with food frequency data using Berry’s index (DDI) and food scores (FSFFQ). The nutritional status of individuals was assessed using anthropometric indices. The diets in both locations were cereal dominated. It was observed that 51% of adolescent boys and 27% of adolescent girls had ‘thinness’ and stunting. The prevalence of undernutrition was higher among adult women (48%) than adult men (36%). The mean diversity indices were FS24hr of 8, DDI of 89–90 and FSFFQ of 64–66 in the two locations. The FS24hr was found to be positively correlated with the NAR of all nutrients while DDI and FSFFQ were correlated with seven and six nutrients, respectively. The DDI and FS24hr showed an association with MAR if the two locations were combined together. Sensitivity and specificity analysis showed that FS24hr gave more true positives than false positives and the area under the Receiver Operating Characteristic curve was 0.68, implying that this measure truly differentiates individuals having low dietary diversity with low MAR from those with low dietary diversity and a high MAR. All three measures of dietary diversity showed a linear association with the nutritional outcomes of adults, while in the adolescent group only DDI showed a relationship. It is concluded that 24-hour diet recall is a good measure for studying the relationship between dietary diversity and nutritional status in adults.

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).

Using data from a survey of deaths of children less than 5 years old conducted in 1997 in a county in Shaanxi Province, China, this paper examines gender differences in child survival in contemporary rural China. First, excess female child mortality in the county in 1994–96 is described, followed by an analysis of the mechanisms whereby the excess mortality takes place, and the underlying social, economic and cultural factors behind it. Excess female child mortality in this county is probably caused primarily by discrimination against girls in curative health care rather than in preventive health care or food and nutrition. Although discrimination occurs in all kinds of families and communities, discrimination itself is highly selective, and is primarily against girls with some specific characteristics. It is argued that the excess mortality of girls is caused fundamentally by the strong son preference in traditional Chinese culture, but exacerbated by the government-guided family planning programme and regulations. This suggests that it is crucial to raise the status of girls within the family and community so as to mitigate the pressures to discriminate against girls in China’s low fertility regime. Finally, the possible policy options to improve female child survival in contemporary rural China are discussed.

Cross-sectional and longitudinal study of a large sample confirms that mean marital coital rates decline very rapidly over the first year of marriage. They seem to halve over the first year of marriage, and then they take perhaps another 20 years to halve again. This pattern of decline is interpreted as evidence against the suggestion that coital rates are closely related to female hormone levels.

The higher correlation of marital coital rates with wife's age than with husband's age, it is argued here, is because wife's age is more closely associated than husband's age with duration of marriage (here seen as the most important of these three variables in the determination of coital rates). This is because of the substantially smaller variance of wife's age at marriage than husband's age at marriage.

From a longitudinal study over 25 years (1951–75) of two adjacent Gambian villages, the data allow estimates of population growth, birth rates, age-specific mortality, female fertility, and infertility rates in the two sexes. Such intensive but small scale local inquiries provide valuable information on topics not covered in official published statistics, and also data from which the reliability of some census details can be estimated. There are many similarities but also differences between the two villages. Population growth rate was 1·1% per annum for Keneba and 2·2% for Manduar. Crude death rates averaged 36·7 per thousand for Keneba and 24·7 for Manduar and showed little difference between the sexes. For Keneba and Manduar respectively stillbirth rates were 63·9 and 88·6, first week mortality 49·2 and 44·9 and neonatal mortality 85·2 and 49·6 per thousand live births. In Keneba, where survival to age 5 years averaged 50%, young child mortality was significantly higher than in Manduar but mortality at older ages was not. Season profoundly affected child mortality: about 45% of all deaths under 15 years occurred in the late wet season, August–October. Maternal mortality in Keneba was 10·5 and in Manduar 9·5 per thousand. Crude birth rates averaged 58·4 per thousand for Keneba and 49·0 for Manduar, rates per thousand women aged 15·44 years averaging 248·5 and 215·3 respectively.

In both villages mean birth interval increased progressively with the survival of the preceding child. In Keneba the interval increased from about 16 months when the first of the two children was stillborn to nearly 37 months when the first child survived to 2 years. In Manduar the corresponding values were 19 and 36 months. Analyses of obstetric histories indicated that total fertility was of the order of 7·5 live births per woman in Keneba and 6·4 in Manduar. Estimates of primary infertility for females were 3·6% in Keneba and 5·6% in Manduar, and for males 3·1% and 1·9%. Estimates of secondary infertility in females were 13% in Keneba and 19% in Manduar.

Using a large special study population and refined indicators of socio-economic status, the relationship of the live birth sex ratio to socio economic variables is examined. The analyses provide control for the possible confounding effects of race and birth order.

The sex ratio is shown to be significantly and positively associated with socio-economic variables. The relationship is not linear, however, but instead is characterized by an apparent ‘diminishing returns’ curve. The major increase in sex ratio is detected as socio-economic status increases from low to moderate. No significant change occurs between moderate and higher socio-economic levels.

Even after controlling for the significant socio-economic effect, the analyses detect a significant difference between the sex ratios of Whites on the one hand and Negroes and Puerto Ricans on the other.

No significant association between birth order and the sex ratio can be detected in the study population.

Urine was collected at weekly intervals for 3 months from 254 menstruant women aged 15–39 years, all of whom were 4 or more years from the menarche. Menstrual cycles were classed as ovulatory if the 24-hr pregnanediol output was 5 μmol or over on a single occasion, or if the total excreted on 2 days, 1 week apart, was 7 μmol or over. Of the 108 women aged 20–24 years, only 62% ovulated in every cycle compared with 88% for the 58 women aged 25–29 years, and 91% for the 44 women aged 30 or over. Unfailing ovulation occurred more often in non-students (99 women, of whom 83·5% ovulated in every cycle) than in age-matched students (111, 59·5%), and more often in women who lived with relatives (127, 83·5%) than in those living in flats and hostels (72, 51·4%).

Coercion may play an important role in compelling young women to engage in sexual intercourse at an early age. With a decline in age at first intercourse and increased reporting of coercive first sex, concerns of adverse reproductive health outcomes such as unintended pregnancy and sexually transmitted infections (STIs), including HIV, have become important issues, particularly in the context of a high HIV prevalence. This paper uses data collected in 2001 from the second round of a longitudinal study of 1130 sexually experienced young women in KwaZulu-Natal to investigate the relationship between coerced first intercourse and selected reproductive health outcomes and behaviours. Nearly 46% of all sexually experienced young women had reported that their first sexual encounter had been coerced. Young women who reported being coerced at first sex were significantly more likely to be Black and living in an urban area. Those who had been coerced at first sex were also more likely to report having had an STI and having experienced unintended pregnancy, than those who had not been coerced at first sex. Coercion at first sex is an important social and public health problem that has a serious impact on the reproductive health and behaviours of young women. Interventions should directly address the issue of sexual coercion by ensuring young women are aware of their reproductive rights.

The aim of this study was to determine the prevalence and sociodemographic correlates of consanguineous marriages in Turkey using data derived from the 2003 Turkey Demographic and Health Survey (TDHS-2003). Demographic surveys conducted in the last 40 years consistently show that Turkey is a country with a high level of consanguinity. In the latest demographic survey (TDHS-2003), a nationally representative sample of 8075 ever-married women, consanguineous marriages accounted for 22% of the total, which is equivalent to a mean coefficient of inbreeding (α) of 0·011. There are changing secular profiles in the rates of consanguinity in general and of the specific sub-types of cousin marriages in particular in Turkey. The prevalence of first cousin marriages among all consanguineous marriages presents a steady decline from one marriage cohort to the next. The changes observed over time may be attributable to several factors such as the increase in educational level of women, the nuclearization of the family system, the mobility from rural to urban settings, a better socioeconomic status of families, an increase in women’s labour force participation in formal sectors, lower fertility rates resulting in a smaller number of cousins available for marriage, and an increased awareness of the effects of consanguineous unions on child health in cases where there is an inherited recessive disease in the family. Any attempts to discourage consanguinity at the population level appear to be inappropriate and undesirable, especially when the consanguineous union remains an integral part of the cultural and social life of Turkey. Nevertheless the WHO-recommended approach to minimizing the negative effects of consanguinity on child health should be followed, i.e. the identification of families with a high risk of a genetic disease and the provision of prospective genetic counselling.

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.

This study’s first objective was to compare the mean birth weights of homosexual and heterosexual men and women. Its second objective was to investigate whether prior male and female fetuses have different effects on the birth weight of subsequent fetuses. The subjects were 3229 adult men and women (the probands), who weighed at least 2500 g at birth, and whose mothers knew the sex of the child (or fetus) for each pregnancy prior to the proband. Information on birth weight, maternal gravidity and other demographic variables was reported on questionnaires completed by the probands’ mothers. The results confirmed earlier reports that boys with older brothers weigh less at birth than boys with older sisters, but they did not confirm reports that girls with older brothers weigh less than girls with older sisters. The results did not show across-the-board differences in the mean birth weights of homosexual versus heterosexual women or homosexual versus heterosexual men. However, the homosexual males with older brothers weighed about 170 g less at birth than the heterosexual males with older brothers. It is suggested that this pattern of results may reflect a maternal immune response to Y-linked minor histocompatibility antigens (H–Y antigens). According to this hypothesis, when the maternal immune response is mild, it produces only a slightly reduced birth weight, but when it is stronger, it produces a markedly reduced birth weight as well as an increased probability of homosexuality.

Nuptiality norms in rural Bangladesh favour birth during the teenage years. An appreciable proportion of teenage births are, in fact, second births. This study examines the relationship between teenage fertility and high infant mortality. It is hypothesized that if physiological immaturity is responsible, then the younger the mother, the higher would be the mortality risk, and the effect of mother's ‘teenage’ on mortality in infancy, particularly in the neonatal period, would be higher for the second than the first births. Vital events recorded by the longitudinal demographic surveillance system in Matlab, Bangladesh, in 1990–92 were used. Logistic regression was used to estimate the effects on early and late neonatal (0–3 days and 4–28 days respectively) and post-neonatal mortality of the following variables: mother's age at birth, parity, education and religion, sex of the child, household economic status and exposure to a health intervention programme.

The younger the mother, the higher were the odds of her child dying as a neonate, and the odds were higher for second children than first children of teenage mothers. First-born children were at higher odds of dying in infancy than second births if mothers were in their twenties. Unfavourable mother's socioeconomic conditions were weakly, but significantly, associated with higher odds of dying during late neonatal and post-neonatal periods. The results suggest that physical immaturity may be of major importance in determining the relationship between teenage fertility and high neonatal mortality.

Coital frequency is studied among couples as a function of marital or cohabiting status, relationship duration, number of children, religious affiliation, income, education, fertility intentions, age, race, self-assessed health, time spent in work, and perceived relationship quality. Data are from the 1987–88 National Survey of Families and Households. Predictors of coital frequency that were stable across several analyses were male's and female's ages, the duration of the relationship, and the male partner's self-assessed health. When the discrepancy in partners' reports was adjusted, cohabitation status, number of children, future fertility intentions, religious affiliation, and relationship quality as assessed by the female partner were significant. The results suggest a substantial idiosyncratic component to the determination of coital frequency in relationships.