Infant mortality, a reflection of socioeconomic and health conditions of a population, is shaped by diverse factors. This study delves into a pre-industrial population, scrutinizing neonatal and post-neonatal deaths separately. Family factors such as mortality crises, religion, and legitimacy are also explored. Data of 9,086 people obtained through multigenerational information from ecclesiastic records from 1603 to 1908 were analysed by means of a joinpoint regression analysis. Death risk was assessed with univariate and multivariate Cox Proportional Hazard models. Early neonatal mortality was 5.6% of births and showed a gradual and steady increase from 1630 to 1908, with no substantial improvement over the three centuries analysed. Late neonatal (4.3% of births) and post-neonatal mortality (18.7% of births) shared a different pattern, showing a decline between the mid-18th and mid-19th centuries, and an increase by the 20th century that could be caused by socioeconomic factors and the impact of several epidemics. In the historical population of Hallstatt, infant survival was influenced by the sex of the newborn, the death of the mother and the precedent sibling, and by the birth interval. Environmental and cultural factors, such as mortality crises and religion, influenced late neonatal and post-neonatal mortality, but not early neonatal mortality. The results highlight the need to independently assess early neonatal mortality in studies of infant mortality in historical populations, and to use as complete time periods as possible to capture differences in mortality patterns.

Head porterage, popularly known in Ghana as Kayayei, has been an old economic venture for young girls and women who migrate from the northern to the southern part of the country. Even though Head Porters view Kayayei as a source of livelihood, conditions such as the outbreak of the 2019 coronavirus disease (COVID-19) further worsened their sexual vulnerabilities, as well as their autonomy to make decisions on contraceptive use. Head Porters, as a term defined in this study, refers to women aged 15 years or older who carry loads from one point of the town to another for a fee. The study is qualitative and used both purposive and simple random sampling in recruiting 120 Head Porters for focus group discussions. The study was planned and implemented in three zones in Kumasi, the Ashanti Regional capital of Ghana, during the lockdown period (between March and April 2020). Factors such as access to contraceptives, self-reported sexual desire, and partner desire to use condoms, sexual demands, and the impact of the COVID-19 pandemic on contraceptive access were assessed. Sexual demands increased during the COVID-19 period, with most Head Porters indicating they used fewer condoms and contraceptives during the same period. The desire to use a condom was limited among both Head Porters and their partners, and access to contraceptives was hampered by fear of getting infected by COVID-19 from a health worker at family planning clinics. The COVID-19 pandemic significantly increased the sexual and economic vulnerabilities of Head Porters in Ghana and impacted their access to family planning services. Governmental and international organizations need to start developing intervention programs for vulnerable populations such as Head Porters before future disease outbreaks.

The UK has experienced alarming increases in the number of individuals living with food insecurity as a result of the rise in the cost of living. The mechanisms linking household economic insecurity to food insecurity, and perceived health outcomes, are not well understood. The aim of this study was to explore how individuals with lived experience of food insecurity are coping with the rise in the cost of living, the trade-offs they might be making between food and other household expenses, and how these might impact eating behaviours and health outcomes. Using a qualitative inductive approach rooted in hermeneutic phenomenology, nine semi-structured interviews were conducted among individuals using charity-run food provision services in Bristol, UK. Narrative accounts from these interviews were analysed thematically. Almost all participants were recipients of benefits at the time of interviews and were living under high levels of economic insecurity. The rise in the cost of living forced complex budget management strategies, including relying on donated food and shoplifting. It also influenced eating behaviours through altered cooking strategies to save energy, substituting food for cheaper, less-nutritious, alternatives, and rationing meals. Food insecurity was experienced as a form of psychosocial violence, engendering high levels of stress, particularly for individuals with diet-related chronic diseases. There is therefore an urgent need for policies that tackle structural causes of overall household economic insecurity, and improve economic access to adequate nutritious foods, to prevent further entrenching social inequalities.

Knowledge about HIV and level of HIV-related stigma have been considered the main indicators of the community’s readiness to combat and bring the HIV epidemic to an end. Of all Serbia, the northern Kosovo province is especially vulnerable to the HIV spread because the infrastructure and the entire regulatory system had to be rebuilt after the ethnic conflict. The study objective was to examine the association between HIV-related knowledge level and attitudes towards people living with HIV (PLHIV) among university students from northern Kosovo using the quantile regression. A total of 1,017 students filled in an anonymous questionnaire. The questionnaire examined socio-demographic characteristics, HIV-related knowledge, attitudes towards PLHIV, sources of information about HIV, past experiences with PLHIV, and health behaviours. The dependent variable in the model was the attitude score (ATS) divided into quantiles (Q) in quantile regression analysis: Q0.10, Q0.25, Q0.50, Q0.75, and Q0.90. The independent variable was the knowledge score (KNS). The model was adjusted for relevant covariates. The majority of students had adequate HIV-related knowledge (89.6%) and 10.4% had lower knowledge. Most students also had a positive attitude (83.9%), while 16.1% were indecisive towards PLHIV. No students exhibiting wrong knowledge and negative attitudes were observed. The KNS and ATS significantly correlated with one another (ρ = 0.383; p = 0.001). The quantile regression model adjusted for variables associated with both KNS and ATS showed a negative association between KNS and ATS in the lowest quantile (Q0.10) of the ATS. In all other quantiles (Q0.25–Q0.90), a higher KNS was associated with having stronger positive attitudes towards PLHIV. This study confirmed that higher knowledge about HIV was associated with stronger positive attitudes towards HIV. Still, some students remain indecisive despite being knowledgeable about HIV. These students could benefit the most from continuing educational programmes to reduce the HIV-related stigma.

Air pollution in households is a prime contributor to health issues in developing countries, as in the case of India. According to the latest National Family Health Survey Report 2022, more than half of India’s rural population and 41 per cent overall still depend on solid or unclean fuel combustions, which may reflect in future health hazards. Thus, it is crucial to understand the issue empirically. To that end, the study traces the transitional pattern of unclean cooking fuel users towards clean fuel over the last 30 years using responses from all five National Family Health Survey rounds. Further, the study uses an adjusted probit model to analyse the determinants that lead to the choice of cooking fuel in a household and a logistic model to examine the association between the choice made and the respiratory health of children under five. The empirical results show that the number of households using unclean fuel has declined over the years, with a slightly higher decline in the last five years. Moreover, it also shows that poverty status and place of residence significantly influence cooking fuel choice. Additionally, children residing in households that use clean fuels are less likely to suffer respiratory infections. In conclusion, the present study provides strong evidence to ameliorate the existing policies in a way that exhorts clean energy use. The authors propose pro-poor, pro-rural policies to expedite the clean energy transition, benefitting the most vulnerable households.

Despite the growing literature on the impact of Covid-19 on antenatal care (ANC) and maternal/neonatal and child health outcomes globally, substantial knowledge gaps remain about the population-level impact in sub-Saharan Africa (SSA). Existing evidence on the ANC impact of Covid-19 in SSA is largely based on health facility or small-scale qualitative research, which are limited in providing population-level understanding. This paper examines the extent to which Covid-19 impacted ANC service utilisation and identifies what population sub-groups were most adversely impacted. It is based on a secondary analysis of the Madagascar Demographic and Health Survey (DHS), the first DHS in SSA released following the Covid-19 pandemic. Multilevel logistic regression analysis was used to estimate the net effect of Covid-19 on ANC and identify the most at-risk population sub-groups. The findings show that all ANC measures considered (no ANC, early ANC, adequate ANC visits) were significantly affected by Covid-19 (p<0.05). On average, Covid-19 was associated with a 42% increase in the odds of having no ANC, a 22% reduction in the odds of starting early ANC during the first trimester, and a 22% reduction in the odds of receiving adequate ANC (at least four visits, starting during the first trimester). Births to older mothers and to mothers with no education were disproportionately affected during Covid-19. Although youth aged 15–24 had poorer ANC compared to older women before the pandemic, the pattern was reversed during the pandemic. Also, the protective effect of education was stronger during than before the pandemic. These findings underscore the importance of Covid-19 impact mitigation strategies targeting the most at-risk groups (e.g. older mothers). Furthermore, essential information/education during pandemics should be in formats accessible to non-literate women. This paper advances understanding of the population-level impact of Covid-19 on ANC and emphasises the need for further research to better understand the population-level impact of Covid-19 across countries of SSA.

Household air pollution (HAP) presents numerous health challenges. The association between HAP and sleep problems has not been extensively studied. This paper examined the effect of HAP due to solid fuel use on sleep problems among older adults in India. Data from the initial phase of the Longitudinal Aging Study in India, which included 51,060 individuals aged 50 years and older, was utilised. Sleep problems were defined as experiencing difficulty falling asleep, waking up during the night, or waking up too early at least five times per week and were classified as a binary variable. Exposure to HAP was defined as the use of solid fuel for household purposes. Multivariate logistic regression was employed to assess the association, and additionally, interaction analysis was conducted to explore the potential moderating effects of age, gender, and residence on this association. The prevalence of sleep problems among older adults was around 12.7%. Sleep problems were higher among older adults who used solid fuel for cooking (OR = 1.25; 95% CI: 1.17, 1.33) and other purposes (OR = 1.13; 95% CI: 1.06, 1.20) in the adjusted model. The place of cooking, ventilation, and type of stove played a significant role in the association between solid fuel use and sleep problems. Individuals over 65, females, and those residing in rural areas were particularly vulnerable to sleep problems due to HAP exposure. The findings highlight the importance of reducing HAP exposure by transitioning to clean fuels as a public health priority within initiatives aimed at promoting healthy aging.

Current prevalence of disability in Bangladesh stands at 7.14%. Due to various misconceptions, stigma, and lack of policies, they are more vulnerable to violence and abuse from perpetrators. However, there is a paucity of research on the prevalence of emotional, physical, and sexual violence in the country. To address this knowledge gap, the current study aims to estimate the prevalence and explore the experiences of emotional abuse, physical, and sexual violence of persons with disabilities with their coping strategies. This study adopted a mixed-method sequential design comprising qualitative and quantitative components. A total of 5000 persons with disabilities were interviewed during the survey, and mini-ethnographic case studies were conducted with 51 purposively selected persons with disabilities from all eight administrative divisions of Bangladesh. Descriptive and bivariate statistical analysis was performed for quantitative data. Qualitative data were analysed through thematic analysis. The study concludes that the lifetime prevalence of emotional, physical, and sexual abuse is 68.9%, 26.6%, and 11.5%, respectively. Male participants were more prone to experience sexual abuse than females for both lifetimes (male: 12.7% & female: 10.3%) and within the last 12 months before the survey (male: 6.6% & female: 5.1%). Neighbours and close family members were found to be perpetrators of emotional and physical violence, whereas immediate family members were the perpetrators of sexual violence. Even though participants shared several coping mechanisms, equal to or less than 0.5% sought help from a counsellor to cope with the trauma. Results from the study correspond to the earlier studies with implications for future research and urgent policy reform. Although women are more vulnerable to experiencing different forms of violence, men with disabilities are no different. However, this remains unseen and unheard. To reduce the prevalence of violence against this marginalised group, a coordinated and collaborative approach is required targeting nationwide sensitisation, easy access to help-seeking centres, and adequate policy implementation.

As COVID-19 spread rapidly during the early months of the pandemic, many communities around the globe anxiously waited for a vaccine. At the start of the pandemic, it was widely believed that Africa would be a significant source of infection, and thus, vaccinating African communities became a primary goal among local and global health authorities. However, when the COVID-19 vaccine became available in March 2021 in Sierra Leone, many people viewed it with scepticism and hesitation. While much literature has focused on access and distribution-related challenges for vaccination in the region, a growing number of studies discuss vaccine hesitancy as driving low vaccine uptake. Shifting attention to understanding the determinants of vaccine hesitancy remains fundamental to increasing vaccination rates, as negative vaccine perceptions tend to delay or prevent vaccination. This study sought to do this by assessing, through semi-structured qualitative interviews, vaccine-related attitudes and experiences of residents of Sierra Leone’s Kono District. In contrast to studies that utilise “knowledge-deficit” models of belief, however, this study drew upon the vaccine anxieties framework (Leach and Fairhead, 2007), which views vaccines as being imbued with personal, historical, and political meaning. Findings suggest that important bodily, social, and political factors, including fear of side effects, the spread of misinformation prompted by poor messaging strategies, and distrust of government and international actors, influenced people’s COVID-19 vaccine attitudes and behaviours. It is hoped that the study’s findings will inform future policies and interventions related to vaccine uptake in Africa and globally.

The promotion of menstrual health and hygiene globally, especially in lower-middle-income countries (LMICs), is a major public health imperative. The primary study objective was to ascertain the change in the patterns of menstrual hygiene practices and their sociodemographic determinants amongst adolescent girls and young women in India. The present study analyses data from the Indian National Family and Health Survey (NFHS), round 4 (2015–2016) and round 5 (2019–21). Women in the age group 15–24 years (n = 241,180) were interviewed regarding their menstrual hygiene practices. The proportion of women using sanitary napkins as absorbent during menstruation increased from 41.8% (NFHS-4) to 64.1% (NFHS-5), with more than six in ten adolescent girls and young women in India using sanitary pads during menses, although the socioeconomically vulnerable more likely to lack access. The higher age group (20–24 years), rural residence, lower wealth quintile, absence of schooling, absence of flush toilets, and lack of exposure to media were factors that were independently associated with the use of cloth as menstrual absorbent. Vaginal discharge was reportedly higher among women using unhygienic products, however, on adjusted analyses, no statistically significant association was observed with the type of absorbent used. The transition from cloth to sanitary pads has nearly doubled on average in the states implementing free and subsidised government pad distribution schemes during the same period.

This study aimed to investigate the influence of socio-demographic and epidemiological factors on the secular changes in body size indicators (height, weight, and BMI) among young adults aged 17–22 years in Moscow from the early 20th century to the present. Published average anthropometric data from screening surveys conducted from 1880/1925–26 to 2020–21 were analysed (4,823 males and 5,952 females), along with demographic data from the Federal State Statistics Service of the Russian Federation. Findings revealed consistent anthropometric trends and strong associations between secular changes in body size of Moscow youth and socio-demographic indicators such as population size, life expectancy, and infant mortality rates. An increase in height and weight was noted against the backdrop of urbanisation, increased life expectancy, and reduced infant mortality. These results indicate that the urbanisation process and the transformation of the epidemiological landscape in 20th-century Russia – marked by enhancements in public health, modernisation of the healthcare system, and medical advancements – have had a significant impact on changes in body size across generations. Notably, from the mid-20th century onwards, with the exception of the final decade, conditions favourable to growth and development were established, culminating in a significant increase in definitive anthropometric parameters across successive generations. The findings underscore the imperative for policymakers to bolster investments in urban development, healthcare, and education. Such strategic investments are essential for sustaining and amplifying the positive physical development trends witnessed.

A minority of ultra-Orthodox (Charedi) Jews choose not to be vaccinated, and their refusal has assumed significant importance from a variety of perspectives. Clinicians often encounter patients whose beliefs are different from their own. Vaccine hesitancy within the US Charedi Jewish community is a factor contributing to outbreaks of disease, reflecting a growing mistrust between communities and arms of the State played out on the terrain of bodies and societies. Clinicians need to be aware of and understand this broader context as a foundation of empathetic listening and epistemic humility that might lead to improved health for the Charedi community based on reinforced trust.

Fluvial flooding is a recurring event in the Aie River basin in Assam, India. On August 14, 2021, floodwater breached a large stretch of embankment in the Bongaigaon District and inundated several villages. Using a cross-sectional design to conduct household surveys in February and March 2022, the study investigates responses six to seven months following the August 2021 flood disasters. The purpose of this study is to determine the prevalence and risk factors of four psychological health outcomes. Being flooded is strongly and adversely associated with each of these mental health outcomes. After adjusting for the potential confounders, the strength of the relationships is reduced to four times (adjusted OR 4.62 [95% CI 2.63–8.1]; p < 0.01) for PTSD, five times (adjusted OR 5.28[95% CI 3.38–8.26]; p < 0.01) for anxiety, and three times (adjusted OR 3.45[95% CI 2.24–5.33]; p < 0.01) for depression, and 21 times for comorbid PTSD, anxiety, and depression (adjusted OR 21.68[95% CI 7.38–63.74]; p < 0.01). The robustness of flood exposure is checked in an extended model. It includes variables that indicate the severity of flooding and various secondary stressors. The present study also explores the effects of ‘loss stressors’ such as crop loss, workday loss, livestock loss, and damage to infrastructure. Located in a resource-constrained setting, the effects of these factors add value to the study. Longer duration of floodwater in the house premise increases the odds of developing anxiety (adjusted OR 1.69[95% CI 1.04–2.75]; p < 0.05) and depression (adjusted OR 1.9[95% CI 1.15–3.12]; p < 0.05). Similarly, deeper floodwater inside the house increases the odds of depression (adjusted OR 1.87[95% CI 1.07–3.28]; p < 0.05). Among all the ‘loss’ stressors, damage to houses and the cost of repairing is significantly associated with PTSD (adjusted OR 2.04[95% CI 1.09–3.82]; p < 0.05), depression (adjusted OR 2.17[95% CI 1.22–3.87]; p < 0.01) and comorbid PTSD, anxiety and depression (adjusted OR 2.16[95% CI 1.07–4.36]; p < 0.05).

Menarche and pubertal onset vary across populations but understanding age-at-menarche (AAM) and pubertal growth tempo is limited in low-income settings. Identifying factors influencing pubertal development is vital for creating targeted health and education programmes supporting adolescent girls’ well-being. Baseline data (n = 1045) from the Ten2Twenty-Ghana study were analysed to examine menarche attainment, pubertal development, AAM, and the associated factors among girls aged 10-17 years in the Mion district, Ghana. The data collection methods included anthropometry, body composition, haemoglobin status, a qualitative 24-hour dietary recall, a food frequency questionnaire, and a pubertal development score (PDS). Binary logistic and linear regression analyses were used to model odds ratios for menarche attainment and regression coefficients for AAM and PDS. About 19.9% of the girls had experienced menarche, with a mean AAM of 13.4 ± 1.5 years. Among post-menarche girls (n = 205/1045), 12.2% and 15.1% experienced early (AAM < 12 years) and late menarche (AAM < 15 years), respectively. The mean PDS was 1.8 ± 0.7 out of 4. Among the adolescent girls, 36.2% were prepubertal, 17.0% early –pubertal, 18.6% mid-pubertal, 27.9% late pubertal, and less than 1% were in the post-pubertal stage. An increase in fat mass (FM), fat-free mass (FFM), height-for-age-z-score (HAZ), and body mass index-for-age-z-score (BAZ) was observed with puberty progression, but a steep decline in HAZ was noticed for girls in late puberty, increasing again post-puberty. Being older (adjusted odds ratio (AOR) = 2.06, 95% C.I.: 1.83, 2.31), stunted (AOR= 0.20, 95% C.I.: 0.10, 0.40), thin (AOR = 0.30, 95% C.I.: 0.11, 0.80), and overweight/obese (AOR = 7.29, 95% C.I.: 2.60, 20.43) were the significant predictors of menarche attainment. Being older (β = 0.39, P < 0.0001), stunted (β= -0.92, P = 0.01), thin (β = 1.25, P = 0.01), and having a literate mother (β = -0.72, P = 0.03) were significantly associated with AMM. A higher HAZ, FM, FFM, age, and Konkomba ethnicity were positively associated with higher PDS. This study highlights the complexity of factors influencing menarche and pubertal development. These insights are essential for developing targeted health and educational programmes that address nutritional and socio-demographic disparities to promote adolescent girls’ well-being and healthy pubertal development.

The Garo tribe, one of a major indigenous communities of Meghalaya, India, relies heavily on their traditional health practices. This research investigates the healthcare-seeking behaviour of Garo women, their health concerns, their indigenous medical knowledge, and their reasons for preferring traditional over modern medicines. Conducted in East Garo Hills, Meghalaya, quantitative data (N = 96) were randomly collected from Garo women aged 15–49 through interviews to understand their health-seeking behaviour. Following a preliminary analysis, qualitative data (N = 12) were gathered through in-depth interviews to identify common illnesses, dimensions of traditional medicines, and reasons for dependency on them. Thematic analysis was performed using Atlas Ti. The result shows that almost 84% of Garo women (N = 86) seek treatment from Ojha (traditional healer) for achik (traditional) medicine, with only 6% using modern health facilities and 10% relying on herbal home remedies. Garo women rely on their age-old traditional remedies for health issues, irrespective of their educational or economic status. From the qualitative findings, this study explores the Garo tribe’s unique traditional medicine, known as ‘achik medicine’, prepared through local herbs and plants, and is disseminated by traditional healers, or ‘ojhas’, whose knowledge is generational. Moreover, every Garo household possesses medicinal plants, and all are knowledgeable about their use. Major health issues faced by Garo women are menstrual disorders, post-delivery weakness, fever with severe headache and jaundice. Reasons for using achik medicines are more effectiveness than modern medicines, cultural identity, preference for natural remedies, efficiency of Ojhas, availability, accessibility, and affordability of Ojhas. Meanwhile, the reasons for using limited use of modern healthcare facilities are poor quality of service and remote location. This study underscores the importance of preserving indigenous knowledge systems and respecting cultural heritage while ensuring the well-being of marginalised communities. Additionally, it highlights the need to improve modern healthcare quality and public transportation in the region.

Hypertensive disorders of pregnancy (HDP) and postpartum depression (PPD) are significant global health challenges affecting maternal and child well-being. HDP, including pre-eclampsia, gestational hypertension, and chronic hypertension, complicate up to 10% of pregnancies worldwide, with profound implications for maternal mortality, particularly in low- to middle-income countries (LMICs) like Ghana. The incidence of HDP is rising globally, contributing substantially to maternal deaths and severe perinatal outcomes such as stillbirth and low birth weight. Concurrently, perinatal mental health issues, including PPD, affect a significant proportion of women globally, with higher prevalence rates observed in LMICs. Despite the known physiological impacts of HDP, their association with maternal mental health remains underexplored, especially in LMIC contexts. A systematic review and meta-analysis were conducted to explore the association between HDP and PPD in LMICs, focusing on available literature and studies from diverse global settings. Additionally, semi-structured qualitative interviews were conducted with healthcare professionals in Ghana to gather insights into local perspectives and experiences regarding this association. The systematic review revealed a consistent association between HDP and increased risk of PPD across various LMIC settings. Meta-analysis findings indicated a significant pooled odds ratio, highlighting a robust statistical linkage between HDP severity and subsequent PPD risk. Qualitative data underscored healthcare professionals’ observations of heightened psychological distress among women with HDP, emphasizing the complex interplay between physiological complications and maternal mental health outcomes in the Ghanaian context. The study findings underscore the critical need for integrated maternal health strategies that address both physical and psychological aspects of pregnancy complications like HDP. By elucidating these connections, the study contributes to advancing evidence-based interventions and support systems tailored to LMIC settings, aiming to mitigate adverse maternal mental health outcomes and improve overall perinatal care in Ghana and similar contexts worldwide. These insights are pivotal for informing policy decisions, guiding healthcare practices, and fostering targeted interventions that enhance maternal well-being during the vulnerable perinatal period.

Understanding the link between HIV/AIDS knowledge and child marriage is important for designing and planning effective intervention programmes. Despite significant advances in HIV/AIDS prevention and treatment, it remains important to study the impact of child marriage on HIV/AIDS knowledge because HIV/AIDS continues to affect millions globally. This study investigated the association of child marriage with scores on an index measuring comprehensive knowledge about HIV/AIDS transmission and prevention. Analysis was conducted on a sample of women aged 18–24 years, using nationally representative DHS household surveys from 18 countries. Findings indicate that there is no direct statistically significant effect of child marriage on women’s comprehensive knowledge about HIV/AIDS once controls for other factors affecting knowledge are included in the regression. However, the coefficients for educational attainment are statistically significant in most countries, at least when secondary or higher education is considered. This suggests that child marriage may affect knowledge about HIV/AIDS indirectly through its impact on educational attainment for girls who marry early.

Reproductive health indicators in many developing countries including Nigeria are poor, and this is due to the less-than-optimum utilization of reproductive healthcare that has been linked to numerous factors including the educational attainment of women and their partners. In societies like Nigeria, marriage is nearly universal and upheld by patriarchal practices, while education is one of the determining factors for the choice of partner in the marriage market, as it also influences household power dynamics. Despite the plethora of studies investigating the link between education and utilization of these services, there is a paucity of research examining educational assortative mating (EAM) and its link to reproductive healthcare utilization. Hence, this study investigated EAM and explored its association with reproductive healthcare utilization from the perspective of family systems theory. Data from the 2018 Nigeria Demographic and Health Survey (n = 19,950) was analysed with frequencies presented and binary logistic regression models fitted. The result showed that high-education (34%) and low-education (46%) homogamy are the most prevalent types of EAM, while 40% of the partnered women reported facility delivery, 11% used modern contraceptives and 20% reported 8+ antenatal care visits. The multivariate analysis showed that compared to women in hypergamy, women in both high-education homogamy and hypogamy are more likely to deliver at a health facility but women in low-education are less likely. Women in both high-education homogamy and hypogamy are more likely, but those in low-education homogamy are less likely to use modern contraceptives. For antenatal care, only women in high-education homogamy are more likely to have 8 or more visits during pregnancy compared to women in hypergamy, while women in low-education homogamy and hypogamy are less likely. These findings provide evidence of the importance of an indicator of social stratification for important family decisions like healthcare utilization.

Covert contraceptive use is a strategy to avoid unintended pregnancy. However, evidence regarding the multilevel factors linking past experiences of unintended pregnancy with covert contraceptive use is limited. The objective of this study was to identify the compositional and contextual factors associated with covert contraceptive use among women with a prior unintended pregnancy. Framed by the socio-ecological model, a cross-sectional study was conducted using data from Round 5 of the Performance Monitoring and Accountability 2020 project in Nigeria. Non-pregnant women aged 15–49 years who reported a previous mistimed or unwanted pregnancy were included (N = 1631). Multilevel logistic regression models with random intercepts were specified to investigate the relationship between covert contraceptive use and compositional and contextual factors. Approximately 4.54% (95% CI = 3.28–6.25) of women reported covert contraceptive use. At the individual level, having less than secondary education (aOR = 5.88, 95% CI = 1.20–28.72) and being single (aOR = 11.29, 95% CI = 2.93–43.56) were associated with higher odds of covert contraceptive use. There was no significant association between covert contraceptive use and the type of unintended pregnancy (mistimed: aOR = 3.13, 95% CI = 0.88–11.13). At the community level, living in a community with average poverty levels (aOR = 6.18, 95% CI = 1.18–32.55) and high exposure to family planning mass media (aOR = 6.84, 95% CI = 1.62–29.11) were associated with higher odds of covert contraceptive use. Measures of variation showed significant variation in covert contraceptive use across communities. Further research is warranted to better understand the underlying mechanisms in these observed associations and variations in covert contraceptive use among women following the experience of an unintended pregnancy. Additionally, there is a need to design family planning strategies that integrate community-level structures.

Marriage with teenage girls is an important health and social challenge, which is caused by various factors. Considering that no research has been done to show the reasons for men’s desire to marry teenage girls, this research was conducted with the aim of identifying the reasons why men marry teenage girls in western Iran. This qualitative research was conducted with the conventional content analysis approach among 37 men in western Iran who married to girls under the age of 18. Targeted, theoretical, and snowball sampling methods were used to reach the participants. To collect data, semi-structured interviews were used both in-person (20 people) and online (17 people). Data analysis was done with Graneheim and Lundman approach and checking the accuracy and strength of the results with Guba and Lincoln criteria. One core category, 9 subcategories, and 88 initial codes were obtained from the data analysis. The core category, foresight along with desired upbringing, included the subcategories of getting sure of purity, to bring up the girl, seeking sexual pleasure, dominating the wife, low expectations, appropriate fertility, encouragement of social organizations and families, following models, and cultural beliefs. The reasons for men marrying teenage girls are rooted in personality traits, family encouragement, and the cultural and social context of the society. Marriage with teenage girls can be prevented by intervening at different levels and taking measures such as training and raising men’s awareness about the consequences of marrying teenage girls, changing men’s cultural and gender beliefs, raising the awareness of parents and social organizations about the adverse effects of child marriage, and establishing appropriate laws.