This study investigated the impact of some socioeconomic, demographic and health and community factors on chronic malnutrition or stunting in Bangladeshi children aged less than 5 years. The analysis revealed that the overall prevalence of stunting was 44%, of which 18% of children were severely stunted, and the demographic characteristics appeared to be the most significant factors for chronic malnutrition. Multinomial logistic regression analysis showed that parents’ education, household economic status, media exposure, number of under-5 children, place of delivery, child’s age, birth order, months of breast-feeding, birth size, mother’s BMI, mother’s height, age of household head, measles vaccine, supplementation of diet with liquids and regional differentials were significantly associated with severe as well as moderate stunting.

This study examines the determinants of current contraceptive use and method choice in Mongolia using data from the 1998 Mongolian Reproductive Health Survey and 2000 Mongolian Population and Housing Census. Since 1976, access to modern contraceptives has been liberalized and all restrictions on the use, distribution and import of contraceptives were removed in 1989. There were some increases in the use of modern contraceptives among married women in the 1990s; however, at the start of the twenty-first century the IUD and periodic abstinence remain the most widely used methods. Women with higher levels of education are more likely to be current users of contraception, and if they are current users, they are more likely to choose the IUD and traditional methods. Women living in rural areas have a higher probability of using contraception and are more likely to choose the IUD and traditional methods. Significant variations exist between primary sampling units in current contraceptive use and in the choice of modern methods. Community-level variables were important predictors in reducing variation between primary sampling unit, when other modern methods were compared with traditional methods.

The low contraceptive prevalence rate and the existence of unmet demand for family planning services present a challenge for parties involved in family planning research in Tanzania. The observed situation has been explained by the demand-side variables such as socioeconomic characteristics and cultural values that maintain the demand for large families. A small, but growing body of research is examining the effect of supply-side factors such as quality of care of family planning services on the demand for contraceptives. This paper analyses the demand and supply factors determining contraceptive use in Tanzania using the Tanzania Service Availability Survey (1996) and the Tanzania Demographic and Health Survey (1996) data sets. The results show that access to family planning services and quality of care of services are important determinants of contraceptive use in Tanzania even after controlling for demand-side factors.

This study investigates the association between body height and inter-generational social advancement through education. Questionnaire data were collected from 2800 students (1023 men and 1777 women) from the universities of Wrocław, Poland. The questions referred to three generations: the students and their parents and grandparents. Information was collected on the age, body height and weight of the students and their parents, and on the parents’ and grandparents’ education. The lowest body heights were typically found for individuals from families with the lowest educational levels, whereas the greatest body heights were found for those brought up in families with a high educational status or in families who had upgraded their status. The size of the change in the educational level of parents is only associated with fathers’ and female students’ body height. Individuals who had advanced from a middle educational level or who came from families with this type of advancement were found to be significantly taller, on average, than those upgrading their educational level from the lowest position. The results show that, for men, educational advancement during the course of their lives or in the earlier generation is more favourable to achieving higher stature, whereas for women, the multi-generational tradition of a high educational status is of greater significance.

It has been widely observed that socioeconomic status (SES) is associated with frequency of cardiovascular disease. Both men and women of low socioeconomic position have increased risk of cardiovascular disease morbidity and premature death. In this study the relationship between SES in childhood, and health status at the age of 50 years was examined. Socioeconomic status in childhood was measured using objective (father’s educational level and number of children in the family) and subjective (self-assessed SES in childhood declared in early adulthood) indicators. Data from the Wrocław Growth Study were completed when subjects were 50 years old, and information concerning health status was added. The results indicated that the objective, universally used measures of SES in childhood such as father’s educational level and size of family did not show any essential relationships with health outcomes in adulthood, both for men and women. By contrast, retrospective, self-assessed SES (as better, average or worse as compared with peers) in childhood was significantly associated with the appearance of cardiovascular disease among women aged 50 years. Women who at the beginning of their adult life declared better socioeconomic condition in childhood were significantly healthier at the age of 50 years (OR=3·43; p=0·02). Moreover, this appeared to be independent of BMI, SES and life-style in adulthood. For men, retrospective self-assessed SES showed no relation to health status at the age of 50 years. The gender differences in the relationships between self-assessed SES in childhood and health status in adulthood are explained by possible selective premature mortality among men from lower childhood SES and/or sex differences in cognitive abilities.

Using data from Bangladesh, this paper examines how the birth order of a child influences parental decisions to place children in one of four activities: ‘study only’, ‘study and work’, ‘neither work nor study’ and ‘work only’. The results of the multinomial logit model show that being a first-born child increases the probability of work as the prime activity, or at least a combination of school and work, rather than schooling only. The results confirm that later-born children are more likely to be in school than their earlier-born counterparts.

This paper uses DHS data from 20 countries in sub-Saharan Africa, collected in the late 1990s and early 2000s, to examine perceived size of newborn and Caesarean section deliveries among teenagers in the region. A comparison between teenagers and older women, based on logistic regression analyses for individual countries, as well as multilevel logistic analyses applied to pooled data across countries, and controlling for the effects of important socioeconomic and demographic factors, shows that in general, births to teenagers are more likely to be small in size but are less likely to be delivered by Caesarean section compared with births among older women. An examination of the country-level variations shows significant differences in perceived size of newborn and Caesarean section deliveries between countries. However, the observed pattern by maternal age does not vary significantly between countries, suggesting that these patterns are generalizable for the region. For teenagers with characteristics associated with higher odds of Caesarean section, being in a country with an overall higher rate particularly amplifies their individual probability.

Domestic spousal violence against women in developing countries like India, is now beginning to be recognized as a widespread health problem impeding development. This study aimed to explore the risk and protective factors for lifetime spousal physical violence. A cross-sectional household survey was carried out in rural, urban and urban-slum areas across seven sites in India, among women aged 15–49 years, living with a child less than 18 years of age. The sample was selected using the probability proportionate to size method. Trained field workers administered a structured questionnaire to elicit information on spousal physical violence. The main hypothesized variables were social support, witnessed father beating mother and experience of harsh physical violence during childhood, alcohol abuse by spouse and socioeconomic variables. The outcome variables included three physical violence behaviours of hit, kick and beat. Odds ratios were calculated for risk and protective factors of violence using logistic regression. Of 9938 women surveyed, 26% reported experiencing spousal physical violence during the lifetime of their marriage. Adjusted odds ratios calculated using multiple logistic regression analysis suggest that women whose husbands regularly consumed alcohol (OR 5·6; 95% CI 4·7–6·6); who experienced dowry harassment (OR 3·2; 95% CI 2·7–3·8); had reported experiencing harsh physical punishment during childhood (OR 1·6; 95% CI 1·4–1·8) and had witnessed their fathers beat their mothers (OR 1·9; 95% CI 1·6–2·1), were at increased risk of spousal physical violence (beat, hit and kick). Higher socioeconomic status and good social support acted as protective buffers against spousal physical violence. The findings provide compelling evidence of the potential risk factors for spousal physical violence, which in turn could help in planning interventions.

Data from a nationally representative study in Bangladesh (BDHS 1996–97) were analysed to identify significant predictors of use of periodic abstinence, in comparison with other modern contraceptive methods. The study found that women in Bangladesh mostly use modern methods during their peak reproductive years, after which some of them switch to periodic abstinence. These women tend to be more from educated and from higher socioeconomic backgrounds and with at least one living son. Another set of data from the Matlab DSS was analysed and the results were in the same direction. Focus group discussions found that women were using the periodic abstinence method incorrectly, abstaining for more days than is necessary. For Bangladeshi contraceptive users to reach a higher degree of use-effectiveness for period abstinence, more IEC materials need to be developed.

With declining levels of international donor funding for financing reproductive health programmes, developing country governments and international donors are looking towards private sector strategies to expand the supply of quality reproductive health services. One of the challenges of a health franchise is to improve the quality of services provided by independent private practitioners. Private providers are more likely to abide by the quality standards set by a franchiser if they see a financial benefit resulting from franchise participation. This study was conducted to measure whether (a) there were improvements in perceived quality of care and perceived access to health facilities once these facilities became part of a franchise and (b) improvements in perceived quality and perceived access were associated with increased client loyalty to franchised clinics. Franchisees were given basic reproductive health training for seven days and services marketing training for two days. Exit interviews were conducted with male and female clients at health facilities. A pre-test measurement was taken in April 2001, prior to the start of project activities. A post-test measurement was taken in February/March 2002, about 9 months after the pre-test. Multilevel regression analysis, which takes the hierarchical structure of the data into account, was used for the analysis. After taking provider-level variation into account and controlling for client characteristics, the analyses showed significant improvements in perceived quality of care and perceived access to services. Private provider participation in a franchise network helps improve client perceptions of quality of, and access to, services. Improvements in client perceptions of quality and access contribute to increased client loyalty to franchised clinics. Once increased client loyalty translates into higher client volumes, providers are likely to see the benefits of franchise participation. In turn, this should lead to increased provider willingness to remain part of the franchise and to abide by the standards of quality set by the franchiser.

Extended durations of postpartum non-susceptibility (PPNS) comprising lactational amenorrhoea and associated taboos on sex have been a central component of traditional reproductive regimes in sub-Saharan Africa. In situations of rising contraceptive prevalence this paper draws on data from the Demographic Health Surveys to consider the neglected interface between ancient and modern methods of regulation. The analysis reports striking contrasts between countries. At one extreme a woman’s natural susceptibility status appears to have little bearing on the decision to use contraception in Zimbabwe, with widespread ‘double-protection’. By contrast, contraceptive use in Kenya and Ghana builds directly onto underlying patterns of PPNS. Possible explanations for the differences and the implications for theory and policy are discussed.

India has a strong base of ancient indigenous systems of medicine and its national health policies and programmes have consistently promoted the integration of Indian Systems of Medicine (ISM) into the country’s official health system. Realizing the safety and efficacy of ISM drugs, the Department of Indian Systems of Medicine and Homoeopathy (ISM&H) has suggested their use for certain women’s health problems and during pregnancy. Although the Government of India has attempted to integrate ISM through the country’s contemporary health programme of Reproductive and Child Health (RCH), utilization dynamics from the clients’ perspective is little understood. This study shows that, at least in urban areas, for the majority of women’s health problems biomedicine is regarded as the first choice, failure of which leads clients to seek treatment from ISM as a final resort. Nevertheless, women showed a preference for ISM treatment for certain specific health problems, strongly backed by a belief in their efficacy. Of the predictors that positively influenced women’s choice of ISM treatment, ‘strong evidenced-based results’ was found to be the most important. Women’s preference for ISM is dependent on the availability of competent providers.

Worldwide, there is increasing recognition that if family and reproductive health programmes are to be successful, the involvement of men is essential. As part of the problem, men also have to be seen as part of the solution. The reality is that in many countries, including Turkey, men generally do not accompany their partners to health facilities for family planning, antenatal and postnatal services and are not expected to attend the labour or birth of their child. Workplace programmes are a potential strategy for meeting the reproductive health education needs of men in industrial cities such as Istanbul. This intervention study was developed to test the feasibility and effects of expanding a special programme for expectant fathers to large workplaces in Istanbul, with the aim of improving the health of Turkish families during the pregnancy, birth and newborn periods. The findings indicate that it is possible to train workplace physicians in Istanbul to conduct regular educational programmes for expectant fathers on reproductive health, and that such programmes may have beneficial effects, especially in the areas of pregnancy nutrition, exclusive breast-feeding, and support behaviours. Considering the difficulty of getting men to attend hospital or clinic-based educational programmes in large urban areas, bringing such training programmes to men at their places of work has the potential to be an important strategy. Given that large workplaces in Turkey already have full-time physicians charged with the duty of health education for employees, this is also a feasible strategy.

In South Asia women are often the primary decision-makers regarding child health care, family health and nutrition. This paper examines the proposition that constraints on women’s status adversely affect the survival of their children. Survey data are used to construct indices of women’s household autonomy and authority, which are then linked to longitudinal data on survival of their children. Proportional hazard models indicate that enhanced autonomy significantly decreases post-neonatal mortality. Enhanced household authority significantly decreases child mortality. A simulation based on estimated effects of eliminating gender inequality suggests that achieving complete gender equality could reduce child mortality by nearly fifty per cent and post-neonatal mortality by one-third.

Most studies of closed birth intervals are regarding their variation at specific orders among females. This paper attempts to study the nature of the distributions of consecutive closed birth intervals. Data from the Uttar Pradesh National Family Health Survey 1998–99 (NFHS-2) were analysed. It was found that, under certain assumptions, the postpartum amenorrhoea period and menstruating interval are negatively associated, indicating that socio-cultural factors are affecting the menstruating interval.

This paper addresses the overall performance and inequalities in the immunization of children in Vietnam. Descriptive and logistic analysis of cross-national demographic and health data was used to examine inequality in immunization, identify the most vulnerable groups in immunization coverage, and identify the gap in coverage between hard-to-access people and the remainder of the population. The gap in the coverage was found to occur primarily in vulnerable groups such as the poor minority or poor rural children. No evidence was found of a difference in immunization coverage because of sex or birth order. However, the age of children showed a significant influence on the rate of immunization. Mother’s education and regular watching of television had a significant influence on child immunization. In order to improve child immunization coverage in Vietnam, efforts should be concentrated on poor children from minority groups and those living in rural areas, especially remote ones. Community development, investment for immunization and re-organization of immunization services at the grassroots level are also key factors to remove the barriers to immunization for vulnerable populations in Vietnam.

With the objective of reducing maternal and neonatal mortality, the Safe Motherhood Program was implemented in Nepal in 1997. It was launched as a priority programme during the ninth five-year plan period, 1997–2002, with the aim of increasing women’s access to health care and raising their status. This paper examines the association of access to health services and women’s status with utilization of prenatal, delivery, and postnatal care during the plan period. The 1996 Nepal Family Health Survey and the 2001 Nepal Demographic and Health Survey data were pooled and the likelihood of women’s using maternal health care was examined in 2001 in comparison with 1996. Multiple logistic regression analysis indicates that the utilization of maternal health services increased over the period. Programme interventions such as outreach worker’s visits, radio programmes on maternal health, maternal health information disseminated through various mass media sources and raising women’s status through education were able to explain the observed change in utilization. Health worker visits and educational status of women showed a large association, but radio programmes and other mass media information were only partially successful in increasing use of maternal health services. Socioeconomic and demographic variables such as household economic status, number of living children and place of residence showed stronger association with use of maternal health services then did intervention programmes.

This study presents an ecological analysis of the relationship between infant mortality and economic status by race in metropolitan Ohio, using census data on mother’s residence and economic status determined by the percentage of low-income families living in each area. The analysis updates previous studies as white–non-white comparisons for total infant mortality are examined for the US censuses of 1960, 1970, 1980, 1990 and 2000; and more detailed period- and broad cause-specific rates are presented for 2000. A pronounced inverse association is consistently found between income status and infant mortality for whites, while for non-whites this pattern first emerges in 1979–81, disappears during the 1980s and then returns more strongly during the 1990s. Similarly, the 2000 data reveal a consistent inverse pattern between income status and infant mortality for white and non-white neonatal and postneonatal death rates, as well as exogenous cause-specific death rates. It is concluded that low-income whites and non-whites have infant mortality rates substantially higher than the overall rate for the population. Policy implications are discussed.

Aiming to further explore possible underlying causes of the recent remarkable stagnation and relative decline in American heights, this paper describes the result of analysis of the commercial US Sizing Survey (2002). Heights are correlated positively with income and education among both white males and females while Body Mass Index (BMI) is correlated negatively among females, as in other samples. In contrast to much of the literature, this paper considers geographic correlates of height such as local poverty rate, median income and population density at the zip code level of resolution. After adjusting for confounding factors that influence height such as income and education, population density is found to be strongly and negatively correlated with height among white men, but less so among white women. The effect on BMIs less convincing. Other ethnic groups are not analysed in detail because of the small number of observations available. Local economic conditions as measured by median income, unemployment and poverty rate do not have a strong correlation with height or BMI after adjusting for individual income and education.

This paper models the proximate determinants of children born to over 13,000 Ethiopian women and of the women’s stated preferences for additional births using the data from the Ethiopian Demographic and Health Survey 2000. Empirical models for the number of children born to women were estimated using Poisson and ordinal regressions. The results show the importance of variables such as maternal education for smaller family size, and that variables reflecting desired family size are strong predictors of the numbers of children born to women. Secondly, binary logistic models for dichotomous variables for women not wanting more children and if getting pregnant would be a ‘big problem’ showed non-linear effects of the surviving and ‘ideal’ number of children. Moreover, the results indicated a desire on the part of women to limit family size, especially as the number of surviving children increased. Probit models were estimated to address potential endogeneity of certain variables. Overall, the results indicated that counselling couples about small family size and increasing the utilization of health care services can lower fertility in Ethiopia.