Infertility affects around 15% of human couples and in many countries approximately 1–4% of babies are born following Assisted Reproductive Technologies (ART). Several ART techniques are used and these differentially affect the sex ratio of offspring successfully produced. These direct effects on sex ratio also have the potential to influence, indirectly, the sex ratios of offspring born to untreated couples. This is of concern because human sex ratio bias may adversely affect public health. Here the extent of indirect effects of ART that could operate, via Fisherian frequency-dependent natural selection, on the progeny sex ratio of unassisted members of a population is heuristically modelled. Given the degrees to which ART techniques bias sex ratios directly, it is predicted that well over 20% of couples would have to reproduce via ART for there to be any discernible effect on the sex ratios produced, in response, by the remainder of the population. This value is greater than the estimated prevalence of infertility problems among human couples. It is concluded that providing ART to couples with fertility problems does not currently generate significant ethical issues or public health concern in terms of indirect effects on the offspring sex ratios of untreated couples.

Gender inequality is often cited as a barrier to improving women’s sexual and reproductive health outcomes, including contraceptive use, in low- and middle-income countries such as those in sub-Saharan Africa. To date there is limited, recent, evidence available regarding women’s empowerment, household status and contraceptive use in Ghana. The objective of this study was to investigate whether women’s empowerment and status in the household were associated with contraceptive use and unmet need for contraception using the 2014 Ghana Demographic and Health Survey. The study sample consisted of 1828 women aged 15–49. Women’s empowerment was measured based on two composite indexes created by the DHS: attitudes towards intimate partner violence and decision-making. Women’s status in the home was measured using indicators of work status, relationship to household head, control over monetary earnings and land ownership. Decision-making was found to be positively associated with contraceptive use and not having unmet need for contraception. Women who justified wife beating in one or more instances were less likely to use contraception, and more likely to have unmet need for contraception. Current or past employment and higher levels of male partner education were associated with contraceptive use. This study indicates that women’s empowerment and household status are influential for contraceptive indicators. Future interventions aimed at improving contraceptive uptake and use should promote women’s empowerment, i.e. decision-making, self-worth and education.

Partnership and fertility patterns of young Filipinos have changed dramatically from previous generations, with a widening gap between sexual initiation and marriage, and concurrent increases in teenage pregnancy and unwanted fertility. Further understanding of young adults’ social contexts and partnership patterns are needed to inform reproductive health programmes and policies affecting young Filipinos. Multivariate Poisson regression models were conducted with longitudinal and inter-generational data from the Cebu Longitudinal Health and Nutrition Survey (1998–2009) to examine the predictors of young women’s fertility. Age at first sex, and number and duration of partnerships each independently and significantly predicted women’s fertility by 2009 after controlling for contextual influences. Young women with more conservative attitudes towards dating, sex and marriage, and who perceived their mothers to have more conservative attitudes, had higher fertility than their peers, as did young women with mothers who reported more adolescent sexual behaviours. In contrast, fertility was lower among daughters who had higher levels of communication with their mothers. Given high levels of unintended fertility and teenage pregnancy in the Philippines, the findings indicate that the interval between sexual initiation and first and subsequent partnerships may be ideal intervention points for reproductive health services for young Filipinos.

The second to fourth digit ratio (2D:4D) is claimed to be a biomarker of prenatal sex steroids. This study compared 2D:4D and waist–hip ratio (WHR) in men and women with nose deformity caused by injuries suggesting risky behaviour with those of unaffected controls. This kind of facial trauma was accepted as an indicator of risk-taking behaviour. The study involved 100 patients (50 women aged 30.74±8.09 years and 50 men aged 30.98±10.86 years) who underwent rhinoplasty due to nose trauma in a hospital in Łódź, Poland, in 2015. For comparison purposes, a control sample of 70 women (aged 23.03±3.36 years) and 70 men (aged 22.87±3.46 years) was recruited. In both groups the following measurements were taken: body height, waist and hip circumferences, II and IV digit lengths and body weight. The results showed that women and men who had suffered nose injury had significantly higher values of WHR than controls. The 2D:4D in women with post-traumatic nose deformity was significantly different than the ratio in control women (p<0.0001) and presented the male pattern. It is concluded that in women risky behaviours seem to be associated with prenatal sex hormone influence, while differences in WHR suggest that this tendency is also related to postnatal hormonal factors. Risky behaviours in men should be linked to postnatal hormonal changes rather than to increased prenatal androgen exposure.

Hindus and Muslims together account for 94% of the population of India. The fertility differential between these two religious groups is a sensitive and hotly debated issue in political and academic circles. However, the debate is mostly based on a period approach to fertility change, and there have been some problems with the reliability of period fertility data. This study investigated cohort fertility patterns among Hindus and Muslims and the causes of the relatively higher level of fertility among Muslims. Data from the three National Family Health Surveys conducted in India since the early 1990s were analysed using a six-parameter special form of the Gompertz model and multiple linear regression models. The results show a gap of more than 1.3 children per woman between those Muslim and Hindu women who ended/will end their reproductive period in the calendar years 1993 to 2025. The socioeconomic and demographic characteristics of Muslims explain 31.2% of the gap in fertility between Muslims and Hindus, while the desire for more children among Muslims explains an additional 18.2% of the gap in fertility.

This paper reviews the literature examining the relationship between women’s empowerment and contraceptive use, unmet need for contraception and related family planning topics in developing countries. Searches were conducted using PubMed, Popline and Web of Science search engines in May 2013 to examine literature published between January 1990 and December 2012. Among the 46 articles included in the review, the majority were conducted in South Asia (n=24). Household decision-making (n=21) and mobility (n=17) were the most commonly examined domains of women’s empowerment. Findings show that the relationship between empowerment and family planning is complex, with mixed positive and null associations. Consistently positive associations between empowerment and family planning outcomes were found for most family planning outcomes but those investigations represented fewer than two-fifths of the analyses. Current use of contraception was the most commonly studied family planning outcome, examined in more than half the analyses, but reviewed articles showed inconsistent findings. This review provides the first critical synthesis of the literature and assesses existing evidence between women’s empowerment and family planning use.

China’s urban population has experienced rapid fertility decline over the past six decades. This drastic change will have a significant impact on China’s demographic, social and economic future. However, the patterns and characteristics of urban China’s fertility decline have not been systematically examined. This study analyses the trends and age patterns of fertility in urban China since the 1950s, and summarizes the major characteristics of reproductive behaviours into four ‘lows’: extremely ‘low’ level of fertility; ‘low’ proportion of two and higher parity births; ‘low’ mean age at birth; and ‘low’ level of childlessness. The paper argues that the highly homogenous reproductive behaviours found in China’s now near 800 million urban population have been in part shaped by the country’s unprecedented government intervention in family planning. The ‘later, longer, fewer’ campaign in the 1970s and the ‘one-child’ policy, in particular, have left clear imprints on China’s reproductive norms and fertility patterns. The government-led family planning programme, however, has not been the only driving force of fertility decline. A wide range of social, economic, political and cultural changes have also affected the transition in family formation, reproductive behaviour and fertility patterns, and this has become increasingly prominent in the past two decades.

The theory of selection of quantitative traits is widely used in evolutionary biology, agriculture and other related fields. The fundamental model known as the breeder’s equation is simple, robust over short time scales, and it is often possible to estimate plausible parameters. In this paper it is suggested that the results of this model provide useful yardsticks for the description of social traits and the evaluation of transmission models. The differences on a standard personality test between samples of Old Order Amish and Indiana rural young men from the same county and the decline of homicide in Medieval Europe are used as illustrative examples of the overall approach. It is shown that the decline of homicide is unremarkable under a threshold model while the differences between rural Amish and non-Amish young men are too large to be a plausible outcome of simple genetic selection in which assortative mating by affiliation is equivalent to truncation selection.

Intra-population socioeconomic changes and migration are powerful factors in changing eating habits. Changes in eating habits could affect the nutritional status, growth, development and health of adolescents. The aim of this study was to compare the diet of adolescents of Moroccan origin living in Spain with that of adolescents living in Morocco. The sample comprised 428 Moroccan adolescents aged from 12 to 19 recruited in high schools: 327 living in Ouarzazate (Morocco) and 101 living in Madrid (Spain). The variables studied were energy intake (kcal/day), diet quality indicators (adherence to the Mediterranean Adequacy Index (MAI); cholesterol intake (mg/day); fibre intake (g/day) and energy profile)); and indicators of keeping traditional customs (halal meat consumption, bread made at home). Teenagers from Morocco living in Madrid consumed more calories, proteins, saturated fats and simple sugars (p<0.001) than those living in Morocco. Their diet was of lower quality than that of their peers in Morocco. This difference was more marked in boys than in girls. Changes in eating habits associated with migration from the south to the north Mediterranean basin can benefit young migrants in an immediate way (through greater availability of energy and nutrients), but later in life it could have negative consequences for their health, increasing the risk of overweight, obesity and cardiovascular and metabolic problems.

Stigma and discrimination within health care settings remain a public health challenge across diverse cultural environments and may have deleterious effects on mental and physical health. This study explores the causes, forms and consequences of HIV-related stigma and discrimination among migrant sub-Saharan African women living with HIV in Belgium. A qualitative study was conducted with 44 HIV-positive sub-Saharan African migrant women between April 2013 and December 2014 in health care settings in Belgium. Data were analysed using thematic content analysis. Twenty-five of the women reported overt stigma and discrimination and fifteen reported witnessing behaviours that they perceived to be stigmatizing and discriminatory in health care settings. The themes that emerged as to the causes of stigma and discrimination were: public perceptions of migrants and HIV, fear of contamination and institutional policies on HIV management. Reported forms of stigma and discrimination included: delayed or denied care, excessive precautions, blame and humiliation. The consequences of stigma and discrimination were: emotional stress, inconsistent health-care-seeking behaviour and non-disclosure to non-HIV treating personnel. Stigma and discrimination in health care settings towards people with HIV, and more specifically towards HIV-positive sub-Saharan African migrant women, impedes sustainable preventive measures. Specialized education and training programmes for non-HIV health care providers require in-depth investigation.

Persistent low fertility rates are an increasing concern for countries with low fertility like Iran. Informed by the Theory of Planned Behaviour, this study examined the immediate factors influencing fertility intentions, using data from the 2012 Tehran Survey of Fertility Intentions. The findings show that more than half of young married adults in Tehran intend to have no more children. The multivariate analysis results indicate that individuals who view childbearing as being detrimental to their personal life, feel less normative pressure to have a/another child, and believe their childbearing decision is not contingent on the presence of economic resources required for childbearing, are more likely to want no (more) children or to be unsure rather than to want a/another child. Attitudes and normative pressure are dominant factors influencing the intention to have a first child, while the intention to have a second child is mainly affected by attitudes and perceived constraints. The policy implications of the results are discussed.

The biraderi (brotherhood) is a long-established, widely prevalent dimension of social stratification in Pakistani communities worldwide. Alongside consanguinity, it offers a route for cementing social solidarities and so has strong socio-biological significance. A detailed breakdown of biraderi affiliation among participants in an ongoing birth cohort study in the northern English city of Bradford is presented. There is historical resilience of intra-biraderi marriage, but with a secular decline in prevalence across all biraderi and considerable reductions in some. While a majority of marriages in all biraderi are consanguineous the prevalence varies, ranging from over 80% to under 60%. In consanguineous unions, first cousin marriages account for more than 50% in five of the fifteen biraderi and >40% in six others. Within-biraderi marriage and consanguinity enhance genetic stratification, thereby increasing rates of genomic homozygosity and the increased expression of recessive genetic disorders. The trends reported constitute putative signals of generational change in the marital choices in this community.

Birth weight is used as a proxy for the general health condition of newborns. Low birth weight leads to adverse events and its effects on child growth are both short- and long-term. Low birth weight babies are more common in twin gestations. The aim of this study was to assess the effects of maternal and socio-demographic risk factors at various quantiles of the birth weight distribution for twin gestations using quantile regression, a robust semi-parametric technique. Birth records of multiple pregnancies from between 1991 and 2005 were identified retrospectively from the birth registry of the Christian Medical College and hospitals in Vellore, India. A total of 1304 twin pregnancies were included in the analysis. Demographic and clinical characteristics of the mothers were analysed. The mean gestational age of the twins was 36 weeks with 51% having preterm labour. As expected, the examined risk factors showed different effects at different parts of the birth weight distribution. Gestational age, chroniocity, gravida and child’s sex had significant effects in all quantiles. Interestingly, mother’s age had no significant effect at any part of the birth weight distribution, but both maternal and paternal education had huge impacts in the lower quantiles (10th and 25th), which were underestimated by the ordinary least squares (OLS) estimates. The study shows that quantile regression is a useful method for risk factor analysis and the exploration of the differential effects of covariates on an outcome, and exposes how OLS estimates underestimate and overestimate the effects of risk factors at different parts of the birth weight distribution.

There has in recent years been a growing interest in the social significance of global health policy and associated interventions. This paper is concerned with neglected tropical disease control, which prescribes annual mass drug administration to interrupt transmission of, among others, lymphatic filariasis. In Tanzania, this intervention is conducted through community-directed distribution, which aims to improve drug uptake by promoting community participation and local ownership in the intervention. However, the average uptake of drugs often remains too low to achieve the intended interruption of transmission. The qualitative research presented here followed the implementation of mass drug administration in Lindi and Morogoro Regions, Tanzania, in 2011 to understand the different forms of involvement in the campaign and the experiences of stakeholders of their part in community-directed distribution. Some health care workers, community leaders and drug distributors were generally positive about the intervention, emphasizing that the drugs were welcome. Other stakeholders, including the drug-receiving population, reported facing a number of dilemmas of uncertainty, authority and exclusion pertaining to their roles in the intervention. These dilemmas should be of interest to donors, policymakers and implementers. Community-directed distribution relies on social relations between the many different stakeholders. Successful and justifiable interventions for lymphatic filariasis require implementers to recognize the central role of sociality and that the voices and priorities of people count.

This study used data from the 2008 Ghana Demographic and Health Survey to investigate the association between selected socio-demographic factors and dietary behaviour as measured by fruit and vegetable consumption among a sample of 6139 young people aged 15–34 years in Ghana. Overall, fruit and vegetable consumption was low in young people, but females were likely to consume more fruit and vegetables than their male counterparts. Respondents from the Mande ethnic group, those who resided in rural areas and those living in the Brong/Ahafo, Ashanti and the Eastern regions consumed more fruit and vegetables than those from other regions. Females who were Catholic/Anglican, Methodist/Presbyterian and Pentecostal/Charismatic were more likely than those of other religions to consume fruit and vegetables, while Muslim males generally consumed more fruit and vegetables. The findings point to the need for interventions to educate young people in Ghana about the health benefits of eating fruit and vegetables.

Information on future intention to use contraceptives is a potential programme indicator for family planning services. Using three consecutive rounds of Ethiopian Demographic and Health Survey (EDHS) data collected in 2000, 2005 and 2011, this study examined whether the sex composition of living children and future desire for additional children were associated with the intention to use contraceptives among Ethiopian women aged 15–49 years who were not using any method of contraception at the time of the survey. The pooled multivariate binary logistic regression analysis indicated that between 2000 and 2011, the intentions of non-users to use contraceptives in the future increased significantly. Women who had at least one child (with an equal number of boys and girls, more boys than girls or more girls than boys) who did not want any more children, and those who were unsure about their desire for additional children, showed an increased intention to use contraceptives in the future, compared with those with an equal number of boys and girls who expressed a desire for additional children. Women with no children and who did not want children, or those who were unclear about their future desire, showed a lower intention to use contraceptives, compared with women with an equal number of boys and girls who wanted a child in the future.

This study discusses fertility trends and variation in countries that completed the transition from high to around-replacement fertility in the 1950s to 1980s, especially in Europe, East Asia and North America, and summarizes the key relevant findings for those countries with a more recent experience of fertility decline towards replacement level. A central finding is that there is no obvious theoretical or empirical threshold around which period fertility tends to stabilize. Period fertility rates usually continue falling once the threshold of replacement fertility is crossed, often to very low levels. While cohort fertility rates frequently stabilize or change gradually, period fertility typically remains unstable. This instability also includes marked upturns and reversals in Total Fertility Rates (TFRs), as experienced in many countries in Europe in the early 2000s. The long-lasting trend towards delayed parenthood is central for understanding diverse, low and unstable post-transitional fertility patterns. In many countries in Europe this shift to a late childbearing pattern has negatively affected the TFR for more than four decades. Many emerging post-transitional countries and regions are likely to experience a similar shift over the next two to three decades, with a depression of their TFRs to very low levels.

Sibling relations are by nature ambivalent with high levels of both altruistic helping and competition. Higher relatedness is often assumed to reduce the occurrence of conflicts between siblings, but evidence of this has been scarce and mixed. Siblings typically compete over resources and parental attention, and parental constellations vary with sibship types. Since full-siblings compete over the same two biological parents, while half-siblings have only one shared biological parent and often a higher number of parents overall, it is hypothesized that conflicts are more common between full- than half-siblings. This study tested this assumption using the British Millennium Cohort Study (n=7527 children at age 11). Conflicts were measured as children’s reports of how much siblings picked on and hurt each other. Households with full-siblings only, maternal half-siblings only, and both full- and maternal half-siblings were compared. The results show that children who were living with only their full-siblings were more likely to experience sibling conflicts compared with children living with their maternal half-siblings only. This was the case also after controlling for several potentially confounding variables. The results suggest that differential access to parental resources of available biological and step-parents may explain the higher amount of sibling conflict between full- compared with maternal half-siblings.

The purpose of this study is to assess the relationship between intelligence (or human capital) and the statistical capacity of developing countries. The line of inquiry is motivated essentially by the scarce literature on poor statistics in developing countries and an evolving stream of literature on the knowledge economy. A positive association is established between intelligence quotient (IQ) and statistical capacity. The relationship is robust to alternative specifications with varying conditioning information sets and control for outliers. Policy implications are discussed.