Determinants of coital frequency among married women in Central African Republic: the role of female genital cutting

This paper examines determinants of one aspect of sexual behaviour--coital frequency--among 2,188 married women in the Central African Republic using a secondary analysis of data from the Demographic and Health Survey of 1994-95. Female genital cutting (or circumcision) is practised in the Central African Republic and self-reported circumcision status was included in the questionnaire enabling it to be examined as a possible determinant of coital frequency. Multiple logistic regression was used to find a subset of factors independently associated with coital frequency. Decreased coital frequency was found in those who had longer duration of marriage, those who were not the most recent wife in a polygamous marriage and those who had more surviving children. Coital frequency was higher in more educated women and those not contracepting because they wanted to get pregnant. After adjusting for confounders no association between female genital cutting and coital frequency was found. The extent to which women can control coital frequency in this culture is not known and fertility desires may override any negative effects of circumcision on sexual pleasure. It was therefore not possible to draw conclusions about how female genital cutting affects a woman's desire for sexual intercourse and consequently there is a need to develop research methods further to investigate this question.     

Determinants of maternity care services utilization among married adolescents in rural India

Background

Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed.

Methodology/Principal Findings

Using the data from third wave of National Family Health Survey (2005–06), available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15–19 years) in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994), selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions.

Conclusions

The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household with married adolescent women belonging to poor and specific sub-groups of the population in rural areas to address the unmet need for maternal healthcare service utilization.     

Is there a link between paternity concern and female genital cutting in West Africa?

Here we explore the relationship between female genital cutting (FGC), sexual behaviour, and marriage opportunities in five West African countries. Using large demographic datasets (n 72,438 women, 12,704 men, 10,695 couples) we explore key (but untested) assumptions of an evolutionary proposal that FGC persists because it provides evolutionary fitness benefits for men by reducing non-paternity rates. We identify and test three assumptions implicit in this proposal. We test whether cut women have reduced extra-pair sex before or within marriage; whether FGC is associated with a younger age at marriage as an indication of partner preference; and whether individual and group-level indicators of paternity concern are associated with a stronger preference for marriage to women with FGC.Our results show that FGC status does not affect the odds of women engaging in several indicators of premarital sex, however women with FGC have significantly lower odds of having more than one lifetime sexual partner. We also show that women with FGC get married at a younger age which supports the argument that FGC status influences women's marriage opportunities, even when it does not restrict sexual activity. Finally, we find that in population groups where reported sexual activity and perceived risk of women's extra-pair sex is high, men have higher odds of marrying a first wife with FGC. Together, these results indicate that paternity certainty may be one of several factors contributing to the persistence of FGC in this sample, and that group-level sexual norms are key to maintaining the practice of FGC through the marriage market.     

Coitus, the proximate determinant of conception: inter-country variance in sub-Saharan Africa

There is a general consensus in the literature that fertility differences between populations can be accounted for by differences in just four key proximate determinants: nuptiality, the postpartum non-susceptible period, contraception and abortion. Natural fecundibility is generally assumed to be constant between populations. This paper puts the theoretical and empirical case for a re-evaluation of that assumption, drawing on the under-utilized data on sexual activity collected in the Demographic Health Surveys (DHSs). Using data for married women in nine African countries, the analysis finds substantial population level differences in mean monthly coital frequency, which, if accurate, suggest an important demographic effect. There is a clear regional patterning to these differences, with levels of activity considerably lower among women in the West African populations included in the study than those from East and southern Africa. For West Africa in particular the data indicate the normality of exceptionally long periods of very infrequent or no intercourse by married women outside the period of postpartum abstinence. The findings challenge prevailing presumptions concerning susceptibility to pregnancy in marriage on which statistics for unmet need for family planning are derived. While doubts are raised over the precision of the sexual activity data used, the paper argues for the need for a greater effort to operationalize the 'proximate determinant of conception', not only for more accurate fertility modelling, but also as a planning tool for a more sensitive provision of family planning services in Africa.     

Preface: Genetics and the human encounter with alcohol

Abstract

In this paper, we calculate a base line of statistical data on the frequency of sexual activity at various ages of Taiwanese women. A cross‐sectional study using questionnaires administered during personal interviews was conducted on more than seventeen thousand women who attended family planning clinics in the Taipei metropolitan area in 1991 and 1992. Of the women surveyed, 2.8 per cent were sexually inactive in the previous month, 83.67 per cent had intercourse one to nine times in the previous month, and 13.56 per cent had intercourse ten times or more. The mean frequency of sexual activity was 6.8 times a month. Age‐specific mean coital frequencies for the age groups of less than 25 years, of 25–34 years, and of 35–44 years were 10.3, 7.3, and 6.6 times per month, respectively. Increased sexual frequency was associated with the following factors: young age, unmarried, lower educational level, fewer years of marriage and being on the pill. When logistic regression was used to control for confounding variables, we found that a woman's age is the most significant factor in predicting her sexual frequency.     

It's all in the timing: coital frequency and fertility awareness-based methods of family planning

Fertility awareness-based methods of family planning help women to identify the days of the cycle they should avoid unprotected intercourse to prevent pregnancy. Therefore using fertility awareness-based methods influences the timing of sexual activity, which may affect the nature of the sexual relationship. Data are used from the clinical trials of two fertility awareness-based methods--the Standard Days Method and the TwoDay Method--to determine the frequency and timing of intercourse during the cycle, and the determinants of coital frequency. The mean coital frequency of study participants was similar to that reported by users of other methods. Results suggest that coital frequency increases with consecutive cycles of method use. At the same time the frequency of intercourse during the identified fertile days and during menses decreases. This evidence implies a behavioural change as couples get more experience using their method and communicating about the fertile days. Coital frequency was also influenced by the method used and by the study sites. Potential differences between the methods and sites that may contribute to this effect are discussed.     

Assessing the utilization of maternal and child health care among married adolescent women: evidence from India

This study explores the prevalence and factors associated with the utilization of maternal and child health care services among married adolescent women in India using the third round of the National Family Health Survey (2005-06). The findings suggest that the utilization of maternal and child health care services among adolescent women is far from satisfactory in India. A little over 10% of adolescent women utilized antenatal care, about 50% utilized safe delivery services and about 41% of the children of adolescent women received full immunization. Large differences by urban-rural residence, educational attainment, religion, economic status and region were evident. Both gross effect and fixed effect binary logit models yielded statistically significant socioeconomic and demographic factors. Women's education, wealth quintile and region are the most important determinants for the utilization of maternal and child health care services. Health care programmes should focus more on educating adolescents, providing financial support, creating awareness and counselling households with married adolescent women. Moreover, there should be substantial financial assistance for the provision of delivery and child care for married women below the age of 19 years.     

Luteal phase defects: a possible relationship between short hyperthermic phase and sporadic sexual behavior in women

Sporadic (less than regular weekly) coital activity is associated with a particular type of infertility—the short hyperthermic (luteal) phase. This preliminary report is the first suggestion that a reduced frequency of human sexual activity might, itself, be associated with subfertile reproductive function.     

Determinants of Sexual Activity and Pregnancy among Unmarried Young Women in Urban Kenya: A Cross-Sectional Study

Objectives

With age of marriage rising in Kenya, the period between onset of puberty and first marriage has increased, resulting in higher rates of premarital sexual activity and pregnancy. We assessed the determinants of sexual activity and pregnancy among young unmarried women in urban Kenya.

Methods

Baseline data from five urban areas in Kenya (Nairobi, Mombasa, Kisumu, Machakos, and Kakamega) collected in 2010 by the Measurement, Learning & Evaluation project were used. Women aged 15-24 years, who had never been married, and were not living with a male partner at the time of survey (weighted n=2020) were included. Using weighted, multivariate Cox proportional hazard regression and logistic regression analyses, we assessed factors associated with three outcome measures: time to first sex, time to first pregnancy, and teenage pregnancy.

Results

One-half of our sample had ever had sex; the mean age at first sex among the sexually-experienced was 17.7 (± 2.6) years. About 15% had ever been pregnant; mean age at first pregnancy was 18.3 (±2.2) years. Approximately 11% had a teenage pregnancy. Three-quarters (76%) of those who had ever been pregnant (weighted n=306) reported the pregnancy was unwanted at the time. Having secondary education was associated with a later time to first sex and first pregnancy. In addition, religion, religiosity, and employment status were associated with time to first sex while city of residence, household size, characteristics of household head, family planning knowledge and misconceptions, and early sexual debut were significantly associated with time to first pregnancy. Education, city of residence, household wealth, early sexual debut, and contraceptive use at sexual debut were associated with teenage pregnancy for those 20-24 years.

Conclusion

Understanding risk and protective factors of youth sexual and reproductive health can inform programs to improve young people’s long-term potential by avoiding early and unintended pregnancies.     

Risky behaviour and HIV prevalence among Zambian men

The objective of this paper is to identify demographic, social and behavioural risk factors for HIV infection among men in Zambia. In particular, the role of alcohol, condom use and number of sex partners is highlighted as being significant in the prevalence of HIV. Multivariate logistic regressions were used to analyse the latest cross-sectional population-based demographic health survey for Zambia (2007). The survey included socioeconomic variables and HIV serostatus for consenting men (N = 4434). Risk for HIV was positively related to wealth status. Men who considered themselves to be at high risk of being HIV positive were most likely to be HIV positive. Respondents who, along with their sexual partner, were drunk during the last three times they had sexual intercourse were more likely to be HIV positive (adjusted odds ratio (AOR) 1.60; 95% confidence interval (CI) 1.00-2.56). Men with more than two sexual life partners and inconsistent condom use had a higher risk for being HIV positive (OR 1.89, 95% CI 1.45-2.46; and OR 1.49, 95% CI 1.10-2.02, respectively). HIV prevention programmes in Zambia should focus even more on these behavioural risk factors.     

A causal approach to the study of fertility and familism

This paper tests, within the framework of LISREL, the causal structures of fertility using data from the 1973-74 Growth of Alberta Family Study (GAFS) of women aged 18-44 who are currently married or living common-law. Differential fertility among two groups of women classified by nativity also are examined. The women's background characteristics (e.g., age, religiosity, and education) are viewed as exogenous variables. The endogenous variables are familism and expected family size; familism is designated as an intermediate variable in the model, linking demographic and socioeconomic (including cultural) factors to fertility, The results indicate that familism acts as an important variable explaining fertility, particularly, among foreign-born women. The study confirms and extends earlier research findings that religiosity and education influence couples' fertility, the former positively and the latter negatively.     

Sex hormones in lesbian and heterosexual women

The authors measured plasma testosterone (T), androstenedione (A), and cortisol (C) levels in seven lesbian and seven heterosexual women matched for age and socioeconomic status. In addition, psychiatric symptoms, physical activity levels, depression, subjective sense of stress, and sexual behavior variables were assessed. There were no significant differences in sex hormone levels between the two groups of women, who were also comparable in psychiatric symptom levels, depression, and self-perceived stress. Lesbian women reported significantly more current physical activity relative to peers. Other than the sexual orientation difference which was a prerequisite for entry into the study, there were virtually no significant differences in sexual behavior although lesbian women tended to have achieved psychosexual milestones at a younger age. We were not able to corroborate the finding of Gartrell, Loriaux, and Chase (1977) that lesbian women have higher T levels, possibly due to the fact that the two groups were closely matched on several behavioral variables potentially affecting testosterone levels.     

Contribution of dihydrotestosterone to male sexual behaviour.

OBJECTIVE--To document the relative importance of endogenous sex steroids in modulating the frequency of orgasms, the dominant aspect of sexual behaviour in healthy eugonadal men. DESIGN--Measurement of adrenal and testicular sex steroids in a sample of army recruits and study of their relation to frequency of orgasms ascertained by questionnaire after potential confounding variables were controlled for. SETTING--Military campus and military hospital laboratories in Athens, Greece. SUBJECTS--92 consecutively enrolled healthy male recruits aged 18-22 years. MAIN OUTCOME MEASURES--Weekly number of orgasms. Serum concentrations of testosterone, dehydroepiandrosterone sulphate, dihydrotestosterone, oestradiol, oestrone, delta-4-androstenedione, and sex hormone binding globulin. RESULTS--Serum dihydrotestosterone concentration was the only independent hormonal predictor of the frequency of orgasms; an increase in concentration of 1.36 nmol/l (about 2 SD) corresponded to an average increase of one orgasm a week. CONCLUSIONS--Differences in concentrations of circulating dihydrotestosterone within the normal range may represent a major predictor of sexual activity in healthy young men.     

Improved HIV Awareness and Perceived Empowerment to Negotiate Safe Sex among Married Women in Ethiopia between 2005 and 2011

Introduction

The HIV prevalence rate in Ethiopia for married (or cohabiting) women is 3 times that found amongst women who have never been married. While marriage used to be seen as a protective factor against HIV, evidence suggests that this is no longer necessarily the case. This study analyses the trend and socio-demographic determinants of HIV awareness and safe sex negotiation among married women in Ethiopia between 2005 and 2011.

Methods

Data from Ethiopian Demographic and Health Surveys conducted in 2005 and in 2011 were analysed. Socio-demographic variables as well as ‘survey year’ were selected to assess their interaction with selected HIV awareness and safe sex negotiation indicators. Multivariable regression analyses were performed. Odds ratios and confidence intervals were computed.

Results

A significant increase in knowledge of HIV and ability to negotiate safer sex occurred between 2005 and 2011 reflecting a positive trend in gender empowerment amongst married Ethiopian women. Some of these advancements were striking, for instance respondents were 3.6 times more likely to have “Heard of AIDS” in 2011 than in 2005. HIV awareness and safer sex negotiation were significantly associated with higher education, higher socioeconomic status, those who had heard of HIV, those of the Orthodox Christian faith, and (to some extent) those living in rural areas.

Conclusion

HIV awareness has increased significantly in Ethiopia over the last decade but married women are still disproportionately susceptible to HIV. Community programmes, already effective in Ethiopia, also need to target this vulnerable sub-group of women.     

Physiological predictors of leptin vary during menses and ovulation in healthy women

Although research has shown interactions between the reproductive system and energy homeostasis, it is not clear how environmental or behavioral factors may factor into these associations. Here we aimed to determine how changes in reproductive state (i.e., phase of the menstrual cycle) and other behavioral and physiological factors may influence leptin levels in healthy women, as well as how sexual activity may play a role in leptin modulation. We collected serum and saliva from 32 healthy women and measured leptin, estradiol, and progesterone. Participants also completed surveys of demographics, health and sexual behaviors, and physical activity. Leptin was predicted by meals per day and missed meals at both menses and ovulation. However, estradiol and physical activity were stronger predictors of leptin at menses, while sexual activity was a stronger predictor of leptin at ovulation. These findings suggest that predictors of serum leptin, and possibly energy storage and expenditure, vary across the menstrual cycle.     

Father absence, parental care, and female reproductive development

This study examines female reproductive development from an evolutionary life history perspective. Retrospective data are for 10,847 U.S. women. Results indicate that timing of parental separation is associated with reproductive development and is not confounded with socioeconomic variables or phenotypic correlations with mothers' reproductive behavior. Divorce/separation between birth and 5 years predicted early menarche, first sexual intercourse, first pregnancy, and shorter duration of first marriage. Separation in adolescence was the strongest predictor of number of sex partners. Multiple changes in childhood caretaking environment were associated with early menarche, first sex, first pregnancy, greater number of sex partners, and shorter duration of marriage. Living with either the father or mother after separation had similar effect on reproductive development. Living with a stepfather showed a weak, but significant, association with reproductive development, however, duration of stepfather exposure was not a significant predictor of development. Difference in amount and quality of direct parental care (vs. indirect parental investment) in two- and single-parent households may be the primary factor linking family environment to reproductive development.     

Differences in nutritional status between rural and urban Yucatec Maya children: The importance of early life conditions

Early-life conditions shape childhood growth and are affected by urbanization and the nutritional transition. To investigate how early-life conditions (across the “first” and “second” 1000 days) are associated with rural and urban children's nutritional status, we analyzed anthropometric data from Maya children in Yucatan, Mexico. We collected weight, height and triceps skinfold measures, then computed body mass and fat mass indices (BMI/FMI), in a cross-sectional sample of 6-year-olds (urban n = 72, rural n = 66). Demographic, socioeconomic and early-life variables (birthweight/mode, rural/urban residence, household crowding) were collected by maternal interview. We statistically analyzed rural-urban differences in demographic, socioeconomic, early-life, and anthropometric variables, then created linear mixed models to evaluate associations between early-life variables and child anthropometric outcomes. Two-way interactions were tested between early-life variables and child sex, and between early-life variables and rural-urban residence. Results showed that rural children were shorter-statured, with lower overweight/obesity and cesarean delivery rates, compared to urban children. Household crowding was a negative predictor of anthropometric outcomes; the strongest effect was in boys and in urban children. Birthweight positively predicted anthropometric outcomes, especially weight/BMI. Birth mode was positively (not statistically) associated with any anthropometric outcome. Cesarean delivery was more common in boys than in girls, and predicted increased height in urban boys. In conclusion, urbanization and household crowding were the most powerful predictors of Maya 6-year-old anthropometry. The negative effects of crowding may disproportionately affect Maya boys versus girls and urban versus rural children. Early-life conditions shape Maya children's nutritional status both in the “first” and “second” 1000 days.     

Voluntary childlessness among American men and women in the late 1980's.

Most studies of childlessness in the United States have relied on unrepresentative, opportunistic samples collected in a variety of ways. Thus, the relationship of various correlates to childlessness is not well known. Some studies have focused on demographic variables, but have not examined attitudinal factors associated with childlessness--something the opportunistic samples have been able to do. In this paper we examine both attitudinal and demographic factors associated with childlessness in the United States. The data used in this paper are from the National Survey of Families and Households collected in 1987 and 1988. The data set includes both demographic data, perceived advantages and disadvantages of having children, and attitudinal data about related social issues. Overall, the rate of voluntary childlessness was not high. Only 3.5 per cent of the men and 2.8 per cent of the women reported that they were childless and did not expect to have children. Only one category of people (unmarried men and women over the age of 35) had rates that exceeded ten per cent. A combined variable of age and marital status was the best predictor of childlessness. A scale of reasons or justifications for having children was the next best predictor. In addition, attendance at religious services, number of hours the respondents desired to work and education (for women only) were related to childlessness. Those who scored highly on measures of support for traditional families and support of extended families also tended to have lower rates of childlessness. Occupational status, religious denomination, and race, on the other hand, were not significantly related to childlessness. Measures of gender equality, religious fundamentalism, and support for mothers working were also not related to childlessness.     

Voluntary Childlessness Among American Men and Women in the Late 1980's

Abstract

Most studies of childlessness in the United States have relied on unrepresentative, opportunistic samples collected in a variety of ways. Thus, the relationship of various correlates to childlessness is not well known. Some studies have focused on demographic variables, but have not examined attitudinal factors associated with childlessness—something the opportunistic samples have been able to do. In this paper we examine both attitudinal and demographic factors associated with childlessness in the United States. The data used in this paper are from the National Survey of Families and Households collected in 1987 and 1988. The data set includes both demographic data, perceived advantages and disadvantages of having children, and attitudinal data about related social issues. Overall, the rate of voluntary childlessness was not high. Only 3.5 per cent of the men and 2.8 per cent of the women reported that they were childless and did not expect to have children. Only one category of people (unmarried men and women over the age of 35) had rates that exceeded ten per cent. A combined variable of age and marital status was the best predictor of childlessness. A scale of reasons or justifications for having children was the next best predictor. In addition, attendance at religious services, number of hours the respondents desired to work and education (for women only) were related to childlessness. Those who scored highly on measures of support for traditional families and support of extended families also tended to have lower rates of childlessness. Occupational status, religious denomination, and race, on the other hand, were not significantly related to childlessness. Measures of gender equality, religious fundamentalism, and support for mothers working were also not related to childlessness.     

Assessing the validity of sexual behaviour reports in a whole population survey in rural Malawi

Background

Sexual behaviour surveys are widely used, but under-reporting of particular risk behaviours is common, especially by women. Surveys in whole populations provide an unusual opportunity to understand the extent and nature of such under-reporting.

Methods

All consenting individuals aged between 15 and 59 within a demographic surveillance site in northern Malawi were interviewed about their sexual behaviour. Validity of responses was assessed by analysis of probing questions; by comparison of results with in-depth interviews and with Herpes simplex type-2 (HSV-2) seropositivity; by comparing reports to same sex and opposite sex interviewers; and by quantifying the partnerships within the local community reported by men and by women, adjusted for response rates.

Results

6,796 women and 5,253 men (83% and 72% of those eligible) consented and took part in sexual behaviour interviews. Probing questions and HSV-2 antibody tests in those who denied sexual activity identified under-reporting for both men and women. Reports varied little by sex or age of the interviewer. The number of marital partnerships reported was comparable for men and women, but men reported about 4 times as many non-marital partnerships. The discrepancy in reporting of non-marital partnerships was most marked for married women (men reported about 7 times as many non-marital partnerships with married women as were reported by married women themselves), but was only apparent in younger married women.

Conclusions

We have shown that the under-reporting of non-marital partnerships by women was strongly age-dependent. The extent of under-reporting of sexual activity by young men was surprisingly high. The results emphasise the importance of triangulation, including biomarkers, and the advantages of considering a whole population.