This study analyses the arrival-cohort effects on the newborn birthweight of Latina women residing in Spain. First, it has been tested whether women of Latin American origin in Spain have an advantage in terms of birth outcomes, a pattern previously documented in the United States and referred to as the ‘Latin American paradox’. Second, it has been examined whether this health advantage of Latina mothers varies by arrival cohort.

A novel database provided by the Spanish National Statistics Office that links the 2011 Census with Natural Movement of the Population records from January 2011 to December 2015 has been used. Poisson regression models were applied to test for differences in the incidence rates of low birthweight (LBW) and high birthweight (HBW) among children of Latina and native mothers, controlling for various demographic, socio-economic, and birth characteristics.

Two distinct arrival-cohort effects on perinatal health were observed. On one hand, first-generation Latina women were found to be at a lower risk of giving birth to LBW infants; however, they experienced a higher incidence of HBW during the study period. Second, Latina women of 1.5 generation, likely stressed by increased exposure to the receiving country, exhibited adverse birthweight results.

Menstruation is part of women’s normal life, which requires basic hygienic practices. Managing hygiene can be affected by several factors and situations such as natural disasters. Focusing on ‘super flooding’ in Pakistan’s Sindh Province, we pay attention to how this ‘natural disaster’ has affected hygienic practices of menstrual cycle of women. The study meticulously examines the dynamics of menstrual hygiene management, encompassing the nuanced encounters with feelings of shame and embarrassment among girls and women situated in flood camps, schools, and community shelters. It also intends to highlight women’s challenge and embarrassment to participate in the distribution process of essential resources such as pads. The insights garnered from this study hold potential relevance for various stakeholders, including policymakers, healthcare practitioners, and researchers, offering a nuanced comprehension of the intersection of menstrual hygiene, climate change, and well-being of women.

Child nutrition, health and development are closely tied to maternal nutrition, health and well-being. The underlying drivers of poor maternal and child nutritional outcomes in sub-Saharan Africa are structural in nature. These risks include social, economic, and environmental factors that together compound vulnerability to poor outcomes. Poverty, as a driver of poor maternal and child health outcomes, is an important determinant that is both a cause and a consequence of malnutrition. The United Nations’ Children’s Fund (UNICEF)’s conceptual model for determinants of maternal and child nutrition outcomes released in 2020, is the agency’s latest iteration of child nutrition frameworks. The model identifies the underlying causes of malnutrition as extending beyond food and diets, to include household level dynamics, maternal factors, and the external environment. The manuscript discusses UNICEF’s conceptual model and its applicability in sub-Saharan Africa. It also considers the evidence on interventions aimed at addressing maternal and child nutrition in the region and the location of social protection among these policy tools, with a special focus on the extent to which these resonate with the conceptual model. It concludes by considering the conditions required for social protection instruments to work in the region and similar settings in the Global South. In this way, the manuscript provides a critical reflection about the role of social protection as a nutrition-sensitive instrument in sub-Saharan Africa, in the context of maternal and child nutrition outcomes.

In the U.S., approximately 11% of infants are born small for gestational age (SGA). While there are many known behavioral risk factors for SGA births, there are still many factors yet to be explored. The purpose of this study was to investigate the maternal early menarche (< 12 years old)- SGA birth association. Data were retrieved from the 2011-2017 National Survey of Family Growth, and multivariate logistic regression was used to evaluate the association. Approximately 4% of mothers reported having an SGA infant and 24% of mothers reported early age at menarche. After controlling for maternal age, race/ethnicity, and annual household income, early menarche was associated with 3% increased odds of SGA, although this finding was not statistically significant (adjusted odds ratio: 1.03, 95% CI: 0.70, 1.53). Additional research is needed on the long-term birth outcomes and health consequences of early menarche.

Childhood obesity/overweight is a worldwide concern and its prevalence is increasing in many countries. The first aim of this study is to analyse the trends in overweight and obesity among children under the age of five in Turkey based on the new World Health Organization (WHO) standards, using data from the ‘five-round of the Turkey Demographic and Health Surveys’ (TDHSs). The second aim is to examine whether or not the maternal/household and individual-level factors are associated with overweight/obesity using TDHS 2003, 2008, and 2013 datasets. A total sample of 14,231 children under the age of five were extracted from the TDHS in 1993, 1998, 2003, 2008, and 2013 to determine the prevalence of the trend. Pooled data from 8,812 children were included in the analysis to examine factors associated with overweight/obesity. Taking into account the clustered data structure, multilevel logistic regression models were utilised. In 1993, 1998, 2003, 2008, and 2013 the prevalence of overweight children was 5.3%, 4.9%, 10.0%, 11% and 11.6%, respectively. The factors that were independently associated with overweight/obesity were as follows: living in single-parent households (adjusted odds ratio (aOR) = 2.27, 95%CI = 1.21–4.26), compared to living in dual-parent households; having an obese mother (aOR = 4.25, 95%CI = 1.73–10.44), overweight mother (aOR = 3.15, 95%CI = 1.29–7.69), and a normal-weight mother (aOR = 2.70, 95%CI = 1.11–6.59) compared to having an underweight mother; being aged between 13–24 months (aOR = 1.72, 95%CI = 1.30 to 2.27), compared to being aged 0-12 months; male gender (aOR = 1.30, 95%CI = 1.11 to 1.53); being stunted (aOR = 2.18, 95%CI = 1.74 to 2.73); high birth weight (aOR = 1.55, 95%CI = 1.08 to 2.23) compared to low birth weight. In addition, overweight was higher in children of mothers who had completed primary school (aOR = 1.21, 95%CI = 1.01 to 1.59) than children of mothers who had not completed primary school. These findings reveal that, over the years, there has been a substantial increase in obesity/overweight among children which demonstrates the importance of evaluating the overweight indicators at the maternal/household level.

Turkish civil code permits child marriages at 16–17 years of age, but if a child is 16 years old judicial consent is needed. Before making a final decision on marriage consent, the judges refer these children to the doctor, and ask whether they are psychologically and physically ready for marriage. While the literature on child marriage in Turkey is rich, little is known about the underlying factors leading 16-year-old girls to request legal child marriage. This study examined the socio-demographic and clinical characteristics of girls applying to the courts for judicial marriage consent. Hospital records of girls admitted to a hospital in the Istanbul province of Turkey between January 2015 and December 2018 for the assessment of their physical and mental readiness for marriage were scanned. Of the 122 girls admitted to hospital for this purpose, eight were excluded as they had incomplete data, leaving 114 participating girls. All girls were Turkish citizens and had been referred from the law courts. Being pregnant/having a child (54.4%), having had a religious (non-legal) marriage (49.1%) and having an intelligence score of less than 90 (91.2%) were common among the participants. Among those who had a religious marriage, 78.6% were pregnant/had a child at the time of evaluation and 32.1% reported that they were pregnant before their religious marriage took place. None of the participants reported being forced to marry, but many had run away from home to marry (33.3%). Among those running away to marry, the major reason for deciding to do this was being pregnant (63.2%). Running away from home to marry was found to be related to lower parental educational levels (p<0.05). Contrary to the literature, the findings indicate that girls who request judicial consent for legal child marriage in Turkey are not being forced to marry. However, lower educational level seems to be an important factor. Below-average intelligence of the girl and her parents, running away from home to marry and early unsafe sexual intercourse, leading to child pregnancy, were found to be closely associated with legal child marriage in Turkey.

With over 1·3 million Anganwadi centres (AWC) (meaning ‘courtyard shelter’), the Indian government runs a nationwide intervention providing nutrition supplement to pregnant mothers to improve the health of their children. Using two successive rounds of the nationally representative cross-sectional National Family Health Survey data (collected during 2005–2006 and 2015–2016) of India, we assessed whether nutrition supplements given to pregnant mothers through AWC were associated with select child health indicators – extremely low birth weight (ELBW), very low birth weight (VLBW), low birth weight (LBW) and neonatal mortality (death during day 0–27) stratified by death during day 0–1, day 2–6 and day 7–27. A total of 148 019 children and 205 593 children were eligible for analysing birth weight and neonatal mortality, respectively. OR with 95% CI, estimated from multivariate logistic regression models, suggest that receipt of nutrition supplements was associated with decreased risk of VLBW (OR: 0·73, 95% CI 0·63, 0·83, P < 0·001), LBW (OR: 0·92, 95% CI 0·88, 0·96, P < 0·001), but not ELBW (OR: 0·80, 95% CI 0·56, 1·15, P = 0·226). Women who always received nutrition supplements during their pregnancy saw lower risk of death of their neonates (OR: 0·67, 95% CI 0·61, 0·73, P < 0·001), including death on day 0–1 (OR: 0·66, 95% CI 0·58, 0·74, P < 0·001), day 2–6 (OR: 0·69, 95% CI 0·58, 0·82, P < 0·001) and day 7–27 (OR: 0·68, 95% CI 0·53, 0·87, P = 0·002). Therefore, nutritional supplementation to pregnant mothers appears to be helpful in deterring various stages of neonatal mortality, VLBW and LBW, though it might not be effective in mitigating ELBW. Findings were discussed considering possible limitations of the study.

Male involvement in maternal health care utilization is an important contributor to maternal health, especially in male-dominated societies. This study aimed to understand the variations and determinants of women’s antenatal care (ANC) utilization and institutional delivery in India and three socioeconomically less-developed states (Bihar, Madhya Pradesh and Uttar Pradesh) using NFHS-4 data (2015–16). Husband’s knowledge of pregnancy care and delivery, having a non-violent marital relationship and a respectful attitude towards his wife, better education and wealth, higher exposure to mass media and fewer children substantially enhanced the probability of him being present at his wife’s ANC visits. Furthermore, men’s presence at any ANC visit was shown to be an important factor influencing institutional delivery in India as a whole, as well as in the three less-developed states. The two major hurdles in maternal and child health care utilization in India were incorrect perception of ‘unnecessary’ maternal health care by families and high cost as reported by husbands. Furthermore, the proportion of husbands who received knowledge from health workers on maternal and child health was too low to achieve the maternal health SDGs by 2030. The dissemination of knowledge on maternal care among husbands, and encouraging their presence during antenatal care, may help secure better maternal health outcomes in India. It is imperative that the husband-involvement agenda is strengthened in India if the SDGs for maternal care are to be achieved.

Continuum of care throughout pregnancy, delivery and post-delivery has proved to be a critical health intervention for improving the health of mothers and their newborn children. Using data from the fourth wave of the National Family Health Survey (NFHS-4) conducted in 2015–16, this study examined the correlates of utilization of maternal health care services and child immunization following the continuum of care approach in India. The study also assessed whether the continuity in utilizing maternal health care services affects the immunization of children. A total of 33,422 survey women aged 15–49 were included in the analysis of maternal health care indicators, and 8246 children aged 12–23 months for the analysis of child immunization. The results indicated that about 19% of the women had completed the maternal health continuum, i.e. received full antenatal care, had an institutional delivery and received postnatal care. Women with a higher level of education and of higher economic status were more likely to have complete continuum of care. Continuity of maternal health care was found to be associated with an increase in the immunization level of children. It was observed that 76% of the children whose mothers had complete continuum of care were fully immunized. Furthermore, the results from propensity score matching revealed that if mothers received continuum of care, the chance of their child being fully immunized increased by 17 percentage points. The results suggest that promotion of the continuum of maternal health care approach could help reduce not only the burden of maternal deaths in India, but also that of child deaths by increasing the immunization level of children.

The aim of this study was to identify social and biological drivers of fetal growth by examining associations with household, preconception, and pregnancy factors in a cohort from Soweto, South Africa. Complete data and ultrasound scans were collected on 519 women between 2013 and 2016 at 6 time points during pregnancy (<14, 14–18, 19–23, 24–28, 29–33 weeks, and 34–38 weeks). Household-level factors, preconception health, baseline body mass index (BMI), and demographic data were collected at the first visit. During pregnancy, gestational weight gain (GWG; kg/week) was calculated. At 24–28 weeks of gestation, oral glucose tolerance test was used to determine gestational diabetes mellitus (GDM) status, and hypertension status was characterised. Longitudinal growth in head circumference, abdominal circumference, biparietal diameter, and femur length were modelled using the Superimposition by Translation and Rotation, a shape-invariant model which produces growth curves against gestational age. A priori identified exposure variables were then included in a series of sex-stratified hierarchical regression models for each fetal growth outcome. No household-level factors were associated with fetal growth. Maternal BMI at baseline was positively associated with all outcome parameters in males and females. Both GWG (in males and females) and GDM (in males) were significant positive predictors of abdominal growth. Males showed more responsiveness to abdominal growth, while females were more responsive to linear growth. Thus, fetal growth was largely predicted by maternal biological factors, and sexual dimorphism in the responsiveness of fetal biometry to biological exposures was evident.

The term ‘obstetric violence’ has been used to describe the mistreatment, disrespect and abuse or dehumanized care of women during childbirth by health care providers. This is a review of the existing literature in India on violence against women during childbirth. The review used the typology of Bohren et al. (2015). An internet search of PubMed, Google Scholar and JSTOR was conducted using the terms ‘obstetric violence’, ‘mistreatment’, ‘disrespect and abuse’ and ‘dehumanized care’. Studies based on empirical research on women’s experiences during childbirth in health facilities in India were included in the review. The search yielded sixteen studies: one case study, two ethnographic studies, two mixed-methods studies, three cross-sectional qualitative studies, seven cross-sectional quantitative studies and one longitudinal quantitative study. The studies were analysed using the seven categories of mistreatment outlined by Bohren et al. (2015): 1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. An additional category of ‘harmful traditional practices and beliefs’ emerged from the Indian literature, which was also included in the review. Although geographically limited, the selected research highlighted varying prevalences of the different forms of ‘obstetric violence’ in both public and private birth facilities in India. ‘Obstetric violence’ in India was found to be associated with socio-demographic factors, with women of lower social standing experiencing greater levels of mistreatment. In response to this normalized public health issue, a multi-pronged, rights-based framework is proposed that addresses the social, political and structural contexts of ‘obstetric violence’ in India.

Unsafe abortions remain a considerable public health problem and continue to be a leading cause of maternal morbidity and mortality throughout the world. This study assessed whether women’s choice of type of health care facility for abortion in India varied by their socio-demographic and economic characteristics, and aimed to determine the significant predictors of choice of health care facility. Data were taken from the 2015–16 Indian National Family and Health Survey (NFHS-4). The study sample included women aged 15–49 years, irrespective of their marital status, who had terminated their last pregnancy by induced abortion in the five years before the survey (N = 6876). A bivariate analysis was carried out to assess the pattern in the choice of health care facility type for an abortion, and a multinomial logistic regression model was fitted to assess the predictors affecting the choice of health care facility type for an abortion. The results showed that, at the time of the 2015–16 survey, women in India went to private facilities more than public facilities for abortion care, irrespective of their age, distance to facility and financial constraints. The probability of visiting a private facility increased with women’s age, gestational age and the wealth quintile. A wide variation in choice of health facility for abortion care by socioeconomic characteristics was observed.

Studies have focused on the effect of short birth spacing on childhood mortality, yet very little attention has been paid to the possibility of an inverse relationship such that child mortality might also positively or negatively affect birth spacing. In Nigeria, where both fertility and child mortality are high, this inverse relationship is a possible reason for the country’s high fertility. The objective of this study was to examine the effect of child death on time to birth of the next child. Data were drawn from the 2013 Nigerian Demographic Health Survey. The study sample comprised 188,986 live births born to women aged 15–49 years within the five years preceding the survey. A multivariate Cox proportional hazard regression model was fitted to the data, and hazard ratios with 95% confidence intervals calculated. More than half of the mothers (68%) already had a next birth by 36 months after the death of the index child. Controlling for other covariates, the Cox regression model showed that the likelihood of next birth was higher when the index child had died compared with when the index child survived (HR: 2.21; CI: 2.03–2.41). Sub-group analysis by geo-political regions in Nigeria showed that in all regions there was a higher likelihood of having a next birth following the death of a preceding child. Death of the index child was found to be a major factor that shortens the length of birth intervals in Nigeria. It is therefore important that the Government of Nigeria intensifies efforts aimed at reducing infant mortality and encouraging adequate birth spacing.