Two sons and a daughter: sex composition and women's reproductive behaviour in Madhya Pradesh, India.

This article examines how the sex composition of women's current children at the start of a pregnancy interval influences both fertility desires and the full range of reproductive actions women may take to realize them, including temporary contraception, abortion and sterilization, in Madhya Pradesh, India, where popular notions of ideal family size and sex composition are dominated by son preference. The analysis is conducted using a dataset of 9127 individual pregnancy intervals from a 2002 statewide representative survey of 2444 women aged 15-39 with at least one child. The results indicate that women's preferences go beyond a singular preference for male children, with the preferred composition of children being two boys and one girl. Women with this composition are 90% less likely to report having wanted another pregnancy (OR 0.097, p < 0.01) relative to those with two girls. These preferences have significant implications for reproductive actions. While sex composition has no statistically significant effect on the use of temporary contraception, those with the preferred sex composition are twice as likely to attempt abortion (OR 2.436, p < 0.01) and twelve times more likely to be sterilized (OR 12.297, p < 0.01) relative to those with two girls only.

'If your husband calls, you have to go': understanding sexual agency among young married women in urban South India.

BACKGROUND: Early marriage is common in many developing countries, including India. Women who marry early have little power within their marriage, particularly in the sexual domain. Research is limited on women's ability to control their marital sexual experiences. METHODS: We identified factors affecting sexual communication among married women aged 16-25, in Bangalore, India, and how factors associated with sexual communication differed from those influencing non-sexual agency. We ran ordered logit regression models for one outcome of sexual agency (sexual communication, n = 735) and two outcomes of non-sexual agency (fertility control, n = 735, and financial decision-making, n = 728). RESULTS: Sexual communication was more restricted (83 women (11.3%) with high sexual communication) than financial decision-making (183 women (25.1%) with high financial decision-making agency) and fertility control (238 women (32.4%) with high fertility control). Feeling prepared before the first sexual experience was significantly associated with sexual communication (odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.13-2.89). Longer marriage duration (OR 2.13; 95% CI = 1.42-3.20) and having worked pre-marriage (OR 1.38; 95% CI = 1.02-1.86) were also significant. Few other measures of women's resources increased their odds of sexual communication. Education, having children, pre-marital vocational training and marital intimacy were significant for non-sexual outcomes but not sexual communication. CONCLUSIONS: Policy-makers seeking to enhance young married women's sexual communication need to consider providing sex education to young women before they marry. More broadly, interventions designed to increase women's agency need to be tailored to the type of agency being examined.

Son preference and sterilisation use among young married women in two slums in Bengaluru city, India.

This paper explores the ways in which women's sterilisation decisions are influenced by the combination of a preference for male children and a desire for smaller family size among young married women in two urban slums in Bengaluru, India. While both son preference and an emphasis on sterilisation are well-known demographic characteristics of most South Asian countries, relatively little research has been conducted that links the two. We take advantage of a longitudinal survey of 416 unsterilised married women aged 16-25 to explore how having sons and the number of children influence a woman's sterilisation decision. Discrete-time event history techniques are used to estimate two models: the first examines the effect of having sons and number of children separately, and the second examines them in combination in the form of an interaction. The results suggest sterilisation is motivated by son preference mainly at lower parities (three or fewer children) and by concerns about family size at higher parities. Understanding how sterilisation and other reproductive behaviours are influenced by the interaction of family size and sex preferences will help policy-makers and programmers to meet the needs of women while continuing to address discriminatory behaviour against females.

Potential role of traditional birth attendants in neonatal healthcare in rural southern Nepal.

The potential for traditional birth attendants (TBAs) to improve neonatal health outcomes has largely been overlooked during the current debate regarding the role of TBAs in improving maternal health. Randomly-selected TBAs (n=93) were interviewed to gain a more thorough understanding of their knowledge, attitudes, and practices regarding maternal and newborn care. Practices, such as using a clean cord-cutting instrument (89%) and hand-washing before delivery (74%), were common. Other beneficial practices, such as thermal care, were low. Trained TBAs were more likely to wash hands with soap before delivery, use a clean delivery-kit, and advise feeding colostrum. Although mustard oil massage was a universal practice, 52% of the TBAs indicated their willingness to consider alternative oils. Low-cost, evidence-based interventions for improving neonatal outcomes might be implemented by TBAs in this setting where most births take place in the home and neonatal mortality risk is high. Continuing efforts to define the role of TBAs may benefit from an emphasis on their potential as active promoters of essential newborn care.

Challenging assumptions about women's empowerment: social and economic resources and domestic violence among young married women in urban South India.

BACKGROUND: Although considerable research has documented the widespread prevalence of spousal violence in India, little is known about specific risk or protective factors. This study examines the relationships between factors that are often considered to be social and economic resources for women and recent occurrence of domestic violence. METHODS: Data were collected from 744 young married women in slum areas of Bangalore, India. Unadjusted and adjusted multivariable logistic regression models were used to determine factors associated with having been hit, kicked or beaten by one's husband in the past 6 months. RESULTS: Over half (56%) of the study participants reported having ever experienced physical domestic violence; about a quarter (27%) reported violence in the past 6 months. In a full multivariable model, women in 'love' marriages (OR=1.7, 95% CI 1.1-2.5) and those whose families were asked for additional dowry after marriage (OR=2.3, 95% CI 1.5-3.4) were more likely to report domestic violence. Women who participated in social groups (OR=1.6, 95% CI 1.0-2.4) and vocational training (OR=3.1, 95% CI 1.7-5.8) were also at higher risk. CONCLUSIONS: Efforts to help women empower themselves through vocational training, employment opportunities and social groups need to consider the potential unintended consequences for these women, such as an increased risk of domestic violence. The study findings suggest that the effectiveness of anti-dowry laws may be limited without additional strategies that mobilize women, families and communities to challenge the widespread acceptance of dowry and to promote gender equity. Longitudinal studies are needed to elucidate the complex causal relationships between 'love' marriages and domestic violence.