"There Is a Big Question Mark": Managing Ambiguity in a Moroccan Maternity Ward.

In Morocco, where extramarital sex and abortion are illegal, single mothers' ambiguous status before the law inflects medical decision-making. Leaky boundaries between the court and the hospital required doctors and administrators to work with multiple forms of documentation while anticipating external surveillance. Gaps between everyday experience and legalized forms of identity created confusion across multiple institutions. When discussing single mothers, hospital staff often spoke of "question marks" that flagged tensions between legibility and liability, disappearance and documentation. Managing question marks ramified surveillance and categorization. Ultimately, however, attempts to administratively resolve single mothers' ambiguity created gaps and inconsistencies that allowed vulnerable patients to disappear from view.

Fifty states of self-control: A U.S. statewide examination of the initiation and inhibition dimensions of self-regulation.

Individual differences in self-control have been shown to reflect two underlying dimensions: initiation and inhibition. We examined the possibility that degrees of self-control might likewise be modeled at a broader social level, similar to other socio-cultural differences that operate at an individual level (e.g., collectivism). To test this notion, we used a variety of mundane behaviors measured at the level of U.S. states to create inhibitory and initiatory indices of self-control at a collective level. We show that statewide levels of initiatory and inhibitory self-control, despite being correlated with one another, exhibit unique patterns of association with a wide range of outcomes, including homicide, suicide, home foreclosures, divorce, and infidelity. This study represents one of the first attempts to model the dimensional structure of self-control at a social level and supports the utility of conceptualizing self-control as an important socio-cultural variable.

Should physicians tell the truth without taking social complications into account? A striking case.

The principle of respect for autonomy requires informing patients adequately and appropriately about diagnoses, treatments, and prognoses. However, some clinical cases may cause ethical dilemmas regarding telling the truth. Under the existence especially of certain cultural, social, and religious circumstances, disclosing all the relevant information to all pertinent parties might create harmful effects. Even though the virtue of telling the truth is unquestionable, sometimes de facto conditions compel physicians to act paternalistically to protect the patient/patients from imminent dangers. This article, which aims to study the issue of whether a physician should always tell the truth, analyzes an interesting case that represents the detection of misattributed paternity during pre-transplant tests for a kidney transplant from the son to the father in Turkey, where social, cultural, and religious factors have considerable impact on marital infidelity. After analyzing the concept of telling the truth and its relationship with paternalism and two major ethical theories, consequentialism and deontology, it is concluded that the value of the integrity of life and survival overrides the value of telling the truth. For this reason, in the case of a high possibility of severe and imminent threats, withholding some information is ethically justifiable.

Jaboya ("Sex for Fish"): A Qualitative Analysis of Contextual Risk Factors for Extramarital Partnerships in the Fishing Communities in Western Kenya.

Extramarital partnerships exacerbate high HIV prevalence rates in many communities in sub-Saharan Africa. We explored contextual risk factors and suggested interventions to reduce extramarital partnerships among couples in the fishing communities on Lake Victoria, Kenya. We conducted 12 focus group discussions with 9-10 participants each (N = 118) and 16 in-depth interviews (N = 16) with fishermen and their spouses. Couples who participated were consented and separated for simultaneous gender-matched discussions/interviews. Interview topics included courtship and marriage, relationship and sexual satisfaction, extramarital relationships and how to intervene on HIV risks. Coding, analysis, and interpretation of the transcripts followed grounded theory tenets that allow analytical themes to emerge from the participants. Our results showed that extramarital partnerships were perceived to be widespread and were attributed to factors related to sexual satisfaction such as women needing more foreplay before intercourse, discrepancies in sexual desire, and boredom with the current sexual repertoire. Participants also reported that financial and sociophysical factors such as family financial support and physical separation, contributed to the formation of extramarital partnerships. Participants made suggestions for interventions that reduce extramarital partnerships to minimize HIV risks at the community, couple, and individual level. These suggestions emphasized improving community education, spousal communication, and self-evaluation for positive behavior change. Future studies can draw upon these findings as a basis for designing community-owned interventions that seek to reduce community-level HIV risk through a reduction in the number of sexual partners.

Extramarital Sex Among Vietnamese Married Men: Results of a Survey in Urban and Rural Areas of Northern and Southern Vietnam.

Research on extramarital sex (EMS) is commonly conducted from a perspective that implicitly understands this behavior as a violation of the marital relationship. In contrast, Vietnamese cultural norms have, at some points in history, condoned if not outright encouraged EMS in the name of preserving family lineage. Yet little is known about the prevalence of EMS among contemporary Vietnamese men and its association with marriage quality. This is a notable gap, given the enormous sociocultural and ideological shifts the country has experienced over the past several decades. Drawing upon a sample of 126 married men (Mean age = 45.56; SD = 10.52) surveyed in urban (Hanoi and Ho Chi Minh City) and rural areas (Ha Tay and Can Tho) in Vietnam, we examined the relationship between EMS and geographic region, demographic characteristics, sexual values, quality of marriage, and sexual satisfaction within marriage. Our results show that geographic location had a strong impact on EMS, while most marital relationship quality variables did not impact the odds of EMS for married men in Vietnam.

Explaining sex differences in reactions to relationship infidelities: comparisons of the roles of sex, gender, beliefs, attachment, and sociosexual orientation.

To the extent that sex differences are mediated by mechanisms such as sex-roles and beliefs, individual differences in these more proximate traits should account for significant portions of relevant sex differences. Differences between women and men in reactions to sexual and emotional infidelity were assessed in a large sample of participants (n = 477), and these target reactions were evaluated as a function of many potential proximate mediators (infidelity implications beliefs, gender-role beliefs, interpersonal trust, attachment style, sociosexuality, and culture of honor beliefs) and as a function of participant sex. Results found a consistent sex difference that was not mediated by any other variables, although a handful of other variables were related to male, but not female, individual differences. These findings suggest particularly promising directions for future research on integrating evolutionarily based sex differences and proximate individual differences.

Race differentials in partnering patterns among older U.S. men: influence of androgens or religious participation?

Using nationally representative data from the 2005-2006 U.S. National Social Life, Health, and Aging Project, this study queried race differences in older men's polyamorous and casual sex, as well as stratification of these patterns by endogenous androgens (testosterone and dehydroepiandrosterone) and by regular religious participation. Results suggested that despite their respective prominence in the biomedical and sociological literatures on sex, neither "bottom up" hormonal influences nor "top down" religious social control were major structuring factors for greater lifetime as well as current likelihood of these behaviors among older Black than White men. Androgens were higher among the former, but did not seem to drive these race patterns. Regular church attendance--while negatively associated with non-monogamous and prolific partnering, and hence possibly a social control mechanism among all men--played only a weak role in moderating ethnic variations in these behaviors. It is speculated that these differences may instead be driven by unexamined current or early factors, including, perhaps, Black men's greater exposure to sexualizing processes in adolescence that, even in late life, may outweigh more temporally-proximal influences.

Male migrants' non-spousal sexual partnerships in the place of origin: an in-depth investigation in two rural settings of India.

Male migrants in India are at disproportionately high risk for HIV, not only because of their sexual behaviours in destination areas but also due to their risk behaviours in their place of origin. While studies have documented male migrants' risky behaviours in the home setting, few have attempted to understand the underlying socio-cultural context in which they engage in such behaviours. This paper examines the patterns and context of male migrants' non-spousal sexual partnerships in two high-out-migration districts of India. Data, drawn from a cross-sectional behavioural mixed-methods study conducted in 2008, included a structured survey with 1272 migrants, followed by in-depth interviews with 33 male migrants. Results suggest that sexual activity was common in the place of origin: around 50% of migrants had sex with a non-spousal female partner and two-fifths had initiated sex in this setting. Migrants' non-spousal sexual behaviours in the home village were influenced by the prevailing socio-cultural context, including migrants' enhanced socio-economic status, attitudes to non-spousal sex and accessibility of sexual partners. Male migrants' non-spousal sexual partnerships in source areas are influenced by socio-cultural factors, which must be considered when designing HIV programmes in India and elsewhere.

The other woman and her child: extra-marital affairs and illegitimacy in twentieth-century Britain.

This article investigates the numbers of 'other women' and their children up until the 1960s in Britain. It analyses 'irregular and illicit unions' in the records of the National Council for the Unmarried Mother and her Child (now One Parent Families/Gingerbread), and explores evidence on these unions in the debates over the passage of the Divorce Acts of 1923 and 1937 as well as the Legitimacy Acts of 1926 and 1959. It suggests that the prevalence of illicit unions throughout the twentieth century and before allows us to question contemporary concerns about our supposed 'divorcing society' and the decline of family life in modern Britain.

"You still need to give her a token of appreciation": the meaning of the exchange of money in the sexual relationships of out-of-school adolescents in rural southwest Uganda.

This article challenges the pervasive assumption that exchanging gifts and money in adolescent sexual relationships is transactional. Data were derived from a multi-method, qualitative sexual health needs assessment of 31 out-of-school adolescents in rural southwest Uganda. Grounded theory analysis allows contextual meanings of exchange to emerge. Adolescents have developed gendered courting and exchange models that parallel marital relationships in this cultural context. Whereas exchange is considered transactional and immoral in some types of relationships, in adolescent relationships, it is not. Young women are not ashamed of, or stigmatized by, the exchange; they are proud of it. The exchange signifies several things: self-respect and a partner's willingness to wait for the relationships to become sexual and, therefore, that they are valued and respected by their partners. This demonstrates commitment from a partner, whose role is as a provider. To expect no gift or to have sex for pleasure are the hallmarks of the worst kind of woman-a malaya. "Need" is the only acceptable rationale for extramartial sex for any woman in this sexual value system. Interventions promoting longer courting and sustained support for one partner would encourage a delay in debut for young women and encourage greater monogamy in young men.

The mistress, the midwife, and the medical doctor: pregnancy and childbirth on the plantations of the antebellum American South, 1800-1860.

This article represents a step towards examining the relationship between three key figures in the antebellum American South: the plantation mistress, the slave-midwife, and the professional male physician. It elucidates how the experiences of pregnancy and childbirth, which brought women close to death, formed the basis of a deeper, positive relationship between the black and white women of the antebellum South, and assesses the ways in which the professionalization of medicine affected this reproductive bond. Evaluating such a complicated network of relationships necessitates dissecting numerous layers of social interaction, including black and white women's shared cultural experiences and solidarity as reproductive beings; the role, power, and significance of slave-midwives and other enslaved caretakers in white plantation births; the cooperation between pregnant bondswomen and plantation mistresses; and the impact that the burgeoning profession of medicine had on the procreative union between antebellum black and white women.

"All the men here have the Peter Pan syndrome--they don't want to grow up": Navajo adolescent mothers' intimate partner relationships--a 15-year perspective.

In 1992 and 1995, data were collected from 29 Navajo Native American adolescent mothers. In 2007 and 2008, data were collected from 21 of the original 29 (72%). Guided by feminist family theory, this investigation sought to (a) examine Navajo adolescent mothers' intimate partner relationships during the transition to parenthood, (b) identify themes in the young mothers' intimate partnerships across time, and (c) assess participants' psychosocial well-being in adulthood. Four themes emerged in the women's long-term intimate relationships: limited support, substance abuse, infidelity, and intimate partner violence. Implications of the findings and suggestions for future research are discussed.

HIV vulnerability and condom use among migrant women factory workers in Puebla, Mexico.

International migration is associated with increased HIV vulnerability, but little is known about the vulnerability of internal migrants. This qualitative study explored perceptions of HIV and condom use among Mexican migrant female factory workers. Migration and male sexual infidelity contributed to increased HIV vulnerability and unprotected sex was ubiquitous. The dominant cultural discourse that dichotomizes "good" (monogamous) and "bad" (sexually stigmatized) women, and male partner's resistance, were barriers to condom use. Women's positive attitudes toward the dual protection (pregnancy and sexually transmitted infections) offered by condoms and sexual agency expressed by refusing unwanted sexual contact are resources for HIV prevention.

"A hint of it, with initials": adultery, textuality and publicity in Jane Austen's Lady Susan.

In spite of Jane Austen's professed "eye" for an adulteress, comparatively little attention has been paid to adultery and divorce as themes and contexts of her fiction. Her unpublished epistolary novel Lady Susan has a distinctive status in Austen's oeuvre, recognized as being exemplary of her "style" and yet atypical of her later achievement. A neglected context for the novel is the extensive reporting of adultery trials in contemporary print culture and the moral panic concerning adultery in the 1780s and 1790s, focusing initially on the adulteress as the brazen woman of fashion and later as a figure of sentimentalized abjection. A particularly notorious case, that involving Lady Henrietta Grosvenor and George III's brother, the Duke of Cumberland, is directly alluded to in Lady Susan. The textual strategies of adultery trial literature, particularly its emphasis on indirection through the use of detail or "hint", had a long-term influence on the development of Austen's fiction and her positioning of herself as a professional writer after the 1790s.

Prevalence of and factors associated with extramarital sex among Nigerian men.

This study used data on currently married and cohabiting men aged 15 to 64 years from the 2003 Nigeria Demographic and Health Survey to examine the prevalence of and factors associated with extramarital sex. The results show that 16% engaged in extramarital sex in the 12 months preceding the survey and had an average of 1.82 partners. The results also show statistically significant association between extramarital sex and ethnicity, religion, age, age at sexual debut, education, occupation, and place of residence. Based on the study results, it could be concluded that significant proportions of Nigerians are exposed to HIV infection through extramarital sex. A fundamental behavioral change expected in the era of HIV/AIDS is the inculcation of marital fidelity and emotional bonding between marital partners. The promotion of condom use among married couples should be intensified to protect women, a large number of whom are exposed to HIV infection from their spouses who engage in unprotected extramarital sex. And, because of gender-based power imbalances within the family, a large number of the women are unable to negotiate consistent condom use by their partners.

Risk of sexual HIV transmission among wives left behind and wives of nonmigrant men in rural areas of China.

In rural areas of China where commercial plasma donation used to be common, little is known about sexual behaviors and condom use among wives left behind by migrating husbands and wives of nonmigrant men. This study investigated sexual behaviors and condom use among married women in rural areas of China. A cross-sectional survey was conducted with 1,873 participants recruited by a cluster-sampling method. Study results showed that wives left behind had a significantly lower mean frequency of sexual intercourse with their husbands in the previous month, a higher rate of multiple sexual partners, a higher rate of self-reported HIV infection, and a lower rate of condom use when compared with wives of nonmigrant men. Also, HIV-infected wives left behind who were infected by their husbands had multiple sex partners and did not use condoms consistently. This research provides additional insight that may be used to develop effective HIV prevention strategies in rural areas of China.

They "miss more than anything their normal life back home": masculinity and extramarital sex among Mexican migrants in Atlanta.

CONTEXT: Gender has been recognized as a significant influence on sexual health behaviors. Labor migration presents an important context of vulnerability for sexual health. To understand how the context of migration affects risk-related practices, both cultural and social aspects of gender need to be explored. METHODS: In the quantitative part of a mixed-methods study conducted in 1999 in Atlanta, 187 Mexican migrant men were asked about their demographic characteristics; sexual history; migration motivations; substance use; social support; leisure-time activities; and ideas about masculinity, sexuality and marriage. Multivariate regression analyses were conducted to test the association between these domains and men's number of partners since their arrival in Atlanta. RESULTS: Number of partners was positively associated with owning a home in Mexico; number of trips back to Mexico; social network size; having had a sex worker as a partner; and going out dancing and to strip clubs on weekends (coefficients, 0.3-4.1). It was negatively associated with age, education, contact with social network members and feeling that sex is tied to emotional intimacy (-0.4 to -1.0). CONCLUSIONS: Programs must acknowledge and target migrant men's social networks and the spaces in which they may encounter risky sexual situations. Multilevel strategies, such as the development of more health-enhancing community spaces and the promotion of safer sexual practices should form part of comprehensive efforts to reduce sexual risk among migrant men.