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While studies in high-income countries have shown that failure to achieve fertility desires is significantly associated with unfavourable personal circumstances, there is barely any empirical evidence on the factors that influence the pattern of unrealized fertility in sub-Saharan Africa. Using data from the 2018 Nigeria Demographic and Health Survey, this paper investigates the roles of ethnicity and the sex composition of living children on unrealized fertility in Nigeria. The results show that the odds of having unrealized fertility were higher among Hausa-Fulani women compared with women of other ethnic groups in Nigeria. Also, having daughters only (no sons) was associated with higher odds of unrealized fertility, after controlling for other important covariates. The findings suggest that cultural norms and pronatalism significantly influence the fertility desires of women in Nigeria, even at the end of their reproductive lifespan.

Marriage involving a man and a woman is a universal social institution, but its practices vary among cultures. In Nigeria, a marriage is recognized after gifts are given, and a bride price is paid by the groom's family to the bride's family. Understanding the bride price will reduce the challenges women face in their marital homes. Women's autonomy is important for them to address matters affecting their health. We examined married Ikwerre women's perspectives on bride price and its impact on their autonomy using qualitative methods. From December 2014 to March 2015, 34 in-depth interviews and six focus group discussions were conducted with married Ikwerre women. Participants reported that patriarchy and a culture of absolute respect for men, not the bride price, was the reason for women's diminished autonomy. Participants noted that payment of the bride price was critical for validating marriage to give women respectable status in society as wives. Patriarchal rule and the demand for absolute respect for men need to be addressed in the Ikwerre culture. A woman's capability to address her health needs and use health care is largely dependent on her ability to act autonomously. Thus, educational interventions to enable women's decision-making are critical.

Women's household autonomy is associated with maternal healthcare utilization in developing countries, but its effects are not consistently positive. In the current study, the researchers test prenatal care utilization in Armenia and Azerbaijan (N = 2,159). After controlling for socioeconomic factors, we find that women's autonomy seems to be a mixed blessing. For instance, participating in daily purchases delays the start of prenatal care, but results in more prenatal care visits. Additionally, a woman's household position as a daughter-in-law has significant negative associations with accessing prenatal care during the first trimester of pregnancy.

In this study, which was part of a larger project I undertook in North-central Nigeria, I explored the differences in the sexual health seeking behavior of Tarok women and men and how these differences affect the spread of HIV. With the help of three research assistants, I conducted 16 in-depth interviews and 24 focus group discussions in four Tarok communities in North-central Nigeria. I found certain negative effects of gender inequality on women's sexual health seeking behavior in particular, a situation that has adverse implications for HIV acquisition and transmission. I therefore concluded that addressing the challenges of gender inequality is imperative for a sustained fight against HIV and AIDS in Nigeria.

Uganda has faced numerous challenges over the past 50 years from overcoming political conflict and civil unrest, to rapid population growth, to combating the HIV epidemic and ever-growing health needs. Women in Uganda have had a major role to play in the health of families and communities. The researchers' purpose in this study, undertaken in rural Uganda, was to a) identify a people-centered definition of development, b) compare it to the process of modernization, and c) investigate how these processes have changed the role women play in decision-making, in areas directly and indirectly related to their health and that of their families. Twenty-two men and women participated in focus group discussion and completed questionnaires. Based on our analysis of discussions it appears that both modernization and development have impacted health positively and negatively. Key themes distilled from interviews included that modernization has led to the breakdown of families; increased maternal responsibility for children; diminished land and economic resources; and an erosion of cultural values and practices that had previously provided stability for the society. In terms of development, women play an increasing role in decision-making processes in the household and are gaining increasing respect for their expertise in a number of areas, notably health care. We propose a movement of grassroots discourse on modernization. Development, and its effect on health, is necessary if the positive aspects of Ugandan culture and those of similar emerging societies are not to be lost (International Covenant on Economic, Social and Cultural Rights, 1966).

This study draws upon a sociocultural stress and coping perspective to examine generational demands in midlife families. It examines both the predictors and family-related circumstances that contribute to perceptions of greater demand, with a focus on gendered and ethnocultural dimensions. Using mixed-methods, data are based on a sample of 236 parents collected in 2006/2007 from four cultural groups: British-, Chinese-, Southern European-, and South Asian Canadian. Key findings reveal that caregiving experiences remain highly gendered and are mediated by ethnocultural background and other work/family contextual characteristics. Recommendations for those who work directly with culturally diverse "sandwiched" generation families are highlighted.

In this study, we aimed to determine the different sociodemographic variables of polygamous and monogamous wives, and the relationship between depression and polygamous marriage. Seventy-nine polygamous wives and 73 monogamous wives from Kahramanmaras, located in southern Turkey, were interviewed. After reviewing the data, we suggest that there is a statistically significant difference between polygamous wives and monogamous wives in terms of Beck Depression Inventory (BDI) scores. The results highlighted many implications for clinical practice and for future research. Additional research needs to be conducted in order to investigate the effects of polygamy on women's mental health.

Child mortality, defined here as mortality under age five, is not evenly distributed but found in clusters. In a contemporary polygamous population in Ghana with extended families, we separate clustering at the parental and household levels, which are often overlapping and inseparable in other historical studies. For eight years, we followed 28,994 individuals, including 9,288 children under the age of five, in 1,703 households. We identified four determinants that had a significant effect on child mortality: sex of the child, age of the child, drinking source, and socioeconomic status. After correcting for these determinants, we still identified significant clustering of child mortality at the level of the village (covariance [cov] = 0.02, p = .04), household (cov = 0.14, p = .003), father (cov = 0.24, p = .001), and mother (cov = 0.18, p = .05). The present data provide clues regarding the levels at which to look for unidentified determinants of child mortality and suggest that the importance of the father could be larger than previously thought.

A micro-level investigation of 983 pregnant women (aged 15-49 years) regarding sex determination and associated factors was carried out in a periurban region of Northern India. Among the women surveyed, 183 chose to use sex determination. The highest percentage of sex determination was among 30-39-year-old women, and general caste and family size were two risk factors associated with sex determination. Correcting imbalances in sex ratios at birth is a complex issue without easy answers, especially in patriarchal societies. Apart from raising awareness among decisionmakers, property rights in favor of women and strict vigilance and record of registration of ultrasound machines are necessary.

School-Based Health Centers (SBHCs) have improved access to primary and preventive health care for underserved children and youth by bringing comprehensive health services into the schools while addressing critical health problems that make it difficult for students to learn. Despite the findings on the positive effects of SBHCs on health outcomes, the literature investigating the relationship between SBHCs and the learning environment is scant. This study utilizes a quasi experimental study to investigate the moderating effects of school type on the relationship between school based health centers and the learning environment. Findings indicate that SBHCs in middle and elementary schools are associated with greater levels of school engagement and satisfaction with the learning environment than those in high schools.

In this study, the author examined the effect of family size preference and sex composition of living children as determinants of induced abortion among women in India by analyzing 90,303 ever-married women aged 15-49, included in India's second National Family Health Survey, conducted in 1998-99. Multivariate logistic regression methods were used to examine the association between induced abortion and possible determinants. The results indicated that a woman's desire to limit family size with preferred sex composition of children, coupled with her autonomy and the sociocultural context, largely determines her experience of induced abortion in India.

In this qualitative study we aimed to describe how older women in a crowded urban community perceive the food insecurity experience and deal with it. In-depth interviews were conducted among 30 Thai older women. Results revealed that older women perceived their food insecurity experience as a negative effect of the current economic downturn globally. They felt that they were confronting a crisis. Problems they dealt with included six issues. The women employed management strategies around food, health, money, and family. Our results suggest a need for welfare reform that facilitates management strategies aimed to meet food security.

Childbirth is significantly influenced by women's cultural perceptions, beliefs, expectations, fears, and cultural practices. Our purpose in conducting this focused ethnography was to determine the perceptions of Ghanaian childbearing women. Twenty-four mothers who received health care at the Salvation Army Clinic in Wiamoase, Ashanti, Ghana, participated in audiotaped interviews. Patterns of thought and behaviors were analyzed, describing the realities of the lives of Ghanaian childbearing women. Themes included centering on motherhood, accessing health care, using biomedicine, ethnomedicine, and spiritual cures; viewing childbirth as a dangerous passage; experiencing the pain of childbirth; and fearing the influence of witchcraft on birth outcomes. Culturally specific knowledge obtained in this study can be utilized by health care providers, health policymakers, and those designing health care interventions to improve the health and well-being of childbearing women in developing countries.

This study examines the gender differences in Chinese- Canadian family caregivers providing care to elderly Chinese care receivers. A random sample of 339 Chinese-Canadian caregivers for elderly care receivers completed a telephone survey. Most of the Chinese family caregivers were females. No major gender differences were reported in the amount and types of caregiving tasks. The level of caregiving burden and predictors were generally similar for both gender groups. Contrary to common belief that sons and daughters-in-law are the key family caregivers in the Chinese culture, the daughters played a more important role in family caregiving. In addition to providing support and services to Chinese female caregivers, strategies to enhance Chinese males' involvement in family caregiving are needed and discussed in the paper.

A growing number of older Americans serve as caregiving resources for their elderly spouses, partners, relatives, and/or friends. Yet, little research has addressed the impact and implications of this trend among African Americans. This article describes the results of a qualitative study examining the intragenerational caregiving experiences and perspectives of two cohorts of African Americans (urban and rural, N = 129) between the ages of 58 and 89. Its findings reveal important differences and commonalities associated with elderly African American caregivers and their care giving in urban and rural settings. Additionally, the study suggests that volunteer caregivers can often fill the void left by partners and relatives who predecease or fail to assume responsibility for the care of their elderly relatives. Their efforts do not displace those of friends and family members, but rather address unmet needs in available care. The discussion focuses on the implications of the study findings for public policy and practice.

Focus groups were conducted with caregivers from eight racial-specific or ethnic-specific populations (African Americans, Chinese, Filipinos, Hispanics, Koreans, Native Americans, Russians, and Vietnamese), to examine cultural variations in caregiving experiences, care-related values and beliefs, care practices, and factors contributing to decisions about the use of caregiver support services. Analysis of focus group transcripts revealed three cross-cutting constructs: familism, group identity, and attitudinal and structural barriers to service use. We discuss these findings in terms of their implications for existing knowledge regarding family responsibility, resource utilization, and program development for racially and ethnically diverse family caregivers.

A focused ethnographic study was conducted among 13 moderately to highly acculturated American mothers of Mexican ancestry to determine how they influence the health of their family members. Using the World Health Organization (WHO) definition of health (a state of physical, mental, and social well-being and not merely the absence of disease) as a guide for interview questions, we conducted 32 in-depth interviews with study participants. The thread of struggle ran through each woman's narrative. Women's process of struggle is presented as one way to conceptualize the gendered nature of household health work.

The literature indicates that mood is an important predictor of physical and psychological well-being. Mood influences a person's health perceptions, treatment compliance, and recovery. Given the importance of mood as an outcome, it is important to identify predictors of mood. The current study examined physical activity, social support, and family structure as determinants of mood among women who had recently begun a walking program. Two hundred and fifty-nine European-American and African-American women between the ages of 30 and 60 participated in the study. A significant positive relation was found between physical activity, social support, and mood, while a negative relation was found between number of children and mood. Hierarchical regression revealed that physical activity, social support of friends, mari- tal status, and number of children were significant predictors of women's mood. Race moderated the relation between number of children and mood. This study suggests that physical activity, social support, and family may be important factors in the psychological well-being of women.

This article describes the household-based health behaviors of a sample of contemporary Mexican American women.1 Using the Household Production of Health (HHPH) as a conceptual framework and ethnographic methods of inquiry, 13 moderately to highly acculturated women of Mexican ancestry participated in multiple interviews about their health beliefs and household health behaviors. This article examines the findings related to the following research question: What are the health-producing and help-seeking behaviors (proximate determinants of health) used by Mexican American women to produce health? Themes focusing on creating healthy environments and treating illness are discussed. Awareness of the activities that women use to create and support household health can enhance the practice of nurses interested in supporting women's health work and improving health outcomes in the Mexican American community.

Culture shapes beliefs about health and illness. It provides the context by which an individual evaluates his or her symptoms to decide whether he or she is healthy or ill. We have largely ignored the impact of culture on the health status of U.S.- and foreign-born Black women. We have operationalized the term Black or African American in a way that obscures cultural differences among women of African descent living in the United States. While we know that people of African descent living in the United States are composed of many different ethnic backgrounds (e.g., persons from the Caribbean and African countries), we have not systematically examined these differences using national data. In this study I examine the relationship between culture and health status using the U.S. Department of Health and Human Services 1991 National Health Interview Survey (NHIS). Significant differences were found between U.S.- and foreign-born Black women. Foreign-born Black women reported more favorable health status than U.S.-born Black women. Measures of socioeconomic status and social support accounted for many differences between the two groups. These findings suggest that culture may play a role in the evaluation of health status. Therefore, U.S.- and foreign-born Black women appear to use different criteria when assessing their health status.

Taiwan has an active family-planning program. Yet the preference for sons is deeply ingrained in the Chinese culture and may discourage women from limiting their family size if they feel they have too few sons. In this study, research problems concerned the relationships between women's stated preferences for the sex of their children, their perceptions of their in-laws' preferences for the number and sex of their children, and their use of birth control and choice of birth control methods. It was found that few women verbalized a preference for the sex of children, but the number of boys already in the family was related to the reliability of contraceptive method used later and to the willingness to consider abortion if pregnancy occurred. The desired number and occurrence of additional children related to women's perceptions of their in-laws' preferences for boys. The perception of in-laws' preferences for girls either related negatively or was not significant.