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Non-consensual sterilisation is not only a historic abuse. Cases of unethical treatment of women around the time of a pregnancy continue in the Twenty-First Century in five continents. Sterilisation is being carried out by some healthcare professionals at the time of delivery, or soon afterwards, without valid consent. A range of contemporary examples of such practices is given. Respecting women's autonomy should be the touchstone of the consent process. Avoidance of force, duress, deception and manipulation should go without saying. Ethnic minority communities and women living with HIV, in particular, are being targeted for this kind of abuse. Attempts have been made in various countries and by international professional organisations to introduce clinical guidelines to steer health professionals away from this malpractice. Survivors have sought justice in domestic and international courts. This paper critically assesses the evidence on the practical, ethical and legal issues around the handling of consent for these procedures. Suggestions are made about possible regulatory responses that address abuse, whilst maintaining access for those individuals who freely elect to undergo these procedures. [ABSTRACT FROM AUTHOR]

Retrospective surveys are important for documenting vital events in historical time periods. The assumption used in these analyses is that the information reported at the time of the interview portrays a representative picture of past events. Using the Census Bureau's 1990 panel of the Survey of Income and Program Participation, this paper examines the potential problems encountered in deriving retrospective statistics when immigrants -- who married or had children outside of the U.S. -- constitute a significant proportion of survey respondents. The inclusion of these "immigrated" vital events in the survey resulted in (1) underestimating the mean age at first marriage for all Hispanics in the survey by 0.4 years, and (2) overestimating the premarital first birth ratio for Asians by 50 percent. Given likely future continued immigration from Latin America and Asia, these results suggest that future surveys should include migration histories in order to enable the survey to produce accurate retrospective statistics for these groups. [ABSTRACT FROM AUTHOR]

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Background Latitude gradients and secular trends in Europe and North America have been found in the male-female ratio at birth ( M/F: male births divided by total births), which is anticipated to approximate 0.515. Methods Annual national data for Asian countries for male and female live births were obtained from the World Health Organization and analyzed with contingency tables. Results A total of 245 938 211 live births were analyzed. An overall increasing trend in M/F was found ( P < 0.0001). A latitude gradient was also noted, with more boys being born in southern, warmer latitudes ( P < 0.0001). There was an overall deficit of 1 351 757 male births based on an anticipated M/F of approximately 0.515. Conclusion M/F is increasing overall in Asia, unlike the decline previously noted in Europe and North America. Moreover, it had been shown that there is a higher incidence of male births in southern Europe than in the north, with the opposite gradient in North America. This paper shows that M/F latitude gradients in Asia are in keeping with those of Europe. The overall M/F in Asia may be rising due to improving socioeconomic conditions, and the interplay of several poorly understood factors is likely. [ABSTRACT FROM AUTHOR]

The impact of female socioeconomic activities on cumulative fertility is a product of a series of life cycle stages, including the initiation of marriage and the timing of subsequent births. In the present paper, the effects of premarital socioeconomic roles on the first stages of family formation-the timing of marriage and the interval between marriage and first birth-are analyzed. Modern socioeconomic roles, especially educational attainment, lead to a postponement of marriage, and thereby age at first birth. However, the same variables tend to have a counter- balancing effect by reducing the interval from marriage to the first birth. [ABSTRACT FROM AUTHOR]

This paper examines the determinants of age at first birth from an explicitly comparative perspective in the following Asian societies: Hong Kong, Indonesia, Malaysia, the Philippines, South Korea, Sri Lanka, Taiwan and Thailand. The key structural variables have the same (or similar) effects in each of the groups examined. Education through primary school and beyond has a strong delaying effect on age at first birth in all eight populations. Difference of rural-urban origin does not affect the timing of motherhood in any of these societies. We also find a remarkably strong effect of shared cultural heritage. All the Confucian groups tend to behave similarly, as do the Muslim and Hindu groups. [ABSTRACT FROM AUTHOR]

The increase in births to Southeast and East Asian (SEEA) immigrants in their adopted countries is of international importance. SEEA women experience the postpartum period differently than that of the general population. Despite the documented difference, there is limited representation of SEEA women in the literature. The purpose of this meta‐ethnography is to synthesise the qualitative findings from different research studies examining the experiences of SEEA immigrant women during the first 4–6 weeks of the postpartum period and has been written in adherence with enhancing transparency in reporting the synthesis of qualitative research (PRISMA). Noblit and Hare's meta‐ethnographic approach was used. Seven articles (four qualitative and three mixed‐methods studies) were reviewed, analysed and synthesised. Four themes emerged: two were facilitators of birth culture (availability and quality of social support and maternity care provider cultural knowledge and response) and two were barriers to birth culture (lack of structural and social support and cultural alienation after childbirth). Due to lack of structural and social support in SEEA immigrant women's adopted countries, they also experienced social and economic hardships after childbirth and made conscious decisions to modify their postpartum cultural practices out of convenience and practicality. SEEA immigrant women also experienced discrimination from maternity care providers, which prevented them from fully engaging in postpartum cultural practices. Maternity care providers can advocate and intervene for SEEA immigrant women by eliciting any postpartum cultural beliefs, assess their social and economic needs early on in prenatal care and make culturally congruent referrals based on those assessments. [ABSTRACT FROM AUTHOR]

Gendercide and femineglect (the deliberate neglect of females vis-à-vis health, education, etc.) is rampant, especially in Asia. This paper reviews gendercide, the selective abortion of female foetuses based solely on gender, and femineglect, along with the inevitable and potentially catastrophic demographic consequences. [ABSTRACT FROM AUTHOR]

The WHO Safe Childbirth Checklist (the SCC) is a clinical tool developed to help health workers follow evidence‐based maternal and perinatal care practices at childbirth. Newborn delivery care practices at facilities in seven countries in East Asia and the Pacific were compared to practices checked by the SCC. The analysis found that the SCC does not incorporate several key evidence‐based practices around birth demonstrated to prevent newborn morbidity or mortality, or harmful practices associated with increased risks. A revision of the standard SCC is needed to maximise its potential to improve newborn outcomes. This can be initiated under the coordinating umbrella of WHO, but must ensure that the realities of labour and childbirth practices in low‐ and middle‐income countries are considered and addressed. [ABSTRACT FROM AUTHOR]

Caesarean section (CS) can prevent maternal and neonatal mortality and morbidity. However, it involves risks and high costs that can be a burden, especially in low and middle income countries. The aim of this study is to assess its magnitude and correlates among women of reproductive age in the urban and rural areas of Vietnam. We analyzed microdata from the national Multiple Indicator Cluster Survey (MICS) conducted in 2014 by using a representative sample of households at the national level in both urban and rural areas. A total of 1,350 women who delivered in institutional settings in the two years preceding the survey were included. Frequency and percentage distributions of the variables were performed. Bivariate and multivariate logistic regression analyses were undertaken to identify the factors associated with CS. Odds ratios with a 95% confidence interval were used to ascertain the direction and strength of the associations. The overall CS rate among the women who delivered in healthcare facilities in Vietnam has rapidly increased and reached a high level (29.2%). After controlling for significant characteristics, living in urban areas doubles the likelihood of undergoing a CS (OR = 1.98; 95% CI 1.48 to 2.67). Maternal age at delivery over 35 years is a major positive correlate of CS. Beyond this common phenomenon, different distinct lines of socioeconomic and demographic cleavage operate in urban compared with rural areas. The differences regarding the correlates of CS according to the place of residence suggest that specific measures should be taken in each setting to allow women to access childbirth services that are appropriate to their needs. [ABSTRACT FROM AUTHOR]

Background: A common means of vaccination coverage measurement is the administrative method, done by dividing the aggregated number of doses administered over a set period (numerator) by the target population (denominator). To assess the quality of national target populations, we defined nine potential denominator data inconsistencies or flags that would warrant further exploration and examination of data reported by Member States to the World Health Organization (WHO) and UNICEF between 2000 and 2016. Methods and findings: We used the denominator reported to calculate national coverage for BCG, a tuberculosis vaccine, and for the third dose of diphtheria-tetanus-pertussis-containing (DTP3) vaccines, usually live births (LB) and surviving infants (SI), respectively. Out of 2,565 possible reporting events (data points for countries using administrative coverage with the vaccine in the schedule and year) for BCG and 2,939 possible reporting events for DTP3, 194 and 274 reporting events were missing, respectively. Reported coverage exceeding 100% was seen in 11% of all reporting events for BCG and in 6% for DTP3. Of all year-to-year percent differences in reported denominators, 12% and 11% exceeded 10% for reported LB and SI, respectively. The implied infant mortality rate, based on the country’s reported LB and SI, would be negative in 9% of all reporting events i.e., the country reported more SI than LB for the same year. Overall, reported LB and SI tended to be lower than the UN Population Division 2017 estimates, which would lead to overestimation of coverage, but this difference seems to be decreasing over time. Other inconsistencies were identified using the nine proposed criteria. Conclusions: Applying a set of criteria to assess reported target populations used to estimate administrative vaccination coverage can flag potential quality issues related to the national denominators and may be useful to help monitor ongoing efforts to improve the quality of vaccination coverage estimates. [ABSTRACT FROM AUTHOR]

The sex ratio at birth (SRB; ratio of male to female live births) imbalance in parts of the world over the past few decades is a direct consequence of sex-selective abortion, driven by the coexistence of son preference, readily available technology of prenatal sex determination, and fertility decline. Estimation of the degree of SRB imbalance is complicated because of unknown SRB reference levels and because of the uncertainty associated with SRB observations. There are needs for reproducible methods to construct SRB estimates with uncertainty, and to assess SRB inflation due to sex-selective abortion. We compile an extensive database from vital registration systems, censuses and surveys with 10,835 observations, and 16,602 country-years of information from 202 countries. We develop Bayesian methods for SRB estimation for all countries from 1950 to 2017. We model the SRB regional and national reference levels, the fluctuation around national reference levels, and the inflation. The estimated regional reference levels range from 1.031 (95% uncertainty interval [1.027; 1.036]) in sub-Saharan Africa to 1.063 [1.055; 1.072] in southeastern Asia, 1.063 [1.054; 1.072] in eastern Asia, and 1.067 [1.058; 1.077] in Oceania. We identify 12 countries with strong statistical evidence of SRB imbalance during 1970-2017, resulting in 45.0 [36.4; 54.8] million missing female births globally. The majority of those missing female births are in China, with 23.1 [16.5; 30.7] million, and in India, with 20.7 [15.5; 26.6] million. [ABSTRACT FROM AUTHOR]

Introduction: Antepartum depression is a contributing factor for adverse maternal and perinatal outcome. The study aimed to assess the antepartum depressive symptoms in selected public health facilities of Nepal. Methodology: This is a mixed-method cross-sectional study that included 143 pregnant women attending the antenatal checkup in four public health facilities of Kathmandu. Edinburgh Postnatal Depression Scale (EPDS) tool with cut-off score > = 10 was used to assess the antepartum depressive symptoms. Bivariate and multivariable analysis was carried out to identify factors associated with the depressive symptoms. Further semi-structured interviews were conducted with 12 pregnant women identified with the depressive symptoms. Result: Of the total 143 pregnant women, 26 (18%, CI at 95% 12.6–25.5) reported depressive symptoms. Multivariable analysis reported higher odds of antepartum depressive-symptoms with health problem, early gestational age, sex preference, and spousal alcohol intake. Thematic analysis of qualitative data further revealed participants’ apprehension on; birth outcome, a family expectation of male child, inadequate support from the family/husband and disturbed family environment. Conclusion: Notable proportion of pregnant women were reported with antepartum depressive symptoms. Women’s perception on patriarchal values for childbirth was revealed to be important factor for the depressive symptoms. The study draws an attention to a need for screening for antepartum depression into primary health care system. Strengthening ongoing efforts on gender equity could contribute the psychological well-being of pregnant women. [ABSTRACT FROM AUTHOR]

Growing evidence from a number of countries in Asia and Africa documents a large shift towards facility deliveries in the past decade. These increases have not led to the improvements in health outcomes that were predicted by health policy researchers in the past. In light of this unexpected evidence, we have assessed data from multiple sources, including nationally representative data from 43 countries in Asia and Africa, to understand the size and range of changing delivery location in Asia and Africa. We have reviewed the policies, programs and financing experiences in multiple countries to understand the drivers of changing practices, and the consequences for maternal and neonatal health and the health systems serving women and newborns. And finally, we have considered what implications changes in delivery location will have for maternal and neonatal care strategies as we move forward into the next stage of global action. As a result of our analysis we make four major policy recommendations. (1) An expansion of investment in mid-level facilities for delivery services and a shift away from low-volume rural delivery facilities. (2) Assured access for rural women through funding for transport infrastructure, travel vouchers, targeted subsidies for services and residence support before and after delivery. (3) Increased specialization of maternity facilities and dedicated maternity wards within larger institutions. And (4) a renewed focus on quality improvements at all levels of delivery facilities, in both private and public settings. [ABSTRACT FROM AUTHOR]

Background Although the influence of the type of institutional setting on the risk of cesarean birth is well documented, less is known about the regional variations in institution-specific cesarean rates within countries. Our purpose was to examine regional variations in cesarean rates across public and private facilities in five Asian countries with a sizeable private sector: Bangladesh, India, Indonesia, Pakistan, and the Philippines. Methods Demographic Health Survey data and a hierarchical model were used to assess regional variations in the mode of delivery while controlling for a wide range of socioeconomic, demographic, and maternal risk factors. Results The risk of cesarean birth was greater in a private facility than in a government hospital by 36-48 percent in India and Indonesia and by 130 percent in Bangladesh. Regional gradients in cesarean birth were found to be steeper for deliveries in private facilities than in government hospitals in India, Indonesia, and the Philippines. The residents of India's high-use states were 55 percent more likely to undergo a cesarean delivery in a government hospital and 83 percent more likely in a private facility than their counterparts in the medium-use states. Similarly, compared to the residents of the Philippines's medium-use provinces, giving birth in a government facility increased the likelihood of a cesarean delivery by 84 percent and by 173 percent in a private facility. Conclusions Large regional variations in cesarean rates suggest the need for more informed clinical decision making with respect to the selection of cases for cesarean delivery and the establishment of well-developed guidelines and standards at the provincial or state levels. [ABSTRACT FROM AUTHOR]

Fertility throughout East Asia has fallen rapidly over the last five decades and is now below the replacement rate of 2.1 in every country in the region. Using South Korea as a case study, we argue that East Asia's ultra-low fertility rates can be partially explained by the steadfast parental drive to have competitive and successful children. Parents throughout the region invest large amounts of time and money to ensure that their children are able to enter prestigious universities and obtain top jobs. Accordingly, childrearing has become so expensive that the average couple cannot afford to have more than just one or two children. The trend of high parental investment in child education, also known as ‘education fever’, exemplifies the notion of ‘quality over quantity’ and is an important contributing factor to understanding low-fertility in East Asia. [ABSTRACT FROM PUBLISHER]

Background: The reliable availability of health technologies, defined as equipment, medicines, and consumable supplies, is essential to ensure successful childbirth practices proven to prevent avoidable maternal and newborn mortality. The majority of global maternal and newborn deaths take place in Africa and Asia, yet few data exist that describe the availability of childbirth-related health technologies in these regions. We conducted a cross-sectional survey of health workers in Africa and Asia in order to profile the availability of health technologies considered to be essential to providing safe childbirth care. Methods: Health workers in Africa and Asia were surveyed using a web-based questionnaire. A list of essential childbirth-related health technologies was drawn from World Health Organization guidelines for preventing and managing complications associated with the major causes of maternal and newborn mortality globally. Demographic data describing each birth center were obtained and health workers reported on the availability of essential childbirth-related health technologies at their centers. Comparison analyses were conducted using Rao-Scott chi-square test statistics. Results: Health workers from 124 birth centers in 26 African and 15 Asian countries participated. All facilities exhibited gaps in the availability of essential childbirth-related health technologies. Availability was significantly reduced in birth centers that had lower birth volumes and those from lower income countries. On average across all centers, health workers reported the availability of 18 of 23 essential childbirth-related health technologies (79%; 95% CI, 74%, 84%). Low-volume facilities suffered severe shortages; on average, these centers reported reliable availability of 13 of 23 technologies (55%; 95% CI, 39%, 71%). Conclusions: Substantial gaps exist in the availability of essential childbirth-related health technologies across health sector levels in Africa and Asia. Strategies that facilitate reliable access to vital health technologies in these regions are an urgent priority. [ABSTRACT FROM AUTHOR]

Discusses an article series in the publication "Lancet" which highlights the possibility of saving the lives of three million newborns who die worldwide every year through low cost measures. Reasons for neo-natal deaths which include infections, premature birth, and asphyxia; Significance of sixteen interventions set out in the papers, which can reduce infant mortality; Description of improving home care practices to further prevent infant mortality; Discussion of births in Africa and South Asia where the mother is not accompanied by a skilled attendent during childbirth.

It is widely known that modern economic development has been accompanied by the initiation and spread of effective limitation of fertility, and that generally the populations which experienced development at a late date also had a belated reduction in childbearing. Here a surprising relation is found between (and within) broad regions: the areas in which traditional age of entry into marriage was late were the areas in which marital fertility was reduced first. [ABSTRACT FROM AUTHOR]