Self-rated health (SRH) is a validated epidemiological measure that captures an individual’s overall health perception and predicts morbidity and mortality. Despite extensive research on SRH among older adults in India, evidence on its transition across the life course remains limited. Using data from 70,595 individuals aged 45 years and above from the Longitudinal Aging Study in India (LASI) 2017–2018, this study examined transitions in SRH from childhood to older adulthood. An adverse SRH trajectory was defined as a shift from good childhood health to poor or fair health in later life. Descriptive, bivariate, and multivariable logistic regression analyses were conducted. Overall, 51% of older adults experienced an adverse SRH trajectory. Higher odds were observed among women (AOR: 1.30), individuals with substance consumption (AOR:1.24), chronic multimorbidity (AOR: 3.37), functional limitations (AOR: 2.03), and depression (AOR: 1.51). Early-life disadvantages – child labour, child marriage, and persistent household poverty – were also significant risk factors. In contrast, higher education and participation in social and physical activities were protective. These findings indicate that an adverse subjective health trajectory is shaped by cumulative life-course exposures rather than ageing alone. Strengthening early-life social investments and community-based wellness initiatives is vital to promote healthy and equitable ageing in India.

This cross-sectional study examines differentials in age at marriage, collecting data from 665 ever-married women in Howrah district, West Bengal, using a mixed-methods approach across three generational cohorts. Quantitative analyses included ANOVA and multinomial logistic regression, complemented by qualitative interviews to contextualize marriage timing. Results revealed a non-linear trajectory of marriage age across generations. Mean age at marriage was 21.4 years, 23.2 years, and 19.5 years in Generation I, Generation II, and Generation III, respectively, with significant differences. MLR results showed respondents in Generation II had higher odds of marrying at ages 19–24 (RRR = 1.5, CI = 0.6–2.7) and ≥25 years (RRR = 1.4, CI = 0.9–4.0), whereas Generation III women had lower odds at ages 19–24 (RRR = 0.3, CI = 0.2–0.9) and ≥25 years (RRR = 0.6, CI = 0.1–0.9), compared to Generation I. Urban women showed delayed marriage at ages 19–24 (RRR = 3.1, CI = 2.6–11.5) and ≥25 years (RRR = 4.5, CI = 2.2–15.5). Higher educated women increased the likelihood of delaying marriage at ages 19–24 (RRR = 1.6, CI = 0.4–1.9) and ≥25 years (RRR = 1.2, CI = 0.8–1.6). Fathers’ secondary education was associated with marriage at ages 19–24 (RRR = 1.5, CI = 1.0–2.3) and ≥25 years (RRR = 4.6, CI = 1.3–15.8), and fathers’ higher education was associated with marriage at ≥25 years (RRR = 2.6, CI = 1.3–12.8); mothers’ secondary education was associated with marriage at ages 19–24 (RRR = 1.7, CI = 1.0–2.9) and ≥25 years (RRR = 3.1, CI = 1.9–12.3), and mothers’ higher education was associated with marriage at ≥25 years (RRR = 3.2, CI = 1.6–10.4). Respondents in white-collar jobs were more likely to delay marriage at 19–24 (RRR = 1.5, CI = 0.3–2.0) and ≥25 years (RRR = 1.6, CI = 0.8–3.4). White-collar employment of fathers increased the odds of marriage at ages 19–24 (RRR = 1.7, CI = 0.7–2.1) and ≥25 years (RRR = 1.6, CI = 0.4–2.6) and of mothers at ages 19–24 (RRR = 1.2, CI = 0.4–1.6) and ≥25 years (RRR = 1.1, CI = 0.3–1.9). Women from the upper wealth quintile were more likely to marry at ≥25 years (RRR = 1.2, CI = 0.5–2.8). Muslim women showed significantly less likelihood to marry at ≥25 years (RRR = 0.2, CI = 0.1–0.6). Ethnographic narratives revealed tensions between aspirations for daughters’ education and parental anxieties related to employment insecurity, dowry, and premarital relationships, shaping marriage decisions.

Temporary Childbirth Migration (TCM), where women return to their natal homes during or after pregnancy, is a common but understudied practice in India and South Asia. This study examines the influence of social support systems on TCM decisions among Indian women, focusing on the roles of husbands, in-laws, and parents. The study was conducted in the Vadu Health and Demographic Surveillance System (HDSS) in Western Maharashtra, India, and involved 41 in-depth interviews with triads comprising women, their husbands, and mothers-in-law. Participants varied in age, education, occupation, marriage, migration type, and delivery method and included women with infants up to two years old. Data were analysed using rapid and traditional coding approaches with predefined and emergent codes. Findings were categorised under four key domains of social support: emotional, financial, instrumental, and informational. Emotional support from mothers fosters a stress-free environment; financial support from family influences location; instrumental support for household tasks differs across settings; and informational guidance from experienced family members guides expectant mothers. Healthcare access, household status, and the husband’s role also shape migration choices. Women prioritise proximity to medical facilities, comfort, and freedom in their natal homes. Decisions are typically inclusive, involving multiple family members. The study shows that social support, cultural norms, and practical needs influence TCM decisions, and further research is needed to support women’s choices during the perinatal period. In conclusion, recognising emotional, financial, informational, and instrumental support can help providers and policymakers improve maternal and child health outcomes.

Single childhood is a growing social phenomenon in Iran that occurs under the influence of various factors that need to be identified. Therefore, the current research was conducted to explain the reasons behind only single children in Western Iran. This qualitative research was conducted using a conventional qualitative content analysis approach in Lorestan province, western Iran. The study participants were parents with one child who no longer wanted to have more children. Key informants were also involved in the study. To identify participants, purposive and snowball sampling were used. Data were collected through semi-structured interviews with 29 couples with one child and seven key informants until saturation was reached. Data analysis was conducted using the Graneheim and Lundman qualitative content analysis approach with the assistance of MAXQDA software (version 2020). Analysis of the interviews obtained four categories, 16 subcategories, and 205 initial codes. The main categories were (1) past negative experiences (concerns about the mother and child’s health, negative experiences with the first child), (2) weak support systems (lack of a supportive environment, dissatisfaction with married life), (3) changing social discourses on childbearing and parenting (spread of individualism, normalization of single-childing in society, considering having a child as more of a limitation, formation of new gender attitudes among women, changes in parental expectations of children, fading of religious beliefs encouraging childbearing, idealism in child-rearing, increased knowledge and access to contraceptives), and (4) inability to overcome challenges (financial challenges, lack of a suitable living environment, social hopelessness, missing opportunities for re-parenthood). Single-child families represent a complex phenomenon driven by a multitude of factors, necessitating interventions at the individual, family, and societal levels to address it. Enhancing financial support, expanding social welfare programmes, emphasizing religious norms that encourage childbearing, strengthening family bonds, and providing appropriate parenting models can potentially increase fertility intentions and behaviours.

What can be learned about pandemic preparedness from greater attention to perspectives of people who live in regions labelled as ‘hotspots’ for disease outbreaks? And how might such attention require us to reconfigure science, policy, and practice – as part of a broader shifting of power in pandemics? These are the questions that motivate and are explored through the papers in this special issue on pandemic preparedness, for which this paper serves as Introduction. All the contributions to this special issue present perspectives, experiences, and reflections from African settings, drawing on research co-designed and conducted in close engagement with local communities or in dialogue with African scientists and public health actors. They approach biosocial questions from the concerns of the disciplinary fields of social, medical, and political anthropology, of engaged interdisciplinary social science, and, crucially, of embedded, ‘grassroots’ fieldwork by researchers who have grown up with the communities they are studying. The team bringing these complementary areas of expertise came together for a collaborative programme on ‘Pandemic preparedness: local and global concepts and practices in tackling disease threats in Africa’ supported by a collaborative award from the Wellcome Trust during 2018–2023. This special issue thus forms part of wider advocacy for rethinking pandemic preparedness and for the value of anthropology in informing its meanings and practices, now more than ever.

In high-income countries, fertility is increasingly postponed into ages when fecundity declines, elevating the risk of unmet reproductive goals. In this context, how individuals perceive their own and their partner’s reproductive potential may carry important implications for well-being and relationship stability, long before clinical infertility is diagnosed. Drawing on 13 waves of longitudinal data from the German Family Panel (pairfam), this study uses individual fixed-effects models to examine how within-person changes in perceived fecundity – both one’s own and one’s partner’s – are related to life satisfaction, relationship satisfaction, and union dissolution. By capturing both individual and partner assessments, this approach emphasizes the couple as the key unit of reproductive experience. Declines in both own and partner’s perceived fecundity are associated with lower life and relationship satisfaction. However, perceptions of a partner’s fecundity exert a stronger influence on relationship outcomes than self-perceptions. In particular, decreases in partner-perceived fecundity increase the risk of separation, a pattern not observed for changes in one’s own fecundity. These associations do not vary significantly by gender but are moderated by parental status and age, with effects being weaker among parents and older individuals. By integrating both self- and partner assessments of fecundity, this study advances a dyadic, life course perspective on fertility. It shows that subjective reproductive potential functions as a relational stressor with meaningful consequences for emotional well-being and relationship trajectories.

This qualitative study explores the contraceptive use behaviours among women with disabilities in low-resource settings in Ghana, a group whose reproductive health needs are often overlooked in mainstream family planning programmes. Sixteen women with visual, physical, and hearing impairments in Apam, Central Region, were purposively selected to participate in semi-structured in-depth interviews conducted in their preferred languages, including Ghanaian Sign Language. Reflexive thematic analysis was used to identify key patterns in the data, revealing four main themes: (1) pathways for acquiring contraceptive knowledge, which included institutional outreach, maternal health visits, and informal peer networks; (2) determinants of non-utilisation, such as fear of side effects, religious stigma, and the desire to have children for future caregiving support; (3) drivers of modern contraceptive uptake, including the pursuit of educational and vocational goals, partner support, and the desire to prevent obstetric trauma; and (4) structural and systemic health inequalities, characterised by communication barriers, inaccessible physical infrastructure, and inconsistent provider attitudes. The findings advance scientific knowledge by moving beyond a simple narrative of unmet need to illustrate how women with disabilities exercise reproductive agency within a complex landscape of intersecting personal, social, and structural constraints. The novel findings highlight the dual role of informal networks in disseminating both accurate information and persistent myths, as well as the nuanced ways in which fertility is viewed as a long-term survival strategy in the absence of robust social support. These insights inform policy by underscoring the urgent need for disability-inclusive family planning services. This requires a multi-pronged approach that includes accessible communication through sign language interpretation, disability-sensitivity training for healthcare workers, retrofitting health facilities to improve physical access, and linking contraceptive services with broader social protection programmes to address the root causes of non-use.

Globally, child marriage is a persistent issue, adversely affecting the rights and well-being of girls. With a special focus on religious affiliation, this study explores the contributing factors leading to child marriage, such as cultural norms, religious beliefs, and socioeconomic conditions. From the Census of India 2011 data, percentage distributions of child marriage were used to assess the trends and magnitude of child marriage over the years. From NFHS-5 data, bivariate and multivariate analyses were conducted to assess factors like education and wealth index. Spatial analysis techniques, including Moran’s I statistics, helped identify the geographic distribution of child marriage. Findings reveal a history of relatively high child marriage rates among Muslims and their faster decline over the last decades. In 2011, under-14 marriages among Hindus exceeded 1.03% more than that of Muslims, with a 0.33% higher incidence of under-18 marriages among Muslims. The sample-based NFHS-5 study highlights significant disparities in child marriage based on the sample populations’ religious affiliations, regions, social categories, education, and wealth. In conclusion, the issue transcends religious boundaries, is rooted in broader social and economic contexts, and advocates for multidimensional interventions.

Persons with mental illnesses may experience stigma from their immediate family members in addition to other forms of stigma. The researchers used semi-structured interviews to investigate the experiences of familial mental illness stigma among 15 people diagnosed with mental illnesses in a mid-sized city in Canada. Five themes that spoke to participants’ experiences of familial mental illness stigma and ways to reduce it were identified by the investigators. The themes included: diagnosis as a ‘double-edged sword,’ potential familial isolation, familial stigma as societal stigma localized, stories of acceptance and support, and confronting potential familial mental illness stigma. Participants’ narratives indicate that familial mental illness stigma is rooted in the broader social or public stigma, which sees its way into familial relations as well. This stigma takes various forms, including relationship bias or unfair treatment, breakdown in romantic relationships, loss of status, verbal and emotional abuse, exclusion from decision-making, and alienation within their immediate and extended families. Familial mental illness stigma experiences negatively impact participant’s psychological well-being and personal empowerment. However, participants also shared ways that family members create supportive environments or actively confront or prevent stigma. Overall, this study has contributed to knowledge on mental illness stigma, particularly familial mental illness stigma from the perspective of participants living with a mental illness in a high-income country. Suggestions for future research include a focus on strategies to prevent ongoing familial mental illness stigma, and large-scale studies to explore familial mental illness stigma to understand why families might themselves at times perpetrate stigma.

Over the past decade, Bangladesh has experienced substantial demographic change alongside increasing climate-related disruption. This study examines the links between extreme climatic events and fertility among married Bangladeshi women of childbearing age who already have children, focusing on how cyclones and floods relate to fertility behaviour in cyclone- and flood-prone villages. A mixed-methods design was used, drawing on 544 household surveys, 74 in-depth interviews with women, 10 focus group discussions with men, and 8 key informant interviews. Comparing two ecologically distinct sites allowed examination of how communities experience and respond to different hazards. The findings indicate divergent fertility patterns by hazard type. In the cyclone-prone site, physical destruction, displacement, and disrupted health-care access were associated with lower fertility. In the flood-prone site, recurrent inundation, reliance on children’s labour, and constrained contraceptive access were associated with higher fertility. Socio-demographic factors, including education, age at marriage, and contraceptive access, were also strongly associated with fertility behaviour. Households in the cyclone-prone area showed greater livelihood vulnerability and lower fertility, whereas those in the flood-prone area showed higher fertility alongside elevated child mortality and a marked preference for sons, who were perceived as better able to assist in disaster recovery. These results suggest that extreme climatic events are associated with differentiated fertility responses, shaped by socio-demographic context, and point to the value of integrating reproductive health services into disaster risk reduction. The study highlights the intersection of climate change, socio-demographic factors, and reproductive health and offers evidence on how hazard-type conditions fertility responses, with implications for climate adaptation and population health policy in climate-vulnerable regions such as Bangladesh.

Sexual-identity disparities in substance use among U.S. veterans, and whether mental-health treatment mitigates risk for those with depression, remain under-examined. Using data on veterans from the 2021–2023 National Survey on Drug Use and Health (NSDUH; N = 7,212), disparities were estimated in past-30-day nicotine, marijuana, binge drinking, and polysubstance use, as well as severe psychological distress (K6≥13) and past-year suicidal ideation. Guided by a biosocial/minority-stress framework, multiple imputation was applied (m = 20) and survey-weighted logistic regression adjusting for age, year, race/ethnicity, sex, education, metro status, insurance, marital status, employment, and income; among veterans with a past-year major depressive episode (MDE), interactions were tested between sexual identity and (a) depression-related clinical contact (DRC) and (b) prescription medication for depressive feelings. Bisexual veterans showed the highest prevalence of marijuana (33.5%) and polysubstance use (30.6%), exceeding that of heterosexual (11.8%, 14.9%) and gay/lesbian veterans (24.0%, 18.8%). Models restricted to veterans with MDE, past-year DRC (DRC defined as any visit or conversation with a health professional about depressive feelings) moderated risk for gay/lesbian veterans, with DRC associated with lower odds of binge drinking and polysubstance use; prescription medication showed a similar moderating pattern for nicotine and polysubstance outcomes. Findings for severe psychological distress and suicidal ideation were mixed and consistent with confounding by indication. Results should be interpreted cautiously given the cross-sectional data, self-report, small sexual-minority subgroups, and non-aligned recall windows (past-year mental health/treatment vs past-30-day substance use). Overall, sexual-identity disparities in substance use are evident, with bisexual veterans bearing the greatest burden, and engagement in DRC and medication among veterans with MDE, particularly gay/lesbian veterans, showing associations consistent with a buffering effect of affirming care. Longitudinal and qualitative studies are needed to test causal pathways and to illuminate lived experiences, and policy/clinical efforts should expand culturally competent, integrated services and routine SOGI data collection to monitor and reduce inequities.

Induced abortions (IAs) constitute a fundamental right contributing to women’s reproductive sexual health allowing them to decide whether they wish to avoid, postpone, space, or conclude their motherhood. In this study, fertility control through IA is analysed according to the age combined with the individual and contextual characteristics of the women. Data from the Voluntary Termination of Pregnancy Statistics (Ministry of Health) and the Vital Statistics (Movimiento Natural de la Población, National Statistics Institute) were combined to capture all pregnancy outcomes, including IAs, live births, stillbirths, and late foetal deaths. Binary logistic regression models were applied to each age group (15–19, 20–29, 30–39, and 40–44 years) to calculate the likelihood of opting for an abortion based on whether individuals have a partner, the number of children, and adjusted for other sociodemographic variables. In the early reproductive stages, the probability of opting for an IA was higher in women without a partner than in those with one. In contrast, in the later years of the reproductive cycle, women with two or more children were more likely to opt for an IA, indicating their desire to stop childbearing. The likelihood of opting for an IA varies according to the woman’s age. Furthermore, sociodemographic characteristics within each group of age undergo significant changes. A more detailed analysis of the reasons leading to the choice of abortion is necessary. Additionally, this study serves as valuable input for family planning public policies.

This ethnographic study, conducted as part of the Pandemic Preparedness Project, explores the pandemic preparedness of communities in NG and its satellite settlements within Kailahun District, Eastern Province, Sierra Leone. The research site was particularly significant due to its history as one of the hardest-hit areas during the 2014–16 Ebola outbreak. NG is served by a Peripheral Health Unit (PHU) that provides health services to seven villages, as well as one distant village far from its designated facility. The study employed long-term observational research methods, where the researcher lived within the community, becoming an integrated observer familiar with local customs and daily life. This ethnographic approach aimed to understand the health-seeking behaviors of residents following the Ebola crisis. The onset of the Covid-19 pandemic during the study period shifted the focus to examine how the community understood and responded to a new pandemic threat. Additionally, the study reflects on the challenges faced by female social scientists in Sierra Leone, where few are trained in ethnographic methods. This article offers insights into the process of conducting ethnographic research in a challenging context, providing valuable guidance for other female researchers seeking to engage in similar bio-social studies.

The term ‘childfree’ differs from ‘childless’ not only as a distinction between a deliberate choice and a condition caused by circumstances, but it also indicates the ongoing efforts of childfree couples to prevent conception through contraception. The choice to remain childfree develops gradually, and for many, it is not decided at the outset. Thus, questions arise about the contraceptives that couples prefer and whether these preferences change as their decision to stay childfree becomes more certain. To explore this, a thematic analysis was conducted following joint interviews with thirty-six heterosexual childfree couples, eighteen each from India and Canada, to identify patterns in their experiences with choosing diverse modes of contraception. Distinctive birth control strategies emerged in the accounts of childfree couples from Canada and India. Among Canadian participants, it was discovered that they utilised a variety of contraceptives at different stages of their relationship, whereas most Indian participants preferred and relied on the male barrier method. The differences in the preferred methods of contraception, as well as the actually used contraception, highlighted the significance of how individual characteristics such as education, occupation, and income interact with cultural and institutional influence.

Antibiotic resistance is a critical global health threat, with over a million deaths linked to resistant infections every year. Inappropriate antibiotic use for childhood diarrhoeal illness is a significant contributor to antimicrobial resistance. This is particularly important in low-resource settings where antibiotics are often used without clear clinical indication. This study explored the knowledge and perspectives of antibiotic stewardship among clinicians and caregivers of paediatric patients in Bangladesh. In-depth interviews were conducted with 18 clinicians and 36 patient caregivers across three government hospitals. While few clinicians were familiar with the term ‘antibiotic stewardship’, most understood its core principles and supported judicious prescribing. Caregivers were generally unfamiliar with the concept of antimicrobial stewardship, though a few acknowledged the risks of antibiotic overuse. Clinicians described informal stewardship efforts but highlighted the absence of structured programmes. Key challenges to stewardship included community-level antibiotic dispensing by informal providers, staffing shortages, caregiver expectations for antibiotics, and pressure to satisfy families’ perceived expectations. Despite barriers, clinicians expressed support for educational initiatives and system-level efforts to promote antibiotic stewardship. These findings underscore the need for integrated, facility- and community-based approaches like decision-making support tools for providers, institutional reviews of antibiotic use, and community education on the dangers of inappropriate antibiotic use. Strengthening antibiotic stewardship in low-resource settings like Bangladesh is essential to curb misuse and combat the growing threat of antibiotic resistance.

This paper compares community responses to Ebola and Covid-19 in two regions of southern and eastern Sierra Leone with reference to the theory of institutional dynamics proposed by the anthropologist Mary Douglas. Institutions, Douglas argued, are conveyed by styles of thought, shaped by the ways human communities, through everyday practices, reinforce systems of classification and denotation. Pandemic advice to ‘follow the science’ proved problematic, since there is no single institution of science, and institutions never stand alone but are bundled with other institutions, reflecting the manifold and intertwined practices of human social life. The paper explores some of the ways a traumatic epidemic of Ebola Virus Disease in Sierra Leone shaped a distinctive local response to this deadly infectious disease in the absence of an effective vaccine. This local approach emphasised social rules based on ideas about sequestration and testing. Communities then proposed to continue this rules-based approach to the pandemic of Covid-19 and showed little initial enthusiasm for vaccination. With Ebola, the adoption of rules resulted in dramatic drops in infection rates. But Covid-19 spreads in different ways, and good results from the application of social rules were much less apparent. The paper shows how communities began to grapple with this new situation. In some cases, vaccine hesitation was overcome by treating the requirement for vaccination as a new form of social discipline. More generally, it is concluded that epidemiologists need to pay specific attention to institutions and institutional dynamics in order to better understand and anticipate public reactions to new disease threats.

Despite biomedical explanations for diseases being increasingly accepted in sub-Saharan Africa, traditional African explanatory models of illness remain widespread. This study sought to understand local explanatory models for illness and patient experiences with different traditional health practitioners (THPs) among a population of rural women in Limpopo, South Africa. This was a cross-sectional qualitative study in which eighty-two in-depth interviews were conducted, and the data were thematically analysed. Study findings indicate that 68% of participants believed illnesses can be caused by bewitchment, and these diseases were often considered too taboo to even be discussed. High percentages of participants also believe that THPs can cure illnesses that medical doctors cannot treat. Additionally, several illnesses were identified related to traditional practices and cultural beliefs, which can only be cured traditionally, via THPs. While the hospital/clinic is often first approached, its failure to resolve illness can often be seen as a sign of the spiritual origin of the ailment. This study is a pre-context for more research around biomedical/traditional medicine collaborations.

This study examines how China’s former one-child policy has shaped fertility attitudes among the Chinese diaspora in the United States. Through semi-structured qualitative interviews with thirty reproductive-age women of Chinese descent, either born in China or first-generation immigrants to the United States, this study explored opinions towards the policy, self-reported impact on reproductive decision-making, and attitudes towards family size. Participants were recruited from an internet-based survey distributed through cultural groups on social media, paper flyers, and email listservs. Interviews were analysed using the principle of thematic analysis by three authors, who met after coding to resolve disagreements. The mean age of participants was 33. Six participants (20%) used an interpreter. Eighteen participants (60%) were born in China. The range of pregnancies was 0–5, and the range of births was 0–2. Authors found that while participants were no longer directly constrained by the one-child policy, many continued to demonstrate preferences for fewer children. Financial strains, resource allocation, societal shame, and internalised social norms emerged as key themes. These themes echo messages promoted during the one-child policy era through propaganda and enforcement measures, such as audits of family registrations, rewards for compliant families, fines, mandatory IUDs, or sterilisations for noncompliant ones, and even forced abortions for ‘unauthorized’ pregnancies. These messages reinforced that small families were more appropriate. These findings suggest a lasting cultural shift towards fewer children as a result of the policy, even after emigration. They also carry theoretical implications towards understanding the long-term social and psychological consequences of reproductive mandates and the generational transmission of policy-shaped fertility norms. This study offers a perspective for nations currently implementing pronatalist fertility regulations. These findings highlight the role of historical policies in shaping contemporary reproductive perspectives, family dynamics, and potentially, engagement with medicine beyond geographic, political, and temporal boundaries.