BACKGROUND: Global regional and national estimates of prevalence of and tends in infertility are needed to target prevention and treatment efforts. By applying a consistent algorithm to demographic and reproductive surveys available from developed and developing countries we estimate infertility prevalence and trends 1990 to 2010 by country and region. METHODS AND FINDINGS: We accessed and analyzed household survey data from 277 demographic and reproductive health surveys using a consistent algorithm to calculate infertility. We used a demographic infertility measure with live birth as the outcome and a 5-y exposure period based on union status contraceptive use and desire for a child. We corrected for biases arising from the use of incomplete information on past union status and contraceptive use. We used a Bayesian hierarchical model to estimate prevalence of and trends in infertility in 190 countries and territories. In 2010 among women 20-44 y of age who were exposed to the risk of pregnancy 1.9% (95% uncertainty interval 1.7% 2.2%) were unable to attain a live birth (primary infertility). Out of women who had had at least one live birth and were exposed to the risk of pregnancy 10.5% (9.5% 11.7%) were unable to have another child (secondary infertility). Infertility prevalence was highest in South Asia Sub-Saharan Africa North Africa/Middle East and Central/Eastern Europe and Central Asia. Levels of infertility in 2010 were similar to those in 1990 in most world regions apart from declines in primary and secondary infertility in Sub-Saharan Africa and primary infertility in South Asia (posterior probability [pp] >/=0.99). Although there were no statistically significant changes in the prevalence of infertility in most regions amongst women who were exposed to the risk of pregnancy reduced child-seeking behavior resulted in a reduction of primary infertility among all women from 1.6% to 1.5% (pp=0.90) and a reduction of secondary infertility among all women from 3.9% to 3.0% (pp>0.99) from 1990 to 2010. Due to population growth however the absolute number of couples affected by infertility increased from 42.0 million (39.6 million 44.8 million) in 1990 to 48.5 million (45.0 million 52.6 million) in 2010. Limitations of the study include gaps in survey data for some countries and the use of proxies to determine exposure to pregnancy. CONCLUSIONS: We analyzed demographic and reproductive household survey data to reveal global patterns and trends in infertility. Independent from population growth and worldwide declines in the preferred number of children we found little evidence of changes in infertility over two decades apart from in the regions of Sub-Saharan Africa and South Asia. Further research is needed to identify the etiological causes of these patterns and trends.

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National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys

This target article presents an integrated evolutionary model of the development of attachment and human reproductive strategies. It is argued that sex differences in attachment emerge in middle childhood, have adaptive significance in both children and adults, and are part of sex-specific life history strategies. Early psychosocial stress and insecure attachment act as cues of environmental risk, and tend to switch development towards reproductive strategies favoring current reproduction and higher mating effort. However, due to sex differences in life history trade-offs between mating and parenting, insecure males tend to adopt avoidant strategies, whereas insecure females tend to adopt anxious/ambivalent strategies, which maximize investment from kin and mates. Females are expected to shift to avoidant patterns when environmental risk is more severe. Avoidant and ambivalent attachment patterns also have different adaptive values for boys and girls, in the context of same-sex competition in the peer group: in particular, the competitive and aggressive traits related to avoidant attachment can be favored as a status-seeking strategy for males. Finally, adrenarche is proposed as the endocrine mechanism underlying the reorganization of attachment in middle childhood, and the implications for the relationship between attachment and sexual development are explored. Sex differences in the development of attachment can be fruitfully integrated within the broader framework of adaptive plasticity in life history strategies, thus contributing to a coherent evolutionary theory of human development.

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Sex, attachment, and the development of reproductive strategies.

In the absence of manipulation, both the sex ratio at birth and the population sex ratio are remarkably constant in human populations. Small alterations do occur naturally; for example, a small excess of male births has been reported to occur during and after war. The tradition of son preference, however, has distorted these natural sex ratios in large parts of Asia and North Africa. This son preference is manifest in sex-selective abortion and in discrimination in care practices for girls, both of which lead to higher female mortality. Differential gender mortality has been a documented problem for decades and led to reports in the early 1990s of 100 million "missing women" across the developing world. Since that time, improved health care and conditions for women have resulted in reductions in female mortality, but these advances have now been offset by a huge increase in the use of sex-selective abortion, which became available in the mid-1980s. Largely as a result of this practice, there are now an estimated 80 million missing females in India and China alone. The large cohorts of "surplus" males now reaching adulthood are predominantly of low socioeconomic class, and concerns have been expressed that their lack of marriageability, and consequent marginalization in society, may lead to antisocial behavior and violence, threatening societal stability and security. Measures to reduce sex selection must include strict enforcement of existing legislation, the ensuring of equal rights for women, and public awareness campaigns about the dangers of gender imbalance.

https://www.pnas.org/content/pnas/103/36/13271.full.pdf

Abnormal sex ratios in human populations: Causes and consequences

The once lean giant has a weight problem that is increasing rapidly 

A bout one fifth of the one billion overweight or obese people in the world are Chinese. China was once considered to have one of the leanest populations,1 but it is fast catching up with the West in terms of the prevalence of overweight and obesity; disturbingly, this transition has occurred in a remarkably short time.2

Data from the 2002 national nutrition and health survey showed that 14.7% of Chinese were overweight (body mass index (BMI; kg/m2) ≥ 25) and another 2.6% were obese (BMI ≥ 30), such that there are currently (2002) 184 million overweight people, and a further 31 million obese people, in China, out of a total population of 1.3 billion (table).3 Although the prevalence of obesity in China is relatively low compared with Western countries such as the United States, where over half of adults are either overweight or obese, it is the rapid increase of the condition,4 especially among children, that is particularly alarming. Data from the China national surveys on the constitution and health in school children …

Overweight and obesity in China

The effects of China's universal two-child policy

Objectives To examine the impact of the one child family policy in China on fertility, preferred family size, and sex ratio. Design Secondary analysis of data from the Chinese cross sectional national family planning and reproductive health survey, 2001. Interviews of representative sample of women aged 15-49. Results Data were obtained from 39 585 women, with a total of 73 202 pregnancies and 56 830 live births. The average fertility rate in women over 35 (n = 17 078) was 1.94 (2.1 in rural areas and 1.4 in urban areas) and for women under 35 (n = 11 543) 1.73 (1.25 and 1.79). Smaller families were associated with younger age, higher level of education, and living in an urban area. The male to female ratio was 1.15 and rose from 1.11 in 1980-9 to 1.23 for 1996-2001. Most women wanted small families: 35% preferred one child and 57% preferred two. Conclusion Since the one child family policy began, the total birth rate and preferred family size have decreased, and a gross imbalance in the sex ratio has emerged.

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Family size, fertility preferences, and sex ratio in China in the era of the one child family policy: results from national family planning and reproductive health survey

Background The suicide rate in China is estimated to be around three times the global average, with women in the 15- to 24-year-old age group particularly vulnerable. Despite this, there is a dearth of information on the prevalence and predictors of depression and suicide ideation in Chinese adolescents. The specific aims of the study were, therefore, to quantify the rates and severity of self-reported depression and suicide ideation in middle-school students, to examine the relationship between depression and attempted suicide, and to identify socio-demographic associations. Methods A cross-sectional survey using self-completion questionnaires was carried out in six middle schools (predominant age range 13–17 years) in an urban and a rural setting in Zhejiang Province in eastern China. Results There were 1,576 completed questionnaires. One–third of the students had suffered symptoms of severe depression, with 16 % admitting to suicide ideation and 9 % to actually having attempted suicide. Factors independently associated with severe depression were female gender, poor self-reported academic performance and rural residence. Similar factors were associated with suicide ideation and attempted suicide. Depression was less common in those without siblings. Patterns of help-seeking showed reliance on friends and parents, with very low levels of professional help-seeking (around 1 %) and 30 % having sought no help from any source for psychological problems. Conclusion The results of the study contributed to service developments and the addition of psychological issues to the school health education curriculum.

Suicide ideation in Chinese adolescents

The goal was to assess rates of anxiety and depression in adolescents in two areas of Zhejiang Province, China. A cross-sectional survey was carried-out using a self-report questionnaire developed for this study. Participants were middle school students (age range 13-16 years) in an urban and a rural setting. There were 1576 completed questionnaires. Symptoms of anxiety sufficient to interfere with enjoyment of life, relaxation, and sleep were common (48%, 40%, and 27%, respectively). School-related problems were the predominant sources of worry. One third reported a history of depression, 16% had at times felt life was not worth living, and 9% reported that they had attempted suicide. Girls were more likely to report symptoms of depression. Patterns of help-seeking showed reliance on friends and parents; only 1% had sought professional help. There were no significant differences in anxiety and depression between one-child and multisibling families.

Qu Jian Ding

Papers

Family size, fertility preferences, and sex ratio in China in the era of the one child family policy: results from national family planning and reproductive health survey

Suicide ideation in Chinese adolescents

Anxiety and Depression in Adolescents in Urban and Rural China