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Building on nascent literature examining the health-related effects of vicarious structural racism, we examined indirect exposure to the Flint Water Crisis (FWC) as a predictor of birth outcomes in Michigan communities outside of Flint, where residents were not directly exposed to lead-contaminated water. Using linear regression models, we analyzed records for all singleton live births in Michigan from 2013 to 2016, excluding Flint, to determine whether birth weight (BW), gestational age (GA), and size-for-gestational-age (SzGA) decreased among babies born to Black people, but not among babies born to White people, following the highly publicized January 2016 emergency declaration in Flint. In adjusted regression models, BW and SzGA were lower for babies born to both Black and White people in the 37 weeks following the emergency declaration compared to the same 37-week periods in the previous 3 years. There were no racial differences in the association of exposure to the emergency declaration with BW or SzGA. Among infants born to Black people, GA was 0.05 weeks lower in the 37-week period following the emergency declaration versus the same 37-week periods in the previous 3 years (95% CI: -0.09, -0.01; p = 0.0177), while there was no change in GA for infants born to White people following the emergency declaration (95% CI: -0.01, 0.03; p = 0.6962). The FWC, which was widely attributed to structural racism, appears to have had a greater impact, overall, on outcomes for babies born to Black people. However, given the frequency of highly publicized examples of anti-Black racism over the study period, it is difficult to disentangle the effects of the FWC from the effects of other racialized stressors.

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BACKGROUND: Smoking during pregnancy and prenatal secondhand smoke exposure increase the risk of preterm birth. As Kentucky has the second highest rate of smoking in the United States and no statewide smoke-free law, an examination of the effect of municipal smoke-free legislation on preterm birth is warranted. OBJECTIVE: This study used state-level live birth data and county-level municipal smoke-free legislation status to assess the association between the presence and strength of smoke-free laws and the likelihood of preterm birth. Moreover, this study hypothesized that pregnant persons living in counties with comprehensive municipal smoke-free laws prohibiting smoking inside all workplaces and enclosed public places would exhibit a lower likelihood of preterm birth than those living in counties with weak or moderate laws (ie, smoke-free laws with exemptions that do not cover all workplaces and enclosed public places) or no smoke-free law. STUDY DESIGN: Using live birth data from the Kentucky Office of Vital Statistics with birth years ranging from 2004 to 2020, a total of 894,372 live births were recorded that indicated that a childbearing person was between the ages of 18 and 49 years and a resident of Kentucky; these live births formed the sample for the study. Municipal ordinances implemented during a given calendar year were coded in the model as present starting with the following calendar year, as the birth records were time deidentified except for the year of birth. This lagged law convention maximized the likelihood that pregnant persons included in the study were exposed to the smoke-free policy for at least a portion of their pregnancy. Multilevel logistic regression was used to assess the effect of smoke-free ordinances on the likelihood of preterm birth, with personal- and county-level variables included as potential covariates and pregnant persons nested within the county of residence. Data analysis was conducted using SAS (version 9.4; SAS Institute, Cary, NC), with an alpha level of .05. RESULTS: Nearly all personal-level variables were associated with preterm birth status. Personal factors associated with an increased likelihood of preterm birth included being older (relative to 18-24 years old; odds ratios [95% confidence intervals]: 1.02 [1.01-1.04] and 1.27 [1.24-1.31] for ages 25-34 and 35-49 years, respectively); having a history of preterm birth (odds ratio, 4.65; 95% confidence interval, 4.53-4.78); and smoking before pregnancy (odds ratio, 1.14; 95% confidence interval, 1.12-1.16). Pregnant persons living in counties with comprehensive laws were 9% less likely to have a preterm birth than those living in counties without a smoke-free ordinance (odds ratio, 0.91; 95% confidence interval, 0.89-0.94; P<.001). There was no difference in the likelihood of preterm birth between those living in counties with moderate or weak laws and those unprotected by any smoke-free ordinance in their county of residence. CONCLUSION: This study demonstrated that comprehensive municipal smoke-free laws are associated with reduced risk of preterm birth and that moderate or weak smoke-free laws are not. The findings have major implications for public health policy and underscore the potential influence of healthcare providers' advocacy for strong smoke-free policies, prohibiting smoking in all workplaces (including restaurants, bars, and casinos), to support healthy pregnancies.

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Fine particulate matter (PM2.5) has been linked to gestational diabetes mellitus (GDM). However, PM2.5 is a complex mixture with large spatiotemporal heterogeneities, and women with early-onset GDM (i.e., diagnosed before 24th gestation week) have distinct maternal characteristics and a higher risk of worse health outcomes compared with those with late-onset GDM (i.e., diagnosed in or after 24th gestation week). We aimed to examine differential impacts of PM2.5 and its constituents on early- vs. late-onset GDM, and to identify corresponding susceptible exposure windows. We leveraged statewide linked electronic health records and birth records data in Florida in 2012-2017. Exposures to PM2.5 and its constituents (i.e., sulfate [SO4 2-], ammonium [NH4 +], nitrate [NO3 -], organic matter [OM], black carbon [BC], mineral dust [DUST], and sea-salt [SS]) were spatiotemporally linked to pregnant women based on their residential histories. Cox proportional hazards models and multinomial logistic regression were used to examine the associations of PM2.5 and its constituents with GDM and its onsets. Distributed non-linear lag models were implemented to identify susceptible exposure windows. Exposures to PM2.5, SO4 2-, NH4 +, and BC were statistically significantly associated with higher hazards of GDM. Exposures to PM2.5 during weeks 1-12 of gestation were positively associated with GDM. Associations of early-onset GDM with PM2.5 in the 1st and 2nd trimesters, SO4 2- in the 1st and 2nd trimesters, and NO3 - in the preconception and 1st trimester were considerably stronger than observations for late-onset GDM. Our findings suggest there are differential associations of PM2.5 and its constituents with early- vs. late-onset GDM, with different susceptible exposure windows. This study helps better understand the impacts of air pollution on GDM accounting for its physiological heterogeneity.

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BACKGROUND: Recent decreases in neonatal mortality have been slower than expected for most countries. This study aims to predict the risk of neonatal mortality using only data routinely available from birth records in the largest city of the Americas. METHODS: A probabilistic linkage of every birth record occurring in the municipality of São Paulo, Brazil, between 2012 e 2017 was performed with the death records from 2012 to 2018 (1,202,843 births and 447,687 deaths), and a total of 7282 neonatal deaths were identified (a neonatal mortality rate of 6.46 per 1000 live births). Births from 2012 and 2016 (N = 941,308; or 83.44% of the total) were used to train five different machine learning algorithms, while births occurring in 2017 (N = 186,854; or 16.56% of the total) were used to test their predictive performance on new unseen data. RESULTS: The best performance was obtained by the extreme gradient boosting trees (XGBoost) algorithm, with a very high AUC of 0.97 and F1-score of 0.55. The 5% births with the highest predicted risk of neonatal death included more than 90% of the actual neonatal deaths. On the other hand, there were no deaths among the 5% births with the lowest predicted risk. There were no significant differences in predictive performance for vulnerable subgroups. The use of a smaller number of variables (WHO's five minimum perinatal indicators) decreased overall performance but the results still remained high (AUC of 0.91). With the addition of only three more variables, we achieved the same predictive performance (AUC of 0.97) as using all the 23 variables originally available from the Brazilian birth records. CONCLUSION: Machine learning algorithms were able to identify with very high predictive performance the neonatal mortality risk of newborns using only routinely collected data.

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This data note describes the linked antenatal and delivery records of the mothers and index children of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort study. These records were extracted from the computerised maternity record system 'STORK' used by the two largest NHS trusts in the study catchment area. The STORK database was designed to be populated by midwives and other health professionals during a woman's pregnancy and shortly after the baby's birth. These early computer records were initiated in the early 1990s, shortly before the start of enrolment to ALSPAC. At this time the use of electronic medical record systems such as 'STORK' was very new, the accuracy of the records has been questioned and little contemporary detailed documentation is available. Small sample spot checks on the accuracy of the information in 'STORK' suggests extensive missingness and differences against gold-standard fieldworker abstracted information in some variables; yet high levels of completeness and agreement with gold-standard data in others. Software code was created using STATA (StataCorp LLC) to transform the original CSV (comma-separated values) files into a cohesive and consistent format which was reviewed for data-completeness for its potential use in future research. The cleaned 'STORK' records provide health, social and maternity data from the very earliest period of the ALSPAC study in an easily accessible format, which is particularly useful when other sources of data are missing.

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Adverse reproductive health outcomes, such as pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility, have been associated with Chlamydia trachomatis and Neisseria gonorrhoea infections. These reproductive health outcomes could be complemented by measuring subsequent pregnancies to assess impact on fertility. The study design was a cohort study of women in Queensland (QLD), Australia, using data linkage methods to link chlamydia and/or gonorrhea testing records (including an unexposed group undergoing full blood count tests; 2000 and 2005) with the QLD Perinatal Registry (2000-2013). The cohort included 132 962 women, with 69 533 records of pregnancies. Women in the exposed group, with no prior pregnancy, had a reduced odds of a pregnancy during the follow up of the study (20-year-old (at 2005) aOR 0.91 95% CI 0.87-0.95, and 25-year-old aOR 0.71 95% CI 0.68-0.75). Women in the exposed group with a prior pregnancy had increased odds of pregnancy during the follow up of the study (20-year-old (at 2005) aOR 1.72 95% CI 1.59-1.86, and 25-year-old aOR 1.35 95% CI 1.26-1.45). Our data provides further evidence at a population level of the significant impact on reproductive outcomes associated with chlamydia and gonorrhea.

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The population of the United States is shaped by centuries of migration, isolation, growth, and admixture between ancestors of global origins. Here, we assemble a comprehensive view of recent population history by studying the ancestry and population structure of more than 32,000 individuals in the US using genetic, ancestral birth origin, and geographic data from the National Geographic Genographic Project. We identify migration routes and barriers that reflect historical demographic events. We also uncover the spatial patterns of relatedness in subpopulations through the combination of haplotype clustering, ancestral birth origin analysis, and local ancestry inference. Examples of these patterns include substantial substructure and heterogeneity in Hispanics/Latinos, isolation-by-distance in African Americans, elevated levels of relatedness and homozygosity in Asian immigrants, and fine-scale structure in European descents. Taken together, our results provide detailed insights into the genetic structure and demographic history of the diverse US population.

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BACKGROUND: Continuity models of midwifery care are rare in Sweden, despite its well-known positive effects. The aim was to describe pregnancy and birth outcome in women participating in a continuity of care project in a rural area of Sweden. METHOD: A register-based study of 266 women recruited to the project and a control group of 125 women from the same catchment area. Midwives provided antenatal care and were on-call 7 a.m. to 11 p.m. for birth. Data were collected from the antenatal and birth records. Crude and adjusted odds ratios with 95% confidence intervals were calculated between women in the project and the control group. RESULTS: There were more primiparous women and highly educated women recruited to the project, and fewer foreign-born and single women, compared to the control group. Women in the project met more midwives and were less likely to have a pregnancy complication. During intrapartum care, women recruited to the project were less likely to need labour augmentation and less likely to have an instrumental vaginal birth and elective caesarean section. They had fewer second degree perineal tears and were more likely to fully breastfeed at discharge. No differences were found in neonatal outcome. The continuity of a known midwife at birth was quite low. CONCLUSION: This study shows that women self-recruited to a continuity of care project in a rural area of Sweden had a higher rate of normal births. There were few differences if having a known midwife or not. Long distances to hospital and lack of staff affected the level of continuity.

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Introduction Official statistics have confirmed that relative to their presence in the population and relative to white children, black children have consistently higher rates of contact with child protective services (CPS). We used linked administrative data and statistical decomposition techniques to generate new insights into black and white differences in child maltreatment reports and foster care placements. Methods Birth records for all children born in Allegheny County, Pennsylvania, between 2008 and 2010 were linked to administrative service records originating in multiple county data systems. Differences in rates of involvement with child protective services between black and white children by age 4 were decomposed using nonlinear regression techniques. Results Black children had rates of CPS involvement that were 3 times higher than white children. Racial differences were explained solely by parental marital status (i.e., being unmarried) and age at birth (i.e., predominantly teenage mothers). Adding other covariates did not capture any further racial differences in maltreatment reporting or foster care placement rates, they simply shifted differences already explained by marital status and age to these other variables. Discussion Racial differences in rates of maltreatment reports and foster care placements can be explained by a basic model that adjusts only for parental marital status and age at the time of birth. Increasing access to early prevention services for vulnerable families may reduce disparities in child protective service involvement. Using birth records linked to other administrative data sources provides an important means to developing population-based research.

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BACKGROUND: The incidence of both gestational diabetes mellitus and preeclampsia is on the rise; however, these pregnancy complications may not be systematically reported. This study aimed to examine differences in reporting of preeclampsia and gestational diabetes between hospital records and birth certificate data, and to determine if such differences vary by maternal socioeconomic status indicators. METHODS: We obtained over 70,000 birth records from 2001 to 2006 from the perinatal research database of the Memorial Care system, a network of four hospitals in Los Angeles and Orange Counties, California. Memorial birth records were matched to corresponding state birth certificate records and analyzed to determine differential rates of reporting of preeclampsia and diabetes. Additionally, the influence of maternal socioeconomic factors on the reported incidence of such adverse pregnancy outcomes was analyzed. Socioeconomic factors of interest included maternal education levels, race, and type of health insurance (private or public). RESULTS: It was found that the birth certificate data significantly underreported the incidence of both preeclampsia (1.38% vs. 3.13%) and diabetes (1.97% vs. 5.56%) when compared to Memorial data. For both outcomes of interest, the degree of underreporting was significantly higher among women with lower education levels, among Hispanic women compared to Non-Hispanic White women, and among women with public health insurance. CONCLUSION: The Memorial Care database is a more reliable source of information than birth certificate data for analyzing the incidence of preeclampsia and diabetes among women in Los Angeles and Orange Counties, especially for subpopulations of lower socioeconomic status.

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OBJECTIVES: Public health professionals rely on quantitative data for the daily practice of public health as well as organizational decision making and planning. However, several factors work against effective data sharing among public health agencies in the US. This review characterizes the reported barriers and enablers of effective use of public health IS from an informatics perspective. METHODS: A systematic review of the English language literature for 2005 to 2011 followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format. The review focused on immunization information systems (IIS) and vital records information systems (VRIS). Systems were described according to the structural aspects of IS integration and data quality. RESULTS: Articles describing IIS documented issues pertaining to the distribution of the system, the autonomy of the data providers, the heterogeneous nature of information sharing as well as the quality of the data. Articles describing VRIS were focused much more heavily on data quality, particularly whether or not the data were free from errors. CONCLUSIONS: For state and local practitioners to effectively utilize data, public health IS will have to overcome the challenges posed by a large number of autonomous data providers utilizing a variety of technologies.

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The authors investigated the possibility that, in interview-based case-control studies, controls are more likely than cases to underreport a history of induced abortion. A case-control study was conducted in White women under 45 years of age who had given birth in Washington State during 1984-1994. The cases were women in three metropolitan counties of Washington State diagnosed with invasive breast cancer during 1984-1994; controls were selected through random digit dialing. A history of induced abortion among study participants was compared between interview data and information collected on the birth record of the last child to whom they gave birth (225 cases, 303 controls). Among women with a prior induced abortion recorded on the birth record, 14.0% of the 43 cases and 14.9% of the 47 controls did not report an induced abortion at interview (difference = -0.9%, 95% confidence interval of the difference: -15, 14). The authors' data do not suggest that controls are more reluctant to report a history of induced abortion than are women with breast cancer.

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PIP: This issue of California Counts provides a context for discussion on multiracial or ethnic population in California with particular emphasis on the increasing number of multiracial or ethnic births in the state. Data was derived from vital statistics birth records for the period 1982-97. In 1977, the Office of Management and Budget (OMB) established minimum categories for the collection, record keeping and presentation of data by race and ethnicity. These categories were used by the Census Bureau to identify the respondents' race and ethnicity. But these categories proved to be incompetent for they no longer reflected the increasing diversity of the nation. So by 1997, after the comprehensive review, the OMB announced a revision of the federal guidelines for data collection by race and ethnicity. The guidelines will help respondents in selecting one or more racial categories. After the revision, the guidelines helped in providing a clear picture of the multiracial status; it showed an increase in multiracial or ethnic births from 12% in 1982 to 14% in 1997, which they were more common among native-born mothers than among foreign-born mothers. In 1997, approximately 20% of native-born mothers, but only 7% of foreign-born mothers gave birth to children of mixed race or ethnicity. This report suggests this issue must be confronted, that is, how to ensure the civil rights of the population that has outgrown the monoracial categories upon which the civil rights laws have been interpreted.^ieng

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PURPOSE: To examine parental demographic characteristics by adult (> or = 20 years at baby's conception) and teenage (< 20 years at baby's conception) paternity in births to very young adolescents (< 15 years at baby's conception). METHODS: This was a population-based, retrospective cohort analysis of all 12,317 very young adolescent mothers residing in California with a first singleton live birth during 1993-1995. Risks for adult, compared to teenage, paternity were evaluated using multivariate logistic regression. RESULTS: Adult fathers, responsible for 26.7% of births to very young adolescents, were a mean of 8.8 years older than the mother. The risk factors for adult compared to adolescent paternity were as follows: father's educational attainment of at least 3 years below that considered adequate for his age [adjusted odds ratio (AOR) = 8.34], father's (AOR = 2.46) or mother's (AOR = 1.36) educational attainment 1-2 years below that considered adequate for their age, mother's birthplace outside the United States (AOR = 3.12), and father's Hispanic ethnicity (AOR = 1.60) or African-American race (AOR = 1.50). CONCLUSIONS: Adult fathers were responsible for over one quarter of the births in our study. Adolescent pregnancy prevention focusing on younger adolescents must programmatically address adult paternity. Variations in adult paternity patterns across cultural groups suggest that we need further study of the role that cultural beliefs and practices play in very young adolescent pregnancy.

PIP: This study examined parental demographic characteristics among persons aged over 20 years, under 20 years, and under 15 years at conception of the first birth in California. Data were obtained from California birth certificates in 1993, 1994, and 1995 and from the 1990 Census. The sample included 12,317 very young mothers of a total of 657,122 single first live births to California residents. The mean age of very young mothers was 13.7 years. Very young mothers tended to be in high school, Hispanic, and born in the US. The birth rate for mothers aged 10-14 years was 1.4/1000; 2.6/1000 for Hispanics, 3.0/1000 for African-Americans, and 0.3/1000 for Whites. Adult males were fathers of 24.3% of babies born to mothers aged 11-12 years. The mean age of fathers was 22.7 years. Adult males were fathers of 26.8% of babies born to mothers aged 13-14 years. Final multivariate models reveal that inadequate educational attainment was a risk factor for adult paternity in births to very young mothers. The risk for adult paternity increased as the father's education adequacy decreased. Race or ethnicity were lower risk factors than father's educational attainment. Very young adolescent mothers who were foreign born were very likely to be involved with an adult male. Adult fathers were an average of 8.8 years older than very young mothers. Adolescent pregnancy prevention programs need to target adult men.

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OBJECTIVE: To investigate the association of different maternal sociodemographic characteristics and infant sex with perinatal mortality among primiparas and multiparas. STUDY DESIGN: Analysis of routine data from the Estonian Medical Birth Registry covering the whole of Estonia. A total of 47 358 infants (including stillborns) with a birth weight 1000 g or more from 1992 through 1994 were studied. Perinatal mortality rate, crude odds ratio (OR) and adjusted OR (calculated by a logistic regression model) were used to evaluate the association. OR values were adjusted for maternal age at delivery, maternal ethnicity, educational level, residence, marital status, smoking status, history of previous abortion and infant sex. RESULTS: The perinatal mortality rate was 12.2 per 1000 total births among primiparous and 14.3 among multiparous women. The highest adjusted ORs of perinatal deaths were found in older (35 years and over) primiparas (1.78; 95% confidence interval (CI 0.88-3.57)) and multiparas (1.81; 95% CI 1.29-2.55), in unmarried (single) primiparas (1.59; 95% CI 1.14-2.20) and multiparas (1.98; 95% CI 1.29-3.05), in smoking primiparas (1.69; 95% CI 1.09-2.63) and multiparas (1.51; 95% CI 1.02-2.25), and in multiparas with unknown smoking status (1.98; 95% CI 1.18-3.33). CONCLUSION: The study provides further evidence that perinatal mortality is positively associated with increased maternal age, unmarried (single) status and smoking.

PIP: This study was conducted to investigate the association of different maternal sociodemographic characteristics and infant sex with perinatal mortality among primiparas and multiparas. The data were based on the Estonian Medical Birth Registry (EMBR) which maintains a database of all infants born in hospitals and of the few home deliveries. From 1992 to 1994, 47,022 live births and 336 stillbirths were recorded in the EMBR. Of mothers younger than 20 years old, 26.5% were primiparous and 2.8% were multiparous; among mothers aged 35 years and older, 1.8% were primiparous and 12.0% were multiparous. Results showed that the perinatal mortality rate was 12.2%/1000 total births among primiparous and 14.3% among multiparous women. The highest adjusted odds ratios of perinatal deaths were found in older (35 years and up) primiparas (79%) and multiparas (1.8%); in unmarried primiparas (1.5%) and multiparas (2.0%); in smoking primiparas (1.7%) and multiparas (1.5%); and in multiparas with unknown smoking status (2.0)%. Therefore, perinatal mortality in Estonia was positively associated with increased maternal age, unmarried (single) status, and smoking.

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BACKGROUND: The Danish Medical Birth Registry (MBR) was established in 1968 and has been computerized since 1973. The primary purpose of the registration is to monitor the health of the newborns and of the quality of the antenatal and delivery care services, but the registry is increasingly being used in research. Major changes in registration have taken place in 1978 and 1991. The paper describes the content and usage of the MBR over time and suggests research topics for the future. RESULTS: A broad scope of studies illustrates how the MBR has been used, either as single data source, linked with data from other registries or with data from interviews or self-completed questionnaires. Validations have shown variations in the quality of data, depending on source, and have underlined the need for constant quality control. Any access to data at the individual level is subjected to special provisions laid down by the Data Surveillance Authority and also requires a permission from the National Board of Health. CONCLUSIONS: The time from conception to early childhood is an important period concerning future health for the individual. The Danish Medical Birth Registry is a valuable tool in this respect, which has not yet been used to its full potential in research or monitoring. Experience indicates that the quality of the registry depends upon having a close link to the staff responsible for delivery services and thus having the necessary specialised skills and interest.

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PIP: This brief article voices a concern about unregistered births and the recent decline in immunization coverage, especially in developing countries. A recent report by UNICEF, "The Progress of Nations, 1998" reports that 1 in 3 newborns, or about 40 million births, are unregistered. Some developing countries lack a registration system. UNICEF is concerned about unregistered births because of the implications for receipt of services. In Kenya, for example, unregistered children may not be eligible for immunization. In the past 20 years, immunization coverage rates have increased from 5% to 80%. This progress may be further improved with the possibility of vaccine coverage for diarrheal diseases and acute respiratory infections. It is predicted that soon it may be possible to save the lives of 8 million children yearly. However, there is a declining trend in immunization at a time when new vaccines are about to enter the market. In addition, 2 million children's lives could be saved if every child were vaccinated. Only 50% of the children in sub-Saharan Africa receive immunization against diphtheria, whooping cough, and tetanus. Measles kills over 800,000 children yearly, but measles immunization is often not performed. Measles immunization varies widely by country in Africa. In Uganda, all children are vaccinated against measles, while only 20% in Kenya are protected against measles. In developed countries, only 89% of children in the US were vaccinated against measles. Adults need vaccination against hepatitis B, which kills about 1 million/year. Yellow fever is reoccurring in Africa and Latin America.^ieng

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We examine mortality and fertility patterns of aboriginal (primarily Evenki and Keto) and Russian (i.e., nonaboriginal) populations from the Baykit District of Central Siberia for the period 1982-1994. Mortality rates in the aboriginal population of Baykit are substantially greater than those observed in the Russians and are comparable to levels recently reported for other indigenous Siberian groups. Infant mortality rates average 48 per 1000 live births among Baykit aboriginals, three times greater than the Russians of the district (15 per 1000 births) and more than double the rates for Inuit and Indian populations of Canada. Similarly, crude death rates of the Baykit aboriginals are twice as high as those observed in either the Baykit Russians or the Canadian aboriginal populations (13 vs 6-7 deaths per 1000 individuals). Birth rates of the indigenous population of Baykit are higher than those of the Russians (33 vs. 15 births per 1000 individuals) but are comparable to those of Canadian aboriginal groups. Violence and accidents are the leading causes of adult male mortality in both ethnic groups, whereas circulatory diseases have emerged as the prime cause of death in women. The greater male mortality resulting from violence and accidents is a widely observed cross-cultural phenomenon. The emergence of circulatory diseases as a major mortality risk for women, however, appears to be linked to specific lifestyle changes associated with Soviet reorganization of indigenous Siberian societies. Marked declines in mortality and increases in fertility were observed in the Baykit aboriginal population during the mid to late 1980s with the government's implementation of anti-alcohol policies. The decline in mortality, however, was largely erased during the early 1990s, as the region became increasingly isolated and marginalized following the collapse of the Soviet Union. Demographic trends in the Baykit District suggest that because the indigenous groups have become more isolated, many are returning to a more traditional subsistence lifestyle.

PIP: This study compares fertility and mortality patterns among the aboriginal and Russian population in the Evenk Autonomous Region in Siberia. Data were obtained from birth and death records at Baykit Hospital during 1982-94 for the population of the district capital at Baykit and nine isolated rural villages. The indigenous population are semi-subsistence reindeer herders. Cause of death data were obtained from a subsample of 164 persons (101 aboriginals and 24 Russians) from Surinda, Poligus, and Sulamai villages. Findings indicate that aboriginal populations had higher mortality rates. Infant mortality was three times higher than in the Russian population at 48.2 infant aboriginal deaths per 1000 births. The crude death rate among aboriginals was double that of Russians at 12.9 deaths per 1000 aboriginals. The crude birth rate was 33 per 1000 aboriginals. The rate of natural increase was an estimated 2% annually among aboriginals and 1% among Russians. Infant mortality and crude death rates among aboriginals were twice as high as among aboriginals in Canada. Canadian and Siberian aboriginal crude birth rates were similar. In both Russian and aboriginal groups, violent and accidental deaths showed strong gender differences. 56% of male aboriginals and 59% of male Russians died from accidents and violence, while only 31% of aboriginal women and 29% of Russian women did. Most Russian accidental and violent deaths were due to asphyxia and poisoning, while most aboriginal accidental and violent deaths were due to gunshot trauma, in part due to alcohol consumption. About 33% of deaths among aboriginal women and 29% among Russian women were due to circulatory diseases. Russian mortality has remained stable over the last 13 years. Aboriginal mortality and fertility fluctuated. The Russian population grew more rapidly over the past 13 years, but levels varied between villages and between villages and Baykit.

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PIP: The 1993-94 Bangladesh Demographic and Health Survey (DHS) reported substantial declines in vital rates, especially the fertility rate, which needed confirmation. The demographic database of the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) contains the birth and death records for 200,000 people whose households have been visited every 2 weeks since 1966. In addition, the system kept records on the pregnancy and contraceptive use status of women of reproductive age since 1977. A validation study was conducted, which entailed the comparison of fertility and infant mortality rates from a special DHS survey conducted in the Matlab treatment area in 1994, with rates obtained by the Demographic Surveillance System (DSS) over the 5 years prior to the survey and also the comparison of the current contraceptive use rate. The records of 2628 women were examined. The Matlab DHS was found to be accurate in estimating fertility both in the treatment and comparison areas. The Matlab DHS infant mortality rates for the 5 years prior to the survey were also consistent with the estimates derived from the DSS. However, the Matlab DHS seemed to have underestimated contraceptive prevalence, which underestimate was substantial for modern temporary methods, especially pills and injectables. Since contraceptive prevalence may also be higher at the national level as a result of this, the total fertility rate for Bangladesh of 3.4 children/woman may be plausible. Although the Matlab DHS figures on vital rates seem to be reliable, the national level DHS estimates may not be as reliable, because women elsewhere in the country may not have reported their children's births and deaths as accurately as did women in the Matlab area.^ieng

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