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Over the past 15–20 years observations in many parts of the world have revealed a negative association between the natural protection afforded by lactational amenorrhoea and contraceptive uptake. This paper uses qualitative and quantitative data to explore the possible explanations for this nagative association in two Bangladeshi populations, one urban and one rural. The findings suggest that a subconscious substitution of contraceptive protection for natural protection against pregnancy is the most likely explanation. It appears that shorter durations of exclusive breastfeeding have led to earlier resumption of menses which in turn prompts the use of contraception. However, other mechanisms appear to play a subsidiary role, at least in the rural population. Moreover, changes in breastfeeding cannot be viewed as totally independent of the promotion of modern family planning. Evidence suggests that family planning staff are poorly equipped to support breastfeeding, and may often encourage the early introduction of supplements. There is a need to consider ways of promoting exclusive breastfeeding as well as ensuring ready access to contraception when fecundity resumes postpartum. Only such an integrated approach is likely to ensure that both negative effects on child health and unwanted pregnancies are avoided.

The poem "Why It's No Fun Being Me at Night" by Sarah Salway is presented. First Line: Each creak on the wooden staircase; Last Line: instead of sitting on rocks.

Interventions to develop community-level empowerment and participation are advocated within public health strategies that emphasise the importance of control as a social determinant of health. Approaches to defining and measuring collective control, however, are limited. We developed and applied a contextually specific framework for identifying the emergence of collective control in the early stage of a UK area-based community empowerment initiative.

BackgroundEthnic health inequalities have long been recorded in Britain. Although socioeconomic deprivation and discrimination are important underlying factors, differential benefit from public health and health-care interventions contribute to these inequalities. Progress is hampered by a scarcity of evidence on what works, creating uncertainty about how to design and deliver interventions so as to mitigate disadvantage. Understanding the links between ethnicity, health care, and health presents substantial challenges in ethnic categorisation, comparability across diversity, elucidating causal pathways, and dangers of stereotyping and stigmatisation. Furthermore, sociologically driven research examining links between ethnicity and health remains largely descriptive. Therefore, that standard systematic reviews and national guidance generally produce limited recommendations for intervention in this area is not surprising. We need more sophisticated and critical approaches to evidence synthesis. We examine the potential of realist synthesis, a theory-driven approach to reviewing research evidence on complex social interventions that aims to show why and under what conditions particular interventions do or do not work. The approach is flexible and iterative, seeking to explicate underlying interventional theories and operational contexts, and often engaging policy or practice decision makers in the process. Such syntheses thereby produce theoretical claims alongside summaries of empirical evidence.

Discusses the misrepresented image of school children at the London, England-based New River Green early-years center in the cover of the February 28, 2003 issue of the periodical 'The Times Educational Supplement.' Implication of the cover and the article; Effects of the image on the nursery.