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Objectives\ud To estimate the population prevalence of severe fear of childbirth (FOC) during pregnancy and investigate its association with: (a) antenatal common mental disorders (depression and anxiety disorder) and (b) elective cesarean birth.\ud \ud Methods\ud 545 participants from an inner‐city London maternity population were interviewed soon after their first antenatal appointment (mean gestation: 14 weeks). Current mental disorders were assessed using the Structured Clinical Interview DSM‐IV. FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ‐A) at approximately 28 weeks gestation (n = 377), with severe FOC defined using a cutoff of WDEQ‐A ≥ 85. Birth mode information was collected at 3 months post‐delivery using an adapted Adult Service Use Schedule. Linear regressions were used to model associations, adjusting for the effects of covariates (age, parity, relationship status, education, and planned pregnancy). Sampling weights were used to adjust for bias introduced by the stratified sampling. We also accounted for missing data within the analysis.\ud \ud Results\ud The estimated population prevalence of severe FOC was 3% (95% CI: 2%‐6%) (n = 377). Depression and anxiety were significantly associated with severe FOC after adjustment for covariates (45% vs 11%; coefficient: 15.75, 95% CI: 8.08‐23.42, P < .001). There was a weak association between severe FOC and elective cesarean birth.\ud \ud Conclusions\ud Severe FOC occurs in around 3% of the population. Depression and anxiety are associated with FOC. Pregnant people with depression and anxiety may be at increased risk of experiencing severe FOC. Attitudes toward childbirth should be assessed as part of routine clinical assessment of pregnant people in contact with mental health services.

BACKGROUND: The impact of underlying parental psychological vulnerability on the future mental health of offspring is not fully understood. Using a prospective cohort design, we investigated the association between dysfunctional parental personality traits and risks of offspring self-harm, depression and anxiety.METHODS: The association between dysfunctional parental personality traits (monotony avoidance, impulsivity, anger, suspicion, and detachment), measured in both mothers and fathers when offspring were age 9 years, and risk of offspring depression, anxiety and self-harm at age 18 years, was investigated in a population-based cohort (ALSPAC) from over 8000 parents and children.RESULTS: Higher levels of dysfunctional maternal, but not paternal, personality traits were associated with an increased risk of self-harm, depression, and anxiety in offspring. Maternal associations were best explained by the accumulation of dysfunctional traits. Associations were strongest for offspring depression: Offspring of mothers with three or more dysfunctional personality traits were 2.27 (1.45-3.54, p < 0.001) times as likely to be depressed, compared with offspring of mothers with no dysfunctional personality traits, independently of maternal depression and other variables.CONCLUSIONS: The accumulation of dysfunctional maternal personality traits is associated with the risk of self-harm, depression, anxiety in offspring independently of maternal depression and other confounding variables. The absence of associations for equivalent paternal traits makes a genetic explanation for the findings unlikely. Further research is required to elucidate the underlying mechanism. Mothers with high levels of dysfunctional personality traits may benefit from additional support to reduce the risk of adverse psychological outcomes occurring in their offspring.

Background Domestic and sexual violence are significant public health problems but little is known about the extent to which men and women with severe mental illness (SMI) are at risk compared with the general population. We aimed to compare the prevalence and impact of violence against SMI patients and the general population. Method Three hundred and three randomly recruited psychiatric patients, in contact with community services for ⩾1 year, were interviewed using the British Crime Survey domestic/sexual violence questionnaire. Prevalence and correlates of violence in this sample were compared with those from 22 606 general population controls participating in the contemporaneous 2011/12 national crime survey. Results Past-year domestic violence was reported by 27% v. 9% of SMI and control women, respectively [odds ratio (OR) adjusted for socio-demographics, aOR 2.7, 95% confidence interval (CI) 1.7–4.0], and by 13% v. 5% of SMI and control men, respectively (aOR 1.6, 95% CI 1.0–2.8). Past-year sexual violence was reported by 10% v. 2.0% of SMI and control women respectively (aOR 2.9, 95% CI 1.4–5.8). Family (non-partner) violence comprised a greater proportion of overall domestic violence among SMI than control victims (63% v. 35%, p < 0.01). Adulthood serious sexual assault led to attempted suicide more often among SMI than control female victims (53% v. 3.4%, p < 0.001). Conclusions Compared to the general population, patients with SMI are at substantially increased risk of domestic and sexual violence, with a relative excess of family violence and adverse health impact following victimization. Psychiatric services, and public health and criminal justice policies, need to address domestic and sexual violence in this at-risk group.

This paper provides a theoretical explanation for the widely debatedempirical finding of “Environmental Kuznets Curves”, i.e., U-shaped relationships between per-capita income and indicators of environmentalquality. We present a household-production model in which the degradationof environmental quality is a by-product of household activities. Householdscan not directly purchase environmental quality, but can reduce degradation by substituting more expensive cleaner inputs to production for less costlydirty inputs. If environmental quality is a normal good, one expectssubstitution towards the less polluting inputs, so that increases in incomewill increase the quality of the environment. It is shown that this onlyholds for middle income households. Poorer households spend all income on dirty inputs. When they buy more, as income rises, the pollution also rises.they do not want to substitute, as this would reduce consumption ofnon-environmental services for environmental amenities that are alreadyabundant. Thus, as income rises from low to middle levels, a U shape can result. Yet an N shape might eventually result, as richer households spend all income on clean inputs. Further substitution possibilities are exhausted.Thus as income rises again pollution rises and environmental quality falls.

This paper provides simple, transparent intuition for the perhaps surprising and certainly widely debated empirical findings of "environmental Kuznets curves", i.e. U-shaped relationships between per-capita income and indicators of environmental quality. We consider one possible component of such relationships: the linkage between income and household choices that impact upon the environment. Our explicit model emphasizes two features. First, degradation of the environmental endowment is a by-product of household activities. We present a household production model in which consumption of marketed commodities generates both a "good", desired non-environmental services, and a "bad", degradation of the environment. Second, while households can not directly purchase environmental quality, they can reorganize their activities so less degradation results. If environmental quality is a normal good, one expects substitution towards less degrading commodities, so that increases in income will increase environmental quality. We show that natural constraints on the desirability and feasibility of such substitution can produce non-monotonic relationships between household income and environmental quality, and in particular can produce household-level environmental Kuznets curves.

Will economic growth inevitably degrade the environment, throughout development? This paper presents a simple household-choice framework that emphasizes the tradeoff between pollution-causing consumption and pollution-reducing abatement expenditures. The framework yields a simple explanation for Environmental Kuznets Curves (EKCs, i.e. non-monotonic, upward-turning paths of environment while development continues) and facilitates analysis of household voting decisions that lead to public regulation of environmental externalities. Our sufficient conditions, more general than the literature, make clear that an asymmetric endowment (i.e. positive environmental quality but zero consumption at zero income) is sufficient for an EKC given standard preferences and a wide range of abatement technologies. The key is that the MRS leads the household to prefer not to abate (or to vote for whatever 'abatement' implies) at low income levels. Without the endowment, abatement technologies alone are insufficient for an EKC path. For a multi-agent setting with externalities, an analogous result is derived in which the chosen tax rate rises with income and environmental quality at first falls and later rises.

This study is designed to measure financial trends and new initiatives in support of the Safe Motherhood (SM) Initiative, identify issues of statistical methodology that may constrain the analysis, and establish a baseline for 1988 against which to measure future financial trends. Global support for specific safe motherhood activities is limited. Funding for selected safe motherhood activities is estimated to have increased (in current dollars) from $691.5 million in 1986 to $818.8 million in 1988. About half this amount was for so-called core activities, including family planning services. The magnitude of support for prevention of the complications of pregnancy is less certain. General health, population and nutrition sector flows increased substantially over the same period and estimated World Bank safe motherhood expenditures in 1989 are triple the previous year's total. New specific safe motherhood activities are beginning to emerge in the form of care for the complications of pregnancy, better secondary and tertiary facilities, training and promotional workshops. In conclusion, it is clear that policies to support maternal health are widely endorsed. However, the effectiveness of donor financing may require far greater attention to two special problems: (a) improving data on SM financial trends; and (b) strengthening recipient countries'capacity to activate project demand.

An estimated 500,000 women, 99 percent of them from the developing world, die each year from pregnancy-related causes. About three quarters of these deaths are the direct result of obstetrical complications -- hemorrhage, infection, toxemia, obstructed labor, and abortion (under primitive and illegal conditions). An estimated equivalent number of infants do not survive their mother's death. For surviving mothers, the consequences of pregnancy have a severe impact on health and family economics. The strategy for safe motherhood is based on two approaches. First, the encouragement of activities that indirectly improve maternal health. These include education, policies to improve women's rights and working conditions, health care and nutrition, transportation and communication systems, water and sanitation facilities, and increases in family income and food production. The second approach targets activities to reduce maternal deaths. These activities include reducing unwanted pregnancies through the provision of family planning services, and through national policies that recognize the importance of this issue. A second objective is to reduce the risks of pregnancy through providing community-based family planning and prenatal services to identify high-risk cases'adequate referral services for the complications of pregnancy, and communication and transport systems to support patient referral procedures.

Will economic growth inevitably degrade the environment, throughout development? We present a household-level framework emphasising the trade-off between consumption that causes pollution and pollution-reducing abatement. Our model provides a simple explanation for upward-turning, non-monotonic paths of environmental quality during economic growth. Its innovation yields sufficient conditions that simultaneously address preferences and technologies. With standard preferences, an asymmetric endowment (i.e., at zero income, consumption is also zero but environmental quality is positive) leads low-income households not to abate, and further this condition is sufficient for an environmental Kuznets curve (EKC) for a wide range of abatement technologies. Without such an endowment, however, even strong economies of scale in abatement are, on their own, insufficient for an EKC.