Background Maternal age < 18 or > 34 years, short inter-pregnancy birth interval, and higher birth order are considered to be high-risk fertility behaviours (HRFB). Underfive mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and underfive mortality in selected Asian and African countries. Methods This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in sub-Saharan Africa, Middle East, North Africa and South Asia from 1986 to 2017 (N = 1,467,728). Previous evidence hints at four markers of HRFB: women’s age at birth of index child < 18 or > 34 years, preceding birth interval < 24 months and child’s birth order > 3. Using logistic regression, we analysed change in the odds of underfive mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. Results Mother’s age at birth of index child < 18 years and preceding birth interval (PBI) < 24 months were significant risk factors of underfive mortality, while a child’s birth order > 3 was a protective factor. Presence of any single HRFB was associated with 7% higher risk of underfive mortality (OR 1.07; 95% CI 1.04–1.09). Presence of multiple HRFBs was associated with 39% higher risk of underfive mortality (OR 1.39; 95% CI 1.36–1.43). Some specific combinations of HRFB such as maternal age < 18 years and preceding birth interval < 24 month significantly increased the odds of underfive mortality (OR 2.07; 95% CI 1.88–2.28). Conclusion Maternal age < 18 years and short preceding birth interval significantly increase the risk of underfive mortality. This highlights the need for an effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for optimal birth spacing.

Violence against women (VAW) is a grave problem in Pakistan, and women from all socioeconomic groups are vulnerable to domestic violence in varying degrees. It is argued that patriarchal definition of gender roles may reinforce the internalized inferiority of women. So, it may not be a mere coincidence that a large number of women in Pakistan justify VAW for various reasons. The objectives of this article are threefold: (a) to identify the drivers of VAW, (b) to see if women's attitudinal acceptance of violence is causally linked with observed violence against women, and (c) to see if attitudinal acceptance of violence mediates between the socioeconomic status of women and observed violence. We used data from the Pakistan Demographic and Health Survey (PDHS) 2012-13. The sample consisted of 3,265 ever married women aged between 15 and 49 years who were interviewed for domestic violence. We used multivariate logit regression analysis to identify the drivers of VAW and used the Karlson-Holm-Breen (KHB) method for mediation analysis. We found that women's attitudinal acceptance of violence, their childhood experience of violence in their parental household, the education of both husband and wife, and some occupation types significantly predicted their experience of spousal violence. In addition, we found that women's attitudinal acceptance of violence mediated the relationships between socioeconomic factors (education and wealth status) and VAW. The significance of the study lies in the fact that it highlights the need to modify the perceptions of violence through change in educational policy. Among multiple other factors, an increase in the economic status of women is an effective hedge against the risk of spousal violence.

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