From:  Multiparity in women + cardiovascular disease: a South Asian perspective

 Socio-cultural determinants of parity and their influence on cardiovascular risk in South Asian women.

Socio-cultural factorMechanism influencing parityEvidence/Quantitative dataDownstream biological effectReference
Son preferenceCouples continue childbearing until a male child is bornObservational data: women often have additional pregnancies if there is no male child; fertility persists until a son is bornIncreased parity → cumulative metabolic stress, insulin resistance, obesity → higher CVD risk[30]
Low female autonomyLimited decision-making about contraception and family sizeOdds ratio 0.72 for contraceptive use among women with low autonomyHigher parity → obesity, metabolic syndrome, dyslipidemia → CVD[32]
Limited education/literacyReduced awareness of family planning and health practicesAdult female literacy rate: 67% in South Asia (2022)Higher parity → poor maternal health behaviors → insulin resistance, increased BMI → CVD[33]
Rural residence/limited access to healthcareFewer opportunities for family planning counseling and servicesContraceptive prevalence: 50% in rural vs. 70% in urban areasHigher parity → cumulative pregnancies → obesity, dyslipidemia → increased CVD risk[31]
Traditional gender rolesSocial expectations prioritize childbearing and homemaking over education/workQualitative data from South Asian surveysHigher parity → limited physical activity and postpartum weight retention → CVD risk[34]
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CVD: cardiovascular disease.