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Background: Reproductive and menstrual factors have been evaluated as surrogates for long-term hormonal exposures in several prospective studies of colorectal cancer, yet findings have been conflicting. Methods: The relation of reproductive and menstrual factors (self-reported via a reproductive history questionnaire) with incident colorectal cancer was investigated among women enrolled in the Women's Health Initiative Observational Study (WHI-OS), a longitudinal cohort of 93 676 postmenopausal women (aged 50-79 years at enrolment) in which 1149 incident cases of colorectal cancer occurred over a median follow-up of 11.9 years. Multivariable Cox proportional hazards models that included established colorectal cancer risk factors were constructed to examine the association of colorectal cancer incidence with reproductive and menstrual factors. Results: Having had two children (vs nulliparous: hazard ratio (HR) = 0.80, 95% confidence interval (CD: 0.64-0.99) was inversely associated with colorectal cancer risk. Compared with never users, ever use of oral contraceptives was associated with lower colorectal cancer risk (HR = 0.74, 95% CI: 0.63-0.86); however, no relationship was observed for duration of oral contraceptives use (4 years vs 1 year: HR = 0.94, 95% CI: 0.67-1.32). None of the remaining reproductive and menstrual factors was associated with colorectal cancer incidence. Conclusions: Parity and prior use of oral contraceptives were associated with lower colorectal cancer risk in this cohort of postmenopausal women.

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This research is one contribution to understanding the nature of policy and of power. the interaction of the state and its machinery with individuals at all levels, the tensions between public and private choices and responsibilities, between public health and clinical health care. Adapting a policy analysis approach, this thesis provides a case study of the development and implementation of reproductive health policies in Ghana. The aim is to enhance understanding of why there are differences between policy and practice and what the potentials are for integrating STD/HIV management into MCH/FP services in Ghana to improve reproductive health. This thesis argues that all elements of policy and policy analysis are located within a 'contextual framework' and are influenced by a range of contextual factors (defined and illustrated through the thesis) which are seldom taken into account in policy process and analysis. It is argued that understanding the different levels of context is fundamental to understanding the processes of policy development and implementation, the actions of actors at all levels and the policy outcomes. Using a multi-level focus and a combination of approaches, this thesis identifies the contextual factors and their manifestations at each level of the policy process and illustrates how they impact on policy. The analysis synthesises macro and micro dimensions gaining a more comprehensive understanding of the influences on and gaps between policy development and implementation. At the implementation level, 27 clinics were visited and 94 clinic staff interviewed in one rural region of Ghana, to ascertain what STD/HIV management services are actually being provided and what factors influence service provision (policy implementation). Interviews with community leaders and focus groups with villagers were conducted in the same region to explore community perspectives of disease and health care services and understand the factors influencing service utilisation (policy outcome). The role of the regional health administration as an intermediary was considered and understanding sought of the concepts of power which influence administrative and management structures. The national level interviews with government and Ministry of Health officials and with donor, NGO and national group representatives, provide further insight into the concepts of power and status and who influences policy making. Finally, all elements are brought together and discussed, a reworked framework is presented and suggestions for future policy and research directions are made.

The reproductive ecology of nine aroid species in the rain forests around Kumasi in Ghana was studied. These species included two seasonal geophytes; Amorphophallus johnsonii and Anchomanes difformis, two herbaceous species; Culcasia saxatilis and Culcasia striolata, Four hemi-epiphytic species with terrestrial phases; Cercestis afzelii, Cercestis stigmaticus, Culcasia angolensis and Culcasia parviflora, and one hemi-epiphytic species without a terrestrial phase when mature; Rhaphidophora africana. These aroids are pollinated by beetles and flies. Anchomanes difformis and Culcasia angolensis exhibit floral heating. Trap mechanisms are present in the inflorescences of Amorphophallus johnsonii, both Cercestis species, in Culcasia parviflora and in C.saxatilis. Pollen is psilate or verrucate to bacculate in most species, but echinate in Culcasia angolensis. Ripe infructescences in most species consist of clusters of large orange to red coloured berries, but Rhaphidophora africana develops gravid spadices, with the outer tapetum peeling away to reveal naked seeds in a pulp. The seeds in most of these aroids germinate quickly and produce high percentage germination, but Amorphophallus johnsonii exhibits bimodal germination, with some seeds germinating immediately and others delaying germination until 8 months later. Evidence of berry flesh inhibition was found in Cercestis afzelii. Two main patterns of climbing are displayed by the hemi-epiphytic aroid species, with continuous growth in Culcasia angolensis and Culcasia parviflora and periodic climbing shown by Cercestis afzelii, Cercestis stigmaticus and Rhaphidophora africana. Growth towards dark areas or 'skototropism' is evident in Culcasia angolensis, Culcasia parviflora and to some extent in Cercestis stigmaticus.

"Will highly educated women have more children in the future?" In this contribution, I address this question by looking at both fertility and fertility intentions; i.e., the number of children people plan to have over their reproductive lives. Intended births are highly correlated with actual births, and in low-fertility settings, childbearing has become associated with the couple's agency. On the other hand, education, which is a marker of income and social status, has remained an important driver of fertility choices. Hence, understanding the reproductive decision-making of women and men with low, medium, and high levels of education is crucial when seeking to determine whether - and if so, to what extent - there is scope for additional policy interventions aimed at raising fertility levels.