Effect of nuptiality, contraception and breast-feeding on fertility in Bangladesh

The effects of marriage, contraception, and post-partum lactational infecundability on fertility in Bangladesh are assessed by applying Bongaarts' formula to survey data for the period 1975-1985. Marriage is universal and age at marriage is low. Breastfeeding is prolonged and has a pronounced effect on fertility. The fertility-reducing effect of contraception increased over the period through increased use of modern methods. The total fertility rate (TFR) declined by 24% from 1975 to 1985. This study shows that the 3 major proximate determinants cannot account completely for variation in national fertility levels.     

Reproductive change in Zimbabwe and Kenya: the role of the proximate determinants in recent fertility trends

This study examines trends in proximate determinants of fertility in Zimbabwe and Kenya. Findings from the four Demographic and Health Surveys conducted in these countries show that the dramatic fall in fertility in these countries is consistent with the underlying trends in the most important proximate determinants of fertility. In Zimbabwe, contraceptive use far exceeds other proximate determinants in influencing fertility levels and trends. The results show that the fertility inhibiting effects of contraception are more important than the effects of postpartum infecundability, marriage patterns, or sterility. The results also show that contraceptive use has its greatest suppressing effects in the middle and younger age groups. However, in Kenya, the dominant fertility inhibiting effect is postpartum infecundability, with contraception coming in second.     

An investigation into proximate determinants responsible for fertility differentials between two rural Bangladeshi populations

The substantial areal variation in Bangladesh's demographic dynamics is demonstrated by the differential fertility in 2 rural areas--Teknaf, where the total fertility rate is 8.0 and Matlab, where this rate is 6.5 in comparison areas and 5.0 in treatment areas. The fertility differences between the comparison and treatment areas of Matlab are usually attributed to the differential use of contraception, while the fertility difference between Teknaf and Matlab as a whole is assumed to reflect dissimilarities in socioeconomic, environmental, and cultural conditions. Application of a model proposed by Bongaarts which permits analysis of the effects of intermediate variables on fertility reveals similar marital patterns in Teknaf and Matlab but different indexes of infecundability and contraceptive use. Both the comparison and treatment areas of Matlab had 1 birth less than Teknaf because of their high infecundability due to a longer duration of breastfeeding (median duration of 30 months in Matlab compared with 22 months for Teknaf). Contraceptive use contributed 0.51 and 2.36 fewer births in Matlab's comparison and treatment areas, respectively, than in Teknaf. The reasons Teknaf mothers breastfeed their infants for shorter durations than Matlab mothers merit further investigation given the significant contribution of prolonged lactational amenorrhea to lowering fertility. Much of the effect on fertility of the increase in contraceptive use in Matlab's experimental area could not have been achieved if lactation durations were at Teknaf levels, further emphasizing the need for research on breastfeeding behavior in different parts of Bangladesh.     

Determinants of fertility decline in China, 1981: analysis of intermediate variables.

This study examines the proximate determinants of fertility in China by making use of the data collected by the One-per-Thousand Sample Fertility Survey of 1982. The results indicate that the most important inhibitor of potential fertility is deliberate control. Its contribution to fertility change has been far greater than all other proximate determinants. The marital structure of the population is also an important factor, while lactational infecundability and induced abortion are relatively unimportant. Comparative results by using data from the In-depth Fertility Survey conducted in Shanghai Municipality, Hebei and Shaanxi Provinces in April 1985 agree well in the ranking of the four intermediate factors. The findings point to successful family planning program and government population policies, which propelled the fertility transition to a substantial degree. Further research needs and policy implications of the results of the study are discussed.     

Determinants of fertility decline in China, 1981: Analysis of intermediate variables

Abstract

This study examines the proximate determinants of fertility in China by making use of the data collected by the One‐per‐Thousand Sample Fertility Survey of 1982. The results indicate that the most important inhibitor of potential fertility is deliberate control. Its contribution to fertility change has been far greater than all other proximate determinants. The marital structure of the population is also an important factor, while lactational infecundability and induced abortion are relatively unimportant. Comparative results by using data from the In‐depth Fertility Survey conducted in Shanghai Municipality, Hebei and Shaanxi Provinces in April 1985 agree well in the ranking of the four intermediate factors. The findings point to successful family planning program and government population policies, which propelled the fertility transition to a substantial degree. Further research needs and policy implications of the results of the study are discussed.     

Effect of famine on fertility in a rural area of Bangladesh

Data on household socioeconomic status collected in the 1974 census and registration data on births, deaths, and migrations for the 1974-77 period from the Demographic Surveillance System of the International Centre for Diarrheal Disease Research, Bangladesh, were used to investigate the effects of the 1974-75 famine on differential fertility in a rural population of Bangladesh. Occupation of household head was used as a measure of socioeconomic status. Overall, fertility declined by 34% over the 1975-76 period and increased by 17% in 1976-77 from the 1974-75 figure. Significantly lower fertility was observed in 1975-76, irrespective of socioeconomic status, but the lower socioeconomic groups were affected more than the higher groups. Post-famine fertility was significantly higher only in the 2 middle occupation categories. The age-specific fertility rates suggest that the famine affected all age groups. The post-famine fertility was higher than that of 1974-75 in all but those aged below 20. At age 40 and over the recovery was slight. Husband-wife separation showed an increase during the famine and particularly among the lower socioeconomic groups. The males of the lower socioeconomic households migrated to other regions to obtain food for the family, thus affecting frequency of coitus. The decline in fertility may be due to several factors: deferred marriage; increase in divorces and husband-wife separations; high fetal wastage; voluntary fertility control through contraception, abstention, or induced abortion; and infecundability. An indirect measure of marriage rate indicated that fewer couples entered into marriage in 1974-75, particularly in the lower socioeconomic groups. Both the higher and lower socioeconomic groups were affected by the famine but the precise mechanisms were not the same. At this stage, it is not feasible to estimate the contribution of each factor to the fertility decline. The lower socioeconomic groups were more affected by husband-wife separations and deferred marriages; the higher socioeconomic groups were affected by mental stress and anxiety.     

Rapid fertility decline in Iran: analysis of intermediate variables

The remarkable decline in fertility in Iran, which saw the total fertility rate fall from 7 children per woman in 1986 to 2 in 2000, has received only limited analysis in the demographic literature. Using the 2000 Iran Demographic and Health Survey and Bongaarts' age-specific fertility model, this paper examines the role of the major proximate determinants of fertility in bringing about the rapid decrease in fertility in Iran. The analysis indicates that contraception had the largest effect on fertility, accounting for 61% of the reduction in fertility from its theoretical maximum. The fertility-inhibiting effect of marriage patterns accounted for an additional 31% reduction, and was most important among the young. Further analysis of contraceptive behaviour suggests that the current period fertility rate of 2.0 children per woman is an outcome of a synchronization of delaying and spacing of births among younger women with stopping of childbearing among women in the middle and late reproductive ages. The policy implications of the results are discussed.     

Cross-cultural dimensions of breastfeeding practices and abstinence: Evidence from Uttar Pradesh and Tamilnadu, India

Summary and Conclusion The analysis contained in this paper brings out very clearly that the practice of breastfeeding and abstinence in the two major states of India: Uttar Pradesh and Tamilnadu are highly related to socio-cultural factors and changes in generational gaps. The findings reveal that literate, non-Hindu, and rich (high SLI) women have shorter breastfeeding durations than illiterates, Hindus, and poor (low SLI) women of Uttar Pradesh and Tamilnadu. In addition, the breastfeeding practice in Uttar Pradesh is influenced by residence background and generational age-gaps. The role of socio-cultural factors in influencing post-partum sexual abstinence period has been found to be significantly important through the variables; residence background, generational age-gaps, religion and working status of women. The results reveal that urban women, of younger cohorts (below 30 years), non-Hindu, and non-working women have shorter abstinence periods compared to rural women, of older cohorts (above 30 years), Hindus, and working women in both the states. The findings from this analysis suggest that apart from modernization process, defined in terms of higher literacy levels, higher developmental and urbanization levels, the changing perceptions and attitude towards lactational practices over the generation has significant dent on shortening of breastfeeding durations and abstinence periods. Thus, the study support the hypothesis that the process of modernization defined in terms of improvement in level of education, family income, urbanization tends to shorten the period of breastfeeding and abstinence, and consequently, the post-partum infecundability is reduced. Such reductions in the infertile periods can be expected to contribute to an increase in natural fertility levels of the population and also on the observed fertility levels, if not counter balanced by the fertility reducing effects of contraception.     

Proximate determinants of fertility in Nigeria

Data from the 1981-82 Nigeria Fertility Survey (NFS) are used to identify the key proximate determinants of fertility in Nigeria. The patterns of their individual and collective effects are analyzed in a search for possible sources of fertility change. Exposure to the risk of childbearing through first marriage is found to be the most important proximate determinant of Nigerian fertility. Subsequent to marriage, fertility is determined mainly by breastfeeding and postpartum sexual abstinence. Where fertility shows significant socioeconomic variations, there are equally identifiable patterns of the impact of the proximate determinants which explain these differentials to a large extent. On a national scale, the observed patterns of the impact of the measured proximate determinants do not appear to suggest that Nigerian fertility is soon to experience a large decline.     

Proximate determinants of fertility in the Kathmandu Valley, Nepal: an anthropological case study

The analytical model of Bongaarts and Potter is employed to compare the proximate determinants of fertility among 3 populations in Nepal's Kathmandu valley. 3 sub-groups are studied: high caste (Brahmin and Chetri) urban residents, high caste urban fringe residents, and low caste untouchables (Sarki). Both survey and anthropological methods are employed. According to the analytical model, the transition in fertility follows 4 phases. The changes in fertility levels from Phase 1 to Phase 4 generally indicate that the transition from natural to controlled fertility is characterized by declines in the proportions of women married and the duration of postpartum infecundability, and a substantial increase in the prevalence and effectiveness of contraceptive practices. The results of this study show that Nepal as a whole is entrenched in Phase 1 of the fertility transition. However, data from the 3 populations reported here clearly indicate that each has begun to experience a demographic transition to different degrees. The Sarkis in this study fall between Phases 2 and 3, as indicated by the total fertility rate (TFR). The rural high castes most closely approximate a population in Phase 3, while urban high castes included in this study are approaching Phase 4. Each of the 3 populations is characterized by a decline in the proportion of women married when compared to all of Nepal. It is also apparent that the relative use-effectiveness of contraceptive methods currently employed is high. Gains in the reduction of fertility, then, will have to be made from increasing and retaining the number of acceptors and in reducing the desired family size of those at reproductive risk.     

Determinants of fertility in Nepal: applications of an aggregate model

Bongaarts aggregate model of the proximate determinants of fertility is applied to data from the 1976 National Fertility Survey in Nepal. Breastfeeding is shown to be the most important limiting factor, resulting in a reduction of about 6 children per woman. Decline in the duration of breastfeeding by 1/4 would increase fertility by 1 additional child per woman. The temporary separation of spouses due to migration is conjectured to be the 2nd most important fertility inhibiting factor, not explicitly accounted for in the standard model. Results are presented for the 3 major ecological regions, urban-rural residence and educational attainment of women. High nuptiality and virtually no contraceptive use in Nepal produce age-specific fertility rates very close to a natural fertility pattern. Total average interval between births is 36 months; about 18 months are solely due to breastfeeding, the remaining months to combined effects of gestation, waiting time to conception, intrauterine mortality and post-partum infecundability. As urbanization increases and pace of modernization becomes more pronounced, the duration of breastfeeding is susceptible to decline.     

The influence of female education,labor force participation,and age at marriage on fertility behavior in Bangladesh

Abstract

This paper studies the relationship between three aspects of female status (education, work experience, and age at marriage) and the use of contraception and fertility in Bangladesh. Education is found to be the variable most strongly correlated with use of contraception and is also one of the significant variables explaining fertility behavior. The most important factor explaining fertility behavior is age at marriage. The higher the age at marriage, the lower the fertility, when all other factors are held constant. Work experience has very little or no effect on current use of contraception and fertility.     

Fertility on the US-Mexico border

Using Bongaarts' model, the relative importance of the proximate determinants of fertility is explored in five populations on the US-Mexico border. For the groups closest to natural fertility (the two Mexican groups), lactation, use of contraception, and marriage all were moderately important in terms of their direct effect on fertility. For the group with lowest fertility (Anglo-American), contraceptive use was an important factor inhibiting fertility; marriage was important but not nearly as important as contraceptive use. For the two US Mexican-American groups, contraceptive use was an important intermediate variable, not as important as for Anglo-Americans, but more important than it was for the two populations in Mexico. The proportion married was a moderately important factor for the Mexican-American groups. For these five populations the principal differences in fertility rates result from substantial differences in the use of effective contraception. Bongaarts' model proved very useful as an analytical framework in this study.     

Greater than expected fertility decline in Ghana: untangling a puzzle

This study examines fertility decline that is larger than expected on the basis of recorded increases in contraceptive prevalence in Ghana. The primary sources of data are three Demographic and Health Surveys (DHS) conducted in the country in 1988, 1993 and 1998. First, the trend in fertility and contraceptive prevalence in Ghana is considered and compared with the trend that would be expected on the basis of prior research. Next, an attempt is made to uncover the explanation behind this unexpected trend. Measures of the quality of the survey data are looked at, as well as trends in the proximate determinants of fertility: contraceptive use, marriage and sexual activity, postpartum insusceptibility and induced abortion. Finally, evidence is presented that couples adjust their coital frequency in accordance with their fertility preferences, behaviour that would influence fertility rates but would not be captured by conventional measures of the proximate determinants of fertility.     

The effect of husbands' fertility preferences on couples' reproductive behaviour in rural Bangladesh

Bangladesh society is profoundly gender stratified, and yet male roles in reproductive health processes have not been rigorously investigated. This study examines the association between men's reproductive health knowledge, attitude and behaviour and their wives' subsequent reproductive behaviour using longitudinal data from the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). A total of 4969 matched husband-and-wife data from a 1998 survey and women's contraceptive use history data following this survey are used. Results show a significant association between husbands' fertility preferences and current use of any family planning method. When wives' background characteristics, and husbands' background and socioeconomic characteristics are controlled for, the predicted probability of using a method of contraception among non-educated wives whose husbands want more children is 0.49 compared with 0.64 for those whose husbands do not want more children. However, the net effect of husbands' preference for additional children diminishes as wives' level of education increases. Among wives who had completed high school, the predicted probability of using a method of contraception is 0.70 for those whose husbands want more children compared with 0.69 for those whose husbands do not want more children.     

Coitus, the proximate determinant of conception: inter-country variance in sub-Saharan Africa

There is a general consensus in the literature that fertility differences between populations can be accounted for by differences in just four key proximate determinants: nuptiality, the postpartum non-susceptible period, contraception and abortion. Natural fecundibility is generally assumed to be constant between populations. This paper puts the theoretical and empirical case for a re-evaluation of that assumption, drawing on the under-utilized data on sexual activity collected in the Demographic Health Surveys (DHSs). Using data for married women in nine African countries, the analysis finds substantial population level differences in mean monthly coital frequency, which, if accurate, suggest an important demographic effect. There is a clear regional patterning to these differences, with levels of activity considerably lower among women in the West African populations included in the study than those from East and southern Africa. For West Africa in particular the data indicate the normality of exceptionally long periods of very infrequent or no intercourse by married women outside the period of postpartum abstinence. The findings challenge prevailing presumptions concerning susceptibility to pregnancy in marriage on which statistics for unmet need for family planning are derived. While doubts are raised over the precision of the sexual activity data used, the paper argues for the need for a greater effort to operationalize the 'proximate determinant of conception', not only for more accurate fertility modelling, but also as a planning tool for a more sensitive provision of family planning services in Africa.     

Lactational amenorrhoea in well-nourished Toba women of Formosa, Argentina

The proximate causes of the contraceptive effect of lactation are still a matter of productive debate. This study sought to disentangle the relative impact that intense breast-feeding practices and maternal nutrition have on the regulation of ovarian function in nursing women. A mixed-longitudinal, direct-observational, prospective study was conducted of the return to postpartum fecundity in 113 breast-feeding, well-nourished Toba women. A sub-sample of 70 women provided data on nursing behaviour, daily activities, diet quality and urinary levels of oestrone and progesterone metabolites. Well-nourished, intensively breast-feeding Toba women experienced a relatively short period of lactational amenorrhoea (10.2 +/- 4.3 months) and a high lifetime fertility (TFR=6.7 live births/woman). Duration of lactational amenorrhoea was not correlated with any of the nursing parameters under study or with static measures of maternal nutritional status. The results indicated that the pattern of resumption of postpartum fertility could be explained, at least partly, by differences in individual metabolic budgets. Toba women resumed postpartum ovulation after a period of sustained positive energy balance. As the relative metabolic load hypothesis suggests, the variable effect of lactation on postpartum fertility may not depend on the intensity of nursing per se but rather on the energetic stress that lactation represents for the individual mother.     

Rural-urban migration and child survival in urban Bangladesh: are the urban migrants and poor disadvantaged?

This paper analyses the levels and trends of childhood mortality in urban Bangladesh, and examines whether children's survival chances are poorer among the urban migrants and urban poor. It also examines the determinants of child survival in urban Bangladesh. Data come from the 1999-2000 Bangladesh Demographic and Health Survey. The results indicate that, although the indices of infant and child mortality are consistently better in urban areas, the urban-rural differentials in childhood mortality have diminished in recent years. The study identifies two distinct child morality regimes in urban Bangladesh: one for urban natives and one for rural-urban migrants. Under-five mortality is higher among children born to urban migrants compared with children born to life-long urban natives (102 and 62 per 1000 live births, respectively). The migrant-native mortality differentials more-or-less correspond with the differences in socioeconomic status. Like childhood mortality rates, rural-urban migrants seem to be moderately disadvantaged by economic status compared with their urban native counterparts. Within the urban areas, the child survival status is even worse among the migrant poor than among the average urban poor, especially recent migrants. This poor-non-poor differential in childhood mortality is higher in urban areas than in rural areas. The study findings indicate that rapid growth of the urban population in recent years due to rural-to-urban migration, coupled with higher risk of mortality among migrant's children, may be considered as one of the major explanations for slower decline in under-five mortality in urban Bangladesh, thus diminishing urban-rural differentials in childhood mortality in Bangladesh. The study demonstrates that housing conditions and access to safe drinking water and hygienic toilet facilities are the most critical determinants of child survival in urban areas, even after controlling for migration status. The findings of the study may have important policy implications for urban planning, highlighting the need to target migrant groups and the urban poor within urban areas in the provision of health care services.     

Biological and behavioral determinants of fertility in Tierra del Fuego

The reproductive history of 182 women in postreproductive life or near menopause from the Chilean part of Tierra del Fuego was traced back by means of familial interviews. These postmenopausal women represent the population since almost the beginning of the settlement, and their reproductive years were spent on the island. Path analysis was applied to analyze fertility determinants of these women and to propose a complex model of interconnections among factors. The reproductive history of these women is characterized by a long fertile span, a short childbearing period, and low fertility. Age at menarche is relatively late, and the age of the women at first birth is mainly determined by their late age at marriage. The use of contraception is related to both spacing and stopping behaviors. The late age of women at marriage, the rhythm of conception, and practices of contraception are proposed as the main determinants of fertility in Tierra del Fuego.     

Determinants of natural fertility in Sudan

The population of Sudan (North) is at a very early stage of fertility transition and experiences high, stable fertility at a close to natural level. The high observed fertility is found to be a function of the high proportion of married women and ineffective contraceptive procedures. The data used in this study were drawn from the 1979 Sudan Fertility Survey (SUDFS), in which 3115 ever-married women 50 years old from 12,028 households were interviewed. 90% of Sudanese women breast fed for at least 6 months and 80% for at least 12. The main inhibitor of fertility is perceived to be lactational amenorrhea averaging about 11.8 months, which is reported to be high, although among younger women the duration of amenorrhea is shorter due to earlier introduction of supplementary foods. An average of 5.2 months of postpartum sexual abstinence is evidenced, but this is shorter than the period of amennorhea, and therefore has no effect on the birth interval. Neither does marital instability or mean length of separation, which are both close to nonexistent. Sudanese women are comparatively very infecund. 22% gave birth within the 1st year of marriage, 62% within the 2nd, and 83% the 3rd. The proportion of ever-users of contraception is high (e.g. 15.4% among the 25-34 among category), but current use was low (8.1% for the same). The use of contraception is responsible for a reduction of 4.2% of the fertility per married woman. The duration of temporary separation between spouses, due to temporary or seasonal migration of husbands, and the pathological causes of high primary sterility, which contribute to the low fecundability, need further investigation.