Fetal loss and contraceptive acceptance among the Bhopal gas victims.

The rates of fetal loss and family planning acceptance among Bhopal gas victims from 1984 to 1989 were compared to those of a control group. In all, 136 eligible women in the affected area and 139 women in the control area were interviewed. Care was taken to ensure that these women had conceived at least once during the previous five years. The The fetal loss rate among the gas-affected women was abnormally high (26.3 per cent) compared to that of women in the control area (7.8 per cent). Family planning acceptance in both areas was similar, with most women using permanent methods. In the case of temporary methods, the percentage of use was higher in the gas-affected area.     

Preface: Genetics and the human encounter with alcohol

Abstract

In this paper, we calculate a base line of statistical data on the frequency of sexual activity at various ages of Taiwanese women. A cross‐sectional study using questionnaires administered during personal interviews was conducted on more than seventeen thousand women who attended family planning clinics in the Taipei metropolitan area in 1991 and 1992. Of the women surveyed, 2.8 per cent were sexually inactive in the previous month, 83.67 per cent had intercourse one to nine times in the previous month, and 13.56 per cent had intercourse ten times or more. The mean frequency of sexual activity was 6.8 times a month. Age‐specific mean coital frequencies for the age groups of less than 25 years, of 25–34 years, and of 35–44 years were 10.3, 7.3, and 6.6 times per month, respectively. Increased sexual frequency was associated with the following factors: young age, unmarried, lower educational level, fewer years of marriage and being on the pill. When logistic regression was used to control for confounding variables, we found that a woman's age is the most significant factor in predicting her sexual frequency.     

Epidemiology of fetal alcohol syndrome among American Indians of the southwest

Abstract

The epidemiological features of Fetal Alcohol Syndrome (FAS) were examined among American Indians in the southwestern United States. All FAS suspects were screened in specific populations of Navajo, Pueblo, and Plains culture tribes. A total of 115 alcohol‐affected children were identified. The incidence of FAS was found to be highly variable from one cultural group to the next, ranging from 1.3 per 1,000 births (1/749) for the Navajo to 10.3 (1/97) for the Plains. The pattern of age‐specific prevalence indicates an increase over the past fifteen years. The overall rate of mothers who have produced fetal alcohol children was 6.1 per 1,000 women of childbearing age with a range of 4 to 33 per 1,000. These maternal prevalence rates were important for the accurate prediction of public health risk because 25 per cent of all mothers who had produced one affected child had also produced others. The average per mother was 1.3 alcohol‐affected children. Other findings indicate that the mothers of these children led highly disruptive and chaotic lives and were frequently isolated from mainstream social activities. In general, the gross social and cultural patterns of the tribes studied can readily explain the variation in incidence of FAS.     

Pattern of menstrual cycle length in South Indian women: A prospective study

Abstract

Data on 8,308 menstrual cycles from 1,740 South Indian women prospectively recorded were analyzed to identify the effect of age on menstrual cycle length. The distribution was skewed to the right with the mean (SD) cycle length of 31.8 (6.7) days. The range of 25–40 days constituted 10–82 per cent of menstrual cycle lengths. In no age group did 28‐day cycles occur in more than 9 per cent of women. Variability as measured by the standard deviation was high among those below 19 years of age, stabilized during 25–39 years, and then increased in women aged 40 years or more. The findings are discussed in the light of other studies and possible implications in fertility control programs.     

Contraceptive use and efficacy in a genetically counseled population

Abstract

This paper reports contraceptive use and efficacy rates among 648 married women aged 15 to 44 who had received genetic counseling six months previously. Over half (53.5 per cent) of the counseled population were using non‐surgical contraception; 20 per cent were pregnant or postpartum; 10 per cent were seeking to become pregnant; 11 per cent were sterilized. Only 4.5 per cent were neither using contraceptives nor seeking to become pregnant. Women who were certain about their reproductive intentions after counseling utilized contraceptives effectively, with only two pregnancies at six months among those seeking to delay wanted pregnancies and only one pregnancy among those seeking to prevent pregnancy. This represents six‐month contraceptive failure rates of 4.3 and 2.1 per cent respectively for the two groups, rates similar to those with comparable intentions in the U. S. population at large. A distinguishing characteristic of the genetically counseled group was that 32 per cent of contraceptive users reported that their reproductive intentions were uncertain after counseling. The six‐month pregnancy rate in this uncertain group was 10 per cent.     

Demographic and contraceptive patterns among women in northern Mindanao,the Philippines

Abstract

Desired family size and contraceptive behavior of 986 ever‐married women aged 15–54 from Northern Mindanao, the Philippines, are described. Using the Dow and Werner typology of demographic and contraceptive patterns, it was found that a majority of the women were traditional in their demographic attitude and contraceptive behavior. A substantial proportion of the women desired medium to large families. Inconsistency in attitude and behavior was also manifested by women who desired small families but have never used efficient family planning methods. Sociodemographic characteristics of these women are described. A majority of the women who have never used efficient contraception also never practiced family planning. Rhythm was the primary method of birth control among demographic innovators and traditionals who have ever used inefficient methods; the pill was popular among contraceptive innovators and the moderns. A considerable proportion of the demographic innovators and the traditionals were not currently using any family planning method; a lesser proportion of contraceptive innovators and moderns were also not using birth control methods. Relevance of the findings to family planning programs is pointed out. Recommendations are given.     

Contraceptive practices and fertility among Southeast Asian,black, and white mothers attending a maternal infant care program

Abstract

The purpose of this analysis was to determine if there were differences in selected fertility characteristics including parity, pregnancy spacing, age at first pregnancy, age of menarche, breastfeeding postpartum, and contraceptive practices among white, black, Hmong, and other Southeast Asian mothers attending a maternal infant care program in Minneapolis, Minnesota, during 1980–82.

White and black mothers were younger than the Hmong and other Asian mothers. The lowest mean age of first pregnancy was among blacks. Ages of first pregnancy were similar for whites, Hmong, and other Asians, although the mean age of menarche was approximately two years later for Hmong and other Southeast Asian mothers compared to the white and black mothers.

Based on self reports at the first postpartum visit one month after delivery, 39 per cent of the whites and 25 per cent of the blacks were breastfeeding. In comparison 8.7 per cent of the Hmong and 17 per cent of the other southeast Asian mothers were breastfeeding.

Maternal age and age at first pregnancy were significant predictors of parity for whites, blacks, Hmong, and the other Southeast Asians. Ever‐use of contraception was a significant predictor of parity only for Hmong.

The highest proportion of ever‐users of contraception was among the white mothers (80 per cent) followed by the blacks (69.3 per cent) and other Asian mothers (34.8 per cent). Hmong mothers had the lowest proportion having used contraception (17.1 per cent).     

Book notes

Abstract

Marriage in Indian society is a religious duty. Consanguineous marriage is common, where individuals prefer to marry within their clan (a unilateral kin group based on either matrilineal or patrilineal descent). Keeping in mind that this form of marriage has certain disadvantages for social and biological as well as demographic aspects of individuals and families, the present study examines the influence of mate selection (i.e., close relatives, distant relatives, not related) on female age at marriage, pregnancy wastages, and survival status of the first child. The study was designed based on the information collected on a sample size of 3,948 married women aged 13–49 in Tamil Nadu, India, by the National Family Health Survey (NFHS), 1992. Results suggest that 48 per cent of women in Tamil Nadu marry their relatives. This practice of marrying relatives is high in rural areas, among Hindus, Scheduled Castes/tribes, and illiterate women as compared to urban areas, among non‐Hindus, non‐SC/ST, and educated women, respectively. The bivariate analysis reveals that women marrying their close relatives had low age at marriage and experienced a higher per cent of pregnancy wastage and child loss (first child) as compared to those women marrying their distant relatives or nonrelatives. The result is found to be consistent even after controlling for selected background variables through multivariate techniques (applied separately for age at marriage, pregnancy wastages, and the survival status of first child). Hence, this study suggests that steps should be taken to inform people about the problems of marrying close relatives through appropriate IEC programs in Tamil Nadu.     

Selection intensities in menopausal and permanent contraceptor women of a rural population in India

Abstract

The opportunity for selection was estimated in the rural population of Visakhapat‐nam District, Andhra Pradesh, India. The index of total selection was found to be low. Selection in relation to birth control reveals that opportunity for selection is lower among the women who completed their fertility by family planning methods than in women who completed their fertility by attaining menopause. Further, the results showed that differential fertility and mortality make equal contributions to the total measure of selection in both groups.     

Factors influencing genetic counseling attendance rate: A geographically based study

Abstract

A study of factors influencing genetic counseling attendance rate has been conducted in the Bouches‐du‐Rhône area, in the south of France. In this area, a birth defects monitoring system (Eurocat n°22) annually covers 23,000 births. All the genetic services are delivered by only one genetic center located in Marseilles, and the data collected are computerized. The comparison of these two data bases gives an opportunity to estimate the rate of genetic counseling attendance after the occurrence of an affected stillbirth or live birth. Among the parents of 358 infants born in 1983–84 in this area with a pathology requiring genetic counseling, 226 (63 per cent) attended the Genetic Center within the first year after birth. The rate of attendance is statistically higher (p < 0.01) for the parents who had a stillbirth (78 per cent) than for those who had a live birth (57 per cent). It is also higher (p < 0.01) for the Marseilles maternities group (68 per cent) than for the group outside Marseilles (50 per cent). The referral delays are also analyzed according to malformation etiology and to viability of the child by the eighth day of lue. Besides evaluating a particular genetic center's effectiveness in diffusing information to the public concerned, this work shows that couples’ request is strongly dependent on a psychological need.     

Do gravidity and age affect pregnancy outcome?

Abstract

Fetal loss has generally been found to vary with gravidity, previous experience of fetal loss, and maternal age, but the literature is divided on the reasons for these associations. In this paper we examine pregnancy histories obtained retrospectively from a nationally representative one‐in‐one‐thousand sample of women in Australia aged 20 to 59 years. The relations of fetal loss ratios with both gravidity and previous outcome are consistent with heterogeneity of risk over the study population and a stopping rule, whereby high‐risk women undertake more pregnancies than low‐risk women to achieve the same number of live births. Evidence is presented that elevated loss ratios in the teens indicate not higher risk but a selection for short gestation intervals, while loss ratios beyond the mid‐thirties do not point unequivocally to a substantial increase in risk at the older reproductive ages.     

First presidential addressbehavior genetics association April 6, 1973

Abstract

The number of births reported by 786 women of native ancestry on the 1954 census of St. Barthélémy, French West Indies, was compared to the number of births registered to these same women in the records of vital events. The magnitude of the difference between the two numbers was related to a woman's parity and marital status, but not to her age or literacy. In general, the agreement between the two numbers was very high, with the mean of reported parities within 5 per cent of the mean of registered births for all age groups except one, where the difference was 5.6 per cent. The women of St. Barthélémy were well able to remember the number of children they had borne. It appears likely that the discrepancies between reported parities and registered statistics in previous studies are the result of cultural misunderstandings in questionnaires, or perhaps sample decay, rather than of women's memory loss.     

Inbreeding among endogamous groups in three multicaste villages of Srikakulam district,Andhra Pradesh,India

Abstract

In the present paper 702 families have been studied belonging to different endogamous groups in three multicaste villages of Srikakulam District, Andhra Pradesh. It is observed that 33.76 per cent of families are consanguineous marriages. With regard to the types of marriages, 12.11 per cent are uncle‐niece; 14.10 per cent are matrilateral cross‐cousins; 5.84 per cent are patrilateral cross‐cousins; 0.57 per cent are first cousins once removed, and 1.14 per cent are second cousins. There are only six couples (0.86 per cent) in intercaste marriages. The coefficient of inbreeding for autosomal and sex‐linked genes, 0.045 and 0.059, respectively, for Chakalis which are higher than Kalingas (F = 0.03; F1 = 0.038), Segidis (F = 0.031; F1 = 0.041), Velamas (F = 0.026; F1 = 0.036), Vysyas (F = 0.027; F1 = 0.034), Malas (F = 0.017; F1 = 0.026), and others (F = 0.026; F1 = 0.032). The t‐tests for mean marriage distances are statistically significant among all castes, but chi‐squares for intergroup difference of consanguineous and nonconsanguineous marriages are statistically significant only among Kalingas and Chakalis, Vysyas and Chakalis, and Malas and Chakalis.     

A biobehavioral model for breastfeeding effects on return to menses postpartum in Javanese women

Abstract

This paper examines the effects of nursing behavior on the duration of lactation amenorrhea in 382 rural Indonesian women who experienced resumption of menses while breastfeeding or were breastfeeding and amenorrheic at the end of a two‐year prospective study. Three primary breastfeeding variables (number of night‐time nursing bouts, number of day‐time nursing bouts, and minutes per bout) were used to develop a behavioral model for breastfeeding. Four breastfeeding patterns were identified for these women. These were designated as: (1) low intensity, (2) medium‐low intensity, (3) medium‐high intensity, and (4) high intensity breastfeeding behavior. Menses resumed at medians of 11.2,16.0,17.6, and 20.8 months, respectively, for these groups. The relationships among the breastfeeding variables in the behavioral model and return to menses were developed and tested by life table and proportional hazards models. Ten per cent of the high intensity breastfeeding group (6 women) delayed menses between 33 and 52 weeks, while 90 per cent (56 women) postponed return of menses for over one year.     

A period analysis of parity distribution among white and nonwhite women in the United States, 1940–1974

Abstract

The historical trends of childlessness and of one‐child, two‐child, and three‐or‐more‐child families among white and nonwhite women in the United States are studied in terms of period fertility tables. Given the age and parity of a woman, we can read from the fertility tables how her parity is expected to change at successive ages during the rest of her childbearing period, if she is subjected to the age‐parity‐specific fertility rates for a particular year. The fertility tables for white and nonwhite women are constructed for the years 1940, 19S0, 1960, 1970, and 1974. These tables show that among white women who have completed their childbearing (with period rates), the percentage with more than two children has decreased from 66 in 1960 to 27 in 1974, whereas the corresponding reduction among nonwhite women is from 67 to 48 per cent (Table 1, Case 1).     

Vasectomy in Guatemala: A follow‐up study of five hundred acceptors

Abstract

Over a thousand vasectomies are performed yearly by the private family planning association (APROFAM) of Guatemala. This study surveyed the experience of five hundred men interviewed 12 to 36 months after vasectomy. Overall, the experience was reported to be positive. Most wives approved of the operation; the attention received at the clinic was satisfactory; and most men considered their general health, sex drive, and marital relations to be unchanged or improved. Negative aspects included post‐operative discomfort one month later (9 per cent) and failure of the operation (2 per cent). Reported satisfaction with the operation was high: 97 per cent expressed no regret. Further analysis indicates that satisfaction was not a function of sociodemographic characteristics, attitudes toward the clinic experience, post‐operative discomfort, or wife's attitude. Rather, dissatisfaction stemmed from failure of the operation or a perceived negative effect of the operation on one's health and sex life.     

Causes of low utilization of amniocentesis by women of advanced maternal age

Abstract

The objectives of this study were to determine current usage of amniocentesis by women of advanced maternal age in a southwestern Ohio county and to determine potential usage levels by surveying women not utilizing the procedure to understand their reasons. For women age 35 and older giving birth in Hamilton County, Ohio, the estimated percentage using amniocentesis was 3.9 in 1978, 7.6 in 1979, and 13.3 in 1980. Approximately comparable statewide utilization rates were 7.0, 11.5, and 17.2 respectively. A telephone survey during the summer of 1980 of 81 Hamilton County women age 35 and older recently giving birth to a normal baby found four main reasons why they did not utilize amniocentesis: (1) they did not feel at an increased risk (29.6 per cent); (2) they had never heard of the test (24.7 per cent); (3) they were opposed to abortion (21.0 per cent); and (4) no one suggested they have the test done (19.8 per cent). Their physicians reported that 81 per cent of these women had received prenatal counseling. Thus, of those counseled, over two‐thirds apparently missed at least one essential message of the counseling they were presumably provided. These findings, coupled with 47.7 per cent of women who knew about amniocentesis saying they would most likely use it if they became pregnant again and their physician recommended it, indicate that utilization of prenatal diagnosis by at least 50 per cent of women age 35 and older is likely with greater public education and greater support of the procedure by obstetricians.     

AN EVALUATION OF CESAREAN SECTION

The risks of cesarean section have been reduced in step with the increase in safety of all major surgical procedures.In a series of 13,153 deliveries, 1,265 (9.6 per cent) were by cesarean section. There were three obstetrical maternal deaths in 11,888 cases in which delivery was by the vaginal route—0.025 per cent. In the series of 1,265 deliveries by cesarean section there was one death attributable to the operation—0.08 per cent.The total uncorrected fetal loss following cesarean section was 3.8 per cent. This compares favorably with fetal loss of 3.2 per cent in the vaginal delivery group in this series, and with fetal loss rates reported from large obstetrical centers.Anesthesia by spinal injection is the method of choice in cesarean section. There were no maternal deaths or accidents attributable to spinal anesthetic, and in no case was it felt that fetal death was attributable to it.The incidence of maternal morbidity in the cesarean section group following spinal anesthesia was 15.8 per cent—less than half the incidence of morbidity following inhalation anesthesia.     

Stereological and histopathological assessment of intrauterine growth restriction placenta from Saudi women

BackgroundPlacental insufficiency causes fetal adaptation, leading to fetal programming of chronic diseases. Placentas with intrauterine growth restriction (IUGR) are smaller than average and may contribute to low birth weight of the newborn. The number of patients with IUGR in the Saudi population is increasing; however, little is known about their placentas. The aim of this study was to assess morphometric and histopathological placental changes in Saudi patients with IUGR.MethodsOverall, 20 healthy pregnant Saudi women (control group) and 20 pregnant Saudi women with IUGR were enrolled. Maternal and fetal morphometric measurements were recorded. The placentas from both groups were processed for histopathological examination using stereological techniques.ResultsThe IUGR group had lower placental weight, volume, length, breadth, and surface area than the control group. The total volume of villi and surface area of the terminal villi were significantly reduced in the IUGR placentas. IUGR group had a reduction in birth weight; length; and circumference of the head, chest, abdomen, and thigh compared to control group.ConclusionThe reduction in placental mass, specifically the reduction in the volume and surface area of villi, the functional units, may have reduced the capacity for nutrient transport. This led to a significant reduction in neonatal measurements. The fetus rearranged nutrient distribution in favor of the brain and other essential organs; however, at the expense of thigh development and growth. This fetal trade-off strategy increases the risk of developing chronic diseases in adulthood. Therefore, IUGR infants may require more clinical attention.     

Childlessness: A panel study of expressed intentions and reported fertility

Abstract

The present research focuses on childed versus childless intentions and subsequent behavior and intentions for a panel of U. S. women. Utilizing data from the 1970 and 1975 National Fertility Surveys (reinterviewed women), we ascertain the consistency between intentions (1970) and behavior and intentions (1975). We find that while women who expressed a zero parity intention in 1970 were very consistent in their behavior and intentions in 1975, nearly 30 per cent of those women intending children had no children by 1975. Furthermore, of these 30 per cent, one‐third had changed their intention to zero parity by 1975. We find that changing intentions from more than zero to zero is associated with higher levels of education, slightly higher income, and to a lesser degree with the importance given religion and with labor force participation.