Changes in contraceptive use and fertility: Panama, 1976 to 1984

Abstract

From 1976 to 1984 important demographic changes occurred in Panama. The total fertility rate declined from 4.5 to 3.7, and contraceptive use amongmarried women 20–44 years of age increased from 55 per cent to 63 per cent. However, using data from three national level reproductive health surveys which were conducted in Panama in 1976, 1979, and 1984, we found that most of the changes took place between 1976 and 1979. Since 1979, overall contraceptive use and fertility have remained virtually unchanged, although there has been an important method‐mix shift toward an increase in the use of contraceptive sterilization and IUD's, with an accompanying decline in the use of oral contraceptives. Although the singulate mean age at marriage remained relatively constant, the average duration of breastfeeding rose 23 per cent during the period. Further gains in contraceptive prevalence and reduction in unplanned fertility in Panama will largely depend on enhanced program efforts first begun in the early 1970's by the Panama Ministry of Health. Future program efforts especially should be directed toward encouraging young couples to space their children more effectively by using temporary methods of contraception.     

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.     

Clinical implications of genetic susceptibility to diabetes mellitus

Abstract

Relatively little attention has been given to the interpretation of age‐at‐marriage differences in fertility. This paper discusses possible demographic and sociological sources of this differential. The argument is made that sociological interpretations deserve increased attention since most of the observed differential persists after control for likely demographic components (premarital pregnancy, unwanted fertility, and subfecundity) and for correlated social and background variables (education of self and parents, religion, farm background, number of siblings, whether respondent's parental family was intact, and husband's age at marriage). Multiple‐classification analysis is employed. The analysis concludes by noting that age at first birth has an even stronger relationship with fertility than age at marriage and that the sociological dimensions of age relevant to age at marriage are even more appropriate to age at entrance into motherhood.     

Fertility of the Tibetans migrated to Northen India

This paper aims to study the fertility rate of the migrant Tibetans residing in Northern India and finding out the factors which are affecting the fertility level among them. Data are reported on age at menarche, age at marriage, first childbirth, use of contraception, widowhood, migration and on various fertility measures in the Tibetan of Northern India living at low and moderate altitude (600–2000 m), who have migrated from high altitude (4000 m above sea level) in Tibet. The migrant Tibetans reported a relatively lower fertility as compared to the high and moderate altitude populations. This lower fertility is mostly attributable to the use of contraception, the later mean age at marriage and first childbirth, and relatively high proportion of widows in the migrant Tibetans. However, the social as well as biological changes in population during migration should not be overlooked, which have a sufficient impact on fertility.     

Social-demographic influence on first birth interval in China, 1980-1992

This study examines the delay between first marriage and first live birth in China among a sample of women who married between 1980 and 1992. Most couples in China only use contraception after the first child is born. Most sample women had their first child within 2 years of marriage. However, there are significant rural-urban differences in the first birth interval, indicating that there was most probably deliberate fertility regulation after marriage among many urban couples. Survival analysis shows that place of residence, level of education, age at first marriage and marriage cohort affect the first birth interval.     

Fertility Changes in Rural Moroccan Berbers during the 20th Century

Morocco’s fertility pattern evolved in the 20th century from a traditional model close to ‘natural fertility’ to a modern pattern incorporating contraception. The very high fertility rate of nearly 7 offspring per woman observed in the 1960s was still at a level of 5.5 offspring per woman in the early 1980s. The total fertility rate subsequently declined to 2.5 by 2003. This decline was apparently, principally, the result of two factors in the urban context: the relative increase in women’s age at marriage and the use of contraception to regulate and to close reproduction. This research studied a group of Berber agriculturists in the region of Marrakech to better understand the extension and modalities of fertility changes in a rural environment. Though delayed, the changes observed in rural Berbers paralleled the general trends seen at the national level. As in the urban environment, the changes affecting reproductive patterns resulted from an increase in the age at marriage of women and the introduction of contraception. However, these changes were apparently minor adaptations to the traditional pattern, in that the progressive increase in mean age at marriage was obtained by the decrease in the frequency of pre-nubile unions (<15 years old) and not from the upward shift of the modal age. On the other hand, contraception apparently was employed to stop childbearing after the expected family size was already attained.     

Changes in contraceptive use and fertility: El Salvador, 1978-88

In El Salvador from 1978 to 1988, contraceptive use among married women 15-44 years of age increased from 34% to 47%, and the total fertility rate declined from 6.3 to 4.6 children per woman. Most of this change took place from 1978 to 1985. Sterilization is the most prevalent method used, but nearly one-half of the women who are sterilized did not use any contraception before their operation. Few young couples use reversible methods of contraception to space births or delay the start of childbearing. On average, women wait 8 years after marriage and have nearly three children before they use contraception.     

Effects of age,cigarette smoking,and other factors on fertility: findings in a large prospective study.

Of 17 032 women taking part in the Oxford Family Planning Association contraceptive study, 4104 stopped using a birth control method to plan a pregnancy on a total of 6199 occasions. The influence of various factors on fertility in these women was assessed by measuring the time taken to give birth to a child. An appreciable inverse relation was observed between age at stopping contraception and fertility both in nulliparous and parous women, but the effect was much greater in the nulliparous women. The most important finding was a consistent and highly significant trend of decreasing fertility with increasing numbers of cigarettes smoked per day; it was estimated that five years after stopping contraception 10.7% of smokers smoking more than 20 cigarettes a day, but only 5.4% of non-smokers, remained undelivered. Some relation was found between fertility and social class, age at marriage, and a history of gynaecological disease, but weight, height, and Quetelet''s index were without noticeable effect.     

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.     

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).     

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.     

Continuing fertility transitions in a plural society: ethnic trends and differentials in Peninsular Malaysia

Fertility in Peninsular Malaysia has declined continuously from the late 1950s, reaching a total fertility rate of 3735 in 1983. All ethnic groups in Malaysia have contributed to this modern demographic transition but the rate of change has been most rapid for Chinese and Indians, Malay fertility having reached a plateau in the early 1980s. The effect of age structure, marital patterns and marital fertility (by parity) on the fertility declines for each ethnic community are analyzed. There has been a tendency, in each ethnic group, for the age distribution within the group of reproductive-age women to grow younger, reflecting the entry into the younger reproductive ages of the large birth cohorts of the 1950s and early 1960s. The effect of this on crude birth rates is hard to determine, because rising age at marriage and increasing use of contraception meant that fertility was increasingly concentrated in the more central reproductive ages. By the 1990s, the earlier declines in fertility will bring about a decline in the proportion of the total population made up of females in the main reproductive ages. After that point, further declines in fertility will be reflected in a sharper decline in the crude birth rate and hence the rate of population increase. Between 1947 and 1980, the age at marriage changed dramatically for females of all ethnic groups. The transition to higher age at marriage for Chinese was completed earlier, and since 1970 has risen by only a year. For Malays and Indians, the rise began later, proceeded faster and continued right up to 1980 when the medium ages at 1st marriage were Malays 22, Indians 23, Chinese 24 years. In 1980, Malay women on average were marrying 5 years later, and Indian women 6 years later than had their mothers' generation in 1947. The proportion never-married among Malay and Indian women aged 20-24 rose from 1/10 to 1/2 over this period; relatively greater changes are evident at ages 25-29. Other factors are the almost complete shift from parent-arranged to self-arranged marriages. Family size desired has decreased for all groups and the decline in breastfeeding has been offset by the sharp increase in the practice of contraception. Continuation of these trends would lead to replacement-level fertility for Malaysian Chinese and Indians by the year 2000. Malay fertility is likely to continue to decline but at a more moderate pace.     

Contraceptive use dynamics of Asian women in Britain

In-depth interviews were conducted with married Asian women from Indian, Pakistani and Bangladeshi backgrounds, to investigate patterns of contraceptive use and influences on contraceptive decision making. The results show two distinctively different contraceptive 'lifecycles'. Non-professional women typically have little knowledge about contraception until after their marriage or first birth. Their patterns of contraceptive behaviour show low levels of contraceptive use until after their first birth, when condom use is most prevalent. Non-professional women are influenced by their extended family, religion and cultural expectations on their fertility and family planning decisions. Professional women show an entirely different pattern of contraceptive behaviour. They are more likely to have knowledge about contraception before marriage, use some method of contraception throughout their childbearing years (typically the pill) and cite personal, practical or economic considerations in their fertility decisions rather than religious, cultural or extended family influences.     

Use of Contraception and Attitudes towards Contraceptive Use in Swedish Women - A Nationwide Survey

ObjectiveTo describe contraceptive use and attitudes towards contraceptive use in Sweden which has the highest abortion rate in Western Europe. Secondary objectives were to investigate knowledge of contraceptive methods and outcomes of unplanned and unwanted pregnancies.DesignTelephone survey.SettingNational survey of women living in Sweden.PopulationWomen between 16 and 49 years.MethodsThe survey contained 22 questions with free text and multi choice answers on demographics, contraceptive use, knowledge of and attitudes towards contraception, the importance of monthly bleeding and experience of unintended pregnancy.ResultsA total of 1001 women participated in the survey. Of all women, 721/1001 (72.1%) currently used contraception whereas 268/1001 (26.8%) women did not. Long acting reversible contraception, (LARC; implant and intra uterine contraception) was used by 24.3% of women. The unmet need of contraception in Sweden was estimated at 8.9% (89/1001 women). A total of 781 (78%) women had never experienced an unintended pregnancy whereas 220 (22%) women had had at least one unintended pregnancy. Users and non-users alike stated that one of the most important characteristics of a contraceptive method is its effectiveness.ConclusionsSweden has a large unmet need for contraception. Furthermore, a large proportion of women have experienced at least one unintended pregnancy. Increasing contraceptive use and promotion of LARC is a possible way forward in the effort to reduce the rates of unwanted pregnancies.     

Fertility at low and high altitude in central Nepal

Abstract

Data are reported on ages of menarche, first marriage and first childbirth, migration, venereal disease, birth control, birth spacing and on completed fertility rate in populations of Central Nepal living at low (8,500 feet) and high altitude (12,400 feet). The high‐altitude population reported a significantly lower completed fertility rate which could be partly accounted for by later age at marriage and first childbirth and increased birth spacing. Longer post‐partum ammenorhea and breast feeding did not account for the increased average pregnancy gap.     

Premarital fertility in Namibia: trends, factors and consequences

Premarital fertility, defined as fertility before first marriage, was found to be highly prevalent in Namibia. According to data from the 1992 and 2000 DHS surveys, the proportion of premarital births was 43% for all births, and 60% for the first birth. This seemed to be primarily due to a late mean age at first marriage (26.4 years) and low levels of contraception before first marriage. Data were analysed using a variety of demographic methods, including multiple decrement life table and multivariate logistic models. Major variations were found by ethno-linguistic groups: Herero and Nama/Damara had the highest levels of premarital fertility (above 60%); Ovambo and Lozi had intermediate levels of premarital fertility (around 40%); Kavongo and San appeared to have kept a more traditional behaviour of early marriage and low levels of premarital fertility (around 20%). The largest ethno-linguistic group, the Ovambo, were in a special situation, with fast increasing age at marriage and average level of premarital fertility. Whites and mixed races also differed, with Afrikaans-speaking groups having a behaviour closer to the average, whereas other Europeans had less premarital fertility despite an average age at marriage. Ethnic differences remained stable after controlling for various socioeconomic factors, such as urbanization, level of education, wealth, access to mass media, and religion. Results are discussed in light of the population dynamics and political history of Namibia in the 20th century.     

Determinants of the sex ratio at birth: Review of recent literature

Abstract

Use of contraception by rural Egyptian women who desire no more children is examined within a modified microeconomic framework. Four sets of factors are hypothesized to influence current use of contraception: (1) costs of contraception, ‘(2) factors influencing the slope of the desired family size function, (3) anticipated costs of child rearing and (4) strength of motivation for fertility regulation. Women's education and two measures of psychic costs were found to be important predictors of contraceptive use. Factors affecting the demand for children and thus indirectly influencing the motivation for fertility regulation were also important. Land ownership, cultivating status of the household, and educational expectations for children were significantly related to current use. Strength of motivation, although significant, was less strongly related to use of contraception. The findings suggest women who want no more children, but who are not practicing contraception, are affected by factors influencing both the costs of contraception and the costs of an unwanted child.     

Differential fertility in Bangladesh: A path analysis

Abstract

This study attempts to show both theoretically and empirically the causal links between selected background, socioeconomic, and demographic variables, on the one hand, and between these variables and cumulative fertility, on the other. Two distinct models, urban and rural, emerge as a result of a statistical test. In both models, neither wife's nor husband's childhood background is found to have any significant direct effects on fertility. Wife's age, religion, and age at marriage are the common variables which directly affect the number of children ever born. While age and religion bear positive direct effects, age at marriage exerts a negative direct effect. The indirect effect of religion is positive both in the rural and urban area. Both the direct and indirect effects of wife's education on fertility in urban Bangladesh are negative. Husband's education, in contrast, has a positive direct effect in the urban area and no effect at all in the rural area.     

Social and biological determinants of age at first marriage in Taiwan, 1970

Abstract

This study examines the social and biological determinants of age at first marriage in two townships in northern Taiwan, one very rural and traditional and the other urban and modernized. For a sample of 5,707 once‐married women a path analysis was performed in which age at first marriage was considered a function of age, educational attainment, urban origin, premarital labor‐force participation, and age at menarche. Age at menarche, with a positive effect on the dependent variable, was the most important direct cause of age at first marriage. Although exogenous variables associated with modernization (urban origin, educational attainment and younger age) had a positive direct effect on age at first marriage, they also had a negative indirect effect on age at first marriage through their negative direct effect on age at menarche.     

Inbreeding and immigration in urban and rural zones of Chile,with an endogamy index

Abstract

From ecclesiastical and civil data on consanguinity, age at marriage, and immigration in Chile from 186S to 1914, comparisons between urban and rural zones are made. A random mating deviation index is developed, and the values indicate deviation toward endogamy in both zones. These values show an inverse relation to those of the exogamy index developed by Freire‐Maia and Freire‐Maia (1963). Values in the rural zone are double those in the urban zone. In the two zones there are no clear differences in age at marriage between consanguineous and nonconsanguineous couples. Thus, we might expect lower fertility in consanguineous marriages only because of a higher probability of homozygosis of deleterious genes.