Unmet need for contraception among HIV-positive women in Lesotho and implications for mother-to-child transmission

In Lesotho, the risk of mother-to-child-transmission (MTCT) of HIV is substantial; women of childbearing age have a high HIV prevalence rate (26.4%), low knowledge of HIV status and a total fertility rate of 3.5 births per woman. An effective means of preventing MTCT is to reduce unwanted fertility. This paper examines the unmet need for contraception to limit and space births among HIV-positive women in Lesotho aged 15-49 years, using the 2004 Lesotho Demographic and Health Survey. HIV-positive women have their need for contraception unmet in almost one-third of cases, and multivariate analysis reveals this unmet need is most likely amongst the poor and amongst those not approving of family planning. Urgent action is needed to lower the level of unmet need and reduce MTCT. A constructive strategy is to improve access to family planning for all women in Lesotho, irrespective of HIV status, and, more specifically, integrate family planning with MTCT prevention and voluntary counselling and testing services.     

Fertility and legal abortion in England and Wales: performance indicators for family planning services.

The relation between fertility rates and legal abortion rates was investigated in a sample of health authorities in England and Wales to see how these varied. Total period fertility rates and total period legal abortion rates were derived from the average number of live births or legal abortions that would be experienced per woman if women experienced the age specific rates of the year in question throughout their childbearing years. The sample of 30 health authorities was selected by taking the districts with the highest and lowest fertility rates in each English region and in Wales in 1986. Total period fertility rates varied from 1.37 in Riverside to 2.42 in Tower Hamlets, while abortion rates varied from 0.25 in East Yorkshire to 0.99 in Riverside. When the two rates were added to provide a potential fertility rate it became clear that some districts with similar potential fertility rates had very different underlying component rates. Such comparisons can be used for service monitoring, indicating the need for better abortion and family planning services in districts with high fertility rates and for better family planning services in those with high abortion rates.     

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.     

Are husbands a barrier to women's family planning use? The case of Morocco

Little is known about men's role in the adoption of family planning. Recent studies suggest that men may be a barrier to women's use of family planning. However, it is not clear whether husbands represent a true or a perceived barrier. Using the 1992 Morocco Demographic and Health Survey data, this study examines (1) whether women and men report concordant fertility desires, discussions, and contraceptive use; (2) the accuracy of women's perceptions of their husbands' fertility desires; and (3) whether husbands are a barrier to women's family planning use. The results demonstrate that, controlling for women's own fertility desires, husbands' true fertility desires are associated with family planning use. Likewise, women who perceive their husbands to want fewer children than they want are more likely to use family planning. Future fertility and family planning programs need to include men to reduce their role as both perceived and true barriers to family planning use.     

Male fertility attitudes: a neglected dimension in Nigerian fertility research

A sample of 202 male Nigerians enrolled in colleges and graduate schools in the state of Kansas were surveyed to determine their perceptions of population problems in Nigeria; attitudes toward family planning, divorce, and male children; and attitudes toward family size. A major limitation of Nigerian-based fertility research has been the neglect of the role of men in couples' reproductive behavior. The majority of Nigerian students surveyed in this study did not think overpopulation is an impending crisis in Nigeria: 40% thought there are just enough people and 13% indicated there are not enough people. 53% supported the concept of a government population policy, but 67% felt the government should not interfere with family size decisions. Although 84% endorsed the idea that family planning services and information should be available, 69% felt women should not practice family planning without the consent of their husbands. 43% believed a man should divorce his wife if the woman is infertile, unable to produce a male child, or unable to bear the number of children demanded by her husband; in addition, 35% indicated a man should marry a second wife or continue to have children if the couple has 5 daughters and no son. In terms of the value of children, 62% stated that children are wealth or better than wealth, whereas 38% claimed that children use up wealth. Duration of stay in the US was inversely correlated with the number of children considered too many, and the number of male children already born was an important determinant of future family size expectations. In general, it appears that level of education and exposure to US standards do not have a major impact on fertility values among Nigerians, particularly the desire for male children. Educated Nigerian men are an important target for population education, however, because they dominate and control many of the structural, behavioral, and cultural dimensions of fertility behavior.     

Family planning in rural Adana, Turkey

This study of family planning in rural Adana, Turkey, collected data from 519 women aged between 16 and 55. Questionnaires were distributed in different districts during February 2006. Ths results showed that 81.3% of women used a contraceptive method. The IUD was the most widely used modern contraceptive method. There is a decrease in the average number of births per woman as the educational level of women increases.     

Determinants of contraceptive use and method choice in Turkey

In this study, the determinants of contraceptive use and method choice are examined based on various variables, classified as individual, cultural, fertility and contextual. The data used came from the 1993 Turkish Demographic and Health Survey. The main finding is that there exists a positive association between the educational level of both spouses and the use of contraceptive methods in Turkey. After all individual, cultural, fertility and contextual variables are controlled, a woman's education is a stronger predictor of method use and method choice than that of her husband. Increasing the educational level of women may be the most effective means of advancing family planning acceptance and increasing the demand for contraceptive services in Turkey. The study also shows that, to a great extent, contraceptive use and choice of modern method depend on the sex of a couple's living children, implying some preference for sons, although generally women prefer to have children of both sexes.     

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.     

Population genetics study of the differential fertility in urban populations

In an urban population with widespread birth control practice the distribution of the number of pregnancies, births and abortions was studied in a cohort of women of completed fertility. The mean number of pregnancies per woman was 4.03 +/- 0.08 (sigma = = 2.98); the mean number of births - 1.12 +/- 0.02 (sigma = 0.77). 7.4% of women which had completed their reproductive performance had no pregnancies and 19.5% - no births. The Crow's Index of the Opportunity for Selection and its components connected with differential fertility and differential mortality were estimated. In the population under study two components of selection - selection at the prenatal stages and selection associated with infertility - are shown to be still significant. Such type of selection is exemplified by investigation of couples suffering from repeated spontaneous abortions.     

Analysing the relationship between family planning workers' contact and contraceptive switching in rural Bangladesh using multilevel modelling

With a population of over 131 million and a fertility rate of 29.9 per 1000, population growth constitutes a primary threat to continued economic growth and development in Bangladesh. One strategy that has been used to cease further increases in fertility in Bangladesh involves using family planning outreach workers who travel throughout rural and urban areas educating women regarding contraceptive alternatives. This study uses a longitudinal database to assess the impact of family planning outreach workers' contact upon contraceptive switching and upon the risk of an unintended pregnancy. Using longitudinal data on contraceptive use from the Operations Research Project (ORP) of the International Centre for Diarrhoeal Disease Research (ICDDR,B) in Bangladesh, multiple decrement life table analysis and multilevel, discrete-time competing risk hazards models were used to estimate the cumulative probabilities of switching to an alternative form of contraceptive use after a woman engaged in a discussion with an outreach worker. After controlling for the effects of socio-demographic and economic characteristics, the analysis revealed that family planning outreach workers' contact with women significantly decreases the risk of transitioning to the non-use of contraceptives. This contact also reduces the risk of an unintended pregnancy. Family planning workers' contact with women is associated with the increased risk of a woman switching from one modern method to another modern method. The study results indicate that side-effects and other method-related reasons are the two primary reasons for contraceptive discontinuation in rural Bangladesh.     

Factors affecting ever-married men's contraceptive knowledge and use in Nigeria

African men play important roles in the decisions about family life, including fertility and family planning. However, fertility and family planning research and programmes have ignored their roles in the past, focusing only on women's behaviours. Since the 1994 International Conference on Population and Development (ICPD), interest in men's involvement in reproductive health has increased. Unfortunately, data on their knowledge and use of contraception are generally scanty. This paper examines knowledge and use of contraception among ever-married men in Nigeria. A total of 1451 ever-married men aged 18-55 were interviewed in Imo and Ondo States, Nigeria. The findings reveal that men's level of contraceptive knowledge is high in the study areas. About 90% knew at least one method of family planning. Furthermore, the level of contraceptive use among married men is such that men could participate in family planning activities if there were adequate programmes to involve them. Men in the sample areas were found not only to support their spouses' use of contraceptives, but were actually using condoms to delay or prevent pregnancy. Age, education, place of residence, number of living children and being counselled for family planning were identified as key factors determining contraceptive knowledge and use among married men in the study areas. To ensure increased participation of men in family planning, programmes must be designed to educate them on the need for family size limitation and involve them in service delivery, even if only to their male counterparts.     

Breast-feeding in Bangladesh

In this paper the duration of breastfeeding is examined in relation to demographic and socioeconomic characteristics of women and households. 98% of Bangladesh mothers breastfeed their children from birth. In data from the Bangladesh Fertility Survey conducted in 1975-1976 on 4998 live births, the mean duration of breastfeeding was 27.3 months. Duration of breastfeeding was positively related with the age of women. Female children were breastfed for periods about 5 months shorter than male children. Children born to urban mothers were breastfed for shorter durations than children born to rural mothers of all age groups. The duration of breastfeeding decreased with the increase of education of the mother. Promotion of breastfeeding should be a primary responsibility of family planning clinics. Further decline in the duration of breastfeeding would increase levels of fertility and infant and child mortality.     

Number and sex ratio of children and impact of parental diabetes in individuals with Type 1 diabetes

Diabet. Med. 29, 1268-1271 (2012) ABSTRACT: Objective To assess the number and sex ratio of children in individuals with Type?1 diabetes mellitus and the influence of parental diabetes on age at onset of Type?1 diabetes in our cohort. Methods In a cross-sectional study in a German region comprising 350?000 inhabitants, 697 subjects with Type?1 diabetes (364 women, 333 men) underwent a standardized assessment regarding the number and sex of their children and the family history of diabetes. Results Compared with 1.36 children per woman in the German background population, the total fertility rate in the calendar year of 2010 in our female cohort with Type?1 diabetes (age 18-49?years) was 0.88. Men with Type?1 diabetes had a fertility rate of 0.65. More men (51.1%) than women (35.7%; P?相似文献   

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.     

Demographic and endocrinological aspects of low natural fertility in Highland New Guinea

The Gainj of highland Papua New Guinea do not use contraception but have a total fertility rate of only 4.3 live births/woman, 1 of the lowest ever recorded in a natural fertility setting. Reproductive and marital histories were obtained from 305 females and 206 males aged 10+. Each subject was asked about: number of live born offspring ever produced; number of stillbirths ever produced; number and names of offspring currently being nursed; number of current and past spouses; and the cause of dissolution of all past marriages. Blood samples were drawn from 172 volunteer female subjects aged 10-60 years and ovarian function was classified by concentration of progesterone. From an analysis of these cross-sectional demographic and endocrinological data, the causes of low reproductive output have been identified in women of this population as: late menarche and marriage, a long interval between marriage and 1st birth, a high probability of widowhood at later reproductive ages, low effective fecundability and prolonged lactational amenorrhea. These are combined with near-universal marriage, and a low prevalence of primary sterility similar to that found in other populations. Of all the factors limiting fertility, by far the most important are those involved in birth spacing, especially lactational amenorrhea. The effects of widowhood on Gainj fertility are negligible. Factors acting to lower fertility fall into 2 categories: those that determine the age of onset of reproduction and those that act to space births. Given the observed pattern of birth spacing, however, the delay in commencement of reproduction represents on average no more than 1 or 2 live births averted/woman. In contrast, were age at 1st reproduction held constant while reducing birth intervals to a mean of 2.0-2.5 years, total fertility would increase to about 7 or 8. Future research on natural fertility should focus on specific behavioral and physiological mechanisms governing the reproductive process.     

Men's social networks and contraception in Ghana

In this paper, longitudinal data from northern Ghana is used to assess the effects of encouragement to use family planning that men receive from their personal network partners on the adoption of modern contraception by their wives. The study tests a conceptual model that, in addition to the effect of men's network encouragement, incorporates the effect of encouragement to use family planning that women receive from their respective network partners and the effect of spousal communication on reproductive matters and approval of family planning. Results show that encouragement received by men from their social networks significantly increases the likelihood of subsequent contraceptive use by their wives but this effect operates primarily by galvanizing spousal communication on reproductive matters. The effect of encouragement received by women from their respective network partners is largely independent from the effect of male network encouragement but it influences contraceptive adoption both directly and through spousal communication.     

Fertility trends in Singapore

In 1966, the Singapore National Family Planning and Population Program established the goal of reaching replacement fertility by 1990 and zero population growth by the year 2030. To achieve this goal, the government relied on a series of incentives and disincentives to discourage births above the 3rd birth order, including tax relief for the 1st 3 children only, paid medical leave for women undergoing sterilization after the 3rd or subsequent birth, monetary stipends in some cases where the mother is sterilized after the 1st or 2nd birth, and increasing accouchement charges for increasing birth orders. Also important to demographic planning were liberalization of Singapore's abortion legislation and more aggressive promotion of contraception. As a result of these efforts, Singapore's crude birth rate has declined from 29.5/1000 population in 1965 to 16.6/1000 in 1985. Also observed have been dramatic declines in infant mortality in this same period, from 26.2/1000 live births to 9.3/1000, and in maternal mortality, from 52/100,000 live births to 10/100,000. In 1985, 42% of total births were to women in the 25-29-year age group. The numbers of 4th and later births fell by 90% between 1966 and 1985. The total fertility rate has declined from 4.6/woman in 1965 to 3.1 in 1970 to 1.6 in 1986. Below replacement level fertility was achieved in 1975, in part because of government policy but also as a result of cultural and socioeconomic factors such as increasing female labor force participation rates, a break-up of the extended family system, a rise in the age at 1st marriage, and rises in educational attainment. The drop in fertility was contributed mainly by the higher socioeconomic class, more affluent, and educated Singaporeans. Thus, in 1981, the government introduced certain pronatalist policies and incentives to encourage better educated women to produce more children, e.g., tax relief and the elimination of monetary incentives to sterilization acceptors above a median income level.     

Reproductive Responses to Economic Uncertainty

In the face of economic and political changes following the end of the Soviet Union, total fertility rates fell significantly across the post-Soviet world. In this study we examine the dramatic fertility transition in one community in which the total fertility rate fell from approximately five children per woman before 1993 to just over one child per woman a decade later. We apply hypotheses derived from evolutionary ecology and demography to the question of fertility transition in the post-Soviet period, focusing on an indigenous community (Ust’-Avam) in the Taimyr Region, northern Russia. We employ a mixed parametric accelerated failure-time model that allows comparison of age at first birth, interbirth interval, and reproductive postponement or cessation prior to and following 1993. We find that short-term reproductive delay alone does not explain the dramatic drop in fertility in Ust’-Avam. Age at first birth remains constant. Interbirth intervals increase moderately. The estimated fraction of women who have ceased or indefinitely postponed reproducing doubles (for parities 2 through 4) or triples (for nulliparous women). We caution against assuming that environmental harshness necessarily leads to earlier and more rapid reproduction. An evolutionary theory of fertility responses to acute environmental shocks remains relatively undeveloped. In such contexts it is possible that selection favors a conservative reproductive strategy while more information is learned about the new environment. When investigating fertility responses to environmental stressors we suggest researchers examine postponement and stopping behavior in addition to changes in age at first birth and interbirth interval.     

Ethnic and gender consensus for the effect of waist-to-hip ratio on judgment of women’s attractiveness

The western consensus is that obese women are considered attractive by Afro-Americans and by many societies from nonwestern developing countries. This belief rests mainly on results of nonstandardized surveys dealing only with body weight and size, ignoring body fat distribution. The anatomical distribution of female body fat as measured by the ratio of waist to hip circumference (WHR) is related to reproductive age, fertility, and risk for various major diseases and thus might play a role in judgment of attractiveness. Previous research (Singh 1993a, 1993b) has shown that in the United States Caucasian men and women judge female figures with feminine WHRs as attractive and healthy. To investigate whether young Indonesian and Afro-American men and women rate such figures similarly, female figures representing three body sizes (underweight, normal weight, and overweight) and four WHRs (two feminine and two masculine) were used. Results show that neither Indonesian nor Afro-American subjects judge overweight figures as attractive and healthy regardless of the size of WHR. They judged normal weight figures with feminine WHRs as most attractive, healthy, and youthful. The consensus on women’s attractiveness among Indonesian, Afro-American, and U.S. Caucasian male and female subjects suggests that various cultural groups have similar criteria for judging the ideal woman’s shape.     

Premarital childbearing in northwest Kenya: challenging the concept of illegitimacy

A number of African countries, including Kenya, have experienced a marked rise in births among unmarried women. In Western countries, reproduction outside of marriage is assumed to be illegitimate and a social problem. One hypothesis used to explain the increasing incidence of premarital fertility in Africa is a breakdown of traditional social controls by the extended family over the sexual behavior of adolescents. A competing hypothesis suggests that unmarried women use sexual relations to achieve goals such as marriage. Among Turkana pastoralists of northwest Kenya, we find a pattern of premarital birth that fits either hypothesis only loosely. Premarital fertility among the Turkana is both widespread and culturally acceptable, with over 30 per cent of women having at least one child prior to marriage. Although women with premarital births initiate childbearing on average one year earlier than women with only marital births, women's marital status does not influence the length of the interval between first and second births. Marriage among the Turkana is not a social trigger for the onset and continuation of reproduction or a means to legitimate reproduction. Marital status of the parents simply determines the custody of a child. In a premarital birth, the father pays a set fee to the mother's family, and the custody of the child remains permanently with the mother's family. If the parents later marry, the father must purchase custody of the child by another fee at that time. Since the Turkana have experienced few effects of modernization, the existence of such a practice suggests that cultural factors must be taken into account before assessing premarital fertility in Africa as a social problem.