Mental health statistics of the future

Abstract

Sterilized and non‐sterilized males and females are compared with respect to the effects of voluntary sterilization on longitudinally reported changes in desire for sexual intercourse in order to ascertain which of several alternative hypotheses provides the best prediction of postoperation perceptions of changes in sexual desire. The results indicate that sterilized women are less likely than sterilized men to report enhanced desire, a result that supports the idea that a gender‐specific explanation of sterilization effects is required to account for the sexual consequences of sterilization.     

Regret,shame, and denials of women's voluntary sterilization

Women face extraordinary difficulty in seeking sterilization as physicians routinely deny them the procedure. Physicians defend such denials by citing the possibility of future regret, a well‐studied phenomenon in women's sterilization literature. Regret is, however, a problematic emotion upon which to deny reproductive freedom as regret is neither satisfactorily defined and measured, nor is it centered in analogous cases regarding men's decision to undergo sterilization or the decision of women to undergo fertility treatment. Why then is regret such a concern in the voluntary sterilization of women? I argue that regret is centered in women's voluntary sterilization due to pronatalism or expectations that womanhood means motherhood. Women seeking voluntary sterilization are regarded as a deviant identity that rejects what is taken to be their essential role of motherhood and they are thus seen as vulnerable to regret.     

Managing feral cats on a university's campuses: how many are there and is sterilization having an effect?

Worldwide domestic and feral cat (Felis catus) numbers have increased. Concerns regarding high populations of feral cats in urban areas include wildlife predation, public nuisance, and disease. This study aimed to estimate the size of the feral cat population on 5 campuses of the University of KwaZulu-Natal, South Africa, to determine whether sterilization has an effect and to make management recommendations. The study used both the total count and mark-recapture methods to estimate the feral cat population on each campus. The study chose a noninvasive method of taking photographs to "mark" individuals and record those who were sterilized. The study estimated a total of 186 cats on all campuses and density at 161 cats km(-2). There was a negative relationship between sterilization and numbers. Sites with higher sterilization showed a lower proportion of younger cats. At the average sterilization of 55%, the population, according to predictions, would remain stable at fecundity, survival, and immigration rates reported by cat caretakers. However, caretakers underestimated cat abundance by 7 ± 37 SD%. Caretakers' feral cat sterilization and feeding programs appear to provide a service to the university community. Key management recommendations were to increase sterilization to 90% to reduce the population over the long term and to raise funds to support the costs incurred by voluntary cat caretakers.     

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.     

Managing Feral Cats on a University's Campuses: How Many Are There and Is Sterilization Having an Effect?

Worldwide domestic and feral cat (Felis catus) numbers have increased. Concerns regarding high populations of feral cats in urban areas include wildlife predation, public nuisance, and disease. This study aimed to estimate the size of the feral cat population on 5 campuses of the University of KwaZulu-Natal, South Africa, to determine whether sterilization has an effect and to make management recommendations. The study used both the total count and mark-recapture methods to estimate the feral cat population on each campus. The study chose a noninvasive method of taking photographs to “mark” individuals and record those who were sterilized. The study estimated a total of 186 cats on all campuses and density at 161 cats km^?2. There was a negative relationship between sterilization and numbers. Sites with higher sterilization showed a lower proportion of younger cats. At the average sterilization of 55%, the population, according to predictions, would remain stable at fecundity, survival, and immigration rates reported by cat caretakers. However, caretakers underestimated cat abundance by 7 ± 37 SD%. Caretakers' feral cat sterilization and feeding programs appear to provide a service to the university community. Key management recommendations were to increase sterilization to 90% to reduce the population over the long term and to raise funds to support the costs incurred by voluntary cat caretakers.     

Case for mandatory fortification of food with folate in Australia, for the prevention of neural tube defects

BACKGROUND: Since the publication of randomized controlled trials demonstrating the prevention of neural tube defects (NTDs) with periconceptional folate, several Australian states have promoted an increase in periconceptional use of folic acid supplements. Since 1996, voluntary fortification of food with folate has been allowed in Australia and New Zealand for the purpose of preventing NTDs. METHODS: For this report, we synthesized published and unpublished data on folic acid supplement use, voluntary fortification, and trends in NTDs. RESULTS: There has been an increase in the proportion of women (up to 30-40%) taking periconceptional folic acid supplements in Australia, and many foods (mainly breakfast cereals) are fortified. Supplement use is strongly correlated with educational and socioeconomic status; consumption of voluntarily fortified foods is not. There has been a fall in NTDs of about 30% in the non-Aboriginal population, but no change has been seen in the Aboriginal population. CONCLUSIONS: These data support mandatory fortification of food as a more equitable approach to achieving sufficient folate intake in the periconceptional period for all women in Australia and New Zealand to prevent the majority of NTDs in their offspring. In May 2004, based on these and other considerations, the Australia and New Zealand Food Regulation Ministerial Council agreed that mandatory fortification of food with folate should be considered as a priority.     

Declining fertility among North American Hutterites: the use of birth control within a Dariusleut colony

Historically, population researchers considered the Hutterites the champions of high fertility, since they most closely approximated the human fertility potential. Yet contemporary researchers have found evidence of a decline in fertility and a shift from natural to controlled fertility behavior among the Hutterite population. Various reasons for these recent changes have been suggested, including the use of birth control. Using interview data from a Dariusleut colony, this is the first paper to document the presence and prevalence of birth control among the North American Hutterites. All interviewed women recognized the use of birth control and reported that female sterilization was the most commonly used method. I address how the various forms of birth control and the reasons for its use relate to the Hutterite ideology.     

Assessing the reproductive behavior of on- and off-reservation American Indian females: characteristics of two groups in Montana

Only limited fertility and general reproductive health data exist on American Indians. Using data from the 1987 Montana American Indian Health Risk Assessment, we found that the fertility of American Indians in Great Falls and on the Blackfeet Reservation was similar to blacks in the U.S. and relatively high when compared with fertility of whites in the United States. The influence of the direct determinants of fertility (nuptiality, contraceptive use, and lactation) was very different for the populations examined in this study. Great Falls American Indians and the U.S. black population were similar regarding age at first sexual intercourse (very young), breastfeeding (low prevalence and short duration), planning status of pregnancies (high unplanned), and contraceptive use (only moderate use). In contrast, Blackfeet women on the reservation and the U.S. white population married relatively late, had very high contraceptive use, used effective methods of contraception, and had moderately high levels of breastfeeding. However, Blackfeet fertility was much higher than that of whites. Three interrelated reasons are suggested as possible explanations. Blackfeet couples either wanted high fertility, were relatively poor users of family planning methods, or used less effective methods until they had exceeded their desired family size after which time they turned to sterilization. These finds raise numerous questions concerning the social and economic factors that may account for these group similarities and differences. Further studies with much larger data sets are needed to address these issues adequately.     

Sterilization in Canberra

The discussion in this article uses data from the 1979 Canberra Population Survey to assess the degree and nature of the resistance to the use of sterilization, particularly male sterilization. In the 1979 Canberra Population Survey, respondents were asked what methods of contraception they would recommend to a couple who had completed their family. About 2/3 recommended sterilization, with vasectomy a more popular 1st choice, particularly for male respondents, than tubal ligation. Compared to 20% of the 1978 sample, 27% of the 1979 sample reported use of sterilization; the increase may reflect not only the increasing popularity of sterilization, but also improved reporting. The 1979 survey provides some confirmation of the forecast that 60% of Australian couples would use contraceptive sterilization as a method of birth control in their fertile lifetime. However, the forecast that the importance of vasectomy may come to equal that of tubal ligation seems highly unlikely, even though there seems to be some recognition by Canberra respondents that vasectomy is simple, safe and reliable. Data from the Canberra survey shows that although a majority of respondents would use sterilization, female sterilization would be preferred largely because men were more resistant to the idea than females. Other researchers have commented on the feeling that fertility decisions and contraception are ultimately the wife's concern. Respondents born outside Australia, the United Kingdom, and Eire were more resistant to the idea of sterilization, but reported higher use of tubal ligation. It is presently suggested that the choice of vasectomy or tubal ligation, or resistance to these methods, may in fact be important indicators of the assimilation of immigrants and of husband-wife communication of Australia. Future studies of sterilization in Australia might profit from focusing on sterilizationas an independent rather than a dependent variable.     

Gender relations: husband-wife fertility and family planning decisions in Kenya

Although Kenya's fertility rate has declined from 6.7 births per woman in the mid-1980s to 5.4 births per woman in 1993 (NCPD, 1994), population growth is still high, yielding a doubling time of 35 years. This study uses the 1993 Kenya Demographic Health Survey data collected from 1257 couples to examine the socioeconomic and sociodemographic characteristics of married men and women and their communication with their spouses over fertility and family planning decision-making practices. The logistic regression analysis shows that education for both men and women, discussion of fertility and family planning between spouses, male approval of use of contraception and male family size desires are important factors that influence ever-use of family planning.     

Sterilization and union instability in Brazil

Brazilian women rely on sterilization as the main source of birth control. Sterilization has been one of the causes of the steep decline in fertility in Brazil, at least since the second half of 1970. It is hypothesized that understanding couples' relationships might be key to explaining this high rate of female sterilizations. Possible reasons for the higher level of fertility among women in unstable unions than among women in stable ones could be the less effective use of contraceptive methods, or that women in unstable unions tend to use less effective or reversible contraceptive methods. In this paper discrete time modelling of the timing of sterilization according to union histories is presented. The analysis uses the calendar data of the 1996 Brazilian DHS. It is shown that women in second or higher order unions have a lower risk of sterilization. This result should be taken into account in the analysis of the determinants of female sterilization in Brazil.     

The theoretical and political framing of the population factor in development

The silence about population growth in recent decades has hindered the ability of those concerned with ecological change, resource scarcity, health and educational systems, national security, and other global challenges to look with maximum objectivity at the problems they confront. Two central questions about population—(i) is population growth a problem? and (2) what causes fertility decline?—are often intertwined; if people think the second question implies possible coercion, or fear of upsetting cultures, they can be reluctant to talk about the first. The classic and economic theories explaining the demographic transition assume that couples want many children and they make decisions to have a smaller family when some socio-economic change occurs. However, there are numerous anomalies to this explanation. This paper suggests that the societal changes are neither necessary nor sufficient for family size to fall. Many barriers of non-evidence-based restrictive medical rules, cost, misinformation and social traditions exist between women and the fertility regulation methods and correct information they need to manage their family size. When these barriers are reduced, birth rates tend to decline. Many of the barriers reflect a patriarchal desire to control women, which can be largely explained by evolutionary biology. The theoretical explanations of fertility should (i) attach more weight to the many barriers to voluntary fertility regulation, (ii) recognize that a latent desire to control fertility may be far more prevalent among women than previously understood, and (iii) appreciate that women implicitly and rationally make benefit–cost analyses based on the information they have, wanting modern family planning only after they understand it is a safe option. Once it is understood that fertility can be lowered by purely voluntary means, comfort with talking about the population factor in development will rise.     

Contraception after childbirth in Thailand

Data from the Third Contraceptive Prevalence Study conducted in 1984 in Thailand were analyzed to learn the extent of contraceptive practice after childbirth. Focusing on those women who had a birth within a given period prior to the survey, for some purposes the analysis was limited to those women whose most recent birth occurred within 1 year of interview, while for others it was extended to women whose most recent birth occurred within the last 2-4 years. The number of women in 4 years following childbirth in the Contraceptive Prevalence Survey 3 sample were 3442 in the unweighted ever married group and 3342 in the unweighted currently married group; the figures were 3447 for the weighted ever married group and 3342 for the weighted currently married group. Thai couples adopted contraception in very substantial proportions and very soon following the birth of a child. Based on women interviewed within 1 year of most recent birth, over half started some contraception by the end of the 6th month and almost 4/5 by the end of the 1st year. The timing of female sterilization was quite different from initiation of all other methods. Female sterilization in Thailand occurred primarily during the immediate postpartum period, while women are still in the hospital after delivery. Relatively few women sterilized in the 2 years following the 1st postpartum month. Of women in their first 2 years following childbirth, 17% were sterilized by the end of the 1st postpartum month and only an additional 3% by the end of the 2nd year. Initiation of temporary methods was not linked to the immediate postpartum period but occurred throughout the 1st year following birth. Contraceptive use during the 1st year following childbirth was more likely among menstruating women than among women who were still amenorrheic. Methods other than female sterilization predominated among women who already experienced the return of menses, suggesting that the return of menses was an important stimulus to their adoption. The data suggest that the proportion of Thai women exposed to risk of unwanted pregnancies for any extended period of time following childbirth is quite modest.     

Nonsurgical fertility control for managing free-roaming dog populations: A review of products and criteria for field applications

About 75% of dogs worldwide are free to roam and reproduce, thus creating locally overabundant populations. Problems caused by roaming dogs include diseases transmitted to livestock and humans, predation on livestock, attacks on humans, road traffic accidents, and nuisance behavior. Nonsurgical fertility control is increasingly advocated as more cost-effective than surgical sterilization to manage dog populations and their impact. The aims of this review were to 1) analyze trends in numbers of scientific publications on nonsurgical fertility control for dogs; 2) illustrate the spectrum of fertility inhibitors available for dogs; 3) examine how differences between confined and free-roaming dogs might affect the choice of fertility inhibitors to be used in dog population management; and 4) provide a framework of criteria to guide decisions regarding the use of nonsurgical fertility control for dog population management. The results showed that the 117 articles published between 1982 and 2011 focussed on long-term hormonal contraceptives, such as gonadotropin-releasing hormone agonists, immunocontraceptives, and male chemical sterilants. The number of articles published biennially increased from one to five papers produced in the early 1980s to 10 to 20 in the past decade. Differences between confined dogs and free-roaming dogs include reproduction and survival as well as social expectations regarding the duration of infertility, the costs of sterilization, and the responsibilities for meeting these costs. These differences are likely to dictate which fertility inhibitors will be used for confined or free-roaming dogs. The criteria regarding the use of fertility control for dog population management, presented as a decision tree, covered social acceptance, animal welfare, effectiveness, legal compliance, feasibility, and sustainability. The review concluded that the main challenges for the future are evaluating the feasibility, effectiveness, sustainability, and effects of mass nonsurgical sterilization campaigns on dog population size and impact as well as integrating nonsurgical fertility control with disease vaccination and public education programs.     

The Spanish woman and birth control

The author presents in this article just a small part of the results obtained in national survey of 1.902 married women, carried out in 1972, on "fertility and family planning in Spain". More specifically, attitudes of this sample of Spanish married women towards family planning are explained. It is pointed out, in the first place, that eight out of every ten interviewed women say that all married couples who can have children ought to have them. Younger women and those with a higher socio-econimic status, however, are less in favor of that statement. Trough several questions it is also evident that the number of interviewees who think that other women control their fertility is higher the more distant from the respondent is the social circle about which the question is formulated. In other words, interviewees resist to admit that persons with whom they are more intimately related control their fertility. Approximately half the women in the sample say that married couples should have as many children as may come, but the other half say that couples should decide the number of children they want to have and when they want to have them. This last opinion is relatively more important among younger and higher status women. Along with the previous finding, almost half of the interviewees are very much in favor or rather in favor of family planning, that proportion being even higher among younger and higher status women. Finally, seven ou of every ten respondents say that there should be wide and complete information about all family planning methods, leaving it up to each individual to use or not to use them according to its own conscience. This opinion, of course, is also more common among younger and higher status women.     

Behavioral mechanisms of male sterilization on plateau pika in the Qinghai-Tibet plateau

Fertility control is an alternative non-lethal method in the management of rodents. Previous modeling suggests that the efficacy of male sterilization depends on mating systems of animals, but behavioral mechanisms of male sterilization have not been investigated. Here we investigated the behavioral mechanism of the sterilant quinestrol in reducing the fertility of plateau pika (Ochotona curzoniae) inhabiting the Qinghai-Tibet plateau. Male pikas treated with quinestrol showed reduced aggression compared to control males, but they showed significantly higher levels of territorial behavior such as long-calls and long-chases. Levels of long-call and long-chase were negatively correlated with the number of newborn pikas in the family. Single-baiting of quinestrol effectively sterilized male pikas and reduced the pregnancy rate of female pikas; this was likely achieved by increased territorial behavior of sterilized pikas which resulted in unsuccessful invasions by fertile adult male pikas. Our study reveals a novel behavioral mechanism, increased territoriality in sterilized males, in the fertility control of plateau pikas.     

Poststerilization regret among women: methodological considerations for the next decade

The literature concerning regret among women following voluntary sterilization shows a lack of methodological rigor. This paper reviews the 7 prospective studies of voluntary sterilization conducted since 1973 that are judged to have adequate design and measurement standards, and suggests methodological considerations for future research. 3 of the studies were conducted in the US, 2 in the UK, 1 in Thailand, and 1 in Pakistan. Only 3 of the 7 studies used control groups and only 3 used standardized pre- and posttest psychological measures. Subjects in all the studies requested sterilization on a voluntary basis. 4 of the 7 studies evaluated contraceptive and menstrual histories before and after sterilization. All the studies varied in their poststerilization follow-up intervals ranging from 2 months and 1 year to 18 months and 2 years. Attrition rates also varied widely across the studies. Although none of these studies presented percentages for precise measures of regret, the overall effect of the sterilization procedure was found to be positive. The relationship between regret and purported indicators of regret, such as depression, anxiety, menstrual difficulties, and desire for reversal, should be documented in prospective, controlled studies. Longer poststerilization follow-up periods are recommended. Responses of childless women and male partners to sterilization should also be considered in future studies. Finally, since repeated references are made to menstrual problems following voluntary sterilization, it is important that studies assessing poststerilization responses control for oral contraceptive (OC) use because OCs reduce menstrual flow and their discontinuation results in a return to normal, although heavier, menstrual flow.     

Two sons and a daughter: sex composition and women's reproductive behaviour in madhya pradesh, India

Summary This article examines how the sex composition of women's current children at the start of a pregnancy interval influences both fertility desires and the full range of reproductive actions women may take to realize them, including temporary contraception, abortion and sterilization, in Madhya Pradesh, India, where popular notions of ideal family size and sex composition are dominated by son preference. The analysis is conducted using a dataset of 9127 individual pregnancy intervals from a 2002 statewide representative survey of 2444 women aged 15-39 with at least one child. The results indicate that women's preferences go beyond a singular preference for male children, with the preferred composition of children being two boys and one girl. Women with this composition are 90% less likely to report having wanted another pregnancy (OR 0.097, p<0.01) relative to those with two girls. These preferences have significant implications for reproductive actions. While sex composition has no statistically significant effect on the use of temporary contraception, those with the preferred sex composition are twice as likely to attempt abortion (OR 2.436, p<0.01) and twelve times more likely to be sterilized (OR 12.297, p<0.01) relative to those with two girls only.     

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.     

Becoming voluntarily childless: An exploratory study in a Scottish city

Abstract

This paper looks at motives that inform the decision to remain voluntarily childless. It is assumed that voluntary childlessness is not a pathological condition nor is it determined by specific social situations. Situations provide the context within which motives emerge, in the case of voluntary childlessness providing individuals or couples with the opportunity to consider unconventional interpretations of family life that may eventually lead to its rejection. Individuals who become childless prior to finding a “partner” tend to come from families which deviated from the nuclear ideal and to reject parenthood. Those whose decision emerges after a “partnership” has been formed tend to have created alternative life styles and wish to protect the advantages of living without children. It is tentatively concluded that the proportion of couples remaining childless will increase.