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.     

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.     

The impact of fertility intentions on behavior: the case of sterilization

In this paper, we take a new approach to the question of whether or not intentions regarding future fertility affect fertility-related behavior. Our approach has three principal features: 1) it takes sterilization as its outcome, rather than pregnancy or birth; 2) it is based on a conceptual model in which fertility-related behavior is seen as determined by a long-range planning process, modified by unanticipated life course contingencies; and 3) it uses data on desired total family size. Using data from the National Survey of Families and Households, we find that achieving one's desired parity has a strong, persistent, and positive effect on the probability of sterilization, supporting our view of the long-term nature of fertility intentions. People do modify their behavior in the face of unanticipated contingencies, but those effects are unexpectedly small.     

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.     

Family size and children's education in Matlab, Bangladesh

This study examines the relationship between family size and children's education in Bangladesh for two periods - 1982 with high fertility and 1996 with low fertility - using data from the Matlab Health and Demographic Surveillance System of the ICDDR,B: Centre for Health and Population Research. Children aged 8-17 years (27,448 in 1982 and 32,635 in 1996) were selected from households where the mother was aged 30-49 years and the father was the head of household. Children's education was measured in terms of completed years of schooling: at least class 1 (among 8-17 year olds), at least class 5 (among 12-17 year olds) and at least class 7 (among 15-17 year olds). After controlling for all variables in the multivariate analyses, level of children's education was not found to be associated with family size during the high fertility period. The family size-education relationship became negative during the low fertility period. In both periods children of educated mothers from wealthier households and those who lived close to primary/high schools had more education, but this socioeconomic difference reduced substantially over time. Boys had more education than girls during the high fertility period but this difference disappeared during the low fertility period. As birth rates fall and the proportion of children from small families increases an increase in children's education is to be expected.     

Why do women stop reproducing before menopause? A life-history approach to age at last birth

Evolutionary biologists have long considered menopause to be a fundamental puzzle in understanding human fertility behaviour, as post-menopausal women are no longer physiologically capable of direct reproduction. Menopause typically occurs between 45 and 55 years of age, but across cultures and history, women often stop reproducing many years before menopause. Unlike age at first reproduction or even birth spacing, a woman nearing the end of her reproductive cycle is able to reflect upon the offspring she already has—their numbers and phenotypic qualities, including sexes. This paper reviews demographic data on age at last birth both across and within societies, and also presents a case study of age at last birth in rural Bangladeshi women. In this Bangladeshi sample, age at last birth preceded age at menopause by an average of 11 years, with marked variation around that mean, even during a period of high fertility. Moreover, age at last birth was not strongly related to age at menopause. Our literature review and case study provide evidence that stopping behaviour needs to be more closely examined as an important part of human reproductive strategies and life-history theory. Menopause may be a final marker of permanent reproductive cessation, but it is only one piece of the evolutionary puzzle.     

The delineation of fertility strategies in a tribal population of India: the Koyas of Koraput District,Orissa

Demographic data collected for a tribal population of India, the Koyas of Koraput District, Orissa, were examined in light of 2 models of reproductive behavior associated with the economic value of children: the replacement effect and son survivorship motivation. Both models are united in the concept that infant/child mortality affects subsequent fertility. The database consists of retrospective fertility histories of Koya women who had completed their reproductive period. The total number was 260, with the total offspring numbering 1407. 2 distinct cohorts of women were formed for the purpose of analysis, separated only by the criterion of offspring survival: women who had experienced infant child mortality (129 women with 739 children); and women who completed their reproductive period without suffering offspring loss of this nature (132 women with 668 children). The cohort without child loss had a mean parity of 5.10, lower than the average parity of 5.73 recorded for the cohort whose reproductive histories included at least 1 infant/child death. Age specific marital fertility and birth interval analyses indicated that this differential was because of biological, not behavioral, factors. The age pattern of fertility of females suffering offspring mortality failed to demonstrate a high rate of childbearing in the later age intervals of the reproductive period, a characteristic pattern of couples attempting to "replace" lost offspring. Birth interval analysis pointed to biological "interval effect," whereby infant/child mortality caused a cessation of lactation and hence a shortening of postpartum amenorrhea. Computer simulation further indicated that the higher fertility differential of the cohort experiencing offspring loss still did not result in high son survivorship values. The findings agree with earlier studies indicating that for predemographic transitional populations, economically motivated fertility strategies are ineffectual.     

Household extension and reproductive behaviour in Taiwan

The inflence of household type on reproductive behavior is examined for a national probability sample of Taiwanese women. Data were derived from a 1980 national household survey of the labor force in Taiwan, focusing on 10,624 couples. Reproductive variables include measures of current and prospective fertility as well as cumulative fertility. In spite of remarkable social and economic development over the past 3 decades, extended families are still widely found in Taiwan. Women in extended households have only slightly higher fertility preferences and current fertility than women in nuclear families once marital duration is controlled. Although women in extended households marry earlier and receive more family help with child care than women in nuclear families, such factors are no longer considered sufficient to produce major differentials in reproductive behavior. Residence and husband's class of work are the strongest correlates of whether a household is currently extended or nuclear. In general, the husband's characteristics are more strongly related to family type than the wife's. Findings suggest that preferences for smaller families and low fertility need not await a transformation to a nuclear family structue.     

Desire for sons and subsequent fertility in rural India. A 20-year longitudinal study

This paper compares the desired fertility of rural Indian women in 1987 with their actual fertility in 2007. Seventy-one respondents who stated definite fertility intentions and had fewer children than desired in 1987 were re-interviewed 20 years later, as part of a larger study. The results indicated that these women had fewer children than intended and stopped childbearing once they reached, or approximated, their desired number of sons. The majority had been sterilized, indicating broad acceptance of lower fertility among rural women and the success of India's family planning efforts, although the practice of sex determination seems also to have played a role. These findings echo those of an earlier longitudinal study of reproductive intentions and outcomes in the same community, demonstrating the persistence of son preference in determining reproductive behaviour, even in the context of low overall fertility. The paper concludes with a discussion of the policy and programme implications of the study's findings.     

Fitness and fertility among Kalahari !Kung

In this paper we develop a model that examines fertility and childhood mortality patterns and their relationship to environmental variables. Interactions among environmental variables can account for different fertility patterns and different mixes of these variables can produce similar patterns of fertility. Our model attempts to quantify the idea that there is a trade-off between producing a few children likely to survive to reproductive age and producing a greater number of children with lower chances for survival. The optimum mix of these strategies depends on environmental characteristics. We use the model to make predictions about fertility and mortality patterns among two Bushmen populations of southern Africa--the Ghanzi and Ngamiland !Kung--using data collected by Harpending in 1967-1968. The results do not support explanations of the low fertilities observed among !Kung Bushmen women, in whom it is thought that fitness is maximized by limiting fertility, and show no relationship between mortality and family size in either !Kung population. Instead, the number of offspring reaching reproductive age in both populations increases as their completed family size increases. We examine the effects of sex, birth order, and paternal investment on mortality. No sex ratio differences and no differences in mortality by sex or birth order are present. Infant mortality among women who married more than once is significantly higher than among women who married once, suggesting that paternal care has a significant effect.     

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.     

Age at first birth and family size: Evidence from a longitudinal study

Abstract

This paper examines the correlates of the relationship of age at first birth to completed parity, using data from a fifteen‐year longitudinal study. Particular emphasis is given to measures of orientation toward family roles which have been singled out in previous studies as a likely causal factor not yet examined. Women who had an early first birth went on to have larger families than women who postponed childbearing longer. Demographic factors, including premarital pregnancies, unwanted births, and fecundity differentials, did not appear to account for the observed relationship. The hypothesis that early socialization toward traditional female roles might account for the higher fertility of women who began childbearing early was not confirmed. Women with a first birth at a young age were not characterized by more traditional sex‐role behavior or attitudes nor did they express higher initial fertility preferences. They did more often increase their fertility preferences over the inter‐survey period.     

Parental preference for sons and daughters in a Western industrial setting: evidence and implications

This paper considers whether sex composition of existing children in Australian families is an important factor in parity progression. Using census data from 1981, 1986, 1991, 1996 and 2001, women are linked with their co-resident children, allowing investigation of family sex composition and its changing impact over time on the propensity to have another child. The study finds that parents are much more likely to have a third and fourth birth if existing children are all of the same sex, indicating a strong preference for children of both sexes. This increased propensity has added around three per cent to the fertility of recent cohorts. The paper concludes with a discussion of the potential impact of sex-selection technologies on fertility. The authors argue that future widespread use of reliable sex-selection technologies might act to increase fertility in the short term, but would lead to a long-term reduction in fertility.     

The Changing Timing of Births in Iran: An Explanation of the Rise and Fall in Fertility After the 1979 Islamic Revolution

Studies exploring the course of period fertility in Iran after the 1979 Islamic Revolution have not examined systematically the role played by changes in the timing of births. Using retrospective data from the 2000 Iran Demographic and Health Survey and frailty hazard models, this study finds that the rise in fertility in the early 1980s was due to faster transitions to the first birth among all social groups of women and to the fourth birth largely among illiterate and less educated women. In contrast, the rapid fertility decline after 1985 is attributed to slower transition to successive births, especially to the second, third, and fourth births. These findings point to the importance of education and contraceptive use (measured by length of previous birth interval) as key determinants of birth timing in Iran. Interaction between age at marriage and education positively influenced the timing of births, with stronger effects among highly educated women, suggesting that the onset of rapid fertility decline was likely driven by these highly educated women. Another interaction between the gender of prior children and education shows that birth timing, even among highly educated women, appears to have been influenced by son preference in Iran.     

Fertility preferences among Malaysian women: an analysis of responses to the new population policy

About 10% of 3887 ever-married women included in the 1984-85 Malaysian Population and Family Survey revealed that they were influenced by the new population policy to desire more children than they had originally wanted. These women were more likely to be rural Malays from the lower socioeconomic class. Ideal family size was more than four children. Children are desired for economic benefits and emotional support. The natality of the Malays has risen since 1980: their total fertility rate has increased while their contraceptive prevalence rate has dropped sharply. Coupled with a decline in the crude death rate, the present fertility preferences and behaviour of the Malays will render the target of the population policy more attainable than is reflected by the survey data.     

Socioeconomic status and fertility in rural Bangladesh

Using a unique set of birth registration data from the Demographic Surveillance System of the International Center for Diarrheal Disease Research, Bangladesh, for the period 1974-77, and socioeconomic information collected in the 1974 census, fertility was studied in relation to occupation, size of dwelling, number of cows and number of boats owned. The total fertility rate was found to vary between 6 and 6.5 except in the famine year of 1975. There was no consistent relationship between fertility and education of women. The age-specific fertility rates by religion show that Muslims had higher fertility at all ages in 1974 and 1977 and at older ages in 1975 and 1976. Overall, however, fertility of Hindus is consistently lower than that of Muslims, but the relative differences are under 10%. Fertility differentials by occupation showed that the household heads who were farm laborers had relatively lower fertility compared to other occupational groups, except for the year 1977 where the families of service holders were found to have relatively lower fertility. Women in households whose heads were businessmen or farmers (owning their land) had above average fertility. In 1974, households in the business occupational groups had, on average, 1 birth more than other households. Women in households with fishermen as heads had below average fertility in 1974 and 1975, but very high fertility in 1976 and 1977. Fertility levels differed according to the type of household in which the family resided. Nuclear families had below average fertility up to the age of 35 and above average fertility at the end of the reproductive age. In the 15-19 age group, augmented families had higher fertility each year examined. The association between dwelling place and fertility is positive each year, the relative differences in fertility between the groups being largest in 1974. Positive relations were found between economic status and fertility.     

Birth wantedness reports: a look forward and a look back

A number of checks can be done to assess reliability of attitudinal data pertaining to fertility. We ascertain how births that would be considered unintended, based on Time 1 reports of fertility intentions, are classified by respondents at a second interview after the birth occurred. The 1988 National Survey of Family Growth and a telephone reinterview allow us to identify respondents who initially intended to postpone or stop childbearing, but who then had a birth, and to analyze the reports they gave of the wantedness of the pregnancy leading to the birth. We also examine wantedness responses of women who claimed in 1988 that they intended to conceive within the next few years. Reports are compared across a range of respondent characteristics and circumstances, including changes in marital status since the initial interview. The analysis reveals nontrivial inconsistency between women's stated birth intentions and their reports about the wantedness of subsequent births. Details across subgroups are examined. Results also provide new information about effects of duration since birth on intention reports.     

Fertility and patterns of labor force participation among married women

Abstract

Past research has shown that the labor market behavior of wives is discontinuous and affected by family events. Specifically, both cross‐sectional and panel data indicate that fertility decreases the period that a married woman spends working. Each birth appears to decrease labor force participation by one year or more. The present study attempts to specify these effects more completely. The variation in work patterns for each parity progression is examined to determine whether the fertility‐work effect is due to a few women who leave the labor force for an extended period during childbearing or due to a large number of women who have intermittent work histories. The analysis uses a national sample of women who were high school sophomores in 1955 and followed up as adults in 1970 and for whom retrospective data for each of the intervening years were obtained. Only married women with uncomplicated marital histories are included in the present study. We find dramatic evidence for two distinct types of response to childbearing. Women tend either to work almost continuously throughout the period or to drop out of the labor force for a very extended period of time after first birth.     

Response reliability of demographic data: a longitudinal study in Sri Lanka.

Response consistency was examined by linking the records of women interviewed in the 1982 Sri Lanka Contraceptive Prevalence Survey with records from the same individuals followed up 3 years later. Seventy-eight percent of women reported identical year of birth in the two surveys, but only 58% were consistent for age at marriage. Data on sterilisation and number of children born were highly reliable, but wives' reports on husband's age and education were relatively weak. Multivariate analysis of the effects of socioeconomic factors on consistency in age reporting confirms that education is the most influential factor related to consistency, followed by religion and husband's occupation.     

Intergenerational transmission of fertility in Spain among cohorts born during the first half of twentieth century

It is known that historically fertility is correlated between generations of the same family. These links tend to be explained either in terms of the biogenetic determinants of reproduction or by the transmission of intra-familial values associated with reproduction and family life. Less is known about the micro-determinants of these links or about the extent to which the progressive modernization of reproductive outcomes over the past century has affected behavior. In this paper, we will address these issues for Spain with data from the Socio-Demographic Survey (SDS) carried out in 1991 and including data on cohorts born between 1900 and 1946. These data enable us to explore the micro determinants of fertility at different points of time during this period. Our results point to the existence of a significant correlation between intergenerational reproductive outcomes that persists and strengthens throughout this period of demographic change. Results confirm the importance of birth order in large family groups where firstborn offspring are more likely to have larger families than subsequent siblings. There is also evidence that the strength of these intergenerational ties increases with the onset of more modern demographic behavior characterized by sharply declining fertility. The results presented here promise to condition future debates on the subject.