Postpartum lactational amenorrhoea as a means of family planning in the Sudan: a study of 500 cases

The lactational histories of 500 Sudanese women were studied retrospectively to examine postpartum lactational amenorrhea as a method of family planning. Particular attention was given to the factors affecting postpartum lactational amenorrhea, including supplementary feeding and the use of modern contraceptive methods. Breast-feeding was overwhelmingly practised (90%) among this sample, which was roughly representative of the Sudanese population as a whole. The prevalence of amenorrhea among this group of lactating women was quite high (73%). Duration of lactational amenorrhea ranged from 2 to 36 months with a median of 12 months. Introduction of supplementary feeding had little effect on lactational amenorrhea up to the 9th month of breastfeeding. Beyond the 12th month of breastfeeding, lactational amenorrhea was significantly prolonged by postponing the introduction of supplementary feeding until the 4th month or later. Ovulation, and hence conception, during lactational amenorrhea was unpredictable. It occurred as early as the 3rd or as late as the 36th month postpartum. Conceptions interrupting lactational amenorrhea soon after delivery (3-9 months) were more frequent among primiparous women. The failure rate of lactational amenorrhea as a contraceptive was 8.4%. Though extremely high compared to that of the pill, lactational amenorrhea was more useful as a fertility control mechanism because, in this study, a high proportion of women initiated pill use, but soon discontinued it because of side effects. Modern contraceptive practice was not prevalent. Amenorrheic mothers accepted the pill after the 6th month postpartum (41%, compared to lactating mothers whose menses had returned who started much earlier. 49% of the women studied relied completely on the protection of lactational amenorrhea. 57% of all lactating women who used the combined pill reported a reduction in milk production. Knowledge of modern contraception was poor and incorrect in many cases, leading to several policy implications, including usage of sterilization.     

Determinants of natural fertility in Sudan

The population of Sudan (North) is at a very early stage of fertility transition and experiences high, stable fertility at a close to natural level. The high observed fertility is found to be a function of the high proportion of married women and ineffective contraceptive procedures. The data used in this study were drawn from the 1979 Sudan Fertility Survey (SUDFS), in which 3115 ever-married women 50 years old from 12,028 households were interviewed. 90% of Sudanese women breast fed for at least 6 months and 80% for at least 12. The main inhibitor of fertility is perceived to be lactational amenorrhea averaging about 11.8 months, which is reported to be high, although among younger women the duration of amenorrhea is shorter due to earlier introduction of supplementary foods. An average of 5.2 months of postpartum sexual abstinence is evidenced, but this is shorter than the period of amennorhea, and therefore has no effect on the birth interval. Neither does marital instability or mean length of separation, which are both close to nonexistent. Sudanese women are comparatively very infecund. 22% gave birth within the 1st year of marriage, 62% within the 2nd, and 83% the 3rd. The proportion of ever-users of contraception is high (e.g. 15.4% among the 25-34 among category), but current use was low (8.1% for the same). The use of contraception is responsible for a reduction of 4.2% of the fertility per married woman. The duration of temporary separation between spouses, due to temporary or seasonal migration of husbands, and the pathological causes of high primary sterility, which contribute to the low fecundability, need further investigation.     

Twinning and the changing pattern of breast‐feeding: A possible relationship in a small rural population

Abstract

Direct and indirect observations suggest that pituitary hormones, namely FSH, LH, GnRH, and GH, are involved in the mechanism of twinning. We hypothesized that prolactin might be involved as well. It is well known that lactation prolactin induces a gonadotropin‐mediated amenorrhea. Otherwise, weaning results in low serum prolactin and high FSH and LH secretion leading to the resumption of ovulation. Thus, variations in serum prolactin in women carriers of a twin gene may have a bearing on their gonadotropin‐mediated twinning liability. The hypothesis was tested using data from a small rural population characterized by a shift from total breast‐feeding to partial breast‐feeding with an early introduction of solid foods to infants.     

Human fertility studies under field conditions. Introduction.

Human fertility is part of biological anthropology embracing human population biology devoted to the analysis of the nature, caused, origin, and development of human variation at molecular, cellular, and whole body levels. The successful outcome of human fertility depends on the interactions of biochemical, physiological, and psychological processes whose disturbance results in slight variations in behavior and even total infertility. The Hutterites in the US have the highest average fertility with over 11 live births/women. Hunter-gatherer groups rarely have more than 4 children/woman. The case of a woman who gave birth to 67 children was recorded. Total infertility often occurs even in noncontracepting societies. The most important factor that determines the character of genetic variation within the human species seems to be comparative population growth, as this was the factor determining which populations spread and which became extinct. The study of the determinants of female fertility has attracted attention recently because pregnancy and motherhood affect daily life, and in turn, reproduction is also affected by daily life. Lactational amenorrhea plays a vital role in child spacing, but the mechanism of breast feeding is complex with factors of duration, frequency, milk production, and suckling frequency interwoven. Female reproduction comprises whole body function, nutrition, body composition (the recent debate on fat stores affecting the onset of fertility), physical work, and mental health all influencing the endocrinological state. Heavy physical labor and intensive training by sportswomen can result in amenorrhea. Beta-endorphins also play a role in lactational amenorrhea along with nutrition and body composition. Infectious and venereal diseases particularly affect fertility, yet genetics protect the placenta against falciparum malaria in sickle-cell trait women.     

Aetiological approach of female reproductive physiology in lactational amenorrhoea.

The duration of postpartum amenorrhea and return of ovulation varies on an individual and population basis. In 1980, in Senegal, the relationship of chronic malnutrition and female fertility was investigated for 2 years. The stability of the female body regarding weight and arm circumference despite a heavy annual workload was a surprising finding. The mean female body mass index was higher for lactating women in amenorrhea than required for restoring menstruation in European women. The mean duration of postpartum amenorrhea was 18.2 +or- .6 months. The difference between those who resumed menstruation (20.9 +or- .9 months) and who still had amenorrhea (25.4 +or- 2.2 months) was significant. The duration of breast feeding determined the duration of amenorrhea. Studies have found a link between ovarian dysfunction and women in harsh third world environments and sportswomen under intensive training with both showing irregular menstruation and amenorrhea. Long duration of cycles in New Guinean women, high amount of anovulation in Zairian forest women, and suppression of testosterone and estradiol levels in hunter-gatherers were found. In affluent Europeans and urbanized women in developing countries postpartum amenorrhea dropped drastically. Long distance runners are often vegetarians with low calorie consumption and with a high degree of menstrual trouble owing to low body fat and weight-for-height. The role of beta-endorphins in the hypothalamic blockade of the gonadotropin releasing hormone pulse generator and high stress or physical training is proven. The functioning of the hypothalamo-pituitary-ovarian axis can be hurt by intensive training. Short-term fasting also suppressed the pulsatile luteinizing hormone and testosterone secretion. The protocol and methodology of an etiological study is outlined regarding the factors of this hypothesis on amenorrhea.     

Conceptive delays of twin-prone mothers: a demographic epidemiologic approach

We studied the time interval to the first birth and to the twin birth using statistical and mathematical models in two groups of mothers, those with twins and those with singletons, from the same population. We made use of a pair-matched case-control design. We treated the maternal birth cohort and parity as confounders and thus as controlled. We also investigated the sex of twin pairs as an interactive variable, employing such methods as survival curve testing and using geometric, gamma, and exponential distributions where appropriate. The expectations derived from the mathematical models yield numerical estimates of fertility components. The results suggest that unlike-sex twin-prone mothers have higher fecundity than controls when they conceive singletons. Further, fecundity appears high and unimpaired before the birth of twins. Mothers of like-sex twins experience somewhat shorter and but more variable birth intervals than corresponding controls before the birth of twins, suggesting within-group heterogeneity. Specifically, the birth of like-sex twins is preceded by low fecundity and a short period of postpartum amenorrhea. Biologically, like-sex (presumably monozygotic) twin-prone mothers have a hormonal defect related eventually to menopausal status that interferes with ovulation and perhaps with lactation. As for unlike-sex twin-bearing mothers, they probably experience a displacement of their maximum fertility potential toward early reproductive life and an extension of their menstrual life. From a methodologic standpoint, the study of the fertility of twin-prone mothers cannot proceed without estimates of the fertility components of birth intervals, as these intervals do not lend themselves to straightforward analytical interpretations by statistical analyses.     

Community-level education accelerates the cultural evolution of fertility decline

Explaining why fertility declines as populations modernize is a profound theoretical challenge. It remains unclear whether the fundamental drivers are economic or cultural in nature. Cultural evolutionary theory suggests that community-level characteristics, for example average education, can alter how low-fertility preferences are transmitted and adopted. These assumptions have not been empirically tested. Here, we show that community-level education accelerates fertility decline in a way that is neither predicted by individual characteristics, nor by the level of economic modernization in a population. In 22 high-fertility communities in Poland, fertility converged on a smaller family size as average education in the community increased—indeed community-level education had a larger impact on fertility decline than did individual education. This convergence was not driven by educational levels being more homogeneous, but by less educated women having fewer children than expected, and more highly educated social networks, when living among more highly educated neighbours. The average level of education in a community may influence the social partners women interact with, both within and beyond their immediate social environments, altering the reproductive norms they are exposed to. Given a critical mass of highly educated women, less educated neighbours may adopt their reproductive behaviour, accelerating the pace of demographic transition. Individual characteristics alone cannot capture these dynamics and studies relying solely on them may systematically underestimate the importance of cultural transmission in driving fertility declines. Our results are inconsistent with a purely individualistic, rational-actor model of fertility decline and suggest that optimization of reproduction is partly driven by cultural dynamics beyond the individual.     

Between the State and Indigenous Autonomy: Unpacking Video Indígena in Mexico

This essay unpacks the complex emergence of video indígena , or state-sponsored small media, at the height of official pluralism in Mexico in the early 1990s. A government video program created in a transitional institutional setting colludes with the indigenous autonomy movement---through the work and visions of individual video makers and cultural activists---to produce a social form and process that has gained international recognition while confronting particular challenges in indigenous communities.     

Hormonal aspects in the causation of human breast cancer: epidemiological hypotheses reviewed, with special reference to nutritional status and first pregnancy

Epidemiology of breast cancer has identified early age at menarche, late first pregnancy, low parity and late menopause as risk factors, but in addition genetic factors, height, weight and living in western countries play a significant role. The international variation in incidence is almost exclusively due to non-genetic factors. Hypotheses in prevention-oriented research are reviewed: 1. obesity-related oestrogen production as a stimulus of the tumour in postmenopausal women; 2. nutritional status and energy expenditure during puberty and adolescence, developed for fertility and fecundity and extended later to breast cancer; 3. reproductive life during early adulthood, age at first pregnancy and its specific effects on breast tissues. The message of preventability of breast cancer is that mammary epithelial differentiation should come early. Our insight concerning events in puberty and early adulthood can be consolidated in one concept on the risk of extended proliferation of breast epithelium during early adulthood in the absence of full differentiation induced by pregnancy. The combined effects of Western-type nutrition, lack of exercise and Western-type women's emancipation sets the stage for breast cancer already at a young age. Since it is unlikely that emancipated women in affluent societies will return to the original life-style of getting pregnant as soon as it is biologically possible, a novel daring way of protection has to be considered. Could a "Breast Differentiation Pill" be developed to offer protection?     

Women's absence,women's power: indigenous women and negotiations with mining companies in Australia and Canada

This article documents the agency of indigenous women in negotiations surrounding major resource projects on indigenous lands. The dominant view in the academic and activist literature is that indigenous women are excluded from negotiations, which helps explain their failure to share in project benefits. The author's experience as a negotiator for indigenous communities in Australia and his research in Canada reveals a different picture, indicating that indigenous women often play a central role in negotiations. The article seeks to explain the inconsistency between the findings reported here and much of the literature, in terms of a broader tendency in the latter to downplay the agency of women in relation to mining; and its failure to adequately recognize the multiple and complex ways in which indigenous women can influence negotiations, and the role of specific cultural, institutional and political contexts in shaping women's participation.     

Ethnicity and fertility in Nigeria

Using a sample of Hausa-Fulani, Yoruba, Ibo, and all other women from the 1990 Nigerian Demographic and Health Survey, this study examines ethnic fertility differentials in Nigeria within the context of the social characteristics and cultural hypotheses. Among all women, we find the net fertility of Hausa-Fulani women to be lower than that of Other women; with no statistically significant difference in the net fertility of Ibo, Yourba, and Other women. But, among currently married women, we find the net fertility of Hausa-Fulani and Yoruba women to be lower than that of Other women, while the net fertility of Ibo women is higher than that of Other women. Overall, the findings of this study are more consistent with the cultural hypothesis, because statistically significant fertility differentials by ethnicity remain, even after controlling for selected socioeconomic and demographic variables.     

A synthetic biosocial model of fertility transition: Testing the relative contribution of embodied capital theory,changing cultural norms,and women's labor force participation

This article presents a biosocial model of fertility decline, which integrates ecological‐economic and informational‐cultural hypotheses of fertility transition in a unified theoretical framework. The model is then applied to empirical data collected among 500 women from San Borja, Bolivia, a population undergoing fertility transition. Using a combination of event history analysis, multiple regression, and structural equation modeling, we examine the pathways by which education responds to birth cohort, parental education and network ties, and how age at first birth and total fertility, in turn, respond to birth cohort, social network ties, education, expectations about parental investment, work, and contraceptive use. We find that in addition to secular trends in education, respondent's education is associated with the education of parents, the investment she received from them, and the education of older siblings. Total fertility has dropped over time, partly in response to increased education; moreover, the behavior of other women in a woman's social network predicts both initiation of reproduction and total fertility, while expected parental investment in offspring negatively predicts total fertility. Involvement in paid work that is incompatible with childcare is associated with a later age of first reproduction, but not subsequent fertility. Contraceptive use partially mediates the effect of education and birth cohort on total fertility, but is not a mediator of the effect of social network or expected parental investment on total fertility. Overall, the empirical results provide support for a biosocial model of fertility decline, particularly the embodied capital and cultural pathways. Am J Phys Anthropol 154:322–333, 2014. © 2014 Wiley Periodicals, Inc.     

Reproduction in high altitude Aymara: physiological stress and fertility planning?

Reproductive characteristics at high altitude are described based on the reproductive histories of 720 Aymara women, collected in 1998 and 1999 in a group of twelve peasant communities at a mean altitude of 4000 m in the Bolivian Altiplano. The reproductive pattern is shaped by a late onset of childbearing, associated with a rather short reproductive span and large birth intervals. Environmental conditions could explain the particularly late age at menarche of rural girls compared with their urban counterparts, whereas the age at first birth is likely to be under cultural control. The short reproductive span appears to result from a large mean interval between last birth and menopause, which is essentially determined by cultural decisions. The birth intervals, which are longer than in many traditional societies, could be the result of a slower restoration of postpartum fecundability induced by the hard way of life inherent in the Altiplano (including poor sanitary and nutritional conditions and high workload), perhaps aggravated by hypoxia. However, a secular trend in fertility is perceptible, towards earlier menarche, earlier age at first birth, increasing reproductive span and a slight increase in live births and surviving offspring, which is probably the result of a slow improvement in living conditions. The existence of birth control on the one hand, and a total fertility rate averaging six live births among the couples who do not practise contraception on the other, are other arguments against the hypothesis of a low natural fecundity in these Aymara groups.     

Sociodemographic correlates of breast feeding in Ghana

This study utilizes data from the Ghana Fertility Survey (GFS) (1979-1980) to investigate breast feeding in Ghana and the factors that affect it. Using life table procedures, we found evidence that, when other factors are held constant, older cohorts, women with no schooling, those who work in the agricultural sector, those affiliated with traditional Ghanaian religions, Mole-Dagbanis, rural residents, residents of the Volta, Brong-Ahafo, northern, and upper regions, and low-parity women show longer durations of breast feeding. It is recommended that, along with other fertility reduction measures, prolonged breast feeding among all Ghanaian mothers should be encouraged to help reduce conception and to ensure healthy children.     

Correlations in fertility across generations: can low fertility persist?

Correlations in family size across generations could have a major influence on human population size in the future. Empirical studies have shown that the associations between the fertility of parents and the fertility of children are substantial and growing over time. Despite their potential long-term consequences, intergenerational fertility correlations have largely been ignored by researchers. We present a model of the fertility transition as a cultural process acting on new lifestyles associated with fertility. Differences in parental and social influences on the acquisition of these lifestyles result in intergenerational correlations in fertility. We show different scenarios for future population size based on models that disregard intergenerational correlations in fertility, models with fertility correlations and a single lifestyle, and models with fertility correlations and multiple lifestyles. We show that intergenerational fertility correlations will result in an increase in fertility over time. However, present low-fertility levels may persist if the rapid introduction of new cultural lifestyles continues into the future.     

Spousal age-gaps,partner preferences,and consequences for well-being in four Colombian communities

Across cultures, women tend to marry older men. This phenomenon is commonly described as the result of evolved mate choice preferences, which cause men to base reproductive decisions on cues of youth and fertility in women, and women to base such decisions on cues of wealth and status in men. Other researchers have challenged this idea, arguing that husband-older spousal age-gaps might not be consistent with the joint preferences of men and women; age-gaps might instead arise as the result of sexual conflict. In such cases, the realized age-gap could benefit one party at a cost to the other. In practice, large age-gaps may result in negative outcomes for younger women married to older men—e.g., because of power differences in these relationships. Testing for the existence of sexual conflict over the size of the spousal age-gap in Tanzania, researchers found no evidence that large age-gaps are harmful to women. Here, we conceptually replicate this previous work, and assess the relationship between spousal age-gaps, partner preferences, and individual well-being in four communities in Colombia. We extend prior methods by inferring the size of idealized age-gaps using network structured mate-choice games, and measuring the realized age-gap directly among ever-married partners. Our analyses suggest that there is limited evidence of sexual conflict over the size of the spousal age-gap in these communities. First, realized age-gaps are not large on average—around 1–7 years across communities. Second, the age-gaps that do exist are consistent with the preferences of both men and women—at least during their early to middle reproductive periods. And, lastly, large age-gaps are not negatively associated with measures of fertility or well-being for either sex. Our results underscore the importance of appreciating the cultural context within which behavioral practices with potentially negative consequences are situated.     

Viewing Change Through the Prism of Indigenous Human Ecology: Findings from the Afghan and Tajik Pamirs

The effects of socioecological transformations such as climate change, the collapse of the Soviet empire, and civil war are examined for 14 villages in the valleys of the Pamir Mountains in the historical Badakhshan region, now divided between Afghanistan and Tajikistan. Preliminary findings indicate concern for food sovereignty, evidence of biocultural impacts of climate change, an increasing burden on women, debilitating opium addiction, the ecological importance of sacred sites, and other priorities related to sustainable livelihoods, such as energy needs (for fuel and lighting) and physical and social infrastructure in the form of roads and schools. In the complex setting of the Pamir Mountains, characterized by both cultural and ecological diversity and marked by artificial political boundaries, the creative and pragmatic interaction between indigenous and scientific knowledge sustains the best hope for survival. Applied research must combine communities of inquirers (research institutions) with communities of social practitioners (farmers, pastoralists, and civil society institutions) to facilitate indigenous participation in generating context-specific knowledge. The goal of such research is practical outcomes that will meet the urgent priorities of village communities. This paper establishes a baseline from which undertake applied human ecological research related to livelihood security.     

Impact of mild temperature hardening on thermotolerance, fecundity, and Hsp gene expression in Liriomyza huidobrensis

The pea leafminer, Liriomyza huidobrensis, is one of the most important economic insect pests around the world. Its population fluctuates greatly with seasonal change in China, and temperature was thought to be one of the important reasons. In attempt to further explore the impact of disadvantageous temperature on L. huidobrensis, 1-day-old adults were shocked at various temperatures (10, 25, 32, and 35 degrees C, respectively) for 4h, and the effects on thermotolerance, feeding, and fecundity were studied. Meanwhile the expression of five heat shock genes (hsp90, 70, 60, 40, and 20) was examined by real-time quantitative PCR. Our results showed that both 32 and 35 degrees C hardenings remarkably increased adult heat resistance, whereas cold tolerance was not improved accordingly. No cross resistance in response to cold and heat stresses was observed. Both adult feeding and fecundity were dramatically reduced, but no effect was observed on egg hatching, larval survival, pupal eclosion, or sex ratio. The results indicate that the deleterious effect on fecundity is the result of direct cessation of oviposition during the period of stress. Simultaneously, the mRNA levels of hsp70 and hsp20 significantly increased upon thermal hardening. Taken together, our results suggest that mild heat hardening improves thermotolerance of L. huidobrensis at the cost of impairment on fecundity, and the induced expression of hsp70 and hsp20 may play an important role in balancing the functional tradeoff.     

Qualitative study of decisions about infant feeding among women in east end of London

ObjectiveTo improve understanding of how first time mothers who belong to a socioeconomic group with particularly low rates of breast feeding decide whether or not to initiate breast feeding.DesignQualitative semistructured interviews early in pregnancy and 6-10 weeks after birth.SettingWomen’s homes in east end of London.Subjects21 white, low income women expecting their first baby were interviewed mostly at home, often with their partner or a relative. Two focus groups were conducted.ResultsWomen who had regularly seen a relative or friend successfully breast feed and described this experience positively were more confident about and committed to breast feeding. They were also more likely to succeed. Exposure to breast feeding, however, could be either a positive or a negative influence on the decision to breast feed, depending on the context. Women who had seen breast feeding only by a stranger often described this as a negative influence, particularly if other people were present. All women knew that breast feeding has health benefits. Ownership of this knowledge, however, varied according to the woman’s experience of seeing breast feeding.ConclusionsThe decision to initiate breast feeding is influenced more by embodied knowledge gained from seeing breast feeding than by theoretical knowledge about its benefits. Breast feeding involves performing a practical skill, often with others present. The knowledge, confidence, and commitment necessary to breast feed may be more effectively gained through antenatal apprenticeship to a breastfeeding mother than from advice given in consultations or from books.

Key messages

• Women who have seen successful breast feeding as part of their daily lives and perceive this as a positive experience are more likely to initiate breast feeding
• Embodied knowledge gained through seeing breast feeding may be more influential than theoretical knowledge about the health benefits for women of lower social class
• Listening to pregnant women talking about breast feeding could help clinicians assess the relative importance of theoretical and embodied knowledge for each woman
• Women hoping to breast feed but with little exposure to breast feeding may benefit from an antenatal apprenticeship with a breastfeeding mother
• Ideally apprenticeship would be with a breastfeeding mother from her social network to minimise the potential barriers of embarrassment and lack of confidence with strangers

     

Differential contribution of indigenous men and women to the formation of an urban population in the Amazon region as revealed by mtDNA and Y-dNA

The human populations of the Brazilian Amazon were formed by interethnic crosses between Europeans, Africans, and Amerindians. The relative contribution of men and women of different ethnic groups was not homogeneous, since the social policies of the first three centuries of Brazilian colonization encouraged mating between European men and indigenous women and, later on, African women. In order to test this model based on historical data, we compared the relative contribution of the Y-DNA and mtDNA of Amerindian and non-Amerindian populations to the formation of the urban population of the town of Belém, in the Amazon region, on the basis of a C→T mutation at locus DYS199 present in 90% of the Amerindian Y-DNA and of five markers that define 99% of the mitochondrial sequences of Amerindians. The contribution of indigenous men to the formation of this population was less than 5%, whereas the contribution of indigenous women was estimated at more than 50% of the mitochondrial sequences of the same population. Thus, the present results demonstrate that the contribution of indigenous women to the formation of the Belém population was 10 times higher than the contribution of indigenous men, a genetic consequence of social behavior and attitudes of the past; our results also help clarify the process of integration of indigenous communities into the urban societies in Brazil and possibly in other countries. Am J Phys Anthropol 109:175–180, 1999. © 1999 Wiley-Liss, Inc.