Consanguineous marriage and differentials in age at marriage, contraceptive use and fertility in Pakistan

Fertility rates in Pakistan have remained consistently high over the past three decades. While numerous studies have examined sociodemographic determinants, the role of biological factors, and particularly consanguinity, has received little attention, even though marriage between close biological relatives continues to be the norm in Pakistan. Reproductive behaviour among women in consanguineous (first cousin) and non-consanguineous unions was compared, using data from a 1995 study of multi-ethnic communities in Karachi and the 1990-91 Pakistan Demographic & Health Survey (PDHS). The results show that, although female age at first marriage has been gradually rising in both study samples, women in consanguineous unions married at younger ages and were less likely to use modern contraceptive methods. In the Karachi sample, women in first cousin unions experienced a higher mean number of pregnancies and also reported a higher mean number of children ever born (CEB). However, their mean number of surviving children did not differ from those born to women in non-consanguineous unions, implying higher prenatal and/or postnatal losses in couples related as first cousins. On the other hand, the PDHS showed both lower CEB values for women in consanguineous marriages and a lower number of surviving children. Given the continuing popularity of consanguineous marriage, these findings have important implications for future fertility reduction in Pakistan.     

Differences in the Access to Sterilization between Women Living and Not Living with HIV: Results from the GENIH Study,Brazil

BackgroundIn many countries, young women of reproductive age have been especially affected by the HIV epidemic, which have fostered research to better understand how HIV infection influences and shapes women´s fertility and reproductive and sexual decisions. In Brazil, few studies have focused on the impact of the HIV epidemic on contraceptive choices among women living with HIV (WLHIV).ObjectiveThis study evaluates the impact HIV infection may have in the access to female sterilization in Brazil, using a time-to-event analysis.MethodsA cross-sectional quantitative study (GENIH study) was conducted between February 2013 and April 2014 in the city of São Paulo, comparing two probabilistic samples of 975 WLHIV and 1,003 women not living with HIV (WNLHIV) aged 18 to 49. Sexual and reproductive data was collected retrospectively in order to reconstruct women''s reproductive trajectories. Given the objectives of this study, the analysis was restricted to women with parity one or more and, in case of WLHIV, to those sterilized after HIV diagnosis and not infected through vertical transmission. The final sample analysis included 683 WNLHIV and 690 WLHIV. A series of multivariable-adjusted Cox models estimated the probability of being sterilized after HIV diagnosis, compared with WNLHIV. Models were adjusted for schooling, race/color, and stratified by parity at last delivery (1–2, 3+). Hazard ratios were calculated for female sterilization, and separately for interval and postpartum procedures (performed in conjunction with caesarean section or immediately after vaginal delivery). Additionally, information regarding unmet demand for female sterilization was also explored.FindingsNo statistical difference in the overall risk of sterilization between WLHIV and WNLHIV in the two parity-related groups is observed: HR = 0.88 (0.54–1.43) and 0.94 (0.69–1.29), respectively, among women with 1–2 children and those with three and more. However, significant differences regarding the impact of HIV infection at sterilization are observed depending on the timing and the type of sterilization procedure. The probability of obtaining an interval sterilization is significantly lower for WLHIV compared to those not living with HIV. The reverse occurs regarding postpartum sterilization. Although sterilization is mainly performed in conjunction with caesarean section in Brazil, it is evident that caesarean sections are not the sole factor increasing the risk of sterilization among WLHIV.ConclusionThe results indicate barriers in the access to services offering interval sterilization for WLHIV and certain facilitation in obtaining the procedure in conjunction with caesarean section. Health policy makers at local and national levels should promote institutional changes in order to facilitate access to interval sterilization and to confront the sensitive discussion of WLHIV’s eligibility for postpartum sterilization. It is also urgent to increase access to a wider range of contraceptive methods for WLHIV and promote dual method protection strategies. Moreover, since condom use may decrease in the future in the context of the preventive effect of antiretroviral therapy, promoting dual methods will expand the choices regarding the reproductive rights of women living with HIV.     

Dominance of Sterilization and Alternative Choices of Contraception in India: An Appraisal of the Socioeconomic Impact

Background

The recent decline in fertility in India has been unprecedented especially in southern India, where fertility is almost exclusively controlled by means of permanent contraceptive methods, mainly female sterilization, which constitutes about two-thirds of overall contraceptive use. Many Indian women undergo sterilization at relatively young ages as a consequence of early marriage and childbearing in short birth intervals. This research aims to investigate the socioeconomic factors determining the choices for alternative contraceptive choices against the dominant preference for sterilization among married women in India.

Methods

Data for this study are drawn from the 2005–06 National Family Health Surveys focusing on a sample of married women who reported having used a method of contraception in the five years preceding the survey. A multilevel multinomial logit regression is used to estimate the impact of socioeconomic factors on contraceptive choices, differentiating temporary modern or traditional methods versus sterilization.

Findings

Religious affiliation, women''s education and occupation had overarching influence on method choices amongst recent users. Muslim women were at higher odds of choosing a traditional or modern temporary method than sterilization. Higher level of women''s education increased the odds of modern temporary method choices but the education effect on traditional method choices was only marginally significant. Recent users belonging to wealthier households had higher odds of choosing modern methods over sterilization. Exposure to family planning messages through radio had a positive effect on modern and traditional method choices. Community variations in method choices were highly significant.

Conclusion

The persistent dominance of sterilization in the Indian family planning programme is largely determined by socioeconomic conditions. Reproductive health programmes should address the socioeconomic barriers and consider multiple cost-effective strategies such as mass media to promote awareness of modern temporary methods.     

Voluntary sterilization in Flanders

From 1966 to 1990 there was a marked rise in the use of voluntary sterilization in Flanders, followed by a fall in women under the age of 40. In the last three decades a remarkable change has occurred in the choice between male and female sterilization. Compared with many other European countries, sterilization of men and women is widely practised in Flanders. In 1996 40% of 40- to 44-year-old women underwent voluntarily sterilization or had voluntarily sterilized partners. Additionally, another 9% of these women were sterilized for medical reasons. Voluntarily sterilized couples are on average older than non-sterilized couples, and, obviously, consider their families to be complete. For couples with a complete family, parity is the most important predictor in the choice between sterilization and non-sterilization. Regularly practising Catholics undergo sterilization least. Also, highly educated couples are less likely to have a sterilization. Couples who ever experienced a contraceptive failure choose sterilization more. Voluntary sterilization has no substantial effect on the fertility of the population since the effect on the prevented numbers of both wanted and unwanted births appears to be small. However, if voluntary sterilization did not occur, differences in fertility within the population would probably increase. It is presumed that the popularity of voluntary sterilization in Flanders has passed its peak and that its use will decline in the near future.     

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.     

Polygyny and fertility in Morocco: the effect of marital instability

This paper analyses the relationship between polygyny and female fertility in the province of Marrakech (Morocco) taking into account the effect of the previous marital instability (number of marriages) and the possible association between female sterility and type of marriage. In the analysed population, polygyny increases in the small towns. Polygynously married women have a higher level of education and show a higher percentage of use of contraceptive methods than the monogamously married ones. Although polygynously married women initially show lower fertility, multivariate analysis carried out on the group of women between 35 and 49 years old show that there are no significant differences in fertility between monogamously and polygynously married women when the effect of the previous marital instability is considerer. Female sterility does not determine marital instability, although it does determine a significant increase in polygynous marriages among the women without children.     

Contraceptive choice of limiters ages 35–44 in the United States: An examination of selection of method from among a number of possible choices

Abstract

Utilizing a subsample of the 1970 National Fertility Survey and discriminant analysis, the choice of contraceptive method was examined. First, choice from among rhythm, chemicals, condoms, oral pill, and IUD was examined. Two significant characteristic dimensions were isolated. The first dimension was interpreted as a distinction among methods from more‐effective to less‐effective. The second dimension was concluded to represent an aesthetics‐health dimension, dividing methods between coitus‐related versus not‐coitus‐related. Second, the choice between these methods and sterilization was examined. The results indicated that income and the number of births to be averted play an important role in the choice of sterilization.     

Reproductive mortality and its relation to different methods of birth control

This report evaluates the decrease in maternal mortality and its relation to family planning methods in Sweden during the years 1911-80. In the 1930s fertility was low but illegal abortions were at a high level and the associated maternal death rate was 18.5 per 1000 women. With the legalization of abortion and the introduction of modern contraceptive methods, the crude reproductive mortality rate in 1965-70 was 1.7 per 100,000 women and this was reduced still further, especially for younger women, by the late 1970s. Standardized reproductive mortality was then 80% higher than the crude rate, indicating the importance of modern family planning methods. Mortality associated with oral contraceptive or IUD use in Sweden during the 1960s and 1970s was lower than in England and the US. Mortality associated with sterilization was 6.2 per 100,000 procedures.     

Female sterilization in Latin America: cross-national perspectives

Fertility levels have dropped substantially in Latin America in recent decades, fuelled by increased contraceptive use and notably a method mix skewed towards female sterilization. This study examined choice of female sterilization in four Latin American countries: Brazil, Colombia, the Dominican Republic and Peru. Data were drawn from national Demographic and Health Surveys conducted in 1995--1996. Discrete-time hazard models were used on the five-year calendar modules of women's reproductive histories to consider the effects of a number of sociodemographic and contextual determinants as they pertained to status at the moment of the event. The results revealed that the likelihood of a woman's having undergone contraceptive sterilization was increasing over time in Brazil and Peru, suggesting that the potential for future growth of this method remains strong. A consistent pattern of increased probability of sterilization with higher education was seen across all countries, seemingly dispelling certain controversial claims that the procedure may have been disproportionately performed on the poor. At the same time, the multilevel analytical approach pointed to significant cluster-level random effects, suggesting that there were additional unmeasured contextual influences on women's propensity to choose sterilization.     

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.     

Sociodemographic attributes of Iranian wives who reported unwanted pregnancies

In a 1989 Family Planning Study in Iran, 40 percent of the married women of reproductive age reported that their last or current pregnancies were unwanted and unintended. This finding is consistent with the results obtained from a number of studies undertaken in the countries of North Africa and the Middle East. Although the phenomenon of unwanted pregnancy is a significant topic in the population studies, it has received very little attention. This paper shows the differences between two groups: group A, those married women who reported that their last or current pregnancies were wanted, and group B, those married women who reported that their last or current pregnancies were unwanted. The findings of this study clearly show significant differences between these two groups in regard to some key sociodemographic attributes: wife/husband's education, actual and desired fertility, wife's current age, past and present practice of contraceptive methods, and extent of satisfaction with family planning services are among the attributes differentiating these two groups. Our examination of these variables suggests that group B had higher parity, fertility, less desire for more children, less use of contraceptive techniques, and less satisfaction with the efficiency of the contraceptive techniques than group A. The relationship between education and wanted/unwanted pregnancies is mixed. The urban women who wanted pregnancies and were 25 years old or older were more educated than those who did not want pregnancies. On the contrary, the rural women whose pregnancies were not wanted were more educated than those who wanted pregnancies regardless of age, parity, and locality differences. Furthermore, the urban/rural women with different levels of parities who did not want to be pregnant were more educated than the urban/rural women who wanted pregnancies. Finally, the standardized regression coefficients, obtained in logistic regression, reveal that among urban women the desire for more children and parity are the first and second most significant independent variables differentiating between group A and group B. Among rural women, living children and the desire for more children were the first and second most important variables differentiating between group A and group B.     

Sociodemographic attributes of Iranian wives who reported unwanted pregnancies

Abstract

In a 1989 Family Planning Study in Iran, 40 percent of the married women of reproductive age reported that their last or current pregnancies were unwanted and unintended. This finding is consistent with the results obtained from a number of studies undertaken in the countries of North Africa and the Middle East. Although the phenomenon of unwanted pregnancy is a significant topic in the population studies, it has received very little attention. This paper shows the differences between two groups: group A, those married women who reported that their last or current pregnancies were wanted, and group B, those married women who reported that their last or current pregnancies were unwanted. The findings of this study clearly show significant differences between these two groups in regard to some key sociodemographic attributes: wife/husband's education, actual and desired fertility, wife's current age, past and present practice of contraceptive methods, and extent of satisfaction with family planning services are among the attributes differentiating these two groups. Our examination of these variables suggests that group B had higher parity, fertility, less desire for more children, less use of contraceptive techniques, and less satisfaction with the efficiency of the contraceptive techniques than group A. The relationship between education and wanted/unwanted pregnancies is mixed. The urban women who wanted‐pregnancies and were 25 years old or older were more educated than those who did not want pregnancies. On the contrary, the rural women whose pregnancies were not wanted were more educated than those who wanted pregnancies regardless of age, parity, and locality differences. Furthermore, the urban/rural women with different levels of parities who did not want to be pregnant were more educated than the urban/rural women who wanted pregnancies. Finally, the standardized regression coefficients, obtained in logistic regression, reveal that among urban women the desire for more children and parity are the first and second most significant independent variables differentiating between group A and group B. Among rural women, living children and the desire for more children were the first and second most important variables differentiating between group A and group B.     

Predicting contraceptive method usage among women in west Scotland

Users of the six major methods of contraception are compared across a broad range of variables using data from a community sample. Differences between the groups were apparent for a range of socioeconomic and reproductive variables, and current users of the various methods also differed in their past use of contraception. Users of barrier methods fared particularly well. Few differences were observed for current health status or for the sociocultural variables examined, although users of natural methods differed from all others in their religious affiliation and commitment. Discriminant analysis showed that the most predictive variables distinguishing women who had opted for permanent methods of contraception (female sterilization and vasectomy) were the woman's stated reason for using her current method and her past contraceptive patterns; the inclusion of social, health and reproductive indicators did little to improve the prediction. It is argued that heightened expectations for contraceptive efficacy in the face of increasing concerns about long-term health consequences have contributed to the increased use of permanent methods.     

Patterns of contraceptive use in Australia: analysis of the 2001 National Health Survey

The purpose of this paper is to review the patterns of contraceptive use in Australia, using data from a nationally representative sample of 5872 women aged 18 to 49. This survey was conducted by the Australian Bureau of Statistics in 2001 as part of the National Health Survey. Results of the analysis indicate that the oral contraceptive pill and condom were the two most frequently used methods. More than 76% of the respondents reported having ever used the pill. Over 23% of women were currently using condoms; of these 80% of the condom users used them for contraception - this included 36% who used condoms for both protection against infection and for contraception - and the remainder used them only for protection. Withdrawal was the third most popular non-surgical method up to age 40. Few women used IUDs, injections or diaphragms. Just over 3% of the respondents were using natural methods with the highest rate reported among those in their 30s. The 'morning-after pill' was reported mostly by women aged 18-24; however, there was no evidence to suggest that it was being used as a primary method of birth control. Contraceptive use declined in older women who turned to sterilization for themselves and/or their partners. Use of the contraceptive pill was somewhat higher among better-educated women, but lower among less-educated women and those from non-English-speaking backgrounds.     

Contraceptive sterilization: A comparison of Mexican‐Americans and Anglos living in U.S. counties bordering Mexico

Abstract

Prior to the U.S.‐Mexico Border Survey of Maternal and Child Health and Family Planning conducted by the Centers for Disease Control in 1979, little information was available about the extent to which Mexican‐Americans in the U.S., relative to Anglos, were using male and female sterilization for contraceptive reasons. This paper compares Mexican‐Americans and Anglos for (a) prevalence of contraceptive sterilization; (b) social and demographic characteristics of users of contraceptive sterlization; and (c) tuning during the reproductive life cycle when contraceptive sterilization occurs. For both Mexican‐Americans and Anglos, contraceptive sterilization (male and female) was the second most prevalent method used. Anglos were more likely to use male than female sterilization (22.4 per cent and 19.5 per cent), while Mexican‐Americans were much more likely to use female than male sterilization (23.2 per cent and 5.8 per cent). Having an unwanted last live birth and/or high parity were important factors related to the use of female sterilization for both Mexican‐Americans and Anglos.     

Marital fertility in polygynous unions in Nigeria

The effect of polygyny on fertility, by age cohort, was examined in 4 regions of Nigeria through use of data from the 1981-82 Nigerian Fertility Survey. Simple tabulation of numbers of live births by maternal age and type of marriage union indicated that, with the exception of the 30-39-year age group, fertility in polygynous unions tends to be higher than that in monogamous marriages. Overall, such tabulations reveal an average of 3.90 births among polygynous women and 3.47 births among monogamous women. However, when age-specific fertility rates were compared, except for women under 20 and over 40 years of age, rates were higher in monogamous unions (7.286 overall) than for women in polygynous households (7.200 overall). Mean completed fertility, taking into account marriage duration as well, shows a tendency for women in polygynous unions to be more fertile (with the exception of women aged 25-44 years who had been married 10-19 years). The absolute difference in fertility between the 2 types of marital unions ranged from 0.32 children in the northwest to 0.64 in the southeast. With adjustment for independent variables such as education, the absolute mean differences were reduced, from between 0.28 children in the southeast to 0.42 in the northeast, but the direction of high fertility was still in favor of women in polygynous unions. But when the covariates (e.g., age at marriage) were taken into account as well as the independent variables, there was a dramatic reduction in the mean difference between the fertility of these 2 groups of women. These findings suggest that some changes in reproductive behavior are taking place in Nigeria that are restricting the fertility of women in polygynous unions. These changes are hypothesized to reflect the spread of formal education in Nigeria, with the expectation that women will contribute to the costs involved in educating their children.     

Effects of oral contraceptive use on body mass index and blood pressure among female villagers in north-east Thailand

The use of contraceptives has become prevalent among females in Thailand in the past 20 years, and oral contraceptive use has been suggested to trigger changes in fat intake, energy expenditure, fat metabolism and blood pressure. Based on field investigations of 391 married women aged 20 years or over in Yasothon Province, North-east Thailand, this study aims to elucidate the effects of oral contraceptive use on body mass index (BMI: kg/m2) and blood pressure, taking into account reproductive histories and socioeconomic conditions. The proportion of obese (BMI > or = 25) subjects was high in the age groups 30-39, 40-49 and 50-59, accounting for, respectively, 39.4%, 51.1% and 48.5% of these populations. The proportion of women with hypertension (90/140 mmHg) was 23.7%, 18.5% and 26.2% in the 40-49, 50-59 and 60-69 age groups. Current contraceptive practices in the studied population included sterilization by operation, oral contraception and injection. These methods accounted for 43.0%, 12.8% and 8.2% of the population, respectively. Sociodemographic factors such as reproductive history, years of education and household income were not significantly related to BMI or to blood pressure (ANOVA with age adjustment). In contrast, oral contraceptive users had significantly higher BMIs and diastolic blood pressures (p<0.01, ANOVA with age adjustment). Multiple regression analysis also revealed that oral contraceptive use was a weak but significant contributing factor to both high BMI and blood pressure when sociodemographic factors were taken into account and controlled for statistically. It can thus be concluded that the use of contraceptive pills, which contain oestrogen and progestin and are provided free of charge to Thai women, tend to increase BMI and to elevate blood pressure.     

Polygyny and fertility differentials among the Yoruba of western Nigeria

Data are analysed from the 1973 surveys of the Nigerian segment of the Changing African Family (CAFN) Project, which covered Yoruba women and men in Ibadan and the Western State of Nigeria. Of the 5874 women who were in union during the CAFN 1 survey, 54% reported that their husband had only 1 wife and 46% that their husband had more than 1 wife. Of the 1234 women in unions in the CAFN 2 survey, 49% reported monogamous husbands and 51% polygynous husbands. Differentials in fertility levels between women in monogamous unions and those in polygynous ones are investigated using mean number of children ever born as the measure of fertility. Factors examined include proportion of childless and infertile women, frequency of intercourse, age, educational level, religion, marital mobility (divorce) rank of wife and sexual abstinence. The CAFN 1 survey shows that wives of polygynists tend to be older than those of monogamists. Because of this the reported mean number of children ever born was higher for the wives of polygynists than for the wives of monogamists. When the data are standardized for the difference in age, the fertility levels of the women in the 2 types of unions were much closer to each other. When religion, education, abstinence, and occupation are also taken into account, it is observed that the 2 groups of women have similar levels of fertility. A multiple classification analysis was performed using number of wives of husband, educational level, religion and father's occupation as variables and occupation of spouse, place of birth, length of abstinence, contraceptive practice and age as covariates. The result also shows that the number of wives of the husband does not significantly affect the fertility level of women when other factors are taken into account. A high proportion of the Yoruba women are in polygynous unions and most of those in monogamous unions are potential wives of polygynists. Because of this, and particularly because most women try to have as many children as they can, the women in the 2 types of unions experience similar levels of fertility.     

Fertility and family planning in Accra

A sample of 1000 currently married women aged 25-39 and living in 3 geographic areas of the Ghanaian capital were interviewed about their contraceptive knowledge and practice. Slightly over 90% of the respondents said that they had heard of ways to delay or prevent pregnancy. There was no difference between the 3 areas, but more of those aged 30-34 had heard about contraception. The chances that a respondent had heard about contraception increased with the level of education. Catholics were less likely to have heard of any contraceptive methods than Protestants. Also, women engaged in traditional informal occupations were the least likely to have heard of any contraceptive methods. Overall, education emerged as the most important differentiating factor. The pill, condom, and IUD were the best known methods. Regarding actual contraceptive practice, only 41% of the respondents were currently using some form of contraception, with about 19% using modern and 27% traditional methods. Results of contraceptive usage by user characteristics show that the majority of women in 2/3 of the areas rely on a mixture of traditional and modern methods; that the % of users (any method) increases with age up to 30-34 years, after which it decreases. The % of ever-users of any type of contraception in this study is highest for the highest education levels, at 84% for women with 2ndary and post 2ndary education. With the exception of the IUD, douche and folklore methods, better educated women have higher ever-use %s for both traditional and modern methods. While the %s of users increases with education for foam, diaphragm and withdrawal; the reverse is observed for the pill and IUD, probably due to fear of negative side effects. Overall, there are no significant variations in contraceptive use by migration status; but the % of non-users is highest among recent migrants who are also the least likely to have ever used modern methods. Fertility differentials across ethnic groups have been observed in Ghana. The Akan have the highest fertility, followed by the Ewe and Ga-Adangbe with moderate fertility, and the northern ethnic groups with the lowest fertility. The Akan also have the highest % of ever users of modern contraceptives, an inconsistency which may be explained by their recent recognition of the burdens of high fertility and their attempts to control it. Religious differences are pronounced, especially between the traditional category on the 1 hand, and Christians and Muslims on the other. Results of an analysis of variance suggests that family size is the strongest motivation for adopting modern contraception, and that it may be used for limiting rather than spacing births.     

Differential fertility by intelligence: the role of birth planning

Urban, white, ever-married women, aged 15-44, were sampled in low and high income census tracts in 16 U.S. cities, using a short adaptation of the Peabody Picture Vocabulary Test as a measure of IQ. After analysis of covariance, in which IQ was the independent variable and children ever born (CEB) was the dependent variable, it was found that there is .19 difference between the mean CEB of high- and low-IQ groups when covariables are controlled. It was shown that there was no significant difference in desired family size associated with IQ. But since the low-IQ women have more fertility than high-IQ women, effectiveness of contraceptive methods was examined. Examination showed that lower fertility was achieved by more effective use by the high-IQ women of methods of theoretically similar effectiveness. Also, those women not using a physician administered contraceptive (PAC) in the 3-year study period had unwanted births at about 3 times the rate of those who used PAC for the entire period. Thus, all American women will have to learn to realize their own fertility goals.