Average Number Of Births Research Articles

Pregnancy and inherited aortopathies: insights from specialized care

Abstract Background Genetic counselling, pregnancy follow-up and delivery planning in women with aortopathy should be conducted by a multidisciplinary team in an expert centre. Purpose Our objective was to analyze the impact of pregnancy on aortopathy outcomes in a centre specialized in inherited cardiovascular conditions in the United Kingdom. Methods All women with aortopathy referred to our centre due to pregnancy between 2016 and 2023 were retrospectively analyzed. Demographic, clinical, obstetric, genetic, electrocardiographic, and multimodal imaging variables were collected. Results Between 2016 and 2023, 22 women with aortopathy were referred to our centre for pregnancy follow-up and delivery planning. Among them, 14 (63.6%) had Marfan syndrome (FBN1+), 4 (18.2%) family history of aortic dissection without known genetic mutations, 2 (9.1%) bicuspid aortic valve with aortic dilation and 2 (9.1%) Loeys-Dietz syndrome (SMAD3+). The average number of births per patient was 1.55. Among those with an identified mutation, 4 (25%) underwent preimplantation diagnosis. In total, there were 40 pregnancies resulting in 34 live births. 15 women (68.2%) had an aortic root dimension <40mm and 7 (31.8%) ≥40mm. There were 4 (26.7%) and 5 (71.4%) patients in each group under beta-blockers. Out of the total 40 pregnancies, there were 6 (15%) miscarriages, all in the first trimester, 2 (5%) cases of preeclampsia and 1 (2.5%) case of gestational diabetes. There were no statistically significant differences between these complications and the aortic root dimension (8 (20%) <40mm vs 1 (2.5%) ≥40mm; p = 0.160) or the absence or presence of treatment (3 (7.5%) vs 6 (15%); p = 0.769). Regarding delivery, 16 patients (72.7%) underwent vaginal delivery and 6 (27.3%) has a caesarean section. After delivery, there were 6 cases of major bleeding, 4 (10%) after vaginal delivery and 2 (5%) after caesarean (p=0.376). One patient had a subacute type A aortic dissection in the context of Marfan syndrome with an aortic root of 40mm before pregnancy. No significant differences were observed in the occurrence of these complications based on the aortic root dimension (5 (12.5%) <40mm vs 2 (5%) ≥40mm; p = 0.928) or the absence or presence of treatment (2 (5%) vs 5 (12.5%) respectively; p = 0.591). 100% of the patients survived pregnancy and the postpartum period. Conclusions Our findings underscore the complexity of managing aortopathy during pregnancy. This highlights the importance of a comprehensive risk assessment for precise pregnancy and delivery planning.

How does hospital organisation influence the use of caesarean sections in low- and middle-income countries? A cross-sectional survey in Argentina, Burkina Faso, Thailand and Vietnam for the QUALI-DEC project

BackgroundImproving the understanding of non-clinical factors that lead to the increasing caesarean section (CS) rates in many low- and middle-income countries is currently necessary to meet the challenge of implementing effective interventions in hospitals to reverse the trend. The objective of this study was to study the influence of organizational factors on the CS use in Argentina, Vietnam, Thailand and Burkina Faso.MethodsA cross-sectional hospital-based postpartum survey was conducted in 32 hospitals (8 per country). We selected women with no potential medical need for CS among a random sample of women who delivered at each of the participating facilities during the data collection period. We used multilevel multivariable logistic regression to analyse the association between CS use and organizational factors, adjusted on women’s characteristics.ResultsA total of 2,092 low-risk women who had given birth in the participating hospitals were included. The overall CS rate was 24.1%, including 4.9% of pre-labour CS and 19.3% of intra-partum CS. Pre-labour CS was significantly associated with a 24-hour anaesthetist dedicated to the delivery ward (ORa = 3.70 [1.41; 9.72]) and with the possibility to have an individual room during labour and delivery (ORa = 0.28 [0.09; 0.87]). Intra-partum CS was significantly associated with a higher bed occupancy level (ORa = 1.45 [1.09; 1.93]): intrapartum CS rate would increase of 6.3% points if the average number of births per delivery bed per day increased by 10%.ConclusionOur results suggest that organisational norms and convenience associated with inadequate use of favourable resources, as well as the lack of privacy favouring women’s preference for CS, and the excessive workload of healthcare providers drive the CS overuse in these hospitals. It is also crucial to enhance human and physical resources in delivery rooms and the organisation of intrapartum care to improve the birth experience and the working environment for those providing care.Trial registrationThe QUALI-DEC trial is registered on the Current Controlled Trials website (https://www.isrctn.com/) under the number ISRCTN67214403.

Traditional birth attendants’ knowledge, preventive and management practices for postpartum haemorrhage in Osun State, Southwestern Nigeria

Traditional birth attendants (TBAs) have become an integral part of the workforce providing delivery services in Nigeria due to the limited number of skilled birth attendants and cultural preferences. This study assessed the knowledge, management and preventive practices regarding postpartum haemorrhage (PPH) among TBAs in selected communities in Osun State, Southwest Nigeria. The study employed a descriptive cross-sectional study design and recruited 260 TBAs in four communities in Osun State. Data were collected by means of an adapted semi-structured questionnaire. Data were analysed using SPSS version 23 and summarized using descriptive and inferential statistics (chi-square and logistic regression) with the level of significance set at p < 0.05. The findings indicated that most (71.4%) of the TBAs were cleric, while others were herbalist (28.6%). Although the majority (76.4%) of the TBAs had good knowledge of the causes and warning signs of PPH, a high percentage (69.3%) of TBAs had poor management practices, while 114 (64.1%) TBAs had inadequate preventive practices. Notably, almost none of the participants practised active management of the third stage of labour; the majority of TBAs did not administer any uterotonic drugs to the mother, nor did they deliver the placenta by controlled cord traction. Gender (P = 0.029), educational level (P = 0.035) and average number of births per month (P = 0.001) significantly influenced TBAs’ management practices. Similarly, the TBA type (P < 0.001), average number of births per month (P = 0.003) and experience with formal training (P = 0.005) showed significant associations with TBAs’ preventive practices. Furthermore, TBAs’ preventive practices towards PPH were influenced by the TBA type (OR: 4.23; 95% CI 1.64–10.90). TBA management practices were also influenced by the TBA type (OR: 4.42; 95% CI 2.03–9.61). Traditional birth attendants in this study had poor management and poor preventive practices for postpartum haemorrhage.

Analysis of Obstetric Outcomes by Hospital Location, Volume, and Teaching Status Associated With Non–Medically Indicated Induction of Labor at 39 Weeks

Non-medically indicated induction of labor has been demonstrated to potentially improve some obstetric outcomes, such as decreasing cesarean birth. It has been reported that rates of cesarean birth and other obstetric outcomes vary among hospitals with different characteristics. To assess whether obstetric outcomes differ between nulliparous individuals with low-risk pregnancies managed with non-medically indicated induction of labor compared with expectant management in different types of hospitals. This retrospective cohort study included non-medically indicated induction of labor at 39 weeks' gestation compared with expectant management of singleton, nonanomalous, births in nulliparous women with low-risk pregnancies in California between January 1, 2007, and December 31, 2011. The initial analysis of these data was performed in 2021. Outcomes were assessed by 3 hospital characteristics: location (urban vs rural), obstetric volume, and teaching (academic vs community) status. Volume was categorized based on the average number of births per year and grouped into low (<1200 births per year), medium (1200-2399 births per year), and high (≥2400 births per year). Births with previous or planned cesarean delivery were excluded, and non-medically indicated induction of labor was defined as induction of labor without a specific medical indication. Testing with χ2 and multivariable logistic regression analyses was used for statistical comparisons with a cutoff level of P = .01. Non-medically indicated induction of labor at 39 weeks' gestation. The primary outcome was cesarean birth, and numerous secondary perinatal outcomes were also assessed. There were 455 044 births included in this study. When stratified by hospital variables, a number of sociodemographic characteristics were significantly different, such as race and ethnicity, age, body mass index, and insurance type. The adjusted odds ratios (aORs) of cesarean birth were significantly lower in all settings with induction of labor except for low-volume hospitals, in which there was no significant difference (aOR, 0.95; 95% CI, 0.82-1.09). Chorioamnionitis and postpartum hemorrhage were lower with induction of labor among nearly every hospital when stratified by hospital characteristics. Neonatal outcomes were improved in all settings with induction of labor compared with expectant management. These findings suggest that non-medically indicated induction of labor may be associated with a lower rate of cesarean births and some maternal and neonatal adverse outcomes in a range of hospital settings.

The Dynamic of the Fertility Age Model in the Two Regions of Russia

Introduction. The increase of the age of mothers at the birth of children is observed in the modern period. The speed of this process in different regions of Russia and the world is different. The aim of this research is to estimate the average age of mothers and the number of children born by one woman in Tyumen and Petropavlovsk-Kamchatsky in 2017–2018. Materials and Methods. The archival documents from medical institutions about 676 women who registered for pregnancy have been analyzed. For temporary comparison for the period from 1985 to 2003, we use the data presented in a previously published monograph. The standard methods of statistics, spatial and temporal analysis are used, which have made it possible to identify the dynamics of the age model of fertility. Results. The authors have determine that the distribution of women by age at the birth of children is the same in two Russian cities. A group of women aged 26 to 33 years is represented with 55% frequency. The average age of women in labor from two cities is the same. In Tyumen is 30.1 ± 0.63, in Petropavlovsk-Kamchatsky is 29.5 ± 0.38. The article provides evidence that in the previous period, the proportion of women in labor aged 18 to 25 years was 60%. In both cities, the distribution of women by the number of births is the same, 83% gave birth twice. 14% of children were born in third births. In the previous time interval, 65% of children were born in first birth. During this period it has been defined that the average number of births in the city of Tyumen is less than in the rural areas of the south of the Tyumen region, and less than among the indigenous women in the north of the region (Khanty and Mansi). Discussion and Conclusion. In the studied period, the dynamic of increase of the age of women in labor is obvious. One of the reasons for this trend is the increase count of mothers giving birth again. The financial support from the state makes possible to implement the two-child and large family model in Russia. But it should be aware of the increased risk of biological problems in the group of older women. It is advisable to discuss the negative consequences of delayed motherhood, for example, through the education system. The material of the article is useful, first of all, for future parents.

Impact of COVID-19 pandemic on births: A university hospital experience

Background/Aim: Many studies have focused on assessing the effects of coronavirus 2019 (COVID-19) on the general population, but insufficient data concerning the impact on vulnerable populations, such as pregnant women, are available. The aim of this study was to compare the results of births before and during the pandemic in terms of maternal and newborn health and to determine the effect of the pandemic on such births. Methods: The population of this descriptive, retrospective cohort study consisted of women who gave birth in Sivas Cumhuriyet University Hospital Gynecology and Obstetrics Clinic between 01.03.2019–31.08.2019 and 01.03.2020–31.08.2020. No sample selection was made. As birth characteristics, the total and average number of births per month, the week of birth, whether there was a preterm birth, and the mode of delivery were evaluated. Age, number of pregnancies and births were evaluated as maternal characteristics. The birth weight and height of the newborn, number of babies with low birth weight, presence of stillbirth, Apgar 0 and 5 minute scores, and birth complications were evaluated as birth outcomes. Countable data were expressed as numbers and percentages and measurement data as mean, standard deviation, and minimum and maximum values. Inter-period means were compared with the t-test, nominal data were compared with the chi-squared test, and P &lt; 0.05 was considered significant. Results: It was observed that a 22.1% increase in the number of births during the pandemic period (n = 685) occurred when compared with the pre-pandemic period (n = 561). The difference in the increase in the number of births in both periods was not statistically significant (P = 0.153). The birth patterns, gender of the newborns, and the birth rates, including low birth weights, were similar during both periods. Gravidity and parity averages and minimum–maximum values were similar in both periods. When the weeks of gestation at birth were compared, it was observed that births occurred in the months before the pandemic, on average, during earlier gestational weeks. The number of births with fetal anomalies and stillbirths were compared, and it was found that the number of cases seen in both periods were similar. Conclusion: In this study, the characteristics and results of the pre-pandemic and pandemic periods were found to be similar.

Study on Risk Factors Related to Intrauterine Adhesion Based on Meta-Analysis.

Objective Intrauterine adhesion (IUA) is a severe complication that occurs following abortion. To evaluate the related risk factors of uterine cavity adhesion by meta-analysis. Methods The research literature on the influencing factors of patients with intrauterine adhesions published from January 2010 to December 2020 in PubMed, EMBASE, Cochrane Library, web of science, CNKI, Wanfang Data, VIP, and CBM were retrieved by computer. Two evaluators independently screened the literature, extracted the data, and evaluated the treatment according to the inclusion and exclusion criteria and then analyzed it with revman5.3 software. Results Finally, 12 literatures were included, with a total sample size of 2341 cases. The results of meta-analysis showed that pelvic inflammation (p = 0.05), negative pressure during uterine suction (p < 0.0001), and uterine suction time (p < 0.00001) were the risk factors for uterine cavity adhesion. The combined or and 95% CI of each factor were 2.05 (1.24, 3.38), 125.61 (67.35, 183.87), and 4.52 (4.21, 4.84), respectively. However, the number of pregnancies, the number of curettages, the average number of births, abortion, myomectomy, menstrual abnormalities, and infertility have little impact on the occurrence of intrauterine adhesions (p > 0.05). Conclusion Pelvic inflammatory disease, negative pressure during uterine suction and uterine suction time are the risk factors leading to uterine cavity adhesion.

Trend Analysis and Prediction of the Number of Births and the Number of Outpatients using Time Series Analysis

The purpose of this study was to analyze the trend of the number of births in Gwangju and the number of outpatients in Pediatric Dentistry at Chonnam National University Dental Hospital over the past 10 years (2010 - 2019) and predict the next year using time series analysis. The number of births showed an unstable downward trend with monthly variations, with the highest in January and the lowest in December. The average number of births in 2020 was predicted to be 682 (595 to 782, 95% CI), and the actual number of births was an average of 610. The number of outpatients was relatively stable, showing a month-to-month variation, with highest in August and the lowest in June. The average number of patients in 2020 was predicted to be 603 (505 to 701, 95% CI), and the average number of actual visits was 587. Despite the decrease in the number of births, the number of outpatients was expected to increase somewhat. Due to the special situation of COVID-19, the actual number of births and patients was to be slightly lower than the predicted values, but it was that they were within the predicted confidence interval. Time series analysis can be used as a basic tool to prepare for the low fertility era in the field of pediatric dentistry.

Clinical Analysis of 17 Cases of Borderline Ovarian Tumors During Pregnancy.

ObjectiveThe study retrospectively analyzed the clinical characteristics and prognosis of 17 cases of pregnancy complicated by borderline ovarian tumors to provide help for clinical workers.Materials and MethodsThe clinicopathological data of 17 patients with ovarian borderline tumors during pregnancy at the Shengjing Hospital of China Medical University from January 2015 to June 2021 were collected and analyzed retrospectively. The average age of the patients was 31.82 years (25–45 years), the average number of pregnancies was 2.06 times (1–6 times), and the average number of births was 0.41 times (0–1 time).ResultsAmong the 17 patients, 4 were diagnosed in the first trimester, 2 in the second trimester, and 11 in the third trimester. Most of the first symptoms were cysts, cyst enlargement, or cyst rupture. Among them, 3 cases (1 in the first trimester and 2 in the second trimester) continued pregnancy after a conservative operation, 9 cases underwent cesarean section and a conservative operation simultaneously, and the mother and child had a good outcome. Two cases underwent conservative operations and induced abortion, and 1 case underwent an ectopic pregnancy operation at the same time. The prognosis of the patients was good without recurrence.ConclusionPreoperative diagnosis of borderline ovarian tumors in pregnancy is delayed, and imaging and tumor markers are not specific. The coincidence rate between intraoperative frozen pathology and postoperative paraffin pathology was not high. Borderline tumors are mainly treated by surgery, and the prognosis for mothers and infants is good.

A report of laparoscopic promontofixation with uterine preservation

ABSTRACT Background: Pelvic organ prolapse is a common disease, accounting for 31.8% to 97.7% of women at clinical examination, of which clinical symptoms account for 2.9% to 11.4%. Pelvic floor disorders, including urinary incontinence, anal incontinence, and genital prolapse, are highly prevalent, affecting approximately one-third of adult women. While these conditions are not life-threatening, their social and economic consequences may be significant. Nowadays, there are many methods to treat female pelvic prolapse, including laparoscopic surgery, laparotomy and vaginal surgery. Choosing a method of treating pelvic organ prolapse is still controversial. Endoscopic surgery is a method having many advantages. In this study, we reported the treatment results for Pelvic organ prolapse by laparoscopic promontofixation without hysterectomy. Methods: A study was conducted on 19 female patients with pelvic organ prolapse, who were treated with the laparoscopy promontofixation for uterin preservation at Hue Central Hospital from June 2019 to June 2021. Results: The average age was 65 years old, the rate of hard work was 77.8%, and the average number of births was 3.8. The rate of macrosomia is 28%. The rate of bladder prolapse stage 2 accounted for 42%, and bladder prolapse stage 3 accounted for the highest rate of 58%. The stage 2 cervical prolapse rate was 32%, of which stage 3 cervical prolapse accounted for the highest rate of 68%. The stage 1 rectal prolapse rate was 50%, and stage 2 rectal prolapse was 1%, of which stage 3 was 42%. The rate of urinary incontinence was 89%. The median hospital stay for surgery was 6.57 days. The average time for laparoscopic promontofixation was 142 minutes, of which the longest time was 180 minutes and the fastest was 60 minutes. There were no complications during surgery. Complications appear after surgery: Burning pain in the lower abdomen was highest at 44%, dull pain in the low back at 33%, constipation at 22%, cystitis at 11%, pain when defecating at 11%. The success rate of the treatment of bladder prolapse after surgery was 100%, the success rate of cervical prolapse was 87.5%, the success rate of rectal prolapse was 88.9%. The rate of no urinary incontinence after 12 months was 75%, the success rate of dysuria treatment was 100%. Conclusions: Our initial experience renders the use of laparoscopic promontofixation with uterine preservation to be safe and efficient in experienced hands. However, it is difficult to perform this technique; the number of samples is small, and we need further research.

Parental status and characteristics of women in substance use treatment services: Analysis of electronic patient records

BackgroundMany women receiving substance use treatment services are mothers. Despite this, research has not proved whether substance use treatment services are addressing the specific needs of mothers. This study explored differences in sociodemographic, psychological, patterns of substance use, and treatment characteristics between mothers and women without children, and between mothers whose children were in alternative care. MethodThe study extracted data from electronic patient records (EPRs) of women who attended South London and Maudsley (SLaM) National Health Services (NHS) Foundation Trust addiction services between 2013 and 2020 (N = 4370). ResultsThe study identified 1730 participants (39.6%) as mothers, of whom 1340 (77.4%) had dependent children. The average number of births was 1.83 (SD = 1.0). Of the participants, 54.3% of mothers did not disclose whether their dependent child(ren) was under their care and 37.5% of mothers indicated that at least one of their child(ren) was in alternative care. Alcohol was the most reported type of substance used in the past 28 days. Mothers also highly reported suicide attempts and hospitalization due to mental health problems. Compared to women without children, mothers were more likely to be young, experience housing problems, use opioids and/or crack-cocaine in the past 28 days and experience lifetime domestic violence victimizations. Mothers were also less likely to have alcohol-related problems, experience overdose, and social isolation than women without children. ConclusionThe study highlights the need for substance use services to invest in approaches to improve mothers' disclosure of parenting and childcare issues. It also demonstrates that EPRs can identify key characteristics of mothers.

Births at Home: About 411 Cases Collected in the Township of Hiheatro in the Southern Part of Togo

This was a cross-sectional and descriptive study conducted from January 2nd to march 30th 2019 in the township of Hihéatro in Togo. We included in the study, women who had given birth at least once at home and who accepted to undergo the survey. Data were collected, using a pre-planned and pre-tested survey sheet, by a team of four trained interviewers under the responsibility of a supervisor. Interviews were carried out in the homes of the respondents after obtaining their informed consent. The parameters studied were the number of births at home, socio-demographic characteristics, and reasons for births at home and maternal and fetal prognosis. 411 women gave birth at home in the township. The average number of births at home per woman was 2 with extremes of 1 and 7 births per woman. The average age of the women was 28.4 years with the extremes of 15 and 38 years. The 25 - 34 age group represented 67.1% of cases. The average parity of the patients was 2. Multiparas represented 59.8% of cases. The main reasons for giving births at home by the interviewees were insufficient financial means in 36% of cases and the lack of means of transport in 28% of cases. Maternal morbidity was marked by 14.1% perineal tear, 1.6% hysterectomy. Four hundred and eleven newborns were registered. Of these newborns, 4.4% were stillborn and 8, 8% did not cry at birth. Free obstetric care and increased awareness on the importance of assisted deliveries will improve the maternal-fetal prognosis.

Horse Agribusiness in Rio de Janeiro, Brazil: production diagnosis and productivity indexes of Mangalarga Marchador breeding systems

This study was carried out to evaluate the production indexes of the Mangalarga Marchador horse farms, in which horse’s breeders were interviewed. The survey with 244 questions, where 262 variables were analyzed, of which 28 were used for the evaluation of productivity. The average number of births per farm/year throughout the Rio de Janeiro is 22.7 foals, which is equivalent to 42.5%, an average, of mares available for breeding. The birth rate is 94% throughout the Rio de Janeiro. More than 60% of stud farms have a mare’s productivity index above 0.5, with the highest average for the Northwestern Fluminense mesoregion (0.70) and the lowest for the Central Fluminense mesoregion (0.52). The ratio between pregnant/donor recipients mares shows an average of 1.96 embryos conceived by donor, considering all farms in the State of Rio de Janeiro. The highest average was observed in the Northwestern mesoregion (2.20 embryos per donor) and the lowest in the Southern Fluminense mesoregion (1.72 embryos per donor). The artificial insemination using a stallion on the farm is greater than the use of natural mating, especially in the mesoregions where fertility rates in embryo transfer are higher. The productivity rate presented an average of 0.23 considering all farms in the State of Rio de Janeiro, and ranged from 0.20 to 0.26 in the Central and Northwestern Fluminense mesoregions, respectively. The Northwestern mesoregion presented the best average productivity index of the Mangalarga Marchador herd in the state of Rio de Janeiro.

Structural equations modelling to quantify the effect of direct and intermediate factors on fertility changes in Egypt during 2000-2014.

Egypt's population increased by 10 million between 2011and 2014 and the total fertility rate increased to 3.5 births per woman. This paper aimed to evaluate the direct and intermediate factors that could explain this increase in the total fertility rate. Data from the 2000 and 2014 Egypt Demographic and Health Surveys were used. The average number of births per woman in the 3 years before the survey was used as a proxy for total fertility rate. A structural equations model was used to measure the total effect of direct and intermediate variables on number of births per woman. The effect of the intermediate variables on births per woman was stronger than the direct factors in both health surveys. In the 2000 and 2014 surveys, the intermediate factors with the greatest effect were: unmet need for family planning methods, discontinuation of using family planning methods in the 5 years before the survey, number of discontinuations of using family planning methods in the 3 years before the survey and child death under 5 years. In the 2000 survey, the direct factors affecting a decline in births per woman were: exposure to family planning messages, woman's work status, wealth index and woman's age 3 years before the survey. In the 2014 health survey, the effect of these variables on fertility declined. This decrease contributed to increasing the total fertility rate to 3.5 births per woman. Population policies should reintensify efforts to reduce the fertility rate based on the factors that influence fertility, such as family planning messages.

Women's Education: An Important Tool for Birth Reduction? A GMM - Poisson Regression Model Approach

Burkina Faso is a country with a shallow level of woman’s education. However, it is one of the most fertile countries. This paper analyzes whether the education of women reduces the number of births and the Total Fertility Rate in Burkina Faso. It also predicts the average number of births per woman and the Total Fertility Rate if women were better educated. Using data from the Demographic and Health Surveys, I model the two-stage Generalized Method of Moments (GMM) with the Heckman model and Poisson regression. The results show that the high fertility in Burkina Faso is mainly due to the low level of the woman’s education. The post-primary education increases the age at first birth. The number of births per woman would be decreased in the quarter and the Total Fertility Rate would pass from 5.4 to 3.6 if all women had at least completed the primary school. If all women had at least an incomplete secondary school, the number of births per woman would halve and the Total Fertility Rate would become 2.0. The government would do better to improve the education system allowing a good education for all, especially for women if it intends to reduce fertility.

Рождаемость в республике Молдова: европейские тенденции и национальная специфика

В настоящее время официальная статистика Республики Молдова, основываясь на данных о численности населения de jure (включая граждан, отсутствующих в стране 12 месяцев и более), дает заниженные оценки коэффициента суммарной рождаемости, что привело к отнесению страны к группе стран со сверхнизким уровнем рождаемости (lowest-low fertility).&#x0D; На основе данных о численности населения de facto, а также результатов Переписи населения и жилищ 2014 г. анализируются уровень и основные тенденции в динамике рождаемости в разрезе условных и реальных поколений. Основная цель исследования – проследить, до какого уровня снизилась рождаемость в Республике Молдова и можно ли ее относить к странам с низкой или очень низкой рождаемостью (low fertility or lowest-low fertility).&#x0D; Результаты исследования показывают, что трансформация рождаемости происходит согласно общей модели, характерной для большинства стран, завершивших или находящихся в процессе перехода рождаемости, однако характеризуется более низкими темпами. Для условных поколений рождаемость установилась на уровне 1,6-1,65 рождений на одну женщину, тогда как для реальных поколений, завершивших или находящихся на стадии завершения репродуктивного периода – на уровне 1,9-2,0 рождения. Даже для самых молодых поколений, достигших на момент переписи 35-летнего возраста (2014 г.), среднее число рожденных детей превысило значение 1,7. Несмотря на то, что в межпереписной период наблюдается сокращение среднего числа рождений к концу репродуктивного периода, среднее число рождений у женщин к 50-летнему возрасту составляет 2,1, а доля тех, кто не родил ни одного ребенка сохраняется на относительно низком уровне. &#x0D; Основываясь на результатах исследования, автор делает вывод, что Республика Молдова не относится к странам с низкой или очень низкой рождаемостью (low fertility or lowest-low fertility), а сохранение более высокого уровня рождаемости по сравнению с другими странами определяется преобладанием сельских жителей в общей структуре населения.

The gender division of labor and second births: Labor market institutions and fertility in Japan

1. IntroductionVery low fertility rates in Southern Europe, Eastern Europe, and East Asia have been a source of great interest for demographers in recent years (Kohler, Billari, and Ortega 2002; Lesthaeghe 2010). Among the theories proposed to explain the emergence of what is termed 'lowest-low' fertility (total fertility rates of 1.3 or lower), theories emphasizing the unevenness of gender-role change have increasingly occupied center stage. Central among these is McDonald's gender equity framework, with its focus on the slow pace of change in men's and women's household roles compared to their increasingly equal participation in the public sphere, especially the labor market (McDonald 2000). Recent work has suggested that increases in gender equality are likely to help societies currently experiencing low fertility to move towards an equilibrium characterized by near-replacement fertility rates (Esping-Andersen and Billari 2015; Goldscheider, Bernhardt, and Lappegard 2015).This paper seeks to make both a theoretical and an empirical contribution to the analysis of how gender equality is related to fertility. First, we bring the role of labor market institutions into the analysis, theorizing the importance of considering how employment norms and work culture affect men's ability to participate in housework. In doing so we establish the connection not only between women's roles in the public and private spheres but also between men's roles in these two spheres. Second, we bring East Asia more fully into the literature on low fertility, which has been dominated by research on Europe. We utilize individual-level panel data from Japan, one of the countries that has had persistently low fertility over the past two decades, despite government policy efforts to raise the birth rate. We employ an analysis strategy that models husband's contribution to household labor in the context of Japanese labor market institutions and then models the effect of husband's household work on the transition to second birth. In demonstrating how gender-role specialization in Japanese marriages is connected to the broader labor market context, we argue that Japanese labor market structure and workplace norms have a negative impact on Japan's fertility rate.2. The household division of labor and fertility2.1 Empirical studiesFollowing McDonald's gender equity perspective and the expectation that a highly gendered household division of labor in postindustrial societies is likely to depress fertility, in recent years a number of empirical studies have endeavored to test this relationship. At the macro level, Feyrer, Sacerdote, and Stern (2008) find a positive relationship in OECD countries between the average household work share of husbands and the average number of births.3 A number of studies using micro-level data find that increased involvement of fathers in childcare and housework increases the likelihood of a second birth. For instance, Olah (2003) compares Sweden, which has had a longstanding dual-earner/dual-carer family model, with Hungary, a country that has emphasized paid work for men and women but a more traditional division of labor at home. She finds that fathers' involvement in household work increases the probability of second birth in both countries.4 Using US data, Torr and Short (2004) find a Ushaped relationship between couples' distribution of household labor and the transition to second birth, with a higher probability of second birth for couples where the wife does most of the housework (the 'traditional' model) as well as for couples where housework is shared relatively equally between spouses.Studies using micro-level data from countries with a more traditional malebreadwinner model have produced somewhat mixed results. In her comparative study of Italy and Spain, Cooke (2009) finds that fathers' share of childcare has no effect on the probability of a second birth in Spain. In Italy, fathers' childcare time has a positive effect but the strength of the effect varies by mothers' employment status. …

The relationship between urogenital fistula and female genital mutilation /Kadin genital mutilasyon ile urogenital fistul arasindaki iliski

Aim: This study investigates relationship between vesicovaginal fistulas and types of female genital mutilation FGM. Material and Methods: The participants of this study were 78 patients, who had taken part in the Fistula Campaign that was carried out in Sudan in December 2014 to raise awareness about development of vesicovaginal fistula. First, patients were examined and their fistula and mutilation types were determined. Then, patients were compared in terms of type of genital mutilation they had undergone. The average length of urinary incontinence, surgery type, development of complications and recurrence of fistula were investigated according to type of FGM. Results: The average age of participants was 25.3±6.7 (16-42) years. The average number of births was 3.3±2.2. Forty-one patients had undergone Type 2 mutilation and 37 had undergone Type 3 genital cutting. When patients from Type II and Type III FGM groups were compared in relation to their surgery type, latter group patients were found to need further transvesical attempt at a significant rate. (p=0.014) The rate of success for Type II FGM group was found to be 73.2% and 78.4% for Type III patient group. The overall rate was calculated as 75.8%(p=0.405). Conclusion: FGM is a significant risk factor for female reproductive health. FGM-related fistulas can cause physical, social and psychological traumas in women, which arises as a serious concern for public health. Therefore, it is important to organize campaigns to raise awareness about fistulas in FGM-practiced regions.

LA MINILAPARATOMIA EN PLANIFICACION FAMILIAR, ESTUDIO EN PROVINCIAS DEL PAIS

Se reporta 304 casos sometidos a la técnica de la minilaparotomía que fueron realizados en veinte ciudades diferentes del país, para efectuar la oclusión tubaria y lograr la esterilización femenina definitiva para controlar su fertilidad, intervenciones quirúrgicas electivas en su mayoría y en un menor número en el post parto inmediato. Previamente, todas las pacientes y su pareja llenaron una solicitud, la cual fue evaluada por un Comité del Departamento de Gineco-obstetricia, que consideró la multiparidad, la edad, la coexistencia con enfermedades intercurrentes, la condición socio-económicas, etc. En las puérperas, la intervención fue efectuada dentro de las 24 a 48 horas del parto; en las no puérperas se realizó después de la regla. La incisión por encima del pubis fue de 3 a 4 cms. , algo más extensa que lo habitual, para la comodidad de la demostración de esta técnica de bloqueo tubario. En el 74% de los casos, la edad fluctuó entre los 30 a 39 años, casadas la gran mayoría. El promedio de partos fue 6 por mujer y 6.7 de gestaciones. El tipo de anestesia más usado fue la general; la raquídea y la epidural en un número menor de casos.

Accidental Pregnancy

Accidental Pregnancy Aeron Hunt (bio) On 13 March 1852, Edward Bulwer Lytton Dickens “arrived at Tavistock House,” the tenth child of Charles Dickens and his wife Catherine (Dickens 625). While the birth occasioned paternal effusions—Plorn, as he came to be called, is deemed “a golden baby,” “a brilliant boy of unheard-of dimensions” in letters to Elizabeth Gaskell and W.H. Wills (Dickens 625, 624)—a sour note is also struck. One hopes that Plorn was spared the reading of Dickens’s announcement to Angela Burdett Coutts: “I am happy to say that Mrs. Dickens and the seventh son—whom I cannot afford to receive with perfect cordiality, as on the whole I could have dispensed with him—are as well as possible” (627). And to William Howitt: “Mrs. Dickens and her boy are in a most blooming condition. I am not quite clear that I particularly wanted the latter, but I have no doubt that he is good for me in some point of view or other” (Dickens 629). Though Plorn came to be a favourite, the novelist’s account of his origins makes it easy to read the child as an accident (a word Dickens does not use), the last in a series of later pregnancies and births that he felt “superfluous” (Bodenheimer 152). It tells us nothing about Catherine Dickens’s perspective on the pregnancy; her biographer Lillian Nayder has suggested that Catherine “never voiced regret at giving birth ten times” (160). Without proof that Charles and Catherine were mutually and deliberately trying to limit their fertility by this point in their marriage, it is impossible to be certain that Plorn was the result of a slip. Even if it were possible, a married, financially comfortable couple is not the most dramatic context for an emblematic image of accidental pregnancy in an era in which literary fallen women such as Gaskell’s Ruth or George Eliot’s Hetty Sorrel captured the public imagination. And the hunt for a single representative instance of an experience that varies so greatly might be misguided in any case. Still, in its ordinariness as well as its specific features, the example of Charles, Catherine, and Plorn highlights aspects of the concept of accident that suggest its particular relevance to the gendered terrain of Victorian reproduction and risk. [End Page 43] Charles and Catherine’s ten children were born toward the end of a long period, starting around 1750, in which fertility in Britain had been on the rise—a rise that resulted from both an increased frequency of marriage and increased fertility within marriage (Szreter 418). For the decades from 1860 to 1940, demographers describe a “dramatic” fertility decline, with the average number of births per woman falling to a little over two from approximately six (Szreter 1). While historians debate the mechanisms behind this decrease, they suggest that efforts to space or stop births played a key role. Periodic abstinence and coitus interruptus are credited for much of the decline; in fact, Simon Szreter suggests that these practices formed part of a larger cultural shift emphasizing the values of self-restraint and continence (chap. 8). For those with the knowledge and the money to employ them—not a large number, according to Szreter—and then the ability to negotiate their use, devices such as pessaries, sponges, douches, and condoms existed as tools to prevent pregnancy, and abortion also played a role in limiting births (McLaren; Szreter 424–31). Insofar as accident implies a failure of intention and agency, this context is significant; one has to be able to imagine the possibility of control in order for the concept to make sense, whether describing a pregnancy that results from an imperfect method of birth control or simply a pregnancy that is unwanted or unintentional, and whether or not specific efforts had gone into prevention. To be sure, such efforts—and the need to name their failures—did not first occur to people in 1860. Accident was used to describe unwanted or unintentional pregnancy well before the start date assigned to this demographic shift: the oed gives 1850 as the first appearance of the usage, but the text that it cites...