Birth Intentions Research Articles

Birth Intention Status and Infant Mortality: Fixed‐Effects Analysis of 60 Countries

AbstractMost studies on the impact of birth intentions on children's well‐being do not separate risks of infant mortality associated with pregnancy intention status from the risks that are associated with sociodemographic characteristics. There is a lack of studies taking a multicountry comparative perspective. We analyzed 60 Demographic and Health Surveys in Asia, the Americas, and Africa to examine the association between birth intentions and infant mortality using sibling fixed‐effects linear probability models accounting for confounding due to time‐invariant maternal characteristics. Compared to wanted births, the probability of infant mortality was higher after an unwanted or mistimed birth, or both, in 41 countries. Particularly in West Africa, mostly mistimed pregnancies were associated with infant mortality, whereas in the Americas unwanted pregnancies mattered more. These differences could be partly due to contextual variation in the concept of birth intentions and in the importance of birth spacing and limiting. We show that the risk of infant mortality after an unwanted/mistimed pregnancy was higher in countries with low human development index and high overall infant mortality rate, highlighting the importance of taking context into account rather than pooling data. To the best of our knowledge, this is the first large‐scale, cross‐regional, and cross‐country comparative study to analyze the association between birth intentions and infant mortality using a fixed‐effects approach.

Third birth intention of the working women with two existing children in Hainan Island, China: The impact of fertility costs and utility

This study evaluates the impact of fertility costs and utility on the third birth intentions among working women with two children in Hainan, China. A cross-sectional survey was conducted in Hainan Island, China in 2021 using an offline survey. Among 1067 working women with two children, only 8.06 % of participants reported having a third-birth intention. After adjustment for potential confounding factors, higher economic cost (odds ratio = 1.89) and lower succession utility (odds ratio = 5.08) were significantly associated with the lack of intention to have a third child. The analysis further demonstrates that family values significantly modulate these economic and utility considerations, highlighting a strong cultural influence on fertility decisions. This finding underscores the necessity for policies that not only mitigate financial burdens but also promote family values supportive of higher fertility. Such measures are essential for creating a cultural and economic environment conducive to higher birth rates.

Effects of Variables Applied in the Theory of Planned Behavior and Moderating Effects of Marriage Value and Pro-natal Policy Perception on Birth Intentions among College Students

Effects of Variables Applied in the Theory of Planned Behavior and Moderating Effects of Marriage Value and Pro-natal Policy Perception on Birth Intentions among College Students

Fertility dynamics during COVID-19: exploring intentions in rural Bangladesh

This paper investigates the impact of the COVID-19 pandemic on fertility intentions among families in the Rangpur region of Bangladesh, considering various socio-economic and demographic characteristics. The study aims to understand how the COVID-19 pandemic influenced fertility decisions, patterns, and how different contextual factors are relevant to explain those intentions. This study adopted a qualitative methodological approach, utilizing a non-probability purposive sampling procedure to select sixty-five rural women as participants who conceived babies during the COVID-19 pandemic and seven health care providers. Data were collected through semi-structured interviews and KII to explore the factors influencing intentional and unintentional childbirths during the pandemic. The findings revealed that, among the respondents, intentional childbirths were more prevalent than unintentional childbirths. The perceived causes of intentional childbirth in rural areas were pandemic-induced factors, demographic characteristics and societal practices to have a baby. The factors to unintentional childbirth were limited access to reproductive health care services and contraceptives, leading to unplanned pregnancies. Additionally, the study highlights that COVID-19 related economic and health conditions did not have a significant impact on fertility decisions in rural areas. Societal norms and attitudes towards family planning, childbearing and family size played key roles in determining birth intentions. Overall, the research emphasizes the need for targeted policies and initiatives to address the challenges of fertility planning during a health crisis.

Trends, patterns and predictors of high-risk fertility behaviour among Indian women: evidence from National Family Health Survey.

Numerous studies have demonstrated that high-risk fertility behaviour (HRFB), which includes maternal age below 18 or above 34 years, short birth intervals (less than 24 months), and high parity (birth order above 4), is associated with adverse maternal and child health outcomes. There is a substantial research gap in the domain of high-risk fertility behaviour in the Indian context. Therefore, this study is designed to investigate the current trends and patterns in the prevalence of high-risk births among Indian women, with a primary focus on identifying contributing factors associated with this prevalence. The study utilized data from the nationally representative National Family Health Survey (NFHS), which has been conducted in five rounds since 1992-93. Data from all rounds were used to assess the overall trend. However, data from the most recent round of NFHS, conducted during 2019-21, were employed to evaluate current levels and patterns of HRFB prevalence and to identify socio-economic and demographic predictors of HRFB using binomial and multinomial logistic regression models. The prevalence of HRFB has exhibited a consistent decreasing pattern from 1992 to 93 to 2019-21 in India. However, 29.56% of married women continue to experience high-risk births with notably higher rates in several states (e.g., 49.85% in Meghalaya and 46.41% in Bihar). Furthermore, socio-demographic factors like wealth index, educational level, social group, religion, mass media exposure, family size, age at marriage, type and region of residence, and reproductive factors like birth intention, place and type of delivery, ANC visits and current contraceptive use were identified as significant predictors of high-risk births among women in India. Despite a 20.4 percentage point decline in HRFB prevalence over the past three decades, a significant proportion of women in specific regions and demographic subgroups continue to experience high-risk births. Therefore, the present study recommends interventions aimed at preventing high-risk births among women in India, with particular emphasis on states with high HRFB prevalence and women from socioeconomically disadvantaged backgrounds.

Social Climate, Uncertainty and Fertility Intentions: from the Great Recession to the Covid-19 Crisis

The literature on fertility in context of crises considers major crises exclusively as economic experiences, however, they are also social phenomena, affecting communities, morality and social interactions. When changes in the social climate are of a sufficient magnitude, they tend to break down the social fabric and generate additional uncertainty, more of a social form, which may affect reproductive decisions beyond economic uncertainty alone. Applying Fixed Effects Models to 18 waves of the Swiss Household Panel (2004–2021), this study evaluates the relationship between changes in social climate and social uncertainty and first and second order childbearing intentions, net of economic uncertainty, sociodemographic determinants and unobserved time-invariant individual and local area characteristics. Canton-level mean and variance of generalized trust and optimism about the future are used as proxies of the quality and the unpredictability of the social climate respondents live in. Besides parity, the study explores period variation by comparing the time around the Great Recession (before, during and after) and the years around the Covid-19 pandemic. Results show that the worsening of the social climate and its growing uncertainty correlate with lower and more uncertain first and second birth intentions. Yet, important parity-period interactions emerge.

Factors affecting pregnancy registration in India: does the pregnancy intention matter?

BackgroundPregnancy registration is one of the most critical components of women’s reproductive health because it is the gateway to entering the continuum of care services such as antenatal care, institutional delivery, and postnatal care. There is a lack of studies exploring the relationship between pregnancy intention and pregnancy registration, especially in the Indian context.MethodThis study used the National Family Health Survey-5 (2019-21) data to explore the relationship between birth intention and failure of pregnancy registration. The bivariate and multivariate (binary logistic regression) analysis was carried out.ResultsAdjusting the effects of socio-demographic and economic characteristics, compared with women with an intended pregnancy, the odds of failure of pregnancy registration were significantly high among women with a mistimed pregnancy (OR = 1.60, 95% CI = 1.47–1.73) and unwanted pregnancy (OR = 1.38, 95% CI = 1.26–1.52). The study found pregnancy intention as a significant predictor of pregnancy registration.ConclusionsResults suggest strengthening the interaction of grassroots-level health workers with women, especially those with possibly lower healthcare autonomy and unintended pregnancy. Higher and earlier pregnancy registration will enhance maternal healthcare utilization and reduce adverse health consequences to mothers and children, thus ensuring better maternal and child health.

TÜRKİYE’DE DEĞİŞEN DOĞURGANLIK TERCİHLERİ: PARİTEYE GÖRE ANALİZLER

The aim of this study is to examine changes in fertility ideals and intentions of women and fertility gap at both macro and micro level for the 1993-2018 period using data of Turkey Demographic and Health Surveys (TDHS), and to analyze fertility intentions of currently married women by parity, i.e. number of children ever born, using 2018 TDHS data employing descriptive and logistic regression methods. According to the findings, while ideal number of children increased in the 25-year period, intended number of children decreased. Although fertility gap is positive when using conventional TFR, it is negative when adjusted TFR is used, meaning actual fertility is greater than ideal or intended number of children. There has been an increase in the level of pronatalism in Türkiye recently, but it would be wrong to conclude that this is reflected in intentions and behaviors. Our multivariate findings covering all parities show that age and child-related variables are important determinants of women's fertility intention. Additionally, region, mother tongue and use of contraceptive methods are important. Socioeconomic variables, however, were not found to be significantly associated with birth intention. Some of these were found to be significant in intention for progression to first- and second-births.

Gaining insight from future mothers: A survey of attitudes and perspectives of childbirth

ObjectiveTo determine whether participant characteristics and/or birth preferences of future mothers are associated with a fear of birth. DesignA cross-sectional survey was used to determine if fear of birth could be profiled in specific participant characteristics and birth choices. SettingUrban New Zealand university. ParticipantsA convenience sample of women (final n = 339) who were < 40 years old, attending university, not pregnant nor had been pregnant but wished for at least one child in the future. FindingsMultivariable analysis identified a subset of four variables that were independently associated with the instrument Childbirth Fear Prior to Pregnancy (CFPP) measuring fear of birth (mean CFPP=38.0, SE=10.1). Preferences of birth by caesarean section (n=32, mean CFPP=44.3, SE=1.8, p < 0.0001), use of epidural analgesia (n=255, mean CFPP=45.0, SE=1.1, p < 0.0001), participants born outside of New Zealand (n=123, mean CFPP=42.9, SE=1.4, p < 0.0001), and participants who scored > 20 (‘severe’) for depression on DASS-21 scale (n=11, mean CFPP=44.8, SE=1.7, p < 0.0001) were all positively associated with CFPP. Post-hoc analyses revealed that mean CFPP was higher for those that perceived birth technologies as easier, safer, necessary, and required. ConclusionsWomen born outside of New Zealand and/or suffering ‘severe’ depression were more likely to have a fear of birth. Fear of birth was associated with the participants choices towards medicalised childbirth. Familiarising women with the provision of maternity care in New Zealand and identifying mental health status early could reduce fear of birth and possibly support the vaginal birth intentions of future parents.

P51 - Factors associated with spontaneous vaginal birth in nulliparous women at term: a systematic review

The aim of this systematic review was to identify the factors associated with spontaneous vaginal birth at term, in nulliparous, women with a singleton pregnancy. Exposures or interventions of interest included those related to safe and modifiable opportunities to attain a primary spontaneous vaginal birth, such as clinical practices, models of care and women’s own intentions and attributes. Nine databases were searched with dates extending from inception to 16 July 2021. Quantitative studies of all designs, published in English, of nulliparous women with a singleton pregnancy and cephalic presentation, who experienced a spontaneous vaginal birth (SVB) at term were included. Covidence was used to manage citation screening and full text review. Two reviewers undertook quality appraisal and RCTs with high risk of bias (ROB 2.0) and other designs (QATSDD) scoring ≤ 50% were excluded. Data was abstracted from 78 studies (31 RCTs, 33 cohort, 9 cross-sectional, 4 prevalence and 2 case control) and factors associated with SVB were categorised as maternal, clinical care and fetal to synthesise findings. There was established evidence to support interventions to address maternal BMI, birth intentions and fear of childbirth as well as childbirth education, breathing and exercise interventions in the antenatal period and midwifery models of care to increase SVB in nulliparas. Findings did not support routine induction to promote SVB, but the relationship between maternal pelvic anatomy and fetal positioning and strategies to optimise labour progression emerged as promising areas for further research. How women give birth the first time is important, and this review highlights key domains where evidence synthesis can guide improvements in care and direct future research.

Developmental Tasks During the Childrearing Stage and Second Birth Intentions among Chinese Married Women: Parenting Adaptation, Division of Childcare, and Marital Adjustment

Although the globally known one-child policy in China was abolished in 2016, the overall fertility rate in the country declined to 1.3 in 2020. In this study, we examined whether the achievement of major developmental tasks during the childrearing stage was associated with intentions to have a second child among Chinese married women. Based on family development theory, we included parenting adaptation, division of childcare responsibilities with the partner, and marital adjustment as key developmental tasks during the childrearing stage. The participants of this study were 315 married Chinese women who lived with a spouse and a child who had not yet entered elementary school. Data were collected through an online survey in February and March 2021. A multiple regression analysis of the data revealed that a lower level of economic parenting stress, a higher level of fairness in dividing childcare responsibilities with the partner, and a more positive change in their marital relationship after having the first child were associated with greater intentions to have a second child.

Third birth intention of the childbearing-age population in mainland China and sociodemographic differences: a cross-sectional survey

BackgroundGlobal fertility declines have become an inevitable trend, and many countries are adopting policies to drive fertility increases. Fertility intention plays an important role in predicting fertility behavior. The Chinese government has recently issued the ‘three-child’ policy, and there is still little research on the third birth intention of the childbearing-age population. Therefore, the aim of this study is to investigate the prevalence and related reasons of third birth intention in the childbearing-age population in mainland China, and analyze the sociodemographic differences.MethodA cross-sectional survey was conducted in mainland China from June to July 2021. A total of 15,332 childbearing-age participants responded and completed the Fertility Intention Questionnaire online through the Wenjuanxing Platform. Data were explored and analyzed by SPSS (version 22.0) software. Descriptive statistics were used to describe the current situation and reasons of third birth intention. Binary logistic regression analysis was applied to assess the influencing factors in the sociodemographic level.ResultsThe mean age of the participants was 32.9 ± 5.94 years. Only 12.2% of participants reported having third birth intention. The subjective norm of having both son and daughter (22.0%) and busy at work (29.2%) accounted for the largest proportion in the reasons of acceptance and rejection, respectively. Age has negative impact on third birth intention (OR = 0.960). Men were 2.209 times more likely to have three children than women (P < 0.001). With the improvement of education and family monthly income, the birth intention shows a downward trend. Compared with Han nationalities, first marriage and city residents, the ethnic minorities, remarriage and rural residents have stronger birth intention (all P < 0.05). And individuals with two existing children are inclined to have the third child (OR = 1.839).ConclusionThe third birth intention in the childbearing-age population in China is still low after the announcement of the three-child policy. It is necessary to create a favorable fertility context for childbearing-age group with high level of third birth intention, like younger, male, minority, remarriage, with lower education and family monthly income, living in rural and two existing children. Furthermore, removing barriers for those unintended is also prominent to ensure the impetus of policy.

Challenges in using Mental Contrasting with Implementation Intentions (MCII) for preparation for natural birth: A feasibility study

ObjectiveWomen who plan a natural birth can benefit from strategies and/or resources that help them prepare for and cope with labour pain. This study aims to identify the feasibility of using Mental Contrasting with Implementation Intentions (MCII) for preparation of primiparous women for natural childbirth. Secondary aims are to test the acceptability of a health-focused information leaflet, and to describe how participants with high natural birth intentions cognitively prepare for birth. MethodsIn third trimester, ten primiparous women participated in this interventional study with follow-up. A health-focused information leaflet on physiological childbirth, MCII, a mental strategy that helps people achieve a desired goal by envisioning obstacles and how to overcome them, and a researcher-developed questionnaire which contained the CBSEI-C32, was used. Survey data were analysed using a combination of descriptive statistics and deductive theoretical thematic analysis. ResultsThe health-focused leaflet was exclusively judged positively. Nine women did not use MCII as instructed, they did not find it helpful for childbirth preparation and wished to have a more positive, health-focused approach towards childbirth. Two themes emerged from the participants’ responses: 'the ability to give birth' which was supported through childbirth preparedness, coping strategies, confidence and external supports and 'the uncertainty of giving birth' which included fears and worries about possible adverse events and the baby’s health. ConclusionMCII was not a promising tool for natural childbirth preparation among primiparous women in Germany. Our findings show that women prefer a positive, health-focused approach, rather than thinking about overcoming obstacles, when they prepare for childbirth.

When partners’ disagreement prevents childbearing: A couple-level analysis in Australia

Background: Studies investigating the correspondence of birth intentions and birth outcomes focus mainly on women’s and men’s intentions separately and disregard the fact that reproductive decision-making is dyadic. Objective: We examine the intention–outcome link for fertility taking a genuine couple-level approach. We aim to understand whether a heterosexual couple’s conflict is solved in favour or against childbirth and whether the male or the female partner prevails in the decision-making. Methods: Drawing on data from the survey Household, Income and Labour Dynamics in Australia (HILDA), we perform logistic regressions in which couples are the unit of analysis and the variables are computed by combining both partners’ characteristics. Results: Results show that disagreement about having a first child is located between ‘agreement on yes’ and ‘agreement on not,’ with half of disagreeing couples having a child. By contrast, disagreement about having another child is shifted more towards ‘agreement on not’ and most often prevents the birth of a child. Women prevail in the decision of having a first child, irrespective of gender equity within the couple, while a symmetric double-veto model is at work if the decision concerns a second or additional child. Conclusions: Couple disagreement is not always sufficient to prevent the birth of a child in a low fertility country such as Australia, and the increasing level of gender equity within the couple does not necessarily imply increasing female decision-making power on childbearing issues. Contribution: The predictive power of fertility intentions is more accurate in models including both partners’ views. Fertility-related policies should consider the dyadic nature of fertility decisions.

Birth intentions among US fathers with disabilities

BackgroundMen’s birth intention is an indicator of their sexual health and plays an important role for their child’s health and development; however, birth intendedness in fathers with disabilities has been unknown. ObjectiveThis study examines disparities in birth intendedness among fathers with and without disabilities and explores whether the differences vary by marital status or race/ethnicity. MethodsData from the 2011–2017 National Survey of Family Growth (NSFG) were used to examine pregnancy intendedness for fathers with (n = 380) and without disabilities (n = 1,324) about their last birth in the five years preceding the interview. Multinomial regression models estimated the odds ratios of fathers’ disability status on birth intention controlling for covariates. Interaction effects of disability status by marital status or race/ethnicity were also tested. ResultsFathers with disabilities were 1.89 (95% CI = 1.21, 2.95) times as likely to report their last birth as unwanted versus intended compared to those without disabilities after adjusting for covariates. Although married fathers without disabilities were less likely to report unintended birth than their unmarried counterparts, the protective effect of marriage was not evident among fathers with disabilities. ConclusionsDisabled fathers are at a higher risk of unintended birth compared to nondisabled fathers. These findings highlight the need to increase access to family planning services for disabled men. Further research is needed to better understand the risk factors that contribute to disabled fathers’ unintended birth and how these are linked to their child and family well-being.

Contraceptive Method Utilization and Determinant Factors among Young Women (15-24) in Ethiopia: A Mixed-Effects Multilevel Logistic Regression Analysis of the Performance Monitoring for Action 2018 Household Survey.

Despite highly effective modern contraceptive methods (both short and long acting) are made widely available and accessible globally, their utilization remains low among young women in low- and middle-income countries, including Ethiopia. Hence, this study is aimed at determining its status and identifying the determinant factors by using nationally representative data. A multilevel analysis of the nationwide Performance Monitoring for Action 2018 of Ethiopia round 6 data, collected from June to July, 2018, was conducted. A total of 982 both married and unmarried young women (15-24) were included in the analysis. Descriptive statistics was used to describe the status of contraceptive method utilization and unmet need across regions. A mixed-effects multilevel logistic regression model was used to identify the determinants of the contraceptive method utilization. Adjusted odds ratios with corresponding 95% confidence intervals were used to show the significance of the associations at p < 0.05. The status of contraceptive method utilization was 54.8% (95% CI: 51.7%, 57.9%), and 18.6% (95% CI: 16.3%, 21.2%) had unmet need. Afar (12.3%), Harari (12.5%), and Ethiopian Somali (20.0%) regions had the lowest contraceptive method utilization. Wealth quintiles and religion were the higher level variables affecting contraceptive method utilization among the young women. Age, marital status, parity, future birth intention, and knowledge of contraceptive methods were the individual level factors identified as determinants of contraceptive method use among the young women. In conclusion, the status of contraceptive method utilization among the young women in Ethiopia is promising as compared to the national target of 55% for 2020; however, still high unmet need exists. The factors also exist both at the contextual and at individual levels. Hence, multilevel interventions need to be in place giving special emphasis to the low performing regions. Besides, region-specific behavioral interventions and family planning services that will be able to reach the young women need to be designed.

Salivary cortisol concentrations in hematogy/oncology nurses on working days and days off.

to assess salivary cortisol concentrations in hematology/oncology nurses on working days and days off. a cross-sectional study carried out with 28 nurses from a university hospital. A sociodemographic, employment and health profile questionnaire was applied. For saliva collection, Salivette® tubes were used. Descriptive and analytical analysis was used. there was no significant difference in cortisol concentrations between working days and days off (p>0.05). The high cortisol concentration was associated with not having children (0.621±0.340; p=0.046), not using medication (0.623±0.133; p=0.017) and birth control pills (0.556 ± 0.228; p=0.047) and intention to leave work (0.951±0.154; p=0.001). A positive correlation was identified between cortisol and absence from work due to health issues (0.72; p=0.05) and weight gain (0.935; p=0.02). in general, cortisol concentration is within the reference parameters, with no significant difference in its secretion on working days and days off.

Intentions and Childbearing

The adult life of women and men is characterised by a plurality of choices and eventspertaining to different life domains. In the literature pregnancy intentions are usuallystudied in isolation from intentions pertaining to other spheres of life. In this research,we investigate the correspondence of birth intentions and birth outcome in a life courseframework, encompassing several life domains such as partnership, education, workand residence. Using longitudinal data from the Generations and Gender Surveys in fiveEuropean countries (Austria, Bulgaria, France, Hungary, and Lithuania), we examine thematching processes of individuals’ childbearing intentions and subsequent outcomespaying attention to the mediating and moderating role of intentions other thanchildbearing. We find empirical support for the hypothesis that adults’ plans aremultidimensional and that the more simultaneous intentions individuals have, the lesslikely they are to achieve their fertility goals. Some intentions, like moving to a newdwelling, facilitate the realization of birth intentions; others, like changing a job, tend tohinder the realisation of birth intentions. Finally, individuals are more successful inachieving their fertility targets in contexts that promote a reconciliation of work andfamily life.

Family-supportive workplace policies and benefits and fertility intentions in South Korea

ABSTRACT In 2017, South Korea’s total fertility rate was 1.26 live births per woman, the sixth-lowest in the world. Employment is significantly negatively associated with second births in Korea. To increase fertility rates and help working women better balance work and family lives, a series of government family-supportive workplace policies and employer-provided occupational benefits have been implemented and expanded. The present study examined the effects of family-supportive workplace policies and benefits on boosting working women's fertility intentions in Korea by the current number of children (i.e. parity). Using the 2007–2012 Korean Longitudinal Survey of Women and Families (N = 3,405 working women), the study examined seven family policies and benefits. Results revealed that childcare leave was significantly associated with increasing working women’s first birth intentions. Also, women’s second birth intentions increased significantly when they had more family-supportive provisions at their workplaces. Despite these results, a majority of women perceived the family provisions to be unavailable at their workplaces. The present study underscores that women's fertility decisions differ significantly by parity and informs policymakers in their efforts to develop family provisions that address these differences and make family provisions more readily available.

Impact of PM2.5 on Second Birth Intentions of China's Floating Population in a Low Fertility Context.

The total fertility rate of the Chinese population has declined dramatically over the last three decades. Research has substantiated the causal link between particulate matter (PM) and adverse health effects. However, the impact of PM on the birth intentions or fertility behavior of the childbearing population remains understudied. The paper analyzes the impact of PM2.5 concentration (a mixture of extremely small solid particles and liquid droplets found in the air) on the second birth intentions of the Chinese floating population. We used urban migrant population matching data at the prefectural level for the analysis. The unique datasets were derived from the Chinese Floating Population Dynamic Survey in 2014 administered by the National Health Commission, the National Prefecture-level City Matching Data administered by the National Bureau of Statistics of China, and the air pollution index PM2.5 collected by the Green Peace Organization. The results show that PM2.5 concentration has a negative impact on the second birth intentions of the floating population. This impact exhibits marked regional heterogeneity: the desire for a second birth across migrant groups living in south China decreases if PM2.5 concentration goes up, while migrants coming from, and living in, north China show strong intentions to have a second birth despite an increase in PM2.5 concentration in northern cities. The results have direct implications for the Chinese government at various levels to play a vital role in making and implementing environmental policies on the mitigation of smog to effectively safeguard the health of individuals and communities and potentially raise China’s fertility rate.