Childbearing Aspirations Research Articles

Determinants of fertility intentions among women of reproductive age in South Africa: evidence from the 2016 demographic and health survey

Against the background of the fertility decline in South Africa in recent years, the present study aimed at understanding the factors that shape South African women’s general childbearing aspirations. Specifically, it sought to examine the effect of selected sociodemographic factors on the fertility aspirations of two groups of reproductive-aged women in South Africa, 15–34 years (younger women) and 35–49 years (older women). The results showed that being black African, having at least secondary-level education, urban residence, being employed and increased parity significantly determined women’s intentions for children, regardless of the age cohort. Belonging to a ‘richer’ wealth index category and living in a household of three or more people significantly determined fertility intentions for younger women, while cohabitation significantly determined fertility intentions for older women. The study also found that urban residence and increased parity significantly reduced fertility indecision for younger women only. Implications for policy interventions are discussed.

OP0331-HPR BARRIERS TO SHARED DECISION-MAKING WITH WOMEN OF REPRODUCTIVE AGE AFFECTED BY CHRONIC INFLAMMATORY DISEASES

Background:Previous research has indicated that women with a chronic inflammatory disease (CID) are likely to discontinue treatment during pregnancy. [1] Reasons for this are complex, including sub-optimal integration of shared decision-making (SDM) into practice.Objectives:The purpose of this study was to assess: 1) physicians’ competencies in risk assessment, treatment and management of women of reproductive age (WoRA) with a CID, and 2) clinical gaps, barriers and challenges to SDM with these patients.Methods:A mixed-methods needs assessment was conducted. [2] Participants included rheumatologists and dermatologists practicing in Germany, United Kingdom, or United States, with at least three years of experience. Exposure to patients diagnosed with rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis or psoriasis was required. A first phase involved collection and thematic analysis of data from semi-structured interviews to identify main challenge areas. The second phase consisted of online surveys to validate and quantify identified challenges, gaps and barriers. Chi-square and Kruskal Wallis H statistical tests were performed to assess differences by specialty, country and gender. Qualitative and quantitative findings were triangulated with insight from experts in medical education and relevant behavioural and clinical fields. [3] The present summary reports data pertaining to rheumatologists only.Results:A total of 24 interviews and 173 surveys were completed with rheumatologists. Depending on the country and specific item, 22% to 64% reported having sub-optimal knowledge of treatment options, patient education aids, and strategies to assess treatment adherence among WoRA with a CID (see figure 1). In addition, 36% reported having sub-optimal knowledge of methods to achieve SDM. Unplanned pregnancies were reported as a barrier to prescribing biologics to WoRA with a CID. Yet, 61% of rheumatologists reported having sub-optimal skills discussing contraceptive methods with patients. In addition, 41% reported having sub-optimal skills adjusting treatment according to changes in pregnancy status or child-bearing aspirations. Few differences in clinical gaps were observed by gender. Notably, a greater proportion of male rheumatologists reported having sub-optimal skills approaching WoRA in a way that makes them feel comfortable discussing their health concerns, compared to female rheumatologists (52% vs. 30%, p=0.046). This skill gap was identified as a contributing barrier to SDM with these patients.Conclusion:This study identified multiple challenges, gaps and barriers relevant to rheumatologists that prevent optimal SDM, risk assessment, treatment and management of WoRA with CID. Findings may be used to develop medical education and continuous professional development interventions for target learners.

Life transitions and women’s desired number of children: the impact of motherhood, relationships and employment

ABSTRACT To better understand the gap between women’s childbearing aspirations and actual levels of childbearing, this paper investigates the importance of employment, relationship and motherhood transitions for predicting women’s desired number of children. Women born in 1973–78 participating in the Australian Longitudinal Study on Women’s Health were asked, at three-time points over six years, how many children they would like to have by the age of 35 years. Women who delayed childbearing, did not marry or enter a cohabiting relationship aspired to fewer children, whilst those who married aspired to more children. Notably, the two-way interactions demonstrated that for women without children, and for women who had had their first child between waves, shifting from secure work to being out of the labour force was associated with desiring fewer children. This finding supports the argument that policies which promote women’s attachment to the workforce enable women to more effectively pursue their aspirations for both motherhood and careers. The findings make a new contribution to the field by indicating that life transitions are more important predictors of desired number of children than background and demographic factors that have long been associated with, and used as explanations for, women’s childbearing.

Pregnancies, abortions, and pregnancy intentions: a protocol for modeling and reporting global, regional and country estimates

BackgroundEstimates of pregnancies, abortions and pregnancy intentions can help assess how effectively women and couples are able to fulfil their childbearing aspirations. Abortion incidence estimates are also a necessary foundation for research on the safety of abortions performed and the consequences of unsafe abortion. Furthermore, periodic estimates of these indicators are needed to help inform policy and programmes.MethodsWe will develop a Bayesian hierarchical times series model which estimates levels and trends in pregnancy rates, abortion rates, and percentages of pregnancies and births unintended for each five-year period between 1990 and 2019. The model will be informed by data on abortion incidence and the percentage of births or pregnancies that were unintended. We will develop a data classification process to be applied to all available data. Model-based estimates and associated uncertainty will take account of data sparsity and quality. Our proposed approach will advance previous work in two key ways. First, we will estimate pregnancy and abortion rates simultaneously, and model the propensity to abort an unintended pregnancy, as opposed to modeling abortion rates directly as in prior work. Secondly, we will produce estimates that are reproducible at the country level by publishing the data inputs, data classification processes and source code.DiscussionThis protocol will form the basis for updated global, regional and national estimates of intended and unintended pregnancy rates, abortion rates, and the percent of unintended pregnancies ending in abortion, from 1990 to 2019.

Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model

Estimates of pregnancy incidence by intention status and outcome indicate how effectively women and couples are able to fulfil their childbearing aspirations, and can be used to monitor the impact of family-planning programmes. We estimate global, regional, and subregional pregnancy rates by intention status and outcome for 1990-2014. We developed a Bayesian hierarchical time series model whereby the unintended pregnancy rate is a function of the distribution of women across subgroups defined by marital status and contraceptive need and use, and of the risk of unintended pregnancy in each subgroup. Data included numbers of births and of women estimated by the UN Population Division, recently published abortion incidence estimates, and findings from surveys of women on the percentage of births or pregnancies that were unintended. Some 298 datapoints on the intention status of births or pregnancies were obtained for 105 countries. Worldwide, an estimated 44% (90% uncertainty interval [UI] 42-48) of pregnancies were unintended in 2010-14. The unintended pregnancy rate declined by 30% (90% UI 21-39) in developed regions, from 64 (59-81) per 1000 women aged 15-44 years in 1990-94 to 45 (42-56) in 2010-14. In developing regions, the unintended pregnancy rate fell 16% (90% UI 5-24), from 77 (74-88) per 1000 women aged 15-44 years to 65 (62-76). Whereas the decline in the unintended pregnancy rate in developed regions coincided with a declining abortion rate, the decline in developing regions coincided with a declining unintended birth rate. In 2010-14, 59% (90% UI 54-65) of unintended pregnancies ended in abortion in developed regions, as did 55% (52-60) of unintended pregnancies in developing regions. The unintended pregnancy rate remains substantially higher in developing regions than in developed regions. Sexual and reproductive health services are needed to help women avoid unintended pregnancies, and to ensure healthy outcomes for those who do experience such pregnancies. Dutch Ministry of Foreign Affairs and UK Aid from the UK Government.

A tale of two viruses: HIV, Ebola and health systems.

A tale of two viruses: HIV, Ebola and health systems.

Couple experiences of provider-initiated couple HIV testing in an antenatal clinic in Lusaka, Zambia: lessons for policy and practice

BackgroundCouple HIV testing has been recognized as critical to increase uptake of HIV testing, facilitate disclosure of HIV status to marital partner, improve access to treatment, care and support, and promote safe sex. The Zambia national protocol on integrated prevention of mother-to-child transmission of HIV (PMTCT) allows for the provision of couple testing in antenatal clinics. This paper examines couple experiences of provider-initiated couple HIV testing at a public antenatal clinic and discusses policy and practical lessons.MethodsUsing a narrative approach, open-ended in-depth interviews were held with couples (n = 10) who underwent couple HIV testing; women (n = 5) and men (n = 2) who had undergone couple HIV testing but were later abandoned by their spouses; and key informant interviews with lay counsellors (n = 5) and nurses (n = 2). On-site observations were also conducted at the antenatal clinic and HIV support group meetings. Data collection was conducted between March 2010 and September 2011. Data was organised and managed using Atlas ti, and analysed and interpreted thematically using content analysis approach.ResultsHealth workers sometimes used coercive and subtle strategies to enlist women’s spouses for couple HIV testing resulting in some men feeling ‘trapped’ or ‘forced’ to test as part of their paternal responsibility. Couple testing had some positive outcomes, notably disclosure of HIV status to marital partner, renewed commitment to marital relationship, uptake of and adherence to treatment and formation of new social networks. However, there were also negative repercussions including abandonment, verbal abuse and cessation of sexual relations. Its promotion also did not always lead to safe sex as this was undermined by gendered power relationships and the desires for procreation and sexual intimacy.ConclusionsCouple HIV testing provides enormous bio-medical and social benefits and should be encouraged. However, testing strategies need to be non-coercive. Providers of couple HIV testing also need to be mindful of the intimate context of partner relationships including couples’ childbearing aspirations and lived experiences. There is also need to make antenatal clinics more male-friendly and responsive to men’s health needs, as well as being attentive and responsive to gender inequality during couselling sessions.

Antiretroviral therapy and reproductive life projects: Mitigating the stigma of AIDS in Nigeria

As millions of people infected with HIV in Africa are increasingly able to live longer and healthier lives because of access to antiretroviral therapy, concerns have emerged that people might eschew protective practices after their health improves. Extending beyond the notion of sexual "disinhibition," researchers have begun to analyze the sexual behavior of people in treatment through the perspective of their marital and childbearing aspirations. This article explores the reproductive life projects of HIV-positive men and women in southeastern Nigeria, showing how actions that contradict medical advice are understandable in the context of patients' socially normative desires for marriage and children. Based on in-depth interviews and observations (June-December 2004; June-July 2006; June-July 2007) of people enrolled in the region's oldest treatment program, we argue that broadly held social expectations with regard to reproduction are experienced even more acutely by HIV-positive people. This is because in Nigeria the stigma associated with AIDS is closely tied to widespread perceptions of social and moral crisis, such that AIDS itself is seen as both a cause and a symptom of anxiety-producing forms of social change. Specifically, in an era of rapid societal transformation, Nigerians see sexual promiscuity and the alienation of young people from traditional obligations to kin and community as indicative of threatened social reproduction. For people who are HIV-positive, marrying and having children offer not only the opportunity to lead normal lives, but also a means to mitigate the stigma associated with the disease. Four ethnographic case studies are provided to exemplify how and why social and personal life projects can trump or complicate medical and public health priorities. These examples suggest that treatment programs must openly address and proactively support the life projects of people on antiretroviral therapy if the full benefits of expanded access to treatment are to be realized.

CHILDBEARING ASPIRATIONS OF PUBLIC HEALTH MATERNITY PATIENTS.

Childbearing Aspirations of Public Health Maternity Patients Robert H. Browning, Program ConsultantM.P.H., and L. L. Parks, DirectorM.D.M.P.H.F.A.P.H.A. CopyRight https://doi.org/10.2105/AJPH.54.11.1831 Published Online: August 29, 2011