Childbearing Decisions Research Articles

Pregnancy and Childbirth Expectations During COVID-19 in a Convenience Sample of Women in the United States.

The COVID-19 pandemic has transformed the health care landscape and shifted individuals’ expectations for and interactions with essential health services, including pregnancy-related care. This study explores alterations to individuals’ pregnancy and childbirth decisions during an infectious disease pandemic. A convenience sample of 380 pregnant individuals with an expected delivery date between April and December 2020 consented to enroll and complete an online questionnaire on their pregnancy and childbirth expectations during the COVID-19 pandemic; a subset of respondents (n = 18) participated in semi-structured phone interviews. Survey data were analyzed quantitatively while interview data were analyzed using a thematic content analysis until a consensus on key themes was achieved. Respondents reported substantial stressors related to shifting policies of health care facilities and rapidly changing information about COVID-19 disease risks. As a result, respondents considered modifying their prenatal and childbirth plans, including the location of their birth (25%), health care provider (19%), and delivery mode (13%). These findings illuminate the concerns and choices pregnant individuals face during the COVID-19 pandemic and offer recommendations to engage in compassionate, supportive, and person-centered care during a time of unprecedented risk and uncertainty.

A multicenter randomized controlled trial protocol to evaluate the effectiveness of an educational intervention on fertility knowledge, intention and behavior among Iranian new couples

BackgroundRecent evidence shows that men and women have inadequate fertility knowledge which may negatively affect their childbearing decisions in future. Given the fact that decision making for fertility needs accurate information, targeted educational interventions especially through media are needed to improve knowledge regarding the best age of fertility, factors affecting fertility potential and fertility options available for sub-fertile couples. Aim of the study is to evaluate whether a fertility educational program can be effective in increasing fertility knowledge, childbearing intention and the planned pregnancy rate among couples referring to premarital counselling centers.MethodsThis study is a parallel randomised clinical trial with pre-test/post-test design. We will recruit 1240 marrying couples referring for compulsory premarital counselling in public health centers through stratified sampling in five metropolitan cities of Iran. The intervention group will receive both the typical premarital counselling training and a fertility knowledge package containing verbal and virtual educational package at five time episodes (one verbal session and four virtual sessions) within 4 weeks. The primary outcomes are fertility knowledge, childbearing intention and the first planned pregnancy rate (positive pregnancy test) and the secondary outcomes include contraception method use, miscarriage and unplanned pregnancy. Participants will respond to a self-administered demographic/reproductive characteristics questionnaire, the Cardiff Fertility Knowledge Scale (CFKS) and the childbearing intention questionnaire.Data will be collected through online questionnaires at baseline and 3, 12 and 18 months after the intervention. Data will be analyzed using Chi-square or Fisher-exact test for categorical variables, Independent sample t-test for normally distributed quantitative variables and Mann–Whitney U test for non-normally distributed quantitative variables. To compare the outcomes between the two groups over the time, repeated measures ANOVA will be used. We hypothesize that the positive impact of increasing the fertility knowledge is the reduced involuntarily childlessness.DiscussionThe findings are proposed to inform government policies and public education strategies aiming at supporting childbearing among young couples who postpone their first pregnancy while they might not have any important social and economic obstacles.Trial registrationThis study was approved by Iranian Registry of Clinical Trials (IRCT), Number: IRCT20201005048925N1, Date of registration: 2020-10-12.

Publication or pregnancy? Employment contracts and childbearing of women academics in China

ABSTRACT The ‘publish or perish’ system has been widespread in the global higher education sector to incentivize academic performance. How the system affects academics in non-western countries has received scant attention. This research studies the relationship between different types of employment contracts, work pressure and the childbearing decisions of women academics in China. The data were collected in 2019 through a survey of 453 women academics working in universities in China. The research establishes a significant correlation between the types of contracts and the reproductive practices of women academics of childbearing age. In order to obtain more detailed information on the underlying consequences of the new system and the respondents’ coping strategies, interviews were conducted with women academics across different stages of their career. We found that the respondents who had not signed a fixed-term contract on average had higher reproductive intentions than those who had signed the contract. They have adapted their reproductive behaviour according to work pressure. The universities adopting such an evaluation system need to adjust the contract terms to allow women academics to be able to balance work and life. The findings contribute to the understanding of the impact of this global trend.

Perceptions of genetic risk, testing, and counseling among individuals with eating disorders.

Eating disorders develop as a result of genetic and environmental factors. Given that they are multifactorial conditions with a genetic component, they fall within the scope of practice for genetic counseling, but people with these conditions are rarely referred. The purpose of this study was to explore the perceptions of causes of eating disorders, recurrence risk, and interest in genetic counseling and testing among individuals with eating disorders. An online survey comprising both multiple choice and free form text questions, vignettes about genetic counseling, and the ED100K (validated eating disorder diagnostic questionnaire) was shared via support organizations and prominent bloggers in the eating disorders community to recruit individuals with a personal history of an eating disorder from November 2018 to February 2019. In total, 107 participants completed the survey. They perceived that both experiences and genetics were important factors in the development of their eating disorder. All responding participants overestimated the risk for recurrence of eating disorders in children, often by a large margin, and a notable minority reported that their experience with an eating disorder had a negative influence on their childbearing decisions. After imagined experience of genetic counseling, participants reported significantly decreased feelings of stigma, shame, and guilt. Most participants expressed interest in genetic counseling; fewer were interested in genetic testing. Genetic counseling may benefit individuals with eating disorders by providing accurate recurrence risk information and reducing feelings of guilt, stigma, and shame, which may in turn encourage earlier support seeking and recovery.

Childbearing Decisions in Residency: A Multicenter Survey of Female Residents.

To characterize how female residents make decisions about childbearing, factors associated with the decision to delay childbearing, and satisfaction with these decisions. In 2017, the authors sent a voluntary, anonymous survey to 1,537 female residents enrolled across 78 graduate medical education programs, consisting of 25 unique specialties, at 6 U.S. academic medical centers. Survey items included personal, partner, and institutional characteristics, whether the respondent was delaying childbearing during residency, and the respondent's satisfaction with this decision. The survey response rate was 52% (n = 804). Among the 447 (56%) respondents who were married or partnered, 274 (61%) were delaying childbearing. Residents delaying childbearing were significantly more likely to be younger (P < .001), not currently a parent (P < .001), in a specialty with an uncontrollable lifestyle (P = .001), or in a large program (P = .004). Among self-reported reasons for delaying childbearing, which were not mutually exclusive, the majority cited a busy work schedule (n = 255; 93%) and desire not to extend residency training (n = 145; 53%). Many cited lack of access to childcare (n = 126; 46%), financial concerns (n = 116; 42%), fear of burdening colleagues (n = 96; 35%), and concern for pregnancy complications (n = 74; 27%). Only 38% (n = 103) of respondents delaying childbearing were satisfied with this decision, with satisfaction decreasing with increasing age. Decisions to delay childbearing are more common in certain specialties, and many residents who delay childbearing are not satisfied with that decision. These findings suggest that greater attention is needed overall, and particularly in certain specialties, to promote policies and cultures that both anticipate and normalize parenthood in residency, thus minimizing the conflict between biological and professional choices for female residents.

Regret over the delay in childbearing decision negatively associates with life satisfaction among Japanese women and men seeking fertility treatment: a cross-sectional study

BackgroundCurrently, in developed countries, increasing numbers of women and men are delaying childbearing but begin seeking fertility treatment later in life. Some women undergoing infertility treatment develop negative feelings such as depression associated with low life satisfaction and regret over the delay in childbearing. We therefore examine the association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors among Japanese women and men seeking fertility treatment.MethodsThis cross-sectional study included 253 women and 196 men referred to fertility facilities in Japan from July to December 2018. Participants completed a questionnaire on life satisfaction, regret over the delay in childbearing decision, infertility-related factors and sociodemographic characteristics. Life satisfaction was measured using the Satisfaction with Life Scale (SWLS), and the degree of regret over delay in childbearing decision was measured on a 7-point Likert scale. Multiple linear regressions, conducted separately by sex, were used to analyze the association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors.ResultsOf the 253 women and 196 men, 102 (40.3%) women and 43 (21.9%) men answered “strongly agree” regarding their regret over the delay in childbearing decision. Among women, life satisfaction was negatively associated with regret (β = − 0.155, 95% CI [− 0.938, − 0.093], p = 0.017), use of assisted reproduction technology (ART) (β = − 0.135, 95% CI [− 2.977, − 0.020], p = 0.047). In contrast, previous live birth was positively associated with life satisfaction (β = 0.134, 95% CI [0.122, 3.739], p = 0.037). In men, we found no significant association of life satisfaction with regret over the delay in childbearing decision and infertility-related factors.ConclusionsRegret over the delay in childbearing decision is negatively associated with life satisfaction among Japanese women seeking fertility treatment. It may be important for women to make better informed decision regarding the timing of childbearing to not regret later in life. Health professionals should address regret over the delay in childbearing decision during fertility treatment and explore ways to spread information on fertility awareness.

Demographic and socio-cultural factors influencing contraceptive uptake among women of reproductive age in Tamale Metropolis, Northern Region, Ghana.

This study assessed some demographic and socio-cultural factors that influence contraceptive uptake among reproductive-aged women in Tamale Metropolis of the Northern Region, Ghana. This was a cross-sectional study conducted from February to March 2015. All three sub Metropolis in Tamale. All community members and women of reproductive age (15-49 years). The study used cluster sampling to recruit women who were interviewed using a structured questionnaire. Nine focus group discussions (FGDs) were also held among community members who were purposively selected. contraceptive uptake (use of contraceptive). The mean age of the women was 26 years. The prevalence of contraceptive uptake among reproductive-age women was 36.8% (165/448). Women with secondary school education [AOR=4.4(95%CI:1.6-12.4)], and those in homes where decisions on having children were made by both partners [AOR=2.1(95%CI:1.1-04.42)] were more likely to use contraceptives. Unemployed women [AOR=0.3(95%CI:0.1-0.8)], women whose husbands were unaware of their contraceptive use [AOR=0.4(95%CI:0.2-0.9)] and those having a culture or religion that frowns on contraceptive use [AOR=0.4(95%CI:0.2-0.8)] were less likely to use contraceptive among women in the Tamale Metropolis. The study found a contraceptive prevalence rate (CPR) in Tamale Metropolis, Northern Ghana to be 36.8%. Education and living in a home where childbearing decisions are made together were identified as positive factors influencing contraceptive uptake. This work was funded by the authors.

Uninformed decision-making and regret about delaying childbearing decisions: A cross-sectional study.

AimThe aim of this study was to examine regret over the timing of the childbearing decision and reasons for its delay.DesignA cross‐sectional study.MethodsThis cross‐sectional study included 219 women and 169 men referred to fertility facilities in Japan from July–December 2018. Participants completed a questionnaire on the reasons for their delay in childbearing decision and the degree of regret regarding their decision. Multiple linear regression was used to analyse the association between degree of regret and the reasons for the delay.ResultsThe top three reasons for the delay in childbearing decision in women were “Establishing the relationship,” “Health problems,” and “Financial security.” The top three reasons in men were “Establishing the relationship,” “Financial security,” and “Lack of fertility knowledge.” Multiple linear regression showed that lack of fertility knowledge was associated with regret over the timing of childbearing decisions in women and men.

Family planning science and practice lessons from the 2018 International Conference on Family Planning.

Since 2009, the International Conference on Family Planning (ICFP) has served as an opportunity for the global reproductive health community to share FP advances and practice lessons in the areas of research, programming, and advocacy. The key takeaways from all 15 tracks were grouped into six thematic areas: 1) Investing in family planning for a lifetime of returns. FP may yield different health and monetary benefits but continues to face a shortage of funding, although locally owned models provide alternative financing solutions. 2) Addressing inequities in family planning for adolescents, youth, and key populations. Marginalized populations and youth still face challenges in accessing FP. Youth-inclusive and user-centered programming show promise in addressing such challenges. 3) Reproductive justice: Abortion care, family planning, and women's wellbeing. Unsafe abortions tend to be more common among younger, poor, uneducated and rural women. Promising evidence show that providers may effectively shift from unsafe practices of dilation and curettage to safer manual vacuum aspiration or misoprostol. 4) Couple dynamics and family planning decision-making. Couples who share everyday life decision-making are more likely to use contraceptives; couple discordance on childbearing and fertility decisions directly influence women's decisions to covertly use FP. 5) Male involvement in FP programming. Male champions and advocates can successfully promote couple uptake of FP. Gender-transformative programming promotes gender equity and can directly impact behavior change. 6) Breakthroughs in novel contraceptives and systems improvement in family planning. User-centered contraceptive technologies and information systems present an opportunity to facilitate self-care and optimal supply chain management. ICFP 2018 highlighted research advances, implementation science wins, and critical knowledge gaps in global FP access and use. More research is needed to determine the scalability of novel technologies, more effective programming and service delivery models to ensure multisectoral knowledge translation and utilization by policymakers.

The Effect of Model Intervention Towards the Intention of Early Detection of Cervical Cancer with Via Test

The purpose of this study was to evaluate the woman of childbearing age decision’s model towards the intention of early detection of cervical cancer with the VIA (visual inspection with acetic acid) test. The design was quasi-experimental. The population of women of childbearing age and sample size was 70. Technique Paired samples statistics. Statistical analysis using the Wilcoxon test with a probability of 0.05. The difference in the value of the pre and post test were seen from the difference in the mean value between the pre and post test. In the treatment group, the difference test results were significant between the pre and post test, the value of p = 0,000. In Control group, the results of the difference test were not significant between the pre and post test, the value of p &gt; 0.05. The Decision Model was a new finding of research where have the highest level of situation awareness on the situation, events and dynamics of its health condition. The decision model showed that with a high level of awareness, the women decided to make early detection of cervical cancer supported by high self efficacy and intention.

Fertility decline in the United States, 1850-1930: New Evidence from Complete-Count Datasets.

Between 1835 and 1935, total fertility in the United States fell from 7.0 to 2.1. New IPUMS complete-count microdata databases of the 1850, 1880, 1910, and 1930 U. S. censuses allow us to study the fertility decline in more detail than previously possible. We construct comprehensive models of couples' fertility incorporating a wide variety of economic, social, cultural and familial factors, including measures of parental religiosity and kin availability outside of the household. The results indicate that while shifts in the occupational structure and increasing urbanization of the population provide the most consistent and substantive contribution to fertility decline over the period, cultural and religious attitudes - as proxied by parents' nativities and child naming practices - played a major role in couples' childbearing decisions.

Labor market influences on Women's fertility decisions: Longitudinal evidence from Canada

While fertility theories suggest that insecure labor market experiences encourage women to postpone having children, few have examined whether job insecurity perceptions influence fertility in the North American context—an omission we address in the current study. Findings from event history analyses of a panel dataset of Canadian workers (Canadian Work, Stress and Health Study) reveal that perceived job insecurity is salient for women's first birth decisions but not subsequent births. Further subgroup analyses show that the association between perceived job insecurity and likelihood of a first birth is limited to college-educated women and those in low unemployment labor market regions. Among women with less than a college degree and those in high-unemployment regions, the likelihood of a first birth does not vary by respondents' perceptions of insecurity. Results suggest a more nuanced relationship between insecure work and women's childbearing decisions than predicted by traditional pro-cyclical accounts of the economy-fertility association.

Uwagi o urodzeniach i niskiej dzietności w Polsce oraz polityce rodzinnej wspierającej prokreację

The below replacement fertility, persisting in many industrial countries, impacts the decrease in the population dynamics and consequently, the population decline. It also imposes the durable shifts in the age composition, which result in distorting relationships between subsequent generations (children, adults, old people). Therefore, fertility growth has become an increasingly highlighted goal of family policy. The article presents the situation in Poland in terms of changes in births and fertility on the one hand, and family policy reforms on the other hand. The attempt to evaluate whether family policy reforms implemented since 2008 might be considered as supportive for demographic renewal refers to numerous comparative studies on fertility effects of different policy measures. In the conclusion, a strong statement is formulated that to evaluate adequately the effects for demographic renewal from a longer time perspective, policy panel surveys on family relative behaviours and childbearing decisions are needed.

Factors Affecting the First Childbearing Decision in Iranian Males

Factors Affecting the First Childbearing Decision in Iranian Males

Practices suggested in social media for birth plans.

To describe and analyze the practices suggested in social media for the elaboration of Birth Plans, available on Blogs/Sites and not included in the WHO recommendations. Qualitative, exploratory, descriptive study with thematic analysis. A total of 41 e-mail addresses were selected for analysis among the 200 web addresses previously identified between March and July 2016. Three web addresses were in Portugal and the others in Brazil. 48 practices not included in the recommendations of the World Health Organization (WHO) were identified. Blogs/Websites, as means of transmission, circulation and production of knowledge, enable the horizontal expression of values, encourage women to plan the events considered important for their deliveries and put childbirth decisions on the hands of women, which has caused controversy in the discourse of humanization of childbirth.

Formal comment on "Assessing the impact of the 'one-child policy' in China: A synthetic control approach".

For nearly half a century, parents in China have faced compulsory quotas allowing them to have no more than one or two children. A great debate in recent years over the impact of this program on China’s population continues in PLOS ONE with the publication of Gietel-Basten et al. (2019). The core question concerns how much higher China’s birth rates might have been had birth quotas not been enacted and enforced. Gietel-Basten et al. argue that the selection of such comparators in recent studies may reflect subjective choices. They profess to avoid such subjectivities by using what they present to be a more scientific, objective, and transparent statistical approach that calculates a weighted average of birth rates of countries with other characteristics similar to China’s. Yet the authors make subjective choices regarding the non-fertility characteristics used to form their comparators which leads to an underestimation of the impact of birth planning. Moreover, their visual presentation, which focuses on the two key sub-phases of the birth program, underrepresents its overall impact. Their comparators suggest that China’s population today would be just 15 million more had it not enacted any birth restrictions since 1970 (one percent above its current population) and that in the absence of one-child limits, which began in 1979, China’s population would be 70 million less. At the same time, the authors acknowledge that the one-child program has had numerous negative consequences. It seems fair to ask how such consequences could result if the program had no significant impact on childbearing decisions.

Fertility variations in the recession context: the case of Greece

Research on the counter- or pro-cyclical nature of aggregate fertility over economic cycles has been inconclusive, as results vary significantly across regions and over time. This work examines the variations in Greek birth rates, and confirms that fertility rates in Greece have declined since 2010. Partly as a response to economic uncertainty, childbearing decisions have been revised downward, although not uniformly across population groups. According to our analysis, almost 40,000 fewer babies were born in Greece between 2010 and 2015 than would have been born if pre-recession fertility rates had remained unchanged. Those missing births are mainly attributed to women under age 30, as well as to non-employed women of all ages. In terms of birth order, most of the missing births are second- or higher-order births. Even if a catch-up process occurs in the years to come, the foregone births are already visible as a cavity on the population pyramid.

Expert perspectives on essential parameters to monitor during childbirth in low resource settings: a Delphi study in sub-Saharan Africa

ObjectiveThere is no consensus on the essential parameters to monitor during childbirth, when to start, and the rate of monitoring them. User disagreement contributes to inconsistent use of the twelve-item modified World Health Organization partograph that is started when the cervix is at least 4 cm dilated. The inconsistent use is associated with poor outcomes at birth. Our objective was to identify the perspectives of childbirth experts on what and when to routinely monitor during childbirth in low resource settings as we develop a more acceptable childbirth clinical decision support tool.MethodWe carried out a Delphi study with two survey rounds in early 2018. The online questionnaire covered the partograph items like foetal heart, cervical dilation, and blood pressure, and their monitoring rates. We invited panellists with experience of childbirth care in sub-Saharan Africa. Consensus was pre-set at 70% panellists rating a parameter and we gathered some qualitative reasons for choices.ResultsWe analysed responses of 76 experts from 13 countries. There was consensus on six important parameters including foetal heart rate, amniotic fluid clearness, cervical dilation, strength of uterine contractions, maternal pulse, and blood pressure. Two in three experts expressed support for changing the monitoring intervals for some parameters in the partograph. 63% experts would raise the partograph starting point while 58% would remove some items from it. Consensus was reached on monitoring the cervical dilation at 4-hourly intervals and there was agreement on monitoring the foetal heart rate one-hourly. However, other parameters only showed majority intervals and without reaching agreement scores. The suggested intervals were two-hourly for strength of uterine contractions, and four-hourly for amniotic fluid thickness, maternal pulse and blood pressure. The commonest reason for their opinions was the more demanding working conditions.ConclusionThere was agreement on six partograph items being essential for routine monitoring at birth, but the frequency of monitoring could be changed. To increase acceptability, revisions to birth monitoring guidelines have to be made in consideration of opinions and working conditions of several childbirth experts in low resource settings.

Physicians' attitudes towards using elective oocyte cryopreservation to accommodate the demands of their career.

Among medical professionals, there appears to be a significant lack of knowledge about oocyte cryopreservation. Medical professionals may be potential candidates for elective oocyte cryopreservation due to the demands and commitments of medical training. There is a paucity of data on this topic among medical professionals. The aim of this study was to assess knowledge, understanding, and beliefs towards elective egg freezing among medical professionals to assess whether they are potential candidates for elective egg freezing. This is a cross-sectional descriptive study in a university-based training program. All medical students, residents, fellows, and faculty were included. An online survey was emailed to potential participants. It included demographic questions regarding childbearing decision-making factors, fertility knowledge, and attitudes towards using elective oocyte cryopreservation. A total of 1000 emails were sent. Of those, 350 completed surveys were received. On average, 33% of responders provided a correct answer to each fertility knowledge question. The duration of training and the heavy workload with long duty hours were the most common influencing factors when deciding the timing of childbearing. Overall, 65% of the male and female responders were concerned about their future fertility. Among those women who had future fertility concerns, 8% were not aware of egg freezing as a fertility option and wished they had had an opportunity to freeze their eggs at an earlier time. Physicians' childbearing decisions can be affected by the demands of their careers. Elective oocyte cryopreservation could be considered an option for family planning. Educational sessions and awareness programs are needed to provide information about available fertility preservation options, which can potentially decrease the rate of regret.

Planning a family in Nairobi's informal settlements: results of a qualitative study.

Childbearing intentions among women in high-fertility contexts are usually classified into those wanting to have a baby, those wanting to 'space' a birth and those wanting to 'limit' their family size. However, evidence from Africa increasingly suggests that women's intentions are more complex than this classification suggests, and that there is fluidity in these intentions. This research explores women's accounts of their childbearing intentions and decisions in order to examine how this fluidity plays out in a low-fertility context in urban Africa. Six focus group discussions were conducted in April and May 2012 with women of reproductive age in Nairobi, Kenya. Participants were recruited using random and purposive sampling techniques. The focus group discussions had an average of seven participants each. Data were coded thematically and analysed using Nvivo software. The analysis explored the factors that women consider to be influential for childbearing and found that the health of the mother and child, costs of raising a child and relationships were commonly reported to be important. Evidence of intentions to space births and limit family size was found. However, the data also showed that there is fluidity in women's family planning intentions, driven by changes in relationships or household finances, which often result in a desire to avoid pregnancy in the present moment. The fluidity observed in women's childbearing intentions cannot be accounted for by the concepts of either 'spacing' or 'limitation' but is best explained by the concept of 'postponement'. The research reveals the need for family planning clinics to provide a full method mix, as well as high-quality counselling, to enable women to choose a method that best suits their needs.