Desire For Additional Children Research Articles

Abstract P4-11-02: Prevalence and impact of fertility concerns in young women with breast cancer

Abstract Introduction: Breast cancer treatments can impair fertility via direct gonadotoxicity (chemotherapy) as well as by introducing delays in childbearing that allow natural ovarian aging. Guidelines strongly recommend fertility counseling and consideration of fertility preservation techniques for premenopausal women who have not completed their desired childbearing at the time of cancer diagnosis. Prior studies have identified high rates of fertility concern but relatively low rates of fertility counseling and use of fertility preservation techniques. We sought to investigate rates of fertility counseling, use of fertility preservation techniques, and how fertility concerns impact cancer treatment decisions in a modern cohort of patients with breast cancer at a large academic medical center in the United States. Methods: All patients seen at Mayo Clinic Rochester with a new diagnosis (within the year prior) of stage 0-4 breast cancer were invited (by mail or in person) to participate in the Mayo Clinic Breast Registry. After informed consent, participants were asked to complete a baseline survey and annual follow-up surveys. On baseline and one-year surveys, patients were queried about desire for future children and fertility concerns. Nurse chart abstraction was used to collect information about tumor subtype, stage, and treatments received. We examined survey data from women diagnosed under the age of 50 who expressed an interest in having future biological children on either the baseline or year 1 survey between February 2015 and October 2020. Descriptive statistics were used to summarize the degree of fertility concern in this population, the impact of that concern on cancer treatment decisions, and steps taken to preserve fertility. Results: Between February 2015 and October 2020, 865 women under age 50 at diagnosis consented to the registry. Of these women, 627 completed a baseline and/or 1-year survey and 100 answered either “yes” or “unsure” to the question: “At the present time, do you wish to have any more biological children in the future?” on one or both surveys. Among the 100 women expressing interest in future child-bearing, 92% were white, 27% had node-positive and one had distant metastatic disease at diagnosis. The age at diagnosis ranged from 19 to 49 years, with a mean age of 33.8 years. Of the 75 who reported a desire for future children at baseline, 28% felt “somewhat concerned” about their future fertility and 40% felt “very concerned.” Of the 70 who reported a desire for future children on the year 1 survey, 17% felt “somewhat concerned” and 59% felt “very concerned.” For those “very concerned” about future fertility at year 1, 65% reported that this concern had a major impact on their treatment decisions. Often, that treatment modification entailed using endocrine therapy for less than 5 years; 52% of those who specified the type of treatment modification they had made indicated this option. Of note, six women who reported no desire for future biological children at baseline were “unsure” at year 1. At year 1, 93% of women recalled a discussion about fertility with their doctor prior to starting treatment, and 49% had taken steps to preserve fertility (32.5% with embryo cryopreservation, 20% with oocyte cryopreservation and 65% with a GnRH agonist; some selected multiple options). Conclusion: We found a reassuringly high rate of patient-reported fertility counseling and use of reproductive endocrinology technologies to preserve fertility in women who reported a desire for additional children at or soon after diagnosis with breast cancer. Consistent with prior studies, fertility concerns frequently impacted breast cancer treatment decisions. It is important to err on the side of inclusivity when providing fertility counseling because desire for fertility can change over time. Citation Format: Samantha Mannion, Alexandra Higgins, Elizabeth A Stewart, Zaraq Khan, Chandra Shenoy, Nicole Larson, Hazel B Nichols, H Irene Su, Ann H Partridge, Fergus J Couch, Janet E Olson, Kathryn Ruddy. Prevalence and impact of fertility concerns in young women with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-02.

Exploring Readiness for Birth Control in Improving Women Health Status: Factors Influencing the Adoption of Modern Contraceptives Methods for Family Planning Practices.

Background: Pakistan is the world’s sixth most populated country, with a population of approximately 208 million people. Despite this, just 25% of legitimate couples say they have used modern contraceptive methods. A large body of literature has indicated that sexual satisfaction is a complex and multifaceted concept, since it involves physical and cultural components. The purpose of this study is to investigate the impact of influencing factors in terms of contraceptive self-efficacy (CSE), contraceptive knowledge, and spousal communication on the adoption of modern contraceptive methods for family planning (FP) under the moderating role of perceived barriers. Methods: Data were collected using an adopted questionnaire issued to married women of reproductive age belonging to the Rawalpindi and Neelum Valley regions in Pakistan. The sample consisted of 250 married women of reproductive age. SPSS was used to analyze the respondents’ feedback. Results: The findings draw public attention towards CSE, contraceptive knowledge, and spousal communication, because these factors can increase the usage of modern methods for FP among couples, leading to a reduction in unwanted pregnancies and associated risks. Regarding the significant moderation effect of perceived barriers, if individuals (women) are highly motivated (CSE) to overcome perceived barriers by convincing their husbands to use contraceptives, the probability to adopt modern contraceptive methods for FP practices is increased. Conclusions: Policymakers should formulate strategies for the involvement of males by designing male-oriented FP program interventions and incorporating male FP workers to reduce communication barriers between couples. Future research should address several other important variables, such as the desire for additional child, myths/misconceptions, fear of side effects, and partner/friend discouragement, which also affect the adoption of modern contraceptive methods for FP practices.

Women's education and desire for additional children in Vietnam: regional differences and the role of son preference.

This paper investigates the relationship between women's education and desire for additional children across the six economic regions of Vietnam. The study employed data from the nationally representative Vietnam Multiple Indicator Cluster Survey (MICS) 2014. Probit regression results showed that for women with one child, higher levels of education were associated with higher fertility desire in two out of six regions. Similar results were found for women with two or more children. Children's sex composition played a role in the desire for additional children, reflecting both son preference and mixed-gender preference. In Vietnam overall, among women with at least one boy, those with lower levels of education were more likely not to want another child. The results, however, differed by region. The findings suggest that the social and economic context of each region, particularly sex ratio at birth and total fertility rate, should be taken into account when designing population policies in Vietnam.

Modern Family Planning Utilization and Its Associated Factors among Currently Married Women in Rural Eastern Ethiopia: A Community-Based Study.

Background The use of modern family planning methods among women of reproductive age (15-49 years) is of public health importance in Ethiopia. Nationally, modern family planning method use remains as low as 35%. Understanding factors associated with the use of modern family planning methods may help to improve maternal and child health. Hence, this study is aimed at assessing modern family planning method use and its determinants among women of reproductive age in the rural districts of Eastern Hararghe zone, Eastern Ethiopia. Methodology. A community-based, cross-sectional survey was conducted among 577 randomly selected, currently married, reproductive-aged women in selected rural districts of Eastern Hararghe, Eastern Ethiopia. Data were collected using a pretested, interviewer-administered questionnaire about women's sociodemographic information, knowledge about contraception, reproductive history, contraceptive use and fertility desire, couple's communication, and decision-making on family planning. Binary and multivariable logistic regression was used to analyze the association between the dependent and independent variables. Result A total of 555 study participants participated, yielding a 96.2% response rate. The overall modern family planning utilization among the study participants was 18.4%. Knowledge of modern family planning methods (AOR = 16.958, CI: 4.768, 60.316), husband approval (AOR = 3.590, CI: 2.170, 5.936), couple's discussion (AOR = 2.852, CI: 1.759, 4.623), male involvement in decisions about family planning (AOR = 2.340, CI: 1.531, 3.576), desire for additional child (AOR = 2.295, CI: 1.528, 3.447), and previous use of contraception (AOR = 0.018, CI: 0.005, 0.063) were significantly associated with modern contraceptive utilization. Conclusion Even though knowledge of modern family planning methods was very high, the overall modern family planning method use in the study area was low. The government should focus on increasing modern family planning method availability. It must also ensure family planning method security and create awareness on modern family planning methods through community-based education and proper counselling to empower women to make an appropriate choice.

DO THE SEX COMPOSITION OF LIVING CHILDREN AND THE DESIRE FOR ADDITIONAL CHILDREN AFFECT FUTURE INTENTION TO USE CONTRACEPTION IN ETHIOPIA?

Information on future intention to use contraceptives is a potential programme indicator for family planning services. Using three consecutive rounds of Ethiopian Demographic and Health Survey (EDHS) data collected in 2000, 2005 and 2011, this study examined whether the sex composition of living children and future desire for additional children were associated with the intention to use contraceptives among Ethiopian women aged 15-49 years who were not using any method of contraception at the time of the survey. The pooled multivariate binary logistic regression analysis indicated that between 2000 and 2011, the intentions of non-users to use contraceptives in the future increased significantly. Women who had at least one child (with an equal number of boys and girls, more boys than girls or more girls than boys) who did not want any more children, and those who were unsure about their desire for additional children, showed an increased intention to use contraceptives in the future, compared with those with an equal number of boys and girls who expressed a desire for additional children. Women with no children and who did not want children, or those who were unclear about their future desire, showed a lower intention to use contraceptives, compared with women with an equal number of boys and girls who wanted a child in the future.

Factors influencing fertility preferences of currently married men in Kenya

Fertility preferences are central in determining the future fertility of the society particularly where and when those desires are implemented. The socio-cultural structures in most African communities have given men the mandate to decide in all aspects of life including family sizes and fertility behaviors. Information on fertility preference in Kenya especially regarding men is very scanty. This study therefore specifically sought to establish the effects of socio-demographic; socio-economic; and socio-cultural factors on fertility preference of currently married men in Kenya. Data was drawn from sample size of 1,757 married men aged 15-54 years who were asked questions on various topics including fertility preference during the 2008/9 KDHS. The study findings revealed that age, number of living children, education, region, occupation, type of marriage and number of living sons were significant factors associated with the desire for additional children at 0.001, 0.01 and 0.05 significance level. In conclusion, fertility preference of currently married men in Kenya is influenced mainly by demographic (age & Number of living children); socio-economic (education & region) and socio-cultural factors (type of marriage & Number of living sons). Recommendations: i) Education for men should be emphasized because education was discovered to have a significant negative effect on the fertility preference; ii) Policies that aim at integrating population into development should be encouraged so as to foster socio-economic development in all the regions and hence minimize the regional disparities as it relates to fertility preferences; iii) Further studies, both qualitative and quantitative, to be carried out in order to explore the socio-cultural religious beliefs, norms and attitudes of men in regards to the value of children; v) Qualitative studies needs to be conducted in the North Eastern region to find out the driving forces for glaringly high fertility preference other than low literacy level.

An Assessment of Communication about Family Planning on Desired Fertility: The Case of Rwanda


 Despite the recognition of the importance of spousal communication in family planning programs, it remains a challenge to many couples in sub Saharan Africa. This paper uses the 2000 Rwanda Demographic and Health Survey (RDHS) to assess spousal communication about family planning on desired fertility. Analysis is done on married people aged 15–49 years. Results indicate that communication about family planning is a significant covariate of the desire to have no more children. The direction of causation in this relationship is plausibly two-way: occurring when already established fertility desires are articulated to the partner, and when a discussion of advantages of child spacing or birth limitation is translated into lower fertility desires, for one or both partners. Results show that fertility desire of wives and husbands are shaped by the partner’s desire, whether or not these are explicitly communicated. Multivariate results show that current age has a small but highly significant effect on the desire for additional children among both men and women. Older men and women are more likely to want no more children. Urban residence is significantly related to desired fertility, indicating the overall level of wanting no more children in urban areas than in rural areas. The paper recommends various alternatives to encourage spousal communication about family planning, taking into consideration various challenges that prevail in African societies.

Repetative percutaneous epididymal sperm aspirations (PESA's) in a rat model resulted in immediate asthenospermia and significant inflammatory changes

In azoospermia, choosing a sperm retrieval method for intracytoplasmic sperm injection (ICSI) depends primarily on the preference and expertise of both the urologist and reproductive endocrinologist. There is insufficient evidence to suggest which method of sperm harvesting (PESA verses testis biopsy/aspiration) optimizes ICSI outcomes. Generally, PESA is attempted first. Not uncommonly, multiple PESA's are necessary due to ICSI failure or, the desire for additional children. Since there is no study stratifying epididymal damage or affect on sperm parameters, we propose a rat model to prospectively evaluate PESA-related changes.

Factors Influencing Fertility Choices Among HIV Infected Mothers in Uasin Gishu District, Kenya

Kenya has borne the major brunt of HIV/AIDS for close to two decades. The problem being exacerbated amongchildbearing mothers as the probability of giving birth to HIV infected baby is heightened. Availability of safe andeffective contraceptive and high quality reproductive health counseling can help a woman practice safer sex anddetermine her future childbearing on a more responsible and informed basis. Therefore, a study to determine howknowledge on contraceptives influenced fertility choices was conducted in Uasin Gishu district Rift valley provincein Kenya from September 2005 to December 2005. Data was collected by systematic random sampling from 400HIV infected mothers in their reproductive age. Interview schedules were administered to the respondents at threesites. Data was analyzed by descriptive statistics. Knowledge on contraceptive was almost universal among therespondents with 99.0% of the respondents being aware of at least one method that women could use to avoidpregnancy. Majority (41.6%) knew at least three methods of family planning followed by 30.4% who knew at leastfour methods while few respondents (3.5%) knew more than six methods of family planning. Desire for additionalchildren was found to increase markedly with the number of methods that respondents were knowledgeable about;none of the respondents who were knowledgeable about one method desired to get any more additional childrenwhereas 30.5% of those who knew at least three methods desired to get additional children. However, desire foradditional births reduced drastically among those who knew more than four family planning methods with noneof those who knew six methods desiring to get additional children. It is seen from the study that it is only withadequate knowledge regarding family planning that one is able to adopt better family planning practices. It is thusrecommended that reproductive health counseling be improved among the HIV infected mother.

The Effect of Education on Fertility in Bangladesh

Using data from the 1989 Bangladesh Fertility Survey and the 1993–94 and 1996–97 Bangladesh Demographic and Health Surveys, this article investigates the effect of education on fertility. It also examines the effect of education on age at marriage at different time periods. Well-educated women were observed to have fewer children than uneducated women. The data also show that the average age at marriage is more than two years higher for women having secondary or higher level of education compared to those who have no education. Educational attainment of woman is generally considered to be a useful index of socioeconomic status as well as of the level of overall social sophistication and, therefore, it is inversely related to the desire for additional children.

In Nigeria, Family Size Governs Which Spouse's Fertility Desires Prevail

It is argued that the study results of Nigerian Yoruba couples reflect a fairly typical pattern in patriarchal societies about a wifes deference to the husbands family size desires early in marriage. After several children the wife attains family acceptance and would be more willing to defend her family size desires. The analysis was based on data collected in 1984 and 1986 surveys among 2662 monogamous Yoruba couples from Oyo state in Nigeria. The Yoruba population is viewed by the researcher as typical of patriarchal societies in sub-Saharan Africa. 73% of couples had at least 3 living children. About 75% of both men and women desired more children. 8% of women and 10% of men desired a stop to childbearing. 49% of couples had another child between 1984 and 1986. The proportions of men and women desiring more children declined between surveys as age number of living children and duration of marriage increased. Women with a primary education were more likely to have a desire for additional children and to have had a pregnancy or birth during 1984-86. Fertility between surveys was directly related to each spouses fertility desires. The proportion of couples having a child between surveys was greater among couples with 4 or fewer children. Where couples disagreed about the desire for an additional child the proportion having a subsequent birth did not vary by which partner wanted additional children. Among couples who agreed to have additional children or to stop childbearing the proportion who had an additional child was higher among families with 4 or fewer children. Among couples that disagreed couples with smaller families were more likely to have another child if the husband wanted another child. Couples with larger families were less likely to have another child if the husband wanted one. Logistic models confirmed bivariate findings. Couples who agreed to have another child were 6 times more likely to have another child. Couples who disagreed were only 3 times more likely.

Fertility norms and son preference in Morocco and Tunisia: does women's status matter?

This paper investigates the normative and behavioural dimensions of son preference in Morocco and Tunisia, using data from the Demographic and Health Surveys of the two countries. It considers three measures of son preference: (1) mothers' ideal number of children, and any preference for having more sons than daughters; (2) the desire for additional children, given their existing family; (3) reported use of contraception in relation to the existing number of children of each sex. The analyses indicate a moderate preference for sons in both countries, and suggest that this preference is somewhat stronger in Tunisia. These findings are interpreted within the cultural context of the two countries, and in particular societal notions of women's status.

Factors affecting the use of contraception in Bangladesh: A multivariate analysis

The government of Bangladesh since independence has tried to strengthen the national family planning program. Using data from the 1989 Bangladesh Fertility Survey on a nationally representative sample of 7984 rural and urban households, the authors consider fifteen socioeconomic and demographic variables and assess their relative importance in relation to current contraceptive use. The data indicate that 31.1% of younger and lower parity women use contraceptives. Women's education, followed by women's participation in family planning decision making, were the most important of selected factors which positively affect current use of contraception. Administrative division, desire for additional children, urban residence, and family planning worker visits were also important factors significantly and positively related to the current use of contraception. Husband's occupation was strongly associated with contraceptive use. Child loss, however, was negatively associated with contraceptive use, followed by sex composition of living children. The authors suggest that women should be encouraged to participate in family decisions, and become informed about their rights, privileges, and family law. Finally, it was found that education makes less difference to contraceptive use where family planning programs are strong.

Influence of son preference on the contraceptive use and fertility of Sri Lankan women.

The effect of moderate son preference on family size is analysed using data from the 1982 Sri Lanka Contraceptive Prevalence Survey whose respondents were followed-up in the 1985 Sri Lanka Contraceptive Survey. Reported reproductive intentions on desire for additional children were not always reflected in overall contraceptive use. Complicating factors were the use of modern and traditional methods and the role of induced abortion. Longitudinal observations of the 1982-85 period relating women's individual reproductive behaviour to their intentions show no consistent behavioural difference between those with and without sons. However, at any given parity, the proportion reporting at least one additional child born during the intersurvey period was higher among those women who intended to have at least one additional child than among those who wanted to stop childbearing. This analysis suggests that son preference finds expression more through reproductive intentions than through actual fertility behaviour in the follow-up period.

Family planning and desire for additional children after cesarean section

OBJECTIVE: To determine the acceptance of contraceptives among cesarean section patients in a West African traditional environment. METHOD: Eighty-three cesarean section patients of a regional hospital in Burkina Faso were interviewed at their homes as to their attitudes towards family planning. RESULT: In collaboration with local midwives, contraception for 2 years had been recommended to the patients. Only one woman had been using contraceptives before. After cesarean, 46 women used contraceptives and 13 had undergone tubal ligature. Contraceptive users had their next pregnancy on average 10 months later than women not practicing contraception. Patients showed a strong interest to limit their family size. None of the woman desired more than 5 children. CONCLUSION: Correct promotion provided, cesarean section patients in a traditional environment accept contraceptives and are interested in family planning.

Household crowding and reproductive behavior.

Ethological studies suggest that animal populations that live in crowded conditions display a number of behaviors that tend to limit the size of the population, such as aberrant forms of sexual behavior, small litter sizes, a higher incidence of spontaneous abortion, ineffectual maternal care, and even cannibalism of their young. Studies of household crowding in North America cities have produced only modest and selective evidence that crowding has similar effects among humans. In this paper, we examine the effect of household crowding on marital sexual relations, on desire for additional children, and on fetal and child loss in Bangkok, Thailand, a city with a much wider range of household crowding than is typically found in North America. In spite of the wider range, and higher mean level of crowding, we find that both the objective and subjective dimensions of crowding have only modest selective effects on sexual and reproductive behavior.

Determinants of contraceptive continuation in rural Bangladesh.

A contraceptive study of rural Bangladeshi women indicated that the previous death of children, number of living children, desire for additional children and son preference were important determinants of contraceptive continuation. The importance of these factors varies to some extent with use of different contraceptive methods.

The Desire for Additional Children among Pakistani Women: The Determinants

"This study examines the determinants of the desire for additional children for currently married women in Pakistan, drawing data from the Population, Labour Force and Migration (PLM) Survey of 1979-80. The variations in the patterns of desired fertility and their relationship to...factors of economic and social change--such as education, husband's occupation, household income, child education, and work--are also analyzed. The analysis is conducted using logit regression models." Consideration is given to differences between rural and urban women.

The Influence of Health Care on Contraceptive Acceptance in Rural Mexico

This paper offers two types of evidence in support of the idea that family planning services are most expediently provided as an integral part of the health and medical organization for maternity care. First, prenatal care and medical attention at delivery are found to be closely associated with postpartum contraceptive acceptance in a 1981 survey of family planning in rural Mexico. Second, interviews of a sample of doctors, nurses, and auxiliaries who provide maternal health services to the rural population reveal that these practitioners favor long birth intervals and small completed families, that they recommend the use of modern contraceptive methods including female sterilization, and that those in the employ of public institutions are motivated to recruit acceptors of these methods. The main impediment to contraceptive acceptance in this context is believed to be fear of side effects and permanent health consequences rather than the desire for additional children.

Son preference in Bangladesh: an emerging barrier to fertility regulation.

SummaryThis study investigates the effect of son preference on contraceptive use and desire for additional children using national level survey data from Bangladesh for the years 1969 and 1979. Son preference had a negative effect on contraceptive use and a positive effect on the desire for additional children regardless of socioeconomic and demographic characteristics. This adverse effect of son preference on fertility regulation seemed to have persisted over the years. Relevant socioeconomic conditions in Bangladesh are described.