Desired Family Size Research Articles

Fecundity and human birth seasonality in Sweden: a register-based study

BackgroundIt is well-established that couples’ fecundities vary widely. Each couple has a relatively constant monthly probability of conceiving, which can vary from zero to quite high. This underlying probability is usually expressed as the time (number of menstrual cycles) the couple requires to conceive. Couples with high fecundity will, on average, need fewer cycles than couples with low fecundity. It is also well-documented that almost all human populations exhibit seasonal variation in births. Most European countries show seasonal variation that usually peak in the spring and are the lowest during the last quarter of the year. The increasingly strong pattern of depressed birth rates in November and December is likely explained by the December–January cut-off threshold for Swedish pupils’ school entry and their parents increasing awareness of the negative effects on school outcomes for children who are juniors in the school-entry cohort they belong to. To actively plan births for a specific time of the year, couples need to have some knowledge of the time required for them to conceive.MethodsWe use the duration between marriage of childless couples and first birth as a proxy measure of couples’ fecundity. Based on this time-to-pregnancy measure we study to what extent couples’ capacity to conceive affects the seasonality of their second births. We hypothesize that in a society with highly controlled fertility and a strong norm of having at least two children, sub-fertile couples will on average show less seasonal variation in second births. Sub-fertile couples, requiring more time to conceive the first time, will be less likely to try to target a desired birth month for their second child because doing so could jeopardize fulfilling their desired family size. We apply multinomial logistic regressions on 81,998 Swedish couples who married while being childless and subsequently gave birth to at least two children between 1990 and 2012, to investigate fecundity’s role in seasonal variation in second births.ResultsWe found that seasonal variation in second births was strongly associated with couples’ observed fecundity, measured as the duration between marriage formation and first birth. Our results support the hypothesis that sub-fertile couples, requiring more time to conceive the first time, show less seasonal variation in second births. The seasonal variations in second order births among couples with normal fecundity shows some similarities to traditional patterns as seen in agricultural and industrial societies of the past, with high numbers of births during the spring, and low numbers during the last quarter of the year. However, two important differences are notable. The characteristic Christmas peak in September has vanished, and the low birth rates in November and December come out much stronger than in the past.ConclusionsThe birth seasonality among couples with normal fecundity are what we would expect if couples actively plan their births according to the cut-off date for Swedish pupils’ school entry. We argue that our findings support the notion that scheduled childbirth is a reality in contemporary sociality.

Postpartum family planning in Rwanda: a cost effectiveness analysis

Background: Globally, there is a large unmet need for family planning in the postpartum period: 90% of women in this group want family planning for birth spacing or to avoid unintended pregnancies and stop child bearing once desired family size has been reached. Women spend on average about 30 years, or three-quarters of their reproductive lives, attempting to avoid pregnancy. In total 76% of Rwandan women want family planning postpartum, yet a 26% unmet need remains. Methods: This cost effectiveness analysis compared the two most frequently-used family planning methods in Rwanda, longer-acting reversible contraception (LARC), injections and subdermal implants, and shorter-acting reversible contraceptives (non-LARC), pills and condoms. Women who do not use contraception postpartum were also represented. A time horizon of 24 months was used to reflect the World Health Organization suggested two-year spacing from birth until the next pregnancy, and the analysis was conducted from a health systems perspective. Results: For women of reproductive age (15-49 years) in Rwanda, including LARC postpartum family planning methods in the options, saves $18.73 per pregnancy averted, compared to family planning options that offer non-LARC methods exclusively. Conclusion: There is an opportunity to avert unplanned pregnancies associated with the increased utilization of LARC methods. Despite the availability of LARC methods in many of Rwanda’s health facilities, the full benefits are not yet realized. LARC is cost-saving compared with non-LARC methods. Effective public health messaging campaigns and other promotion targeting current resistance to LARC use for the postpartum population could both enhance health and save public health funds.

Inequality, survival to adulthood, and the growth drag of pollution

AbstractWe theoretically investigate the interrelationship between economic inequality and the exposure to pollutants during the course of economic development. Environmental pollution adversely affects children’s probability of surviving to adulthood, thereby reducing parental expenditures on children’s quality and increasing the number of births necessary to achieve a desired family size. Children’s exposure to environmental pollution is determined by economic inequality because wealthier households live in cleaner areas, which then shapes variations in the level of human capital per child. This is the key mechanism through which environmental conditions impose a growth drag on the economy. Our theory proposes explanations for: (i) the hump-shaped evolution of child mortality ratios between cleaner and more polluted areas during the course of economic development, and (ii) the observed positive correlation between inequality and the concentration of pollutants at the local level.

Postpartum family planning in Rwanda: a cost effectiveness analysis

Background: Globally, there is a large unmet need for family planning in the postpartum period: 90% of women in this group want family planning for birth spacing or to avoid unintended pregnancies and stop child bearing once desired family size has been reached. Women spend on average about 30 years, or three-quarters of their reproductive lives, attempting to avoid pregnancy. In total 76% of Rwandan women want family planning postpartum, yet a 26% unmet need remains. Methods: This cost effectiveness analysis compared the two most frequently-used family planning methods in Rwanda, longer-acting reversible contraception (LARC), injections and subdermal implants, and shorter-acting reversible contraceptives (non-LARC), pills and condoms. Women who do not use contraception postpartum were also represented. A time horizon of 24 months was used to reflect the World Health Organization suggested two-year spacing from birth until the next pregnancy, and the analysis was conducted from a health systems perspective. Results: For women of reproductive age (12-49 years) in Rwanda, including LARC postpartum family planning methods in the options, saves $18.73 per pregnancy averted, compared to family planning options that offer non-LARC methods exclusively. Conclusion: $2.8 million US$ per year can be saved if LARC is included as a contraceptive choice across all health centers in Rwanda; this cost savings provides the opportunity for these funds to be allocated to other high value interventions. Potential inclusion of these methods at Rwanda’s faith-based health facilities warrants further attention.

Socio-demographic profile of IUCD acceptors attending Post-Partum Unit (P.P.U.) of Guru Govindsingh Hospital, Jamnagar -

Background: The family welfare programme is a priority health programme for our country. In spite of integrated and concerted efforts, the programme has not been able to make an appreciable reduction of Crude Birth Rate. This was mainly because it had almost become synonymous with sterilization and majority of the couples had undergone sterilization only after achieving their desired family size of more than three children. So, the program has shifted its focus on spacing methods to reduce CBR. Aims: To assess the socio-demographic profile of women using IUCD and the decisionmaking status of women in selection of spacing methods. Material and Methods: All IUCD acceptors (Total 413 women) attending postpartum unit of G.G. Hospital, Jamnagar from October 2012 to December 2012 were studied. Results: A total 185 (44.79%) acceptors were in the age group of 24–28 years, 337(81.59%) of acceptors were literate, 238 (57.62%) acceptors had two or more living children. In 370 (89.58%) cases, IUCD was inserted within 10 days of menstruation & only 20 (4.84%) women had got IUCD inserted within 6 weeks of last delivery. Only 28 (6.77%) women took decision themselves for IUCD insertion. Decision making status of women was positively associated with their high education level. Conclusion: Majority of IUCD users were young women, indicating that spacing is being adopted in the early twenties. Majority of the users were literate & their educational level was significantly associated with their decision making status in matters of opting for contraception. Keywords: IUCD acceptors, Socio-demographic profile, postpartum unit

“If I don’t have children, they will know that I’m sick”: fertility desires of women and men living with HIV in Iringa, Tanzania

ABSTRACTAs safer conception services are expanded and integrated into HIV care systems, these services will need to address cultural, social, economic and medical concerns of women and men living with HIV. We conducted interviews with 30 HIV-positive women, 30 HIV-positive men, and 30 healthcare providers that examined factors specific to the experience of living with HIV that influence fertility desires in Iringa, Tanzania. HIV-related factors fell under five themes: knowing one could prevent mother-to-child transmission; reaching an ideal family size in the context of HIV-related infant mortality; concealing one’s HIV status; being able to provide for children; and managing HIV disease progression. Integration of safer conception counseling that includes locally-tailored messaging around desired family size, health risks, stigma and financial considerations into safer conception services will help people living with HIV reach their reproductive goals, while reducing the risks of HIV transmission.

Influences on the decision to use contraception among Sarawakian women with diabetes: a qualitative exploration

Family planning is extremely important for women with diabetes due to the various health risks and other social impacts of pregnancy in this population. Unfortunately, contraceptive use among women with diabetes remains low. This study explored the reasons influencing the decision to use contraception among East Malaysian (Sarawakian) women with diabetes. This was an exploratory qualitative study conducted at an urban public health clinic in Sarawak. Purposive sampling was used to recruit 12 women with type 2 diabetes mellitus. Semi-structured in-depth interviews were audio recorded and transcribed and then subjected to interpretive thematic analysis. Five themes appear to influence the decision to use contraception: likelihood of becoming pregnant, desired family size, personal health risks associated with getting pregnant, social implications of getting pregnant, and opinions of significant others. Among Sarawakian women with diabetes, the decision to use contraception was influenced by more than just health-related factors. Contraception counselling for this group of women should factor in their health beliefs, personal values, and social factors. Community involvement and peer support are potential strategies to improve contraception use.

Update on Permanent Contraception for Women

We completed this review to update readers on the current literature and controversies surrounding different approaches to permanent female contraception. Permanent contraception continues to be a popular method of pregnancy prevention. The withdrawal of the Essure® hysteroscopic approach to permanent contraception from the US market and the increased use of salpingectomy to decrease risk of ovarian cancer have changed options available to women. Current studies support allowing adult women who desire no future pregnancies to access permanent contraception regardless of age, parity, or marital status. Permanent contraception may offer particular benefit to women with complex medical issues, and those who decline hormonal contraception or intrauterine devices. We also discuss the development of new methods of permanent contraception, including the FemBloc® system and polidocanol foam. Permanent contraception remains an important option for women who have completed desired family size as it results in long-term, non-hormonal prevention of pregnancy. Women should be thoroughly counseled on the different methods of permanent contraception as well as the risks and benefits.

Attitudes towards family formation among men attending fertility counselling.

Men and women are increasingly postponing childbearing until an age where fertility has decreased, meaning that they might have difficulties in achieving their desired family size. This study explored childless men's attitudes towards family formation. Data were collected through semi-structured qualitative interviews with 21 men attending the Fertility Assessment and Counselling Clinic in Copenhagen or Horsens, Denmark. Data were analysed using content analysis. The men envisioned a nuclear family with their own biological children, but they experienced doubts and ambivalence about parenthood and feeling ‘ready’. Their lack of readiness was linked to their awareness of the sacrifices and costs involved with parenthood, and their belief that they could safely delay parenthood. The men did not consider that they may be unable to have their own biological children. This study highlights the importance of considering men's attitudes and preferences towards family formation when understanding couples' decision-making. Contrary to common understanding, the findings show that men are as concerned with the planning and timing of parenthood as women, but their knowledge of the age-related decline in fertility is poor. Men need to gain more awareness of the limitations of fertility and the impact of female and male age on the ability to achieve parenthood aspirations.

Modelling the proximate determinants of fertility for Brazil: the advent of competing preferences

More than half of the world’s population lives in a country where fertility is below replacement level (MYRSKYLA; KOHLER; BILLARI, 2009). In Brazil, the total fertility rate (TFR) went down from 4.26 children per women in 1980 to 1.91 in 2010. Some internal disparities exist. We use data from the DHS from 1986, 1996 and the PNDS from 2006, the most recent survey available, to decompose and analyze fertility rates using a framework proposed by Bongaarts (2001), which is especially useful to explore and compare factors behind total fertility rates. The framework includes desired family size (DFS), unwanted fertility, sex preference, replacements for child mortality, rising age at childbearing, involuntary infertility and competing preferences. By understanding fertility components across time in Brazil, this paper illuminates how these factors vary by socio-demographic characteristics (race, religion, wealth, education, and place of residence), and how these factors combined have formed TFR throughout the years and in contexts of both high and low fertility. We found that, contrarily to what happened in the past, women in recent periods are having, in aggregate, fewer children than their ideal family sizes. However, unwanted pregnancies still explain why certain social groups have more children than desired. We also find that women with higher levels of education tend to desire more children than women with lower educational levels. Competing preferences is the main explanation for this disparity.

Changes in demand for children between 2003 and 2013 in Nigeria: Evidence from survey data

Abstract Nigeria has one of the highest fertility rates in Africa. Data from 2013 Demographic and Health Surveys indicate a virtual stagnation of fertility rate since 2003. Low contraceptive use and pronatalist attitudes are among the factors contributing to the high fertility rate in Nigeria. In this manuscript, we pooled data from three most recent waves of Demographic and Health Surveys to examine trends in demand for children over time and identify the factors associated with change in demand for children. The data show that demand for children has declined since 2003 although not monotonically so. Variables that were positively associated with increased likelihood of desiring no additional children were residence in the South-West (as opposed to residence in the North-Central), exposure to family planning (FP) messages on the mass media, number of children ever born, educational level, and urban residence. In contrast, uncertainty about fertility desire was more widespread in 2008 compared to 2013 although less widespread in 2003 than in 2013. The likelihood of being undecided about fertility desire was positively associated with discrepancies in family size desires between husband and wife, parity and Islamic religious affiliation. Programs should aim to increase access to effective contraceptive methods and promote demand for contraceptives as a way of fostering a sustainable reduction in demand for children. Furthermore, strategies that address uncertainty by fostering women’s understanding of the social and health implications of large family sizes are relevant.

Engaging Men in Family Planning: Perspectives From Married Men in Lomé, Togo.

Family planning programs have made vast progress in many regions of sub-Saharan Africa in the last decade, but francophone West Africa is still lagging behind. More emphasis on male engagement might result in better outcomes, especially in countries with strong patriarchal societies. Few studies in francophone West Africa have examined attitudes of male involvement in family planning from the perspective of men themselves, yet this evidence is necessary for development of successful family planning projects that include men. This qualitative study, conducted in 2016, explored attitudes of 72 married men ages 18-54 through 6 focus groups in the capital of Togo, Lomé. Participants included professional workers as well as skilled and unskilled workers. Results indicate that men have specific views on family planning based on their knowledge and understanding of how and why women might use contraception. While some men did have reservations, both founded and not, there was an overwhelmingly positive response to discussing family planning and being engaged with related decisions and services. Four key findings from the analyses of focus group responses were: (1) socioeconomic motivations drive men's interest in family planning; (2) men strongly disapprove of unilateral decisions by women to use family planning; (3) misconceptions surrounding modern methods can hinder support for family planning; and (4) limited method choice for men, insufficient venues to receive services, and few messages that target men create barriers for male engagement in family planning. Future attempts to engage men in family planning programs should pay specific attention to men's concerns, misconceptions, and their roles in family decision making. Interventions should educate men on the socioeconomic and health benefits of family planning while explaining the possible side effects and dispelling myths. To help build trust and facilitate open communication, family planning programs that encourage counseling of husbands and wives in their homes by community health workers, trusted men, or couples who have successfully used or are currently using family planning to achieve their desired family size will be important.

Determinants of family planning use among married women in bale eco-region, Southeast Ethiopia: a community based study

BackgroundFamily planning is the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. Providing family planning could prevent maternal deaths by allowing women to delay motherhood, space births, avoid unintended pregnancies and abortions, and stop childbearing when they reach their desired family size. Despite the fact that family planning is advantageous for maternal and newborn health and the services and commodities are free of charge, the reason of not using modern family planning methods is unclear in Bale Eco-Region. Therefore, this study assessed the contraceptive prevalence rate and its determinants among women in Bale Eco-Region, Ethiopia.MethodsA community-based cross-sectional study design (both quantitative and qualitative methods) was conducted from December 2016 to February 2017. Five hundred sixty-seven women were successfully interviewed using structured and pre-tested questionnaire. A multistage sampling technique was employed. Data were entered into Epi-data version 3.1 and exported to SPSS version 21. Logistic regression analyses were done and a significant association was declared at p-value less than 0.05. All focus group discussions and key informant interviews were recorded and analyzed thematically.ResultsThe overall contraceptive prevalence rate was 41.5%. Injectable (48.1%), implants (22.6%) and pills (20.0%) were the most contraceptive methods utilized by study participants. Spousal (husband’s) opposition (38.8%), religious beliefs (17.7%), concern and fear of side effects (14.8%), and distance of family planning service (5.9%) were the reasons for not using contraceptive methods. Having more than seven deliveries (AOR = 2.98, CI = 1.91–6.10, P = 0.000) and having birth interval less than 24 months between the last two children (AOR = 3.8, CI = 13.41–21.61, P = 0.003) were significantly associated with utilization of contraceptive methods.ConclusionLow contraceptive prevalence rate might be attributed by husband opposition, religious beliefs, concern and fear of side effects. Having more than seven deliveries and birth interval less than 24 months between the last two children were determinants of contraceptive use. Family planning consultation opportunities should be created to make male’s involved and to increase their responsibility for family planning use.

Modelling age specific fertility rate in India through fertility curves

One of the important demographic features of any population is the fertility rate which has a direct relationship with both the social and the biological environment. Demographic factors like age at marriage, present family size, gender preference (Mahadevan [27], Bhasin [3], Asari and John [2], Chachra and Bhasin [18], Bhasin and Nag [19]) and socio economic factors like education, occupation, religion, contraceptive practice, etc. (Bhatia [20], Asari and John [2]) are the determinants of desired family size and all these are considered as the cause of the variation of fertility. So far researchers have proposed a variety of reproductivity measures and mathematical models to describe the reproductivity pattern of human population (Islam and Ali [21], Peristera and Kostaki [22] and Nasir et al. [23]). The objective of this study is to examine the current pattern of Age Specific Fertility Rate(ASFR) and to study the trend in fertile age groups by fitting non linear models to the ASFR data for all the states in India obtained from the sample registration system [1], of India. Cross Validity Prediction Power (CVPP), Shrinkage, and R2 are used to identify the best model for the states. Model identification for Forward Age Specific Fertility Rate (FASFR) and Backward Age Specific Fertility Rate (BASFR) along with validity measures are also presented in this paper.

Family Patterns In The Context Of International Migration: Evidence From Families Of International Migrants In Lagos, Nigeria

Migration is generally conceived of as the movement of people from one place to another involving change of usual residence. When the movement is from one country to another, it is international migration; when it is within the country, it is referred to as internal migration. The focus of this paper is international migration involving the movements of Nigerians to other countries. Migration tends to create a disruption in social relationships and networks that have existed over the years. It has been theorized that the longer the duration of stay by the migrating member, the more permanent will be the disruption of existing family pattern and relationship. Some studies on international migration in sub-Saharan Africa appear to concentrate more on the issues of “brain-drain” and social differentiation between migrants’ and non-migrants’ households. This paper examine dthe influence of international migration on family patterns. The study’s specific objectives were to investigate the relationship between international migration and the role of migrants in family’s decision-making process; attainment of desired family size; family headship; and childrearing among families of international migrants in Lagos, The study adopted the non-experimental research design. A sample size of six hundred respondents was drawn from six hundred households with families members living outside Nigeria. The study locations were Eti-Osa and Kosofe Local Government Areas in Lagos State. Our findings indicate that there is no relationship between duration of travel of spouses and the number of children born by the respondents. One could speculate that the desired number of children is usually born before the spouses stay away from this country. The absent family members are usually consulted before important family decisions are made because of the former’s financial strength or birth ranking/position compared to the respondents.

Fertility Preferences and Cognition: Religiosity and Experimental Effects of Decision Context on College Women.

Better models of culture and cognition may help researchers understand fertility and family formation. We examine cognition about fertility using an experimental survey design to investigate how fertility preferences of college women are affected by two prompts that bring to mind fertility-relevant factors: career aspirations and financial limitations. We test the effects of these prompts on fertility preferences and ask how effects vary with respondent religiosity, an aspect of social identity related to fertility preferences. We find significant effects of treatment on fertility preferences when accounting for religiosity: less religious women who considered their career aspirations or financial limitations reported smaller desired family size, but this effect was attenuated for more religious women. Our study demonstrates how fertility preferences are shaped by decision contexts for some socio-demographic groups. We discuss how the findings support a social-cognitive model of fertility.

Abortion as a Process of Birth Limiting Rather than Spacing among Educated Urban Couples in West Bengal, India

D espite the high level of usage of traditional contraceptive methods, particularly among the urban and educated couples, the eastern Indian state of West Bengal has achieved the replacement level of fertility. This paper attempts to understand the patterns, dynamics of contraceptive use and associated outcomes (method failure and abortions) during the inter-pregnancy intervals among the urban educated-couples who ever used any traditional contraceptive methods in Howrah, West Bengal using both quantitative and qualitative approach. The findings showed that the use of traditional contraceptive methods was high due to lower comprehen- sive knowledge and misconceptions about modern methods, particularly among men. High prevalence of unintended pregnancies and induced abortions was observed, particularly for traditional contraceptive users. The calculated unintended pregnancy rate and ratio in the study population were 235 per 1,000 pregnancies and 570 per 1,000 women, respectively. Similarly, the calculated rate of induced abortion was 78 per 1,000 pregnancies with an abortion ratio of 99 per 1,000 live births. Due to the motivation to have small families, couples if they had at least one surviving child, opted to regulate their unintended pregnancies with induced abortion, especially among only traditional contraceptive users. This indicates that women considered abortion as a process of birth limiting rather than spacing to maintain the desired family size and the choice of contraceptives determining number of pregnancies.

The relationship between contraceptive use and unintended pregnancies among married women in Thatta district, Pakistan.

Background & aim: The rate of unintended pregnancy has decreased from 24% to 16% in the last four to five years in Pakistan. However, this rate stills varies among the women living in the rural and urban areas of Pakistan. The females residing in the rural areas are less likely to have many contraceptive choices and receive no/low-quality family planning services; as a result, they end up with birth control failure and unintended pregnancy. Regarding this, more studies are needed to investigate the association between the unintended pregnancy and contraceptive use, particularly in the rural areas of Pakistan.Therefore, the aim of the present study was to determine the relationship between contraceptive use and unintended pregnancy among the women at reproductive age living in Thatta district, Sindh, Pakistan. Methods:This nested case-control study was conducted on the women living in Thatta district during June 2011-July 2012. The pregnant women who did not want more children were considered as cases, and those who intended to have more children were considered as controls. The categorical and continuous variables were analyzed using the Chi-square test and independent t-tests, respectively. Results: According o the results of the present study, the use of contraceptive methods was significantly associated with increased risk of unintended pregnancy among the women living in Thatta district [OR: 2.77 (1.46-5.25)]. Moreover, there was 14% increased risk of unintended pregnancy with one year increase in the age of the women [OR: 1.14 (1.10-1.19)]. The age at marriage showed negative association with unintended pregnancy [OR: 0.92 (0.87-0.97)]. The women having at least one son (alive) were almost three times more likely to report their recent pregnancies as unintended, compared to those with no living son [OR: 2.97 (1.82-4.84)]. In addition, the husband’s education and their opposition with the use of family planning methods [OR 2.16 (1.06-4.39)] were found to be associated with unintended pregnancy. Conclusion: As the findings of the present study indicted, the unintended pregnancy is likely to occur when the women have achieved their desired family size as evidenced by the higher mean age and presence of at least one living son. We recommend to improve the quality of care and family planning services to deal with issues of birth control failure by taking such measures as the provision of emergency contraception and support.

Determined to stop? Longitudinal analysis of the desire to have no more children in rural Mozambique

Classic demographic theories conceptualize desired family size as a fixed goal that guides fertility intentions over the childbearing years. However, a growing body of research shows that fertility plans, even nominally long-term plans for completed childbearing, change in response to short-term conditions. Because of data limitations, much of this research has focused on low-fertility contexts, but short-term conditions are likely to be even more important in high-fertility contexts. This paper uses three waves of survey data collected in rural Mozambique to study predictors of the desire to stop childbearing in a context of relatively high fertility and high individual and social instability. We use fixed effects models to assess how women’s desires to stop childbearing are shaped by demographic factors, household economic conditions, and health status, controlling for constant individual characteristics. Results provide evidence that fertility desires both reflect stable underlying goals and evolve in response to individual and social circumstances.

Sex preferences for children in Ghana: the influence of educational attainment

Education influences aspects of demographic behaviour and outcomes including a child sex preference. Sex preferences of children have been studied in different societies because of its associated social and demographic implications. Using the 2014 Ghana Demographic and Health Survey, we examined the association between educational attainment and sex preferences of children. Findings from the study indicated that there is preference for sons (26.1%) compared to daughters (17.4%). At higher levels of education, there is a higher likelihood for no preference for a sex of a child. Among the characteristics of respondents that influenced sex preferences are: gender, lineage, religion, occupation and desired family size. Acquisition of knowledge through education to some extent alter fertility preferences and hence the need to motivate individuals to attain some level of education.