Family Size Preferences Research Articles

Fertility Desires and Family Size Preferences of HIV Positive Women Accessing Care in the University of Port Harcourt Teaching Hospital

Introduction: Women living with HIV may or may not intend to bear children. They may also have different preferences in terms of family sizes. The desire of HIV positive women to bear children and their family size preferences has significant implication for horizontal and vertical transmission of this incurable disease. This study, therefore, aims to determine fertility preferences and their predictors among HIV positive women accessing care at UPTH, Port Harcourt, Rivers State.
 Methods: The study was a descriptive cross-sectional study among 402 women within the reproductive age (15-49 years) who were on Antiretroviral Therapy (ART). Participants were recruited using systematic sampling method and were interviewed with an interviewer-administered questionnaire. A semi-structured, self-administered questionnaire was used to obtain participant’s socio-demographic characteristics, desire for children, use, demand and choice of contraception and reproductive characteristics. With SPSS version 20, data was summarised as descriptive statistics and Chi-square test was used to test for association.
 Results: The study showed that 81.8% of respondents desire to have children out of which 96 (29.3%) desired one to two children, 169 (51.5%) desired three to four children, and 18 (5.5%) wanted five or more children. Factors such as age, marital status, and disclosure of Sero-status to partner were found to be associated with family size preferences (p<0.05).
 Conclusion: HIV positive women in Port Harcourt have high fertility desires and moderate family sizes preferences; thus, indicating the need for more support and involvement of the government and relevant stake holders in ensuring better access to ART services in the country. More resources should be channelled towards provision of effective preventive medications and services, people who live with HIV (PLHIVs) should be continuously and adequately sensitised with the necessary knowledge on how to make healthy reproductive decisions, as well as on available practicable reproductive options for HIV-infected women should be made efficient, and easily accessible.

Predictors of underachieved and overachieved fertility among women with completed fertility in Ghana.

BackgroundA woman’s ability to achieve her preferred family size is critical in addressing issues of high fertility in sub-Saharan Africa. The socio-cultural context in sub-Saharan Africa presents some difficulty for the attainment of preferred fertility for many women. Few studies in sub-Saharan Africa have examined the extent to which women are unable to achieve their preferred family sizes. This study, therefore, examines the factors that are associated with the non-attainment of women’s preferred fertility by the end of their reproductive years.Data and methodsThe study analyzed pooled cross-sectional data with a sub-sample of 1,888 currently married women aged 45–49 years from five rounds of the Ghana Demographic and Health Survey, 1993 to 2014. Test of associations and multinomial logistic regression analysis were used to examine the predictors of underachieved and overachieved fertility relative to achieved fertility.ResultsThe results indicate that 44 per cent of the women recorded overachieved fertility while about 36 per cent underachieved their fertility. Partner wants more, experiencing child loss and married more than once were significantly associated with overachieved fertility. Nonetheless, increased years of a woman’s education and delaying her at first birth were negatively associated with overachieved fertility. On the other hand, underachieved fertility was significantly associated with having a partner with fewer fertility preference, being of the Islamic faith and ever use of modern contraception.ConclusionPartner’s fertility preference, child loss experience, marrying more than once and ever use of modern contraception were important predictors of a woman’s inability to achieve her fertility preference. Policies to regulate men’s fertility behaviour, delaying age at first birth, use of modern contraception, encouraging longer years of education, and reducing infant and child mortality are important strategies to achieve fertility preference in Ghana.

How does the sex composition of children affect men's higher ideal family size preference relative to women and contraceptive use patterns among couples? A cross-sectional analysis of dyadic couple's data in India

IntroductionSon preference, an ongoing concern in India, is a known driver of ideal family size preferences and contraceptive use among couples. These associations can vary substantially with parity and can influence men and women differently. This study assesses the association of sex composition of children by parity and a) men's higher ideal family size preference relative to women and b) use of modern contraceptives by couples. MethodsWe used the Couples Recode dataset from National Family Health Survey (NFHS) 2015-16 and identified couples who had at least one child and had complete responses for variables used in the study (N = 56,731 couples). We developed multivariable linear and logistic regression models to study the association between sex composition of children by parity and our dependent variables. ResultsOur findings indicate that the sex composition of children is associated with men's higher ideal family size preference, relative to women, among couples with four or more children. We also find that couples with less than four children are less likely to use modern contraceptives when they have an equal or a greater number of daughters than sons compared to those who have no daughters. Findings suggest that couples with four or more children are more likely to use modern contraceptives when they have at least one son and one daughter and are less likely to use contraceptives when they have all daughters and no sons, than couples who have no daughters. ConclusionThis study contributes to existing research on the relationship between sex composition of children with ideal family size preferences and contraceptive use by highlighting meaningful differences between higher and lower parity couples. Findings from the study can be used by family planning programs in India to customize family planning counselling messages by both sex composition and parity.

Community Health Centers' Practices, Barriers, and Facilitators for Providing a 1-Year Supply of Oral Contraception on Site.

High-quality family planning services help women to achieve their preferred family size and birth spacing, which in turn leads to improved health outcomes and better quality of life. This study investigates whether women have access to a 1-year supply of oral contraceptives (OCs) on site when they receive care at community health centers and whether states require coverage for a 1-year supply. This study used a concurrent, mixed-methods approach, with a single phase of quantitative research (survey of health centers) and two phases of qualitative research (50-state policy environment scan and in-depth interviews). Only three states require coverage for a 1-year supply of OCs under all Medicaid and private insurance coverage mechanisms; the majority of states limit it through at least one mechanism. The survey found that 50.9% of health centers provided OCs on site, and of these, only 29.9% offered up to a 1-year supply at a time. An analysis of interviews revealed that clinician and pharmacist preferences and the organization's overall approach to family planning played a role in these practices. This study finds that that only a minority of health centers provide a 1-year supply on site and that a minority of states have rules requiring coverage for a 1-year supply of OCs. To remedy these gaps, change is needed at multiple levels, including health center practices, clinician knowledge and beliefs, federal agency guidance, and state-level insurance policy.

Rural Small-Scale Women Farmers and Preference for Family Size in South-East Nigeria

Among other things, fertility control in Nigeria may not be feasible without recourse to socioeconomic issues such as micro-occupation classification and dominant family cultural traditions facing women and their relationship to fertility behaviour. Rural small-scale women farmers are a relatively closed group with some uniqueness for the understanding of the value of children (VOC) in socioeconomic and cultural contexts and its relationship with fertility behaviour in developing nations. This study, guided by the VOC model, focuses on determining factors for preference for family size (0-4 children) among rural small-scale women farmers in Eha-Amufun in Enugu state. 200 married women (mean age = 33.9; mean age at marriage = 24.5) from 20 agricultural co-operative societies were selected for the study. The study adopted a survey and quantitative research design. Besides the sociodemographic information of the study participants, the study elicited from the respondents information on their choice of family size, the connection of family size with their occupation and the circumstances surrounding son preference and son adoption in the family and rural contexts. The collected data were analysed using the ordinal logistic regression model. The findings show that economic independence, son preference and male child adoption negates limiting family sizes to 0-4 (p<.05) however, age, formal education, children as source of labour and economic independence were positively correlated with the desire for a family size of 4 children and above. In view of the limitations of the study and the ability of the VOC model to unveil spurious factors for fertility behaviour among women, there is a need for comparative studies of rural closed groups in developing nations and their fertility behaviour.Among other things, fertility control in Nigeria may not be feasible without recourse to socioeconomic issues such as micro-occupation classification and dominant family cultural traditions facing women and their relationship to fertility behaviour. Rural small-scale women farmers are a relatively closed group with some uniqueness for the understanding of the value of children (VOC) in socioeconomic and cultural contexts and its relationship with fertility behaviour in developing nations. This study, guided by the VOC model, focuses on determining factors for preference for family size (0-4 children) among rural small-scale women farmers in Eha-Amufun in Enugu state. 200 married women (mean age = 33.9; mean age at marriage = 24.5) from 20 agricultural co-operative societies were selected for the study. The study adopted a survey and quantitative research design. Besides the sociodemographic information of the study participants, the study elicited from the respondents information on their choice of family size, the connection of family size with their occupation and the circumstances surrounding son preference and son adoption in the family and rural contexts. The collected data were analysed using the ordinal logistic regression model. The findings show that economic independence, son preference and male child adoption negates limiting family sizes to 0-4 (p<.05) however, age, formal education, children as source of labour and economic independence were positively correlated with the desire for a family size of 4 children and above. In view of the limitations of the study and the ability of the VOC model to unveil spurious factors for fertility behaviour among women, there is a need for comparative studies of rural closed groups in developing nations and their fertility behaviour.

Influence of Older Generation’s Fertility Behaviours on Daughter’s Desired Family Size in Bihar, India

This paper investigates the associations between preferred family size of married women aged 16-34 in rural Bihar (India) and the fertility behaviours of their biological mother and mother-in-law. This information is based on scheduled interviews of 450 pairs of index women (i.e. women central in our analysis) and their mother-in-laws conducted in 2011. Preferred family size is first measured by Coombs scale, allowing us to capture latent desired number of children, and then categorized into three categories (low, medium, and high). Ordered logistic regression is employed to estimate the preferred family size of index women. We find that family size preferences of index woman is not associated with mother's fertility but with mother's education. Mother-in-law's desired number of grandchildren is positively associated with preferred family size of index woman and remains significant even after controlling for relevant socioeconomic characteristics. However, in the case where index woman has higher education than her mother-in-law, her gets smaller. This suggests that education may provide women with greater autonomy in their decision making on childbearing.

Conjoint Analysis of Consumers' Preference towards Packaged Milk

Consumption of milk is considered as an essential set of choices in our Indian food habits, due to which we attempted to find out the consumer preference of milk towards packaged milk and conducted a conjoint analysis of the factors influencing the purchase decision of packaged milk. The research was carried out with a sample of common individuals/households residing in the Ghaziabad region. We collected the data using a structured questionnaire by using convenient random sampling technique. One-sample t-test was used to ascertain the significant attributes for the purchase of milk. To know the relationship between family size, family income, qualification, and purchase preference of milk categories, chi-square test was conducted. The study found that taste, price, easy availability, and brand were the significant attributes for the purchase of packaged milk. It was found that family income and qualification played a very significant role in the consumers' preference for the purchase of packaged milk. Factors such as packaging, quality, and safe for health were found to be the non-significant factors for the purchase decision of packaged milk. The study found that consumers perceived packaged milk to be more hygienic, safe, and of better quality

Exposure to Armed Conflict and Fertility in Sub-Saharan Africa.

Changes in fertility patterns are hypothesized to be among the many second-order consequences of armed conflict, but expectations about the direction of such effects are theoretically ambiguous. Prior research, from a range of contexts, has also yielded inconsistent results. We contribute to this debate by using harmonized data and methods to examine the effects of exposure to conflict on preferred and observed fertility outcomes across a spatially and temporally extensive population. We use high-resolution georeferenced data from 25 sub-Saharan African countries, combining records of violent events from the Armed Conflict Location and Event Data Project (ACLED) with data on fertility goals and outcomes from the Demographic and Health Surveys (n = 368,765 women aged 15-49 years). We estimate a series of linear and logistic regression models to assess the effects of exposure to conflict events on ideal family size and the probability of childbearing within the 12 months prior to the interview. We find that, on average, exposure to armed conflict leads to modest reductions in both respondents' preferred family size and their probability of recent childbearing. Many of these effects are heterogeneous between demographic groups and across contexts, which suggests systematic differences in women's vulnerability or preferred responses to armed conflict. Additional analyses suggest that conflict-related fertility declines may be driven by delays or reductions in marriage. These results contribute new evidence about the demographic effects of conflict and their underlying mechanisms, and broadly underline the importance of studying the second-order effects of organized violence on vulnerable populations.

Evolutionary dynamics of culturally transmitted, fertility-reducing traits.

Human populations in many countries have undergone a phase of demographic transition, characterized by a major reduction in fertility at a time of increased resource availability. A key stylized fact is that the reduction in fertility is preceded by a reduction in mortality and a consequent increase in population density. Various theories have been proposed to account for the demographic transition process, including maladaptation, increased parental investment in fewer offspring, and cultural evolution. None of these approaches, including formal cultural evolutionary models of the demographic transitions, have addressed a possible direct causal relationship between a reduction in mortality and the subsequent decline in fertility. We provide mathematical models in which low mortality favours the cultural selection of low-fertility traits. This occurs because reduced mortality slows turnover in the model, which allows the cultural transmission advantage of low-fertility traits to outrace their reproductive disadvantage. For mortality to be a crucial determinant of outcome, a cultural transmission bias is required where slow reproducers exert higher social influence. Computer simulations of our models that allow for exogenous variation in the death rate can reproduce the central features of the demographic transition process, including substantial reductions in fertility within only one to three generations. A model assuming continuous evolution of reproduction rates through imitation errors predicts fertility to fall below replacement levels if death rates are sufficiently low. This can potentially explain the very low preferred family sizes in Western Europe.

Age at first marriage, age at first sex, family size preferences, contraception and change in fertility among women in Uganda: analysis of the 2006\u20132016 period

BackgroundUganda’s fertility was almost unchanging until the year 2006 when some reductions became visible. Compared to age at first marriage and contraceptive use, age at sexual debut and family size preferences are rarely examined in studies of fertility decline. In this study, we analyzed the contribution of age at first marriage, age at first sex, family size preferences and contraceptive use to change in fertility in Uganda between 2006 and 2016.MethodsUsing data from the 2006 and 2016 Uganda Demographic and Health Survey (UDHS), we applied a nonlinear multivariate decomposition technique to quantify the contribution of age at first marriage, age at first sex, family size preference and contraceptive use to the change in fertility observed during the 2006–2016 period.ResultsThe findings indicate that 37 and 63% of the change in fertility observed between 2006 and 2016 was respectively associated with changing characteristics and changing fertility behavior of the women. Changes in proportion of women by; age at first marriage, age at first sex, family size preferences and contraceptive use were respectively associated with 20.6, 10.5 and 8.4% and 8.2% of the change in fertility but only fertility behavior resulting from age at first sex was significantly related to the change in fertility with a contribution of 43.5%.ConclusionsThe study quantified the contribution of age at first marriage, age at first sex, family size preferences and contraceptive use to the change in fertility observed between 2006 and 2016. We highlight that of the four factors, only age at sexual debut made a significant contribution on the two components of the decomposition. There is need to address the low age at first sex, accessibility, demand for family planning services and youth-friendly family planning services to young unmarried women such that they can achieve their desired fertility. The contribution of other factors such as education attainment by women and place of residence and their relationship with changes in fertility calls for addressing if further reduction in fertility is to be realised.

Determinants of Change in Fertility among Women in Rural Areas of Uganda.

Fertility among rural women in Uganda continues to decline. Studies on fertility in Uganda have focused on the overall fertility in the country. In this study, we focus on determinants of change in fertility among rural women in Uganda using a multivariate Poisson decomposition technique to quantify the contribution of changes in the socioeconomic and demographic composition of women which we also refer to as the characteristic effects and changes in their fertility behavior (the coefficients' effects or risk of childbearing) to the overall reduction in fertility among women in rural areas during the 2006–2016 period. The “characteristics effects” are used to mean the effect of changing composition of women by the socioeconomic and demographic characteristics between 2006 and 2016. On the other hand, fertility behavior also presented as coefficients' effects mean changes in the risk or likelihood of giving birth to children by the rural women between the two survey years. Our findings indicate that the mean number of children ever born (MCEB) reduced from 4.5 to 3.9 in 2006 and this reduction was associated with both the changes in composition of women and fertility behavior. The composition of women contributed to 42% while the fertility behavior contributed to 58% of the observed reduction. The education level attained and the age at first sex showed significant contributions on both components of the decomposition. The observed decline in fertility is largely associated with the variation in the risk of childbearing among the rural women. The variation in the risk of childbearing by education and age at first sex of the rural women showed to be the biggest contribution to the observed change in fertility. Continued improvements in access, attendance, and completion of secondary schools by women in rural areas will be the key drivers to Uganda's overall transition to low fertility. Furthermore, with improved access to mass media in the rural areas, there can be changes in attitudes and large family size preferences which can create a conducive environment for the utilization of family planning services in the rural communities. Efforts should therefore focus on applying appropriate methods to deliver packaged family planning messages to these communities.

Examining internal migration effects on short versus long interbirth intervals in Cotonou, Benin Republic

BackgroundThe literature on migration-fertility relationship uses various measures of fertility, such as fertility rates, actual fertility and family size preferences. This study introduces a different measure—interbirth intervals over women’s reproductive years—to examine how internal migration is associated with short interbirth intervals (less than 24 months) and long interbirth intervals (greater than 60 months) in Cotonou, the largest city of Benin Republic.MethodsThe paper uses primary data on 2852 live births to 1659 women aged 15–49 years from the 2018 Fertility and Migration Survey in Cotonou. Competing-risks models were fitted for the analysis.ResultsNineteen percent of live births were of short interbirth intervals and 16% were of long interbirth intervals. The prevalence of short interbirth intervals was higher among migrants who spent less than 5 years in Cotonou (29%) than among non-migrants (19%) and earlier migrants (18%). Non-migrants had the highest proportion of long interbirth intervals (19%). Within the first 5 years following the migration to Cotonou, migrants had higher subhazard ratio (SHR) of short interbirth intervals (SHR: 1.71, 95% CI: 1.33–2.21) and lower SHR of long interbirth intervals (SHR: 0.64, 95% CI: 0.47–0.87) than non-migrants. This association holds after controlling for socioeconomic characteristics—but with a slightly reduced gap between migrants who spent less than 5 years in Cotonou and non-migrants. Afterwards and irrespective of women’s socioeconomic backgrounds, migrants who spent 5 or more years in Cotonou and non-migrants had similar risks of short and long interbirth intervals. Finally, from 5 years of stay in Cotonou, migrants for reasons other than school or job were less likely to experience short interbirth intervals (SHR: 0.65, 95% CI: 0.46–0.98 for migrants who spent 5–10 years in Cotonou, and SHR: 0.74, 95% CI: 0.54–1.02 for migrants who spent more than 10 years in Cotonou) than non-migrants.ConclusionFamily planning programmes should mainly target migrants in the early years after their arrival in Cotonou. Moreover, non-migrants need to be sensitised on the adverse health outcomes of long interbirth intervals.

What are the barriers to implementing psychosocial assessment in the private sector?

High-quality family planning services help women to achieve their preferred family size and birth spacing, which in turn leads to improved health outcomes and better quality of life. This study investigates whether women have access to a 1-year supply of oral contraceptives (OCs) on site when they receive care at community health centers and whether states require coverage for a 1-year supply.This study used a concurrent, mixed-methods approach, with a single phase of quantitative research (survey of health centers) and two phases of qualitative research (50-state policy environment scan and in-depth interviews).Only three states require coverage for a 1-year supply of OCs under all Medicaid and private insurance coverage mechanisms; the majority of states limit it through at least one mechanism. The survey found that 50.9% of health centers provided OCs on site, and of these, only 29.9% offered up to a 1-year supply at a time. An analysis of interviews revealed that clinician and pharmacist preferences and the organization's overall approach to family planning played a role in these practices.This study finds that that only a minority of health centers provide a 1-year supply on site and that a minority of states have rules requiring coverage for a 1-year supply of OCs. To remedy these gaps, change is needed at multiple levels, including health center practices, clinician knowledge and beliefs, federal agency guidance, and state-level insurance policy.

Sharing experiences of military midwifery

High-quality family planning services help women to achieve their preferred family size and birth spacing, which in turn leads to improved health outcomes and better quality of life. This study investigates whether women have access to a 1-year supply of oral contraceptives (OCs) on site when they receive care at community health centers and whether states require coverage for a 1-year supply.This study used a concurrent, mixed-methods approach, with a single phase of quantitative research (survey of health centers) and two phases of qualitative research (50-state policy environment scan and in-depth interviews).Only three states require coverage for a 1-year supply of OCs under all Medicaid and private insurance coverage mechanisms; the majority of states limit it through at least one mechanism. The survey found that 50.9% of health centers provided OCs on site, and of these, only 29.9% offered up to a 1-year supply at a time. An analysis of interviews revealed that clinician and pharmacist preferences and the organization's overall approach to family planning played a role in these practices.This study finds that that only a minority of health centers provide a 1-year supply on site and that a minority of states have rules requiring coverage for a 1-year supply of OCs. To remedy these gaps, change is needed at multiple levels, including health center practices, clinician knowledge and beliefs, federal agency guidance, and state-level insurance policy.

Inter-spousal communication: A means for achieving concordant fertility goals

Background: Spousal communication strategy has gained attention as an effective means of reducing couple’s fertility preferences, its continuous measurement cannot be overemphasised in literature Objecive: This study examined concordance and discordance in the desired number of children among couples in Nigeria. Methods: The study used the 2013 Couple dataset of Nigeria Demographic and Health Survey. The method of data analyses involved univariate, chi-square and binary logistic regression. Results: The result showed that 34% of couples agreed on common fertility desires, while 66% disagreed. The logistic regression analysis using Likelihood Ratio test, showed that couples communication significantly explained the indirect effects of background variables on concordant fertility desire (P<0.001). Conclusion: We therefore, recommend that couples’ communication on family size preferences be encouraged by programs geared towards achieving SDG-3,5 aimed at improving women and child health and gender equality in decision making.

Marital violence and fertility in a relatively egalitarian high-fertility population.

Ultimate and proximate explanations of men’s physical intimate partner violence (IPV) against women have been proposed. An ultimate explanation posits that IPV is used to achieve a selfish fitness-relevant outcome, and predicts that IPV is associated with greater marital fertility. Proximate IPV explanations contain either complementary strategic components (for example, men’s desire for partner control), non-strategic components (for example, men’s self-regulatory failure), or both strategic and non-strategic components involving social learning. Consistent with an expectation from an ultimate IPV explanation, we find that IPV predicts greater marital fertility among Tsimané forager-horticulturalists of Bolivia (n = 133 marriages, 105 women). This result is robust to using between- versus within-subject comparisons, and considering secular changes, reverse causality, recall bias and other factors (for example, women’s preference for high-status men who may be more aggressive than lower-status men). Consistent with a complementary expectation from a strategic proximate IPV explanation, greater IPV rate is associated with men’s attitudes favouring intersexual control. Neither men’s propensity for intrasexual physical aggression, nor men’s or women’s childhood exposure to family violence predict IPV rate. Our results suggest a psychological and behavioural mechanism through which men exert direct influence over marital fertility, which may manifest when spouses differ in preferred family sizes.

CONTRACEPTIVE USE AND FAMILY SIZE PREFERENCES AMONG RURAL WOMEN IN SOKOTO STATE, NIGERIA

Background: The interplay of high fertility, low contraceptive use and high maternal mortality continues to decimate populations across sub-Saharan Africa. This study aimed to determine contraceptive use and family size preferences among rural women in Sokoto State, Nigeria. Methods: It was a cross-sectional study conducted in rural communities of Sokoto State, Nigeria, using both quantitative and qualitative methods of data collection. It involved interviews to a random sample of 202 women of child bearing age using semi-structured interviewer- administered questionnaires, and focus group discussions among women and men. The quantitative data were analyzed using the IBM SPSS version 17 computer statistical package; while the qualitative data were transcribed, sorted, categorized and analyzed thematically. Results: The mean age of the women was 27.9 + 8.0 years, most of them had no formal education (85.6%) and were aged 14-19 years when they had their first pregnancy (84.2%). Of the 202 respondents only 10 (5.0%) were using modern contraceptives, most commonly pills 4 (40.0%), and injectable contraceptives 4 (40.0%). The main barriers to use of modern contraceptives were religious beliefs, desire for more pregnancies, poor understanding of FP concept/ disapproval by husbands; and lack of communication between couples. Almost all the respondents 197 (97.5%) preferred large family sizes and most of them 149 (73.8%) were willing to have as many children as possible. Conclusion: These findings underscore the need for governments and other stakeholders to make female education the central focus of FP promotion programs, in addition to involving men and religious leaders. Keywords: Contraceptive use, modern contraceptives, family size preferences, rural women, SokotoÂ

Fertility, Family Size Preference and Contraceptive Use in Sub-Saharan Africa: 1990-2014.

In view of an unusual transition in sub-Saharan Africa (SSA) fertility, periodic re-appraisal is necessary. Using an ecological design, data from Demographic and Health Surveys between 1990 and 2014 were analysed to investigate trends in completed family size (CFS), total fertility rate (TFR), family size preference (FSP), and contraceptive prevalence rate (CPR). The correlates of changes in fertility levels, FSP and CPR were explored. Results showed that CFS declined and was lowest in Southern and Western Africa. However, average CFS for Central African countries appeared virtually the same over the period. Changes in TFR and FSP followed patterns similar to CFS. Western and Central region had very slow increase in CPR with many below 20% as at 2014. Eastern and Southern Africa had faster increase in CPR with some countries achieving almost 60%. Regression results showed that contraceptive prevalence (β= -1.96, p=0.027) and median age at first marriage (β= -0.23, p=0.06) were negatively related to TFR while employment (β= -21.7, p <0.001) was negatively related to FSP. In summary, fertility levels and family size preference declined while contraceptive use improved particularly in Southern and the Eastern Africa. Increased female labour force participation is another potential route to fertility decline in SSA.

SIBSHIP SIZE AND YOUNG WOMEN'S TRANSITIONS TO ADULTHOOD IN INDIA.

In India, a substantial proportion of young people are growing up in smaller families with fewer siblings than earlier generations of young people. Studies exploring the associations between declines in sibship size and young people's life experiences are limited. Drawing on data from a sub-nationally representative study conducted in 2006-08 of over 50,000 youths in India, this paper examines the associations between surviving sibship size and young women's (age 20-24) transitions to adulthood. Young women who reported no or a single surviving sibling were categorized as those with a small surviving sibship size, and those who reported two or more surviving siblings as those with a large surviving sibship size. Bivariate and multivariate regression analyses were conducted to ascertain the relationship between sibship size and outcome indicators. Analysis was also done separately for low- and high-fertility settings. Small sibship size tended to have a positive influence in many ways on young women's chances of making successful transitions to adulthood. Young women with fewer siblings were more likely than others to report secondary school completion, participation in vocational skills training programmes, experience of gender egalitarian socialization practices, adherence to gender egalitarian norms, exercise of pre-marital agency and small family size preferences. These associations were more apparent in low- than high-fertility settings.

Perspectives of displaced Syrian women and service providers on fertility behaviour and available services in West Bekaa, Lebanon

Prior to the conflict, Syria had relatively high fertility rates. In 2010, it had the sixth highest total fertility rate in the Arab World, but it witnessed a fertility decline before the conflict in 2011. Displacement during conflict influences fertility behaviour, and meeting the contraceptive needs of displaced populations is complex. This study explored the perspectives of women and service providers about fertility behaviour of and service provision to Syrian refugee women in Bekaa, Lebanon. We used qualitative methodology to conduct 12 focus group discussions with Syrian refugee women grouped in different age categories and 13 in-depth interviews with care providers from the same region. Our findings indicate that the displacement of Syrians to Lebanon had implications on the fertility behaviour of the participants. Women brought their beliefs about preferred family size and norms about decision-making into an environment where they were exposed to both aid and hardship. The unaffordability of contraceptives in the Lebanese privatised health system compared to their free provision in Syria limited access to family planning services. Efforts are needed to maintain health resources and monitor health needs of the refugee population in order to improve access and use of services.