High Fertility Rates Research Articles

Understanding fertility behavior of the Forcibly Displaced Myanmar Nationals in Bangladesh: A qualitative study.

Rohingya- the Forcibly Displaced Myanmar Nationals (FDMN)- are largely characterized by a high total fertility rate (TFR) and a low contraceptive prevalence rate. This study aimed to explore the reasons behind their high fertility behavior by utilizing the Theory of Planned Behavior. We adopted a cross-sectional qualitative research approach. Fifteen semi-structured, face-to-face in-depth interviews were conducted with the Rohingya husbands, wives, and community leaders (Majhi and Imam/Khatib) living in Camps 1 and 2 of Ukhiya Refugee Camp, Cox's Bazar, Bangladesh. We analyzed the qualitative data using the thematic analysis approach. The Muslim-majority FDMN predominantly constructed the fertility outcome as the will and order of Allah. On the one hand, the Rohingya parents highlighted various religious, political, economic, and social advantages of having more children, especially sons. On the other hand, beliefs about religious restriction, fear of side effects, and community pressure against contraception sustained the reality of the low contraceptive prevalence rate in the community. Alarmingly, the Rohingya religious leaders and mass people were found highly politically motivated to continue the practice of high fertility with a view to 'expanding the Rohingya community' or 'to increase Muslim soldiers', so that they may fight back and take control of their ancestors' place in Myanmar in the future. Furthermore, these pronatalist attitudes and beliefs translated into high TFR through various high-fertility-supportive social norms and practices widely prevalent in the Rohingya community. These include child marriage, gendered division of labor, women's subordinate nature, the Purdah system, and joint-family members' support during childbirth and rearing. Religion, ethnic identity, and the unique political context and experiences of the Rohingya people jointly explain their high fertility behavior. This study warrants the urgency of initiating social and behavior change communication programs to change the religiopolitically-motivated high-fertility notions that prevailed in the Rohingya community.

Predictors of desire to limit childbearing among reproductive age women in high fertility regions in Ethiopia. A multilevel mixed effect analysis

BackgroundA high fertility rate can have a number of expensive consequences for developing nations, such as limiting economic growth, adversely impacting women and their children’s health, and reducing access to quality education, nutrition, and employment. The problem is more obvious in Ethipia’s high fertility regions. Therefore, this study aimed to assess predictors of desire to limit childbearing among reproductive age women in high fertility regions in Ethiopia.MethodsThe analysis was based on secondary data using the 2016 Ethiopian Demographic and Health Survey. Stata version 14 software was used for analysis. A multi-level mixed-effect logistic regression analysis was fitted. Adjusted Odds Ratio at 95% confidence interval was used to show the strength and direction of the association. Statistical significance was declared at a P- value less than 0.05.ResultsThe overall desire to limit childbearing in high fertility regions in Ethiopia was 37.7% (95% CI: 36.28, 39.17). Age; 25–34 (AOR = 3.74; 95% CI: 2.97, 4.73), 35–49 years (AOR = 14; 95% CI: 10.85, 18.06), women education; Primary education (AOR = 0.73; 95% CI: 0.61, 0.88), secondary and higher (AOR = 0.29; 95% CI: 0.19, 0.43), from the community level variables Oromia National Regional state (AOR = 5.86; 95% CI: 2.82, 12.23), high proportion of community level poverity (AOR = 0.67; 95% CI: 0.45, 0.98), and high proportion of community level media exposure (AOR = 1.53; 95% CI: 1.07, 2.19) were statistically significant factors for desire to limit childbearing in high fertility regions of Ethiopia.ConclusionNearly four in ten women had the desire to limit childbearing in high fertility regions in Ethiopia. Thus, to fulfill the women’s desire to limit childbearing, Ministry of Health and health facilities are needed to increase financial support strategies and Family planning programs that enable pregnant women from poor households to use health services. In addition, increasing community level media exposure are important interventions.

Maternal Health Services in Pakistan

Background: Women must be provided with necessary health services for a child's good health and future during pregnancy. Women's health has experienced a considerable epidemiological change during the past several decades. Maternal well-being and health affect not only the developed world but predominantly the developing nations. Differences in resource allocation between industrialized and developing countries ultimately led to notable differences in pregnancy complications and deaths. Aim: To investigate these barriers. A literature review was carried out to address this research topic. Methodology: Six online databases AMED, CINAHL PLUS, PUBMED, MEDLINE, COCHRANE LIBRARY and SCIENCE DIRECT were used for a preliminary search that yielded 6353 articles. No grey literature was discovered due to time restrictions. Seven publications were discovered to be eligible for inclusion in the literature review after carefully reading, analysing, and evaluating them with the help of critical appraisal techniques. After the initially searched articles were filtered using robust inclusion and exclusion criteria. Findings: Data were taken from different sources like the Pakistan Demographic and Health Surveys (PDHSs), WHO, and a comparison was made with the findings from different factors. The analysis concentrates on women of Pakistan having maternal health issues and maternal health services. The Critical Appraisal Skills Program (CASP) is used for the assessment and qualitative analysisof this study. Practical implications: By addressing the issues highlighted in this paper there appears to be substantial room for improvements in Pakistan’s pregnancy outcomes. This review provides a better understanding of the risk factors determining maternal mortality in Pakistan.Public awareness is important as this paper almost covered the different platforms which are working on maternal health servicesto aware the society. To promote maternal health messages and encourage pregnant women to receive maternal healthcare services, policymakers, healthcare professionals, and health organizations can adopt a variety of campaigns. Results: This study discussed the impact of different factorswhich effect on maternal health. Different factors are associated with utilizing maternal healthcare services at antenatal care and delivery stages of pregnancy in Pakistan. This review concentrated on the economic and social vulnerability of pregnant women and emphasized the importance of parallel, more all-encompassing initiatives, like poverty reduction and women's empowerment. Poor maternal health in Pakistan has many root causes, including undernourishment of young girls, early marriage, high fertility rates, and unmet contraceptive needs. Conclusion: The key factors influencing women's hesitation and refusal to use the health facilities in Pakistan include structural hurdles, maternal knowledge and education levels, and men's dominance in decision-making, according to the themes drawn from the literature. Keywords: Pregnant women, Maternal health, Ante-natal care, Pakistan,Demographic and health surveys,

CONTENT OF NITRATES IN SUNFLOWER SEEDS AND ITS PROCESSING PRODUCTS WHEN GROWN ON GRAY FOREST SOILS

The excessive accumulation of nitrates in plant products is a consequence of the uncontrolled application of high and ultra-high rates of mineral fertilizers, in particular, nitrogen fertilizers that contain nitrate nitrogen. During the last decades in Ukraine, intensive farming measures are used everywhere in agriculture, which are determined by the introduction of high and often unbalanced rates of mineral fertilizers. This led to an increase in the content of nitrates in field crops, in particular in grain, oil and other technical crops. With the targeted use of mineral fertilizers, it is possible to increase the content of nitrates both in sunflower seeds and in the products of its processing: oil, fusi oil, and meal. One of the important factors in preventing the accumulation of nitrates in plant products is the periodic agrochemical and agroecological monitoring of soils in order to identify imbalances in the content of nutrients, changes in acidity, humus, and the content of other substances. The purpose of the research is to determine the content of nitrates in sunflower seeds and their processing products: fusi from oil and meal, taking into account the indicators of the agrochemical composition of the gray forest soil. The research was conducted during 2021-2022 on the production crops of FG "Zorya Vasylivka" village. Vasylivka, Vinnytsia district, Vinnytsia region. The laboratory analysis of the agrochemical composition of the soil according to the indicators of humus content, easily hydrolyzed nitrogen, mobile phosphorus, exchangeable potassium, pH reaction of the soil solution was carried out at the Zhytomyr branch of the State Institution "Derzhgruntokhorona" (Institute of Soil Protection of Ukraine) according to standard methods. Laboratory analyzes of the content of nitrates in sunflower seeds, fuschia and meal were carried out at the Vinnytsia branch of the State Institution "Derzhgruntokhorona" (Institute of Soil Protection of Ukraine) according to standard methods. In the conditions of the right-bank forest-steppe, when growing sunflowers on gray forest medium-loamy soils with a low provision of easily hydrolyzable nitrogen, medium - mobile phosphorus and high - exchangeable potassium when N45P45K45 is applied under its sowing, the nitrate content in sunflower seeds is 32.2 mg/kg, which in 9 ,3 times less than the maximum permissible concentration. At the same time, when making meal from sunflower seeds, the nitrate content in it increases by 47%, which requires additional control when using it for fodder purposes. And the content of nitrates in sunflower oil fuzz is 24% lower than in sunflower seeds, which makes it safer for feed use than meal.

Early life supplementation with a natural blend containing turmeric, thymol, and yeast cell wall components to optimize rumen anatomical and microbiological development and productivity in dairy goats

Ruminants are born with an anatomically, microbiologically, and metabolically immature rumen. Optimizing the rearing of young ruminants represent an important challenge in intensive dairy farms. Therefore, the objective of this study was to evaluate the effects of dietary supplementation of young ruminants with a plant extract blend containing turmeric, thymol, and yeast cell wall components such as mannan oligosaccharides and β-glucans. One hundred newborn female goat kids were randomly allocated to 2 experimental treatments, which were unsupplemented (CTL) or supplemented with the blend containing plant extracts and yeast cell wall components (PEY). All animas were fed with milk replacer, concentrate feed, and oat hay, and were weaned at 8 wk of age. Dietary treatments lasted from wk 1 to 22 and 10 animals from each treatment were randomly selected to monitor feed intake, digestibility, and health-related indicators. These latter animals were euthanized at wk 22 of age to study the rumen anatomical, papillary, and microbiological development, whereas the remaining animals were monitored for reproductive performance and milk yield during the first lactation. Results indicated that PEY supplementation did not lead to feed intake or health issues because PEY animals tended to have a higher concentrate intake and lower diarrheal incidence than CTL animals. No differences between treatments were noted in terms of feed digestibility, rumen microbial protein synthesis, health-related metabolites, or blood cell counts. Supplementation with PEY promoted a higher rumen empty weight, and rumen relative proportion to the total digestive tract weight, than CTL animals. This was accompanied with a higher rumen papillary development in terms of papillae length and surface area in the cranial ventral and caudal ventral sacs, respectively. The PEY animals also had higher expression of the MCT1 gene, which is related to volatile fatty acid absorption by the rumen epithelium, than CTL animals. The antimicrobial effects of the turmeric and thymol could explain the decreased the rumen absolute abundance of protozoa and anaerobic fungi. This antimicrobial modulation led to a change in the bacterial community structure, a decrease in the bacteria richness, and to the disappearance (i.e., Prevotellaceae_UCG-004, Bacteroidetes_BD2-2, Papillibacter, Schwartzia, and Absconditabacteriales_SR1) or decline of certain bacterial taxa (i.e., Prevotellaceae_NK3B31_group, and Clostridia_UCG-014). Supplementation with PEY also decreased the relative abundance of fibrolytic (i.e., Fibrobacter succinogenes and Eubacterium ruminantium) and increased amylolytic bacteria (Selenomonas ruminantium). Although these microbial changes were not accompanied with significant differences in the rumen fermentation, this supplementation led to increased body weight gain during the preweaning period, higher body weight during the postweaning period, and higher fertility rate during the first gestation. On the contrary, no residual effects of this nutritional intervention were noted on the milk yield and milk components during the first lactation. In conclusion, supplementation with this blend of plant extracts and yeast cell wall component in early life could be considered as a sustainable nutritional strategy to increase body weight gain and optimize the rumen anatomical and microbiological development in young ruminants, despite having minor productive implications later in life.

Subsequent fertility after cesarean scar pregnancy: a retrospective analysis

BackgroundCesarean scar pregnancy (CSP) refers to the implantation and growth of the gestational sac at a uterine scarring site due to a previous cesarean section. The effects of CSP on subsequent fertility have emerged as a clinical issue of importance in gynecology and obstetrics in China owing to the increasing rate of cesarean section over the past 30 years in combination with the abolition of the national family planning policy, allowing for subsequent pregnancies. Therefore, we aimed to investigate the effects of CSP treatment on subsequent fertility and pregnancy outcomes.MethodsThe study consecutively enrolled 499 women treated for CSP at Taizhou Hospital between January 2009 and December 2018. The study outcomes were the rate of secondary infertility and pregnancy outcomes. Clinical information was collected at the time of admission for CSP treatment. Information on subsequent fertility and pregnancy outcomes was collected via telephonic follow-up.ResultsAmong the 499 women who met the inclusion criteria for CSP, 48 were lost to follow-up. Most women (74.9%, 338/451) did not express the desire for a subsequent pregnancy after CSP treatment. Among the 113 women who initially desired a subsequent pregnancy, 62 finally abandoned fertility plans. Among the 51 women who pursued pregnancy, 48 pregnancies were recorded in 43 women, infertility secondary to CSP treatment was identified in 15.7% (8/51) of women, and 60.8% (31/51) of women achieved full-term pregnancy, with placenta accreta spectrum identified in two women, one requiring a hysterectomy during cesarean section due to massive bleeding. Among the 16 women treated with uterine artery embolization combined with uterine aspiration and 18 women treated by ultrasound-guided local lauromacrogol injection combined with uterine aspiration, a successful full-term pregnancy rate of 68.8% (11/16) and 88.9% (16/18), respectively, was achieved. There were five cases of recurrent CSP among all 76 pregnancies (6.6%).ConclusionOver a long-term follow-up of women after CSP treatment, a high successful fertility rate was identified, with also an increased CSP recurrence rate. Uterine artery embolization combined with uterine aspiration and ultrasound-guided local lauromacrogol injection combined with uterine aspiration showed high rates of successful post-treatment fertility and pregnancy.

A Comparative Assessment of the Urbanization – Fertility Nexus in Most Urbanized Countries of Sub-Saharan Africa

Abstract There is a near-consensus in the literature that urbanization is incompatible with large family size owing to factors such as high cost of urban living, opportunity cost of having children in urban centers and increasing awareness of benefits of small family size. However, a cursory glance at the data on sub-Saharan Africa cast doubt on the incompatibility of urbanization with high fertility rate. Hence, this paper investigates the urbanization-fertility nexus in the two most urbanized countries of SSA – Nigeria and South Africa. Exploiting time series data for both countries within a Fully Modified Ordinary Least Square (FMOLS) framework, the incompatibility hypothesis is refuted in both countries. Specifically, the analysis suggests that in Nigeria and South Africa, increasing degree of urbanization is positively related with fertility rate with the magnitude of the relationship being higher in Nigeria than South Africa. These findings imply that policies aimed at improving urbanization process and reducing fertility rates are crucial in both countries.

Therapeutic exploration of polyherbal formulation against letrozole induced PCOS rats: A mechanistic approach

ObjectiveThis study aimed to develop an effective alternative medicine with multi potential herbs against polycystic ovarian syndrome (PCOS) in rats induced by letrozole treatment. Materials and methodPolyherbal syrup was prepared with a combination of S. asoca bark, G. sylvestre leaves, P. daemia aerial parts, C. zeylanium stem bark, C. bonduc seeds, and W. somnifera roots ethanolic extract. In vitro cell viability study, adenosine monophosphate-activated protein kinase (AMPK), and glucose transporter 4 (GLUT4) gene expression assay were carried out on the Chinese Hamster Ovarian (CHO) cell line. For the PCOS induction letrozole (1 mg/kg p. o.) was given for 21 consecutive days. The PCOS induction was confirmed by measuring estrus irregularity, insulin resistance by oral glucose tolerance test (OGTT), and hyperandrogenism by measuring serum total testosterone level 21 days after completion of letrozole treatment. After induction of PCOS, metformin (155 mg/kg p. o.), and polyherbal syrup (100 mg/kg, 200 mg/kg, and 400 mg/kg p. o.) were administered for further 28 days. The treatment efficacy was measured by measuring serum lipid profile, fasting insulin level, sex hormones level, ovarian steroidogenic enzymes, ovarian tissue insulin receptor, AMPK, and GLUT4 protein expression levels, and histomorphological studies. The post-treatment effect was confirmed by reproductive performance studies. ResultsLetrozole-induced PCOS rats showed significant estrus irregularity, abnormal sex hormones levels, and hyperandrogenism indicated by showing increased free androgenic index and decreased sex hormones binding globulin (SHBG) level. The insulin resistance in PCOS rats was indicated by increased fasting glucose levels with impaired glucose clearance in the OGT test. Homeostasis Model Assessment Index of Insulin Resistance (HOMA-IR) increased level, also decreases INSR, GLUT4, and AMPK mRNA expression in ovarian cells confirming the insulin resistance in PCOS rats. Ovarian histology in PCOS rats also showed many follicular cysts, atretic follicles, and the absence of corpus luteum. The administration of polyherbal syrup, in a dose-dependent manner, effectively restored these alterations. The treatment of polyherbal formulation 400 mg/kg possesses highly significant efficacy over the treatment of metformin in PCOS rats. It mainly acts by reducing peripheral and ovarian hyperandrogenism and improves insulin sensitivity via activating the insulin receptor and AMP-activated kinase-mediated transcription and translation of GLUT4 from the cytoplasm to the ovarian membrane improves glucose uptake and promotes the follicular development and ovulation. The higher fertility rate, delivery index, and survival of delivered pups confirm the broader and superior efficacy of PCOS. These beneficial actions are mainly attributable to the formulation's inclusion of the key secondary metabolites flavonoids and phytosterols. In conclusion, the prepared polyherbal syrup was found to be the safest and most effective alternative medicine for both endocrinal and metabolic complications of PCOS women.

Pregnant Latinas' perspectives on pursuing expanded carrier screening: "It is better to know than not".

With the advance of genetic technologies, the use of expanded carrier screening (ECS) in the prenatal setting is growing. ECS tests for a wide range of inherited genetic disorders regardless of racial/ethnic background and family history. Latinxs are an important ECS stakeholder group as they are the largest minority group with the highest fertility rate in the United States. Yet, the Latinx population has, to date, been underrepresented and understudied in genetics/genomics research. We conducted a study to explore the knowledge and perspectives of pregnant Latinas regarding ECS in which descriptive statistics and content analysis were used to analyze the data. Thirty-two pregnant Latinas - mostly of low educational levels (no education beyond high school) and with less than $20,000 annual household income living in rural areas were surveyed, provided with education about ECS, and interviewed. Participants were found to possess limited knowledge about ECS prior to being interviewed. Most (68.8%), however, expressed interest in pursuing ECS following the educational component that explained ECS. Their interest was mainly driven by the desire to know their baby's chance of developing a genetic disorder, the low risk of ECS procedures for both pregnant Latinas and their fetus, and the opportunity to better prepare for raising a child with a genetic condition. Our findings contribute to the limited research in the genetics/genomics field by providing in-depth insights into the perspectives of pregnant Latinas regarding ECS. Obstetric providers and genetic counselors should provide culturally appropriate education and counseling to empower pregnant Latinas to make informed decisions about the use of ECS.

Choices and availability of family planning services: evidence from census-based health facility assessment data in Bauchi state, Nigeria

Background: Controlling family planning (FP) has long been the goal of most nations and cultures. FP aims to keep the population under control while also improving living conditions. Many countries, especially the developing ones, which Nigeria is among, face the challenge of dealing with overpopulation due to high fertility rates. FP is considered a veritable way of dealing with high fertility problems. The present study assesses the choices and availability of FP services in Bauchi state health facilities. Methods: This study leveraged Noi Polls census data on Health Facility Assessment for Bauchi state. We conducted a descriptive analysis and analyzed the primary health facility assessment data using counts and percentages. Result: Findings of the study revealed that 80% of the health facilities studied in Bauchi State offer FP services. 91.2% and 77% of the facilities in the urban and rural areas, respectively, offer FP services. This translates to 8.8% and 23% of health facilities in urban and rural areas, respectively, not offering FP services. Based on proportions, assessing the facilities that offer FP by ownership shows that public health facilities are more into FP services (80%) compared to the private-for-profit (80%) health facilities and facilities owned by NGOs and faith-based organizations (83.3%). By facility level of care, 87.5% of secondary healthcare facilities in Bauchi State offer FP services compared to primary healthcare facilities (79.5%). FP services provided in the studied facilities include counseling, contraceptive injectables, oral contraceptive pills, male and female condoms, implants, Intra-Uterine Contraceptive Devices IUCD, sterilization methods, and natural/traditional methods. Conclusion: Considering that over 80% of health facilities considered in this study locates in rural Bauchi state, with over 22% not offering FP clearly shows a gap that the government must address. The distribution of FP services across the state's local government areas is inequitable as some local governments have more health facilities offering the services than others, thus giving residents in those areas a higher chance of benefitting from those services.

Socio-economic and education related inequities in use of modern contraceptive in seven sub-regions in Uganda

BackgroundAdvocacy for equity in health service utilization and access, including Family Planning (FP) continues to be a cornerstone in increasing universal health coverage. Inequities in Family planning are highlighted by the differences in reproductive health outcomes or in the distribution of resources among different population groups. In this study we examine inequities in use of modern contraceptives with respect to Socio-economic and Education dimensions in seven sub-regions in Uganda.MethodsThe data were obtained from a baseline cross-sectional study in seven statistical regions where a program entitled “Reducing High Fertility Rates and Improving Sexual Reproductive Health Outcomes in Uganda, (RISE)” is implemented in Uganda. There was a total of 3,607 respondents, half of whom were women of reproductive age (15-49 years) and the other half men (18-54 years). Equity in family planning utilization was assessed by geography, wealth/economic and social-demographics. The use of modern family planning was measured as; using or not using modern FP. Concentration indices were used to measure the degree of Inequality in the use of modern contraceptives. Prevalence Ratios to compare use of modern FP were computed using modified Poisson regression run in STATA V15.ResultsThree-quarters (75.6%) of the participants in rural areas were married compared to only 63% in the urban. Overall use of modern contraceptives was 34.2% [CI:30.9, 37.6], without significant variation by rural/urban settings. Women in the higher socio-economic status (SES) were more advantaged in use of modern contraceptives compared to lower SES women. The overall Erreygers Concentration Index, as a measure of inequity, was 0.172, p<0.001. Overall, inequity in use of modern contraceptives by education was highest in favor of women with higher education (ECI=0.146, p=0.0001), and the concentration of use of modern contraceptives in women with higher education was significant in the rural but not urban areasConclusionInequities in the use of modern contraceptives still exist in favor of women with more education or higher socio-economic status, mainly in the rural settings. Focused programmatic interventions in rural settings should be delivered if universal Family Planning uptake is to be improved.

Fertility trends by HIV status in a health and demographic surveillance study in Magu District, Tanzania, 1994-2018.

Sub-Saharan Africa (SSA) has the highest fertility rates and highest HIV disease burden globally. However, it is not clear how the rapid expansion of anti-retroviral therapy (ART) for HIV has impacted the fertility gap between HIV-infected and uninfected women. We used data from a Health and Demographic Surveillance System (HDSS) in north-western Tanzania to explore trends in fertility rates and the relationship between HIV and fertility over the 25-year period. From 1994 to 2018, births and population denominators from the HDSS population were used to obtain age-specific fertility rates (ASFRs) and total fertility rates (TFRs). HIV status was extracted from eight rounds of epidemiologic serological surveillances (1994-2017). Fertility rates by HIV status and in different levels of ART availability were compared over time. Independent risk factors for fertility changes were examined using Cox proportional hazard models. There were 24,662 births from 36,814 women (15-49) who contributed a total of 145,452.5 Person-Years of follow-ups. The TFR declined from 6.5 births per woman in 1994-1998 to 4.3 births per woman in 2014-2018. The number of births per woman was 40% lower in women living with HIV than in HIV-uninfected women (4.4 vs. 6.7), although this difference narrowed over time. The fertility rate in HIV-uninfected women was 36% lower in 2013-2018 than in 1994-1998(age-adjusted HR = 0.641; 95% CI 0.613-0.673). In contrast, the fertility rate in women living with HIV was relatively unchanged over the same follow up period (age-adjusted HR = 1.099; 95% CI 0.870-1.387). There was a notable fertility decline among women in the study area from 1994 to 2018. Fertility remained lower in women living with HIV than in HIV-uninfected women, but the difference continued to narrow over time. These results highlight the need for more research into fertility changes, fertility desire and family planning use in Tanzanian rural communities.

We have almost accepted child spacing. Let's wait on family planning and limiting children': Focus group discussions among young people with tertiary education in Somalia

ObjectiveSomalia has high rates of maternal mortality, fertility and pregnancy among young women. Factors contributing to this situation are a lack of knowledge regarding sexual and reproductive health, early marriages, cultural norms and the unmet need for or use of contraceptives. This study aimed to explore the perceptions of family planning among young men and women with tertiary education in Mogadishu. MethodsA purposeful and convenience strategy using snowballing was used to recruit participants. Four focus group discussions were held online with 26 young women and men aged 19–25 years old. All participants were studying at five different universities in Mogadishu, and only one participant was married. The data were analysed using thematic analysis. FindingsThe findings showed that participants objected to the concept of family planning but supported the concept of child spacing. They highlighted that people of their generation with tertiary education practise child spacing to combine careers with family life. Although all the participants knew of the benefits of child spacing, they had different opinions on whether modern contraceptive methods were an option for them. They were more comfortable with traditional contraceptive methods and believed that the quality of the modern contraceptive medicine available in the country was unreliable. ConclusionOur findings suggest that it is crucial not only to include young people in family planning awareness initiatives and implementation but also to give them a voice to advocate family planning and start dialogues within their own communities.

High PrEP uptake and objective longitudinal adherence among HIV-exposed women with personal or partner plans for pregnancy in rural Uganda: A cohort study.

In Uganda, fertility rates and adult HIV prevalence are high, and many women conceive with partners living with HIV. Pre-exposure prophylaxis (PrEP) reduces HIV acquisition for women and, therefore, infants. We developed the Healthy Families-PrEP intervention to support PrEP use as part of HIV prevention during periconception and pregnancy periods. We conducted a longitudinal cohort study to evaluate oral PrEP use among women participating in the intervention. We enrolled HIV-negative women with plans for pregnancy with a partner living, or thought to be living, with HIV (2017 to 2020) to evaluate PrEP use among women participating in the Healthy Families-PrEP intervention. Quarterly study visits through 9 months included HIV and pregnancy testing and HIV prevention counseling. PrEP was provided in electronic pillboxes, providing the primary adherence measure ("high" adherence when pillbox was opened ≥80% of days). Enrollment questionnaires assessed factors associated with PrEP use. Plasma tenofovir (TFV) and intraerythrocytic TFV-diphosphate (TFV-DP) concentrations were determined quarterly for women who acquired HIV and a randomly selected subset of those who did not; concentrations TFV ≥40 ng/mL and TFV-DP ≥600 fmol/punch were categorized as "high." Women who became pregnant were initially exited from the cohort by design; from March 2019, women with incident pregnancy remained in the study with quarterly follow-up until pregnancy outcome. Primary outcomes included (1) PrEP uptake (proportion who initiated PrEP); and (2) PrEP adherence (proportion of days with pillbox openings during the first 3 months following PrEP initiation). We used univariable and multivariable-adjusted linear regression to evaluate baseline predictors selected based on our conceptual framework of mean adherence over 3 months. We also assessed mean monthly adherence over 9 months of follow-up and during pregnancy. We enrolled 131 women with mean age 28.7 years (95% CI: 27.8 to 29.5). Ninety-seven (74%) reported a partner with HIV and 79 (60%) reported condomless sex. Most women (N = 118; 90%) initiated PrEP. Mean electronic adherence during the 3 months following initiation was 87% (95% CI: 83%, 90%). No covariates were associated with 3-month pill-taking behavior. Concentrations of plasma TFV and TFV-DP were high among 66% and 47%, 56% and 41%, and 45% and 45% at months 3, 6, and 9, respectively. We observed 53 pregnancies among 131 women (1-year cumulative incidence 53% [95% CI: 43%, 62%]) and 1 HIV-seroconversion in a non-pregnant woman. Mean pillcap adherence for PrEP users with pregnancy follow-up (N = 17) was 98% (95% CI: 97%, 99%). Study design limitations include lack of a control group. Women in Uganda with PrEP indications and planning for pregnancy chose to use PrEP. By electronic pillcap, most were able to sustain high adherence to daily oral PrEP prior to and during pregnancy. Differences in adherence measures highlight challenges with adherence assessment; serial measures of TFV-DP in whole blood suggest 41% to 47% of women took sufficient periconception PrEP to prevent HIV. These data suggest that women planning for and with pregnancy should be prioritized for PrEP implementation, particularly in settings with high fertility rates and generalized HIV epidemics. Future iterations of this work should compare the outcomes to current standard of care. ClinicalTrials.gov Identifier: NCT03832530 https://clinicaltrials.gov/ct2/show/NCT03832530?term=lynn+matthews&cond=hiv&cntry=UG&draw=2&rank=1.

Understanding the Positive Effects of the COVID‐19 Pandemic on Women's Fertility in Norway

AbstractThis study examines the effect of the COVID‐19 pandemic on fertility in Norway at the individual level. Studies using data at the macrolevel have found a positive short‐term effect of the pandemic on the fertility level in Norway, but women's fertility response to the pandemic may differ depending on their life situation. We use the first lockdown on March 12, 2020, as a marker of the pandemic and apply a regression discontinuity design to compare births of women that were conceived before the pandemic started with those conceived during the first eight months of the pandemic. The positive effect on women's fertility in Norway was mainly driven by women in life phases that have generally high fertility rates (women aged 28–35 years and women who already have children). These groups are likely to be in an economically and socially secure and stable situation in which the restrictions due to the pandemic had limited influence. Besides two exceptions, we do not find differences in the effect of the pandemic on childbearing by women's work situation. This is most likely related to the strong welfare state and the generous additional pandemic‐related measures taken by the Norwegian government.

Reproductive performance of rabbit females from three paternal lines with a different potential for growth rate and resilience

A total of 197 nulliparous rabbits (from three paternal lines) were used to test potential strategies to overcome the consequences on reproduction associated with the selection for high growth rate. The R line was selected for growth rate during the growing period for 37 generations, the RF line was founded through a high selection intensity of elite animals of the R line, and the RFLP line, which was obtained by backcrossing RF animals with the LP line (a long-lived productive maternal line, characterised by high resilience). BW, perirenal fat thickness, fertility, daily feed intake, milk yield and blood metabolites of females were controlled from 1st artificial insemination to 3rd parturition. Litter size, litter weight, individual weight and feed ingestion of kits were controlled from birth to weaning. Our results show that RF females were significantly lighter than R and RFLP females throughout the trial (−5.0%; P < 0.05). Furthermore, RF animals had a higher fertility rate than RFLP females, at first cycle (+10.5 percentage points; P < 0.05). However, RFLP had a higher fertility rate than RF females at second cycle (+21.5 percentage points; P < 0.01). On average, RFLP females had higher perirenal fat thickness than R females at parturition (+3.0%; P < 0.05) and higher daily feed intake than of R and RF females during gestation and late lactation (+9.7 and +8.7%, respectively; P < 0.05). RFLP females produced more milk than R and RF females in the two first lactations (+18.5%; P < 0.001). In the first three parturitions, R females delivered fewer kits born alive (−1.7 kits than RF and RFLP; P < 0.05). In addition, R females’ blood had a higher concentration of glutamine and glutamate than RFLP (+24 and +22.7%, respectively; P < 0.05). RFLP litters were heavier than both R and RF litters throughout lactation. However, R kits were heavier at birth than RF and RFLP (+7.9%). Results suggest that the foundation of a paternal line using elite animals could generate females with better early reproductive performance. In addition, backcrossing the RF line with a maternal LP line resulted in a genetic line whose females had a different resource allocation strategy to foster reproduction during the studied period.

Intention to use contraceptives and its correlates among reproductive age women in selected high fertility sub-saharan Africa countries: a multilevel mixed effects analysis

BackgroundIntention to use contraceptive methods has an overriding importance to better visualize the women’s future needs and more likely to translate it to actual behavior. It is therefore important to identify the motivating correlates such as education, women empowerment, as well as deterring factors like fear of side effects, infertility after contraceptive use, lack of knowledge regarding family planning methods among married women in countries with high fertility rates in sub-Saharan Africa. This helps to control family size, unintended pregnancies, and poor health outcomes for infants and mothers.MethodsA secondary data analysis was performed using the recent Demographic and Health Surveys. A total weighted sample of 178,875 reproductive age women was included in this study. A multilevel mixed-effect binary logistic regression model was fitted. The odds ratios along with the 95% confidence interval were generated to identify the correlates of the intention to use contraceptives. A p-value less than 0.05 was declared as statistical significance.ResultsOverall, the intention to use contraception was 37.66% (95% CI, 37.44, 37.88). Whereas, the proportion of women who intend to use contraception was 59.20%, 53.30%, 42.32%, 37.88%, 37.63%, 35.25%, 31.32%, 20.64%, 20.30% in Burkina Faso, Burundi, Niger, Mali, DR. Congo, Nigeria, Angola, Gambia, and Chad respectively. Age; 15–24 (AOR = 3.72, 95% CI, 3.58, 3.86) and 25 − 24 years (AOR = 2.81, 95% CI, 2.74, 2.89), education of women; primary (AOR = 1.16, 95% CI, 1.13, 1.20), and secondary (AOR = 1.32, 95% CI, 1.27, 1.37), wealth index; middle (AOR = 1.15, 95% CI, 1.12, 1.18), rich (AOR = 1.28, 95% CI, 1.24, 1.32), number of living children 1–2 (AOR = 1.42, 95% CI, 1.37, 1.48), 3 or more (AOR = 1.77, 95% CI, 1.69, 1.85), age at cohabitation ≥ 18years (AOR = 1.37, 95% CI, 1.33, 1.40), heard family planning messages in the media (AOR = 1.47, 95% CI, 1.43, 1.50), history of ever terminated pregnancy (AOR = 1.13, 95% CI, 1.09, 1.17) and perceived distance to the health facility as not big problem (AOR = 1.16, 95% CI, 1.13, 1.19) were the correlates of intention to use contraceptives.ConclusionThe finding of the current study demonstrates that the intention of contraceptive use among reproductive age women in high fertility countries in SSA was relatively low as compared to previous studies. Thus, each national authority, especially in Chad and Gambia would be keen to know the level of contraceptive use intentions for their respective region, the drivers of contraceptive use intention and to map priorities for behavioral change. Any intervention strategy that promotes intention of contraceptive use should consider these factors for better success. Future researchers interested in the area should also address qualitative variables like socio-cultural factors, which might have an effect on intention of contraceptive use.

Factors influencing contraceptive use among women of reproductive age in plantation farming communities in South-South Nigeria.

The use of contraceptives by women of reproductive age remains one of the cost-effective ways of reducing maternal, infant, and child mortality and achieving a decline in the high fertility rate in the country. This was a descriptive cross-sectional study aimed to assess the association between the location of residence, occupation, and education level and the current use of contraceptives among women of reproductive age resident in plantation farming communities in South-south Nigeria. The test of associations between the dependent and independent variables and covariates was conducted using the Likelihood ratio Chi-square as appropriate. Multiple logistic regressions using the best-fit option of covariate selection were done with the use of contraceptives as the dependent variable. Of the 609 participants recruited, 189 (31.03%) were currently using a contraceptive. Women with secondary education were less likely to use contraceptives compared to the none educated [AOR=0.07; CL: 0.013-0.39]. Location and age were also significant predictors of the use of contraceptives by women in plantation farming communities in Nigeria. Deliberate and purposeful targeting of women and girls of reproductive age in plantation farming communities should be prioritized in the universal access to contraceptive use.

Fertility Outcome in Polycystic Patient after Bariatric Surgery

Background and Aim: Medically induced weight loss often restores ovulation among polycystic ovarian syndrome (PCOS) women with obesity. Women with PCOS are more likely to be obese and have abdominal fat than women without PCOS, which is the most prevalent metabolic condition in premenopausal women. The present study aimed to determine the fertility outcome in polycystic obese women after bariatric surgery. Patients and Methods: This cohort study was conducted on 56 polycystic women with obesity undergoing bariatric surgery in the bariatric surgery department of Luqman International Hospital, Saidu Sharif Swat for the duration from 2017 to 2022. Polycystic patients were investigated for main outcome such as liver birth rates and pregnancy. SPSS version 26 was used for data analysis. Results: The live birth rates and pregnancy rates in PCOS women seeking fertility were 83% and 94.8% whereas in control cases were 77.6% and 68.4% respectively. PCOS women took 34 ± 26 months to get pregnant for the first time following surgery, and controls took 31 ± 24 months. There was no significant difference between PCOS neonates and controls in terms of their birth weight means (2856 + 624 g vs. 3246 + 592 g), but the number of newborns with low birth weights was similar between the two groups. Maternal problems (18.4% in PCOS and 23.6% in controls) and newborn complications (24.6% in PCOS and 15.4% in controls) were uncommon, with no differences between groups. Conclusion: Women with PCOS were more likely to have high fertility rates after bariatric surgery, especially in those seeking fertility, with no difference between those with hyper androgenic PCOS and those without. There were few maternal or neonatal complications such as preeclampsia and gestational diabetes associated with these pregnancies. Keywords: Bariatric surgery, Polycystic patients, Obesity, Fertility outcome

Determinant Factors of Post-Partum Contraception among Women during COVID-19 in West Java Province, Indonesia.

One of the manifestations of family development is pregnancy planning, where this method is applied 0-42 days after childbirth. Post-partum contraception is an effort to avoid pregnancy by using contraceptive medicine from 42 days to 84 days after childbirth. This research aims to analyze the attitudes of fertile couples who use contraceptive devices after childbirth during the COVID-19 pandemic and the factors that influence it. This research uses a quantitative method approach. The sampling technique was random sampling with proportional sampling so that 280 respondents were obtained from 3 regencies/cities in West Java with high fertility rates and low post-partum contraceptive participation rates. Quantitative data analysis used univariate, bivariate, and multivariate methods. The results showed that the final model of the analysis of the most determining factors for post-partum contraception during a pandemic were family support, healthcare staff support, counselling with healthcare staff, attitudes, and age at first marriage. Fertile couples with the highest amount of family support are more likely to use post-partum contraceptive devices during COVID-19. The results of this study can be used as material for consideration in making decisions about post-partum contraception, especially during the COVID-19 pandemic.