High Parity Births Research Articles

Geospatial analysis of determinants of neonatal mortality in Ghana

BackgroundGhana did not meet the Millennium Development Goal 4 of reducing child mortality by two-thirds and may not meet SDG (2030). There is a need to direct scarce resources to mitigate the impact of the most important risk factors influencing high neonatal deaths. This study applied both spatial and non-spatial regression models to explore the differential impact of environmental, maternal, and child associated risk factors on neonatal deaths in Ghana.MethodsThe study relied on data from the Ghana Demographic and Health Surveys (GDHS) and the Ghana Maternal Health Survey (GMHS) conducted between 1998 and 2017 among 49,908 women of reproductive age and 31,367 children under five (GDHS-1998 = 3298, GDHS-2003 = 3844, GDHS-2008 = 2992, GDHS-2014 = 5884, GMHS-2017 = 15,349). Spatial Autoregressive Models that account for spatial autocorrelation in the data at the cluster-level and non-spatial statistical models with appropriate sampling weight adjustment were used to study factors associated with neonatal deaths, and a p-value less than 0.05 was considered statistically significant.ResultsPopulation density, multiple births, smaller household sizes, high parity, and low birth weight significantly increased the risk of neonatal deaths over the years. Among mothers who had multiple births, the risk of having neonatal deaths was approximately four times as high as the risk of neonatal deaths among mothers who had only single birth [aRR = 3.42, 95% CI: 1.63–7.17, p < 0.05]. Neonates who were perceived by their mothers to be small were at a higher risk of neonatal death compared to very large neonates [aRR = 2.08, 95% CI: 1.19–3.63, p < 0.05]. A unit increase in the number of children born to a woman of reproductive age was associated with a 49% increased risk in neonatal deaths [aRR = 1.49, 95% CI: 1.30–1.69, p < 0.05].ConclusionNeonatal mortality in Ghana remains relatively high, and the factors that predisposed children to neonatal death were birth size that were perceived to be small, low birth weight, higher parity, and multiple births. Improving pregnant women’s nutritional patterns and providing special support to women who have multiple deliveries will reduce neonatal mortality in Ghana.

Unmet need for family planning among Myanmar migrant women in Bangkok, Thailand

Women migrating to different destinations may use, and be exposed to, different contraceptive behaviours. The unmet need for family planning can lead to a number of high-risk and high-parity births, thereby increasing maternal mortality. The study's objectives were to identify the prevalence of the unmet need for family planning and predictors for unmet need among Myanmar migrants. Data were collected from a survey of 360 Myanmar migrant women in Bangkok. Participating women's median age was 30 years. The prevalence of the unmet need for family planning was 15.8%. The adjusted odds ratio (AOR) of those in age group 36–45 years having an unmet need more so than the age group 18–25 years and 26–35 years was 2.52 (AOR–2.52, confidence interval [CI] 0.73–8.73); those with poor knowledge about family planning were three times more likely to have an unmet need for family planning than those with a good knowledge level (AOR–3.17, CI 1.30–7.68). The odds ratio of the respondents with an unmet need for family planning who were more dissatisfied with accessibility to family planning compared to those who were satisfied was twofold (AOR–2.05, CI 1.01–4.17) and fourfold for those who were unable to access a family planning outlet (AOR–4.17, CI 1.96–8.86). The findings of this study suggest that targeted interventions could not only increase knowledge and awareness of family planning, but also increase the visibility of sexual and reproductive healthcare services.

The quantity of education and preference for sons: Evidence from Taiwan's compulsory education reform

This paper attempts to identify the causal effect of parental education on the male ratio at birth. To deal with the endogeneity of parental education, we exploit Taiwan's educational reform in 1968 making education compulsory up to the ninth grade. Based on a uniquely large and detailed administrative data set from Taiwan, our results show that the average education level of mothers is positively related to the male ratio at birth, both in the case of high-parity births and when mothers are at least 30 years old.

Pregnancy Medicaid Expansions and Fertility: Differentiating Between the Intensive and Extensive Margins

The theoretical and empirical links between public health insurance access and fertility in the United States remain unclear. Utilizing a demographic cell-based estimation approach with panel data (1987–1997), we revisit the large-scale Medicaid expansions to pregnant women during the 1980s to estimate the heterogeneous impacts of public health insurance access on childbirth. While the decision to become a parent (i.e., the extensive margin) appears to be unaffected by increased access to Medicaid, we find that increased access to public health insurance positively influenced the number of high parity births (i.e., the intensive margin) for select groups of women. In particular, we find a robust, positive birth effect for unmarried women with a high school education, a result which is consistent across the two racial groups examined in our analysis: African American and white women. This result suggests that investigating effects along both the intensive and extensive margin is important for scholars who study the natalist effects of social welfare policies, and our evidence provides a more nuanced understanding of the influence of public health insurance on fertility.

Predicting high risk births with contraceptive prevalence and contraceptive method-mix in an ecologic analysis

BackgroundIncreased contraceptive use has been associated with a decrease in high parity births, births that occur close together in time, and births to very young or to older women. These types of births are also associated with high risk of under-five mortality. Previous studies have looked at the change in the level of contraception use and the average change in these types of high-risk births. We aim to predict the distribution of births in a specific country when there is a change in the level and method of modern contraception.MethodsWe used data from full birth histories and modern contraceptive use from 207 nationally representative Demographic and Health Surveys covering 71 countries to describe the distribution of births in each survey based on birth order, preceding birth space, and mother’s age at birth. We estimated the ecologic associations between the prevalence and method-mix of modern contraceptives and the proportion of births in each category. Hierarchical modelling was applied to these aggregated cross sectional proportions, so that random effects were estimated for countries with multiple surveys. We use these results to predict the change in type of births associated with scaling up modern contraception in three different scenarios.ResultsWe observed marked differences between regions, in the absolute rates of contraception, the types of contraceptives in use, and in the distribution of type of birth. Contraceptive method-mix was a significant determinant of proportion of high-risk births, especially for birth spacing, but also for mother’s age and parity. Increased use of modern contraceptives is especially predictive of reduced parity and more births with longer preceding space. However, increased contraception alone is not associated with fewer births to women younger than 18 years or a decrease in short-spaced births.ConclusionsBoth the level and the type of contraception are important factors in determining the effects of family planning on changes in distribution of high-risk births. The best predictions for how birth risk changes with increased modern contraception and for different contraception methods allow for more nuanced predictions specific to each country and can aid better planning for the scaling up of modern contraception.

FAR BELOW REPLACEMENT FERTILITY IN URBAN CHINA.

China's urban population has experienced rapid fertility decline over the past six decades. This drastic change will have a significant impact on China's demographic, social and economic future. However, the patterns and characteristics of urban China's fertility decline have not been systematically examined. This study analyses the trends and age patterns of fertility in urban China since the 1950s, and summarizes the major characteristics of reproductive behaviours into four 'lows': extremely 'low' level of fertility; 'low' proportion of two and higher parity births; 'low' mean age at birth; and 'low' level of childlessness. The paper argues that the highly homogenous reproductive behaviours found in China's now near 800 million urban population have been in part shaped by the country's unprecedented government intervention in family planning. The 'later, longer, fewer' campaign in the 1970s and the 'one-child' policy, in particular, have left clear imprints on China's reproductive norms and fertility patterns. The government-led family planning programme, however, has not been the only driving force of fertility decline. A wide range of social, economic, political and cultural changes have also affected the transition in family formation, reproductive behaviour and fertility patterns, and this has become increasingly prominent in the past two decades.

Grandmultiparity: Is it really an independent predictor of adverse pregnancy outcomes?

Context: Grandmultiparity has been associated with increased adverse maternal and perinatal outcomes mostly in poor-resource settings. The question remains to what extent parity on itself contributes to unfavorable obstetric outcomes. There are limited studies that control for other predictor variables of maternal and perinatal outcomes in high parity pregnancies. Aim: This compared the adverse maternal and perinatal outcomes among grand multiparas with age-matched low parous counterparts to generate data for focused obstetric care. Subjects and Methods: An age-matched case–control study was performed on 2009–2014 data of all the high parity births in a second-tier mission hospital in a state capital city, Nigeria. Selected maternal and fetal outcome variables were compared between the women of high parity (para ≥5) and low parity (para 1–4). The primary outcomes were adverse maternal and perinatal variables. The statistical tests were done with statistical significance at 0.05) with stillbirths, low birth weight, macrosomia, preterm birth, chronic hypertension, gestational hypertension anemia, induction of labor, cephalopelvic disproportion/obstructed labor, and cesarean section. Conclusions: The prevalence of grandmultiparity was low at 2.52%. With the exception of abnormal lie, high parity was not associated with increased adverse fetal and maternal outcomes in this study.

Fécondité et niveau d’instruction des femmes pendant le socialisme d’État en Europe centrale et orientale

Cet article analyse l’évolution de la descendance finale des femmes nées entre 1916 et 1960 dans sept pays d’Europe centrale et orientale (Croatie, République tchèque, Hongrie, Pologne, Roumanie, Slovaquie et Slovénie). L’effet de l’élévation du niveau d’instruction sur la fécondité des cohortes est analysé en tenant compte de l’infécondité et des naissances de rang élevé à l’aide des méthodes de décomposition et de standardisation appliquées aux données issues des recensements entre 1980 et 2000. Le recul de la fécondité des cohortes résulte de l’augmentation du niveau d’instruction d’une part et de la réduction du nombre de naissances de rang élevé d’autre part. Ces deux effets négatifs sont partiellement contrebalancés par la diminution de la proportion de femmes sans enfant. L’analyse montre que les évolutions de la fécondité des cohortes ont été largement partagées dans les différents pays, malgré des différences d’intensité. Il ne semble pas exister de tendance de fécondité spécifique aux pays socialistes, excepté la proportion de femmes sans enfant qui continue de diminuer (alors qu’elle augmente dans les pays occidentaux pour les femmes nées après 1940). En Roumanie, Pologne et Hongrie, la politique fortement pronataliste a pu ralentir la baisse des parités de rang élevé.

Hopes, dreams and anxieties: India's one-child families

ABSTRACTWhile rapid fertility decline in India in the last two decades has received considerable attention, much of the discourse has focused on a decline in high parity births. However, this paper finds that, almost hidden from the public gaze, a small but significant segment of the Indian population has begun the transition to extremely low fertility. Among the urban, upper income, educated, middle class, it is no longer unusual to find families stopping at one child, even when this child is a girl. Using data from the India Human Development Survey of 2004–2005, we examine the factors that may lead some families to stop at a single child. We conclude that the motivations for this very low fertility are likely to be a more extreme form of those for low fertility rather than reflecting the qualitative change in ideologies and worldviews that is hypothesized to accompany very low fertility during the second demographic transition.

MORE MISSING WOMEN, FEWER DYING GIRLS: THE IMPACT OF SEX-SELECTIVE ABORTION ON SEX AT BIRTH AND RELATIVE FEMALE MORTALITY IN TAIWAN

This study finds that the introduction of sex-selective abortion in Taiwan due to the legalization of abortion when prenatal sex-detection technology was already available increased the fraction of males born at higher parities and changed the composition of mothers choosing to give birth. Controlling for compositional changes, we find that access to sex-selective abortion reduced relative neonatal female mortality rates for higher-parity births. (JEL: J13, J16)

The mid-twentieth century Baby Boom and the changing educational gradient in Belgian cohort fertility

AbstractBACKGROUNDThe historical transition towards low fertility in many Western countries was interrupted during the period around the 1950s and '60s, called the Baby Boom. This upturn in fertility was completely unanticipated. One of the reasons for expecting continued fertility decline rather than fertility recovery was the expansion of female participation in higher education.OBJECTIVEThis research investigates how the recovery of fertility and declining ages at first birth observed during the Baby Boom era can be reconciled with the expansion of female participation in education. How did the pre-existing negative educational gradient in fertility evolve in the cohorts that produced the Baby Boom?METHODSUsing Belgian 1981 Census data, I estimate retrospective measures of cohort fertility. Potential sources of bias in the retrospective data are discussed. Trends in timing and quantum components are charted by women's levels of educational attainment for cohorts born between 1901 and 1940. A counterfactual simulation is used to delineate the role played by the changing educational gradient in completed fertility.RESULTSThe recovery of fertility was pervasive in Belgium, but there was a clear convergence between educational groups in terms of the quantum of fertility. Both low and high parity births increased: childlessness declined particularly among the highly educated while the share of women with three or more births went up in all educational groups, but most sharply among the highly educated. The educational gradient in completed fertility was strongly reduced. Without this shift, the recovery of completed fertility would have been about 25% less than its actual magnitude. The educational gradient for age at first birth remained stable: ages at first childbirth declined across all levels of educational attainment.CONCLUSIONSConvergence in the quantum of fertility across educational groups suggests a major weakening of the role incompatibility between obtaining a degree in higher education on the one hand and subsequently getting married and having children on the other hand. Declining ages at first marriage and childbirth indicate that this period was generally conducive to family formation. The reduction in the educational gradient was a crucial ingredient of the emergence of today's fertility patterns.(ProQuest: ... denotes formulae omitted.)1. IntroductionIn many Western countries, the transition from medium-high to low fertility that occurred from late nineteenth to the late twentieth century was interrupted during the period around the 1950s and '60s known as the Baby Boom. Increased childbearing during that era remains enormously consequential through its impact on current population aging. Yet, we know surprisingly little about the causes of the Baby Boom. At the time when it occurred, no one was expecting it. Today, most textbooks routinely ascribe the revival of fertility to the air of optimism and economic growth in the wake of the low fertility trough of the Great Depression. Yet, the recovery of fertility was already underway before and during the Second World War in most countries. Significantly, only a small part of the Boom can be explained by the timing mechanisms of postponement (during the Depression era) and recuperation (in times of post-war optimism). It also clearly involved a recovery of cohort fertility (Van Bavel and Reher 2013).The end of the Baby Boom was just as unexpected as its start. Indeed, by the 1960s, pro-cyclical fertility was considered one of the most firmly based empirical findings in the social sciences. Around 1960, mainstream demography was predicting that further fertility increases would accompany continuing economic growth (Butz and Ward 1979: 318). That did not happen, however, and the post-hoc explanations given for subsequent fertility decline were very similar to the ones given for low and declining fertility before the Second World War (Van Bavel 2010). …

Dyadic fertility decisions in a life course perspective.

This paper focuses on how couples arrive at joint decisions with regard to fertility behaviour. We build upon previous work on decision rules that couples might apply as heuristics in order to arrive at joint action in cases in which partners' fertility preferences differ. Previous research found either stronger effects of women's desires or symmetrical effects of both spouses' desires and net benefits associated with (further) children on proceptive behaviour. The latter finding is in line with the notion of household utility maximisation, in which both partners' preferences enter into a joint utility function with equal weight. On the other hand, some evidence indicates that one partner can exercise a 'veto' if he or she anticipates individual utility losses from a further child (due to opportunity costs arising in other life domains). We now enhance previous research by applying a life-course perspective. Our analysis makes use of variation in initial conditions due to previous births: couples decide on fertility in different situations as they find themselves in different life course stages and have had certain experiences. Parity-specific differences affect not only fertility outcomes but also the decision-making process itself. Our findings show that the decision to have a first child is made jointly, and each partner may exercise a veto. On the other hand, women appear to dominate decisions on higher parity births, not per se, but because they are (still) the ones more affected by the concomitant housework.

Pathways to Low Fertility in India

This paper examines emerging patterns of low fertility in regions of India. Using data from the National Family Health Survey, I find that, on average, women in India's low-fertility states follow an ordered life course of marriage followed by first birth, but limit higher-parity births through sterilisation at earlier ages and at higher rates. For a longitudinal perspective, I focus on the Indian state of Kerala, where the total fertility rate has been at- or below-replacement levels for more than 20 years. Women across successive birth cohorts in Kerala are marrying later, but, once married, they transition to first birth at similar rates across birth cohorts. Unlike in most of Europe and East Asia where non-marriage and substantial delays in marriage and childbearing drive low fertility, widespread female sterilisation and the restriction of childbearing to the period soon after marriage are important factors driving below-replacement fertility in regions of India.

The Baby Boom and Its Causes: What We Know and What We Need to Know

This study analyzes the timing, magnitude, and volume of the mid‐twentieth century baby boom in European and non‐European Western countries. The baby boom is found to have been especially strong in the non‐European countries, fairly strong in some European countries, and quite weak in others. While the boom has often been linked with postwar economic growth and the recuperation of births postponed during the Depression era, we argue that this is only a limited part of the story. In most cases the recovery of the birth rate started well before the end of World War II, a fact not accounted for by existing theories. We investigate the roles played by the recovery of period as well as cohort fertility, the underlying marriage boom, and the recovery of marital fertility. We identify major puzzles for future research, including the reasons for strongly declining ages at marriage and the role played by contraceptive failure in the rise of high‐parity births.

The Influence of Neighbors' Family Size Preference on Progression to High Parity Births in Rural Nepal

Large families can have a negative impact on the health and well-being of women, children, and their communities. Seventy-three percent of the individuals in our rural Nepalese sample report that two children is their ideal number, yet about half of the married women continue childbearing after their second child. Using longitudinal data from the Chitwan Valley Family Study, we explore the influence of women's and neighbors' family size preferences on women's progression to high parity births, comparing this influence across two cohorts. We find that neighbors' family size preferences influence women's fertility, that older cohorts of women are more influenced by their neighbors' preferences than are younger cohorts of women, and that the influence of neighbors' preferences is independent of women's own preferences.

Linking high parity and maternal and child mortality: what is the impact of lower health services coverage among higher order births?

BackgroundA number of data sets show that high parity births are associated with higher child mortality than low parity births. The reasons for this relationship are not clear. In this paper we investigate whether high parity is associated with lower coverage of key health interventions that might lead to increased mortality.MethodsWe used DHS data from 10 high fertility countries to examine the relationship between parity and coverage for 8 child health intervention and 9 maternal health interventions. We also used the LiST model to estimate the effect on maternal and child mortality of the lower coverage associated with high parity births.ResultsOur results show a significant relationship between coverage of maternal and child health services and birth order, even when controlling for poverty. The association between coverage and parity for maternal health interventions was more consistently significant across countries all countries, while for child health interventions there were fewer overall significant relationships and more variation both between and within countries. The differences in coverage between children of parity 3 and those of parity 6 are large enough to account for a 12% difference in the under-five mortality rate and a 22% difference in maternal mortality ratio in the countries studied.ConclusionsThis study shows that coverage of key health interventions is lower for high parity children and the pattern is consistent across countries. This could be a partial explanation for the higher mortality rates associated with high parity. Actions to address this gap could help reduce the higher mortality experienced by high parity birth.

Residual confounding explains the association between high parity and child mortality

BackgroundThis study used data from recent Demographic and Health Surveys (DHS) to examine the impact of high parity on under-five and neonatal mortality. The analyses used various techniques to attempt eliminating selection issues, including stratification of analyses by mothers’ completed fertility.MethodsWe analyzed DHS datasets from 47 low- and middle-income countries. We only used data from women who were age 35 or older at the time of survey to have a measure of their completed fertility. We ran log-binominal regression by country to calculate relative risk between parity and both under-five and neonatal mortality, controlled for wealth quintile, maternal education, urban versus rural residence, maternal age at first birth, calendar year (to control for possible time trends), and birth interval. We then controlled for maternal background characteristics even further by using mothers’ completed fertility as a proxy measure.ResultsWe found a statistically significant association between high parity and child mortality. However, this association is most likely not physiological, and can be largely attributed to the difference in background characteristics of mothers who complete reproduction with high fertility versus low fertility. Children of high completed fertility mothers have statistically significantly increased risk of death compared to children of low completed fertility mothers at every birth order, even after controlling for available confounders (i.e. among children of birth order 1, adjusted RR of under-five mortality 1.58, 95% CI: 1.42, 1.76). There appears to be residual confounders that put children of high completed fertility mothers at higher risk, regardless of birth order. When we examined the association between parity and under-five mortality among mothers with high completed fertility, it remained statistically significant, but negligible in magnitude (i.e. adjusted RR of under-five mortality 1.03, 95% CI: 1.02-1.05).ConclusionsOur analyses strongly suggest that the observed increased risk of mortality associated with high parity births is not driven by a physiological link between parity and mortality. We found that at each birth order, children born to women who have high fertility at the end of their reproductive period are at significantly higher mortality risk than children of mothers who have low fertility, even after adjusting for available confounders. With each unit increase in birth order, a larger proportion of births at the population level belongs to mothers with these adverse characteristics correlated with high fertility. Hence it appears as if mortality rates go up with increasing parity, but not for physiological reasons.

Changes in the distribution of high-risk births associated with changes in contraceptive prevalence

BackgroundSeveral birth characteristics are associated with high mortality risk: very young or old mothers, short birth intervals and high birth order. One justification for family planning programs is the health benefits associated with better spacing and timing of births. This study examines the extent to which the prevalence of these risk factors changes as a country transitions from high to low fertility.MethodsWe use data from 194 national surveys to examine both cross section and within-country variation in these risk factors as they relate to the total fertility rate.ResultsDeclines in the total fertility rate are associated with large declines in the proportion of high order births, those to mothers over the age of 34 and those with multiple risk factors; as well as to increasing proportions of first order births. There is little change in the proportion of births with short birth intervals except in sub-Saharan Africa. The use of family planning is strongly associated with fertility declines.ConclusionsThe proportion of second and higher order births with demographic risk factors declines substantially as fertility declines. This creates a potential for reducing child mortality rates. Some of the reduction comes from modifying the birth interval distribution or by bringing maternal age at the time of birth into the ‘safe’ range of 18-35 years, and some comes from the actual elimination of births that would have a high mortality risk (high parity births).

Exploring the association between short/long preceding birth intervals and child mortality: using reference birth interval children of the same mother as comparison

BackgroundThis study used data from recent Demographic and Health Surveys (DHS) to examine the impact of short or long preceding birth intervals on neonatal and under-five mortality. In order to minimize the effect of selection issues, we examined child mortality outcomes of the same mother, comparing short or long interval births against births with what had previously been considered optimal intervals.MethodsWe analyzed 47 DHS datasets from low- and middle-income countries. For each dataset, we compared neonatal and under-five mortality of short preceding interval births (<18 months, <24 months) to reference interval births (24-<60 months) of a mother, using conditional logistic regression matching on the mother. We also conducted the same matched analysis for long (≥60 months, ≥72 months) preceding interval births. These associations were then meta-analyzed. We also stratified the analyses by mothers’ completed fertility (fertility at end of reproductive period) to assess whether maternal characteristics highly correlated with completed fertility modify the association between birth interval and child mortality.ResultsChildren with shorter preceding intervals had increased odds of both neonatal (<24 months, OR: 1.61, 95% CI: 1.52-1.70) and under-five mortality (<24 months, OR: 1.48, 95% CI: 1.40-1.56). When the associations were stratified by the mothers’ completed fertility, the impact of short intervals was greatly reduced or eliminated for low fertility mothers. In contrast, mortality associations became stronger for children of high fertility mothers. However, when the births of high fertility mothers were limited to birth orders 2-4, the associations were comparable to those of low fertility mothers. Longer preceding birth intervals had lower odds of mortality than reference intervals (i.e. under-5 mortality for ≥60 months, OR 0.59, 95% CI: 0.52-0.67). This effect was also mediated by mothers’ completed fertility; there was a strong protective effect of longer birth intervals for the high fertility mothers but not for low fertility mothers.ConclusionsThese analyses reproduced findings reported in previous literature that shorter birth intervals are associated with higher child mortality. However the negative impact of short birth intervals may only occur in high parity births. Reproductive health interventions that seek to lengthen birth intervals may have larger impact by targeting women with high parity. This finding is consistent with the concept of maternal depletion as the underlying cause of increased adverse child outcomes associated with shorter birth intervals.

Offspring Sex Preference in Frontier America

Analysis of the fertility histories of women born between 1850 and 1900, as given in the Utah Population Database (UPDB), reveals the effect of the number, as well as the sex composition, of previous children on birth-stopping and birth-spacing decisions. Specifically, agricultural and Church of Jesus Christ of Latter-day Saints (LDS) households—two sub-populations that might have placed different values on male and female children for economic, social, and/or cultural reasons—showed a distinct preference for male children, as expressed by birth stopping after the birth of a male child and shorter birth intervals in higher-parity births when most previous children were female. Remarkably, women in both the early "natural fertility" and the later contraceptive eras used spacing behavior to achieve a desired sex mix. Although the LDS population had relatively high fertility rates, it had the same preferences for male children as the non-LDS population did. Farmers, who presumably had a need for family labor, were more interested in the quantity than in the sex mix of their children.