Reproductive Trajectories Research Articles

Racismo antinegro e morte materna por COVID-19: o que vimos na Pandemia?

Abstract Anti-Black Racism traverses the lives of Black and Brown women, compromising sexual and reproductive health. Obstetric racism during pregnancy, prenatal care, childbirth, abortion, and puerperium affects these women, exposing them to harmful and often lethal maternal outcomes. This study aims to present racism and its manifestations in maternal death by COVID-19. It included data from COVID-19 notifications among pregnant women and puerperae recorded in the severe acute respiratory syndrome database (2021 and 2022). Information on race/skin color, age, region, clinical signs and symptoms, ICU, and deaths were collected. The results indicate how racism affects Black and Brown pregnant women and puerperae, who have higher lethality due to COVID-19 compared to White women (a difference of 14.02%), particularly in the puerperium. Black and Brown pregnant women least accessed the ICU. After adjustments, maternal death in the puerperium for Black women was 62% more likely than for White women (OR=1.62; 95%CI: 1.01-2.63). Racism and its manifestations (dis)organize the reproductive trajectories of Black and Brown women, whose interaction with sexism contributes to harmful and lethal maternal outcomes by COVID-19.

Anti-Black racism and maternal death from COVID-19: what have we seen in the Pandemic?

Anti-Black Racism traverses the lives of Black and Brown women, compromising sexual and reproductive health. Obstetric racism during pregnancy, prenatal care, childbirth, abortion, and puerperium affects these women, exposing them to harmful and often lethal maternal outcomes. This study aims to present racism and its manifestations in maternal death by COVID-19. It included data from COVID-19 notifications among pregnant women and puerperae recorded in the severe acute respiratory syndrome database (2021 and 2022). Information on race/skin color, age, region, clinical signs and symptoms, ICU, and deaths were collected. The results indicate how racism affects Black and Brown pregnant women and puerperae, who have higher lethality due to COVID-19 compared to White women (a difference of 14.02%), particularly in the puerperium. Black and Brown pregnant women least accessed the ICU. After adjustments, maternal death in the puerperium for Black women was 62% more likely than for White women (OR=1.62; 95%CI: 1.01-2.63). Racism and its manifestations (dis)organize the reproductive trajectories of Black and Brown women, whose interaction with sexism contributes to harmful and lethal maternal outcomes by COVID-19.

Hurricanes affect diversification among individual life courses of a primate population.

Extreme climatic events may influence individual-level variability in phenotypes, survival and reproduction, and thereby drive the pace of evolution. Climate models predict increases in the frequency of intense hurricanes, but no study has measured their impact on individual life courses within animal populations. We used 45 years of demographic data of rhesus macaques to quantify the influence of major hurricanes on reproductive life courses using multiple metrics of dynamic heterogeneity accounting for life course variability and life-history trait variances. To reduce intraspecific competition, individuals may explore new reproductive stages during years of major hurricanes, resulting in higher temporal variation in reproductive trajectories. Alternatively, individuals may opt for a single optimal life-history strategy due to trade-offs between survival and reproduction. Our results show that heterogeneity in reproductive life courses increased by 4% during years of major hurricanes, despite a 2% reduction in the asymptotic growth rate due to an average decrease in mean fertility and survival by that is, shortened life courses and reduced reproductive output. In agreement with this, the population is expected to achieve stable population dynamics faster after being perturbed by a hurricane ( ; 95% CI: 1.488, 1.538), relative to ordinary years . Our work suggests that natural disasters force individuals into new demographic roles to potentially reduce competition during unfavourable environments where mean reproduction and survival are compromised. Variance in lifetime reproductive success and longevity are differently affected by hurricanes, and such variability is mostly driven by survival.

Prevalence and correlates of reproductive coercion across ten sites: commonalities and divergence

BackgroundReproductive coercion (RC) is a type of abuse where a partner asserts control over a woman’s reproductive health trajectories. Recent research emphasizes that RC experiences may differ within and across low- and middle-income countries (LMICs), as compared to higher income contexts, given social pressures surrounding childbearing. To date, nationally representative surveys have lacked comprehensive measures for RC, leading to gaps in understanding its prevalence and risk factors. Across eight LMICs (10 sites), we aimed to (1) validate the RC Scale; (2) calculate prevalence of RC and specific behaviors; and (3) assess correlates of RC.MethodsThis analysis leverages cross-sectional Performance Monitoring for Action (PMA) data collected from November 2020 to May 2022. Analyses were limited to women in need of contraception (Burkina Faso n = 2767; Côte d'Ivoire n = 1561; Kongo Central, Democratic Republic of Congo (DRC) n = 830; Kinshasa, DRC n = 846; Kenya n = 4588; Kano, Nigeria n = 535; Lagos, Nigeria n = 612; Niger n = 1525; Rajasthan, India n = 3017; Uganda n = 2020). Past-year RC was assessed via five items adapted from the original RC Scale and previously tested in LMICs. Confirmatory factor analysis examined fit statistics by site. Per-item and overall prevalence were calculated. Site-specific bivariate and multivariable logistic regression examined RC correlates across the socioecological framework.ResultsConfirmatory factor analysis confirmed goodness of fit across all sites, with moderate internal consistency (alpha range: 0.66 Cote d’Ivoire–0.89 Kinshasa, DRC/Lagos, Nigeria). Past-year reported prevalence of RC was highest in Kongo Central, DRC (20.3%) and lowest in Niger (3.1%). Prevalence of individual items varied substantially by geography. Polygyny was the most common RC risk factor across six sites (adjusted odds ratio (aOR) range: 1.59–10.76). Increased partner education levels were protective in Kenya and Kano, Nigeria (aOR range: 0.23–0.67). Other assessed correlates differed by site.ConclusionsUnderstanding RC prevalence and behaviors is central to providing woman-centered reproductive care. RC was most strongly correlated with factors at the partner dyad level; future research is needed to unpack the relative contributions of relationship power dynamics versus cultural norms surrounding childbearing. Family planning services must recognize and respond to women’s immediate needs to ensure RC does not alter reproductive trajectories, including vulnerability to unintended pregnancy.

Women infertility and common mental disorders: A cross-sectional study from North India.

Infertility is a very distressing condition. It is often associated with long-term stress, which can emerge as anxiety and depression. To understand the effect of socio-demographic variables, reproductive trajectories, and lifestyle variables on stress, depression, and anxiety independently and to understand the relationship of psychological variables with each other among infertile and fertile women. This cross-sectional study recruited 500 women which included 250 primary infertile cases and 250 age-matched fertile controls of the age group 22-35 years. A pretested modified interview schedule was administered which included demographic variables, lifestyle variables, and reproductive trajectories. In addition, psychological tools like PSS, GAD-7, and PHQ-9 were used to collect the data pertaining to Stress, anxiety, and depression, respectively. Data analysis was performed with the statistical software version SPSS, IBM version 24. Infertile women are more prone to various psychological disorder (stress, anxiety and depression). None of the demographic and lifestyle variables were associated with stress, anxiety, and depression among infertile women. Only reproductive trajectories were found to be causing stress, anxiety, and depression respectively among infertile women. In addition, stress is leading to both anxiety and depression among infertile women but only to depression in fertile women. Infertile women should be counselled by medical experts regarding reproductive trajectories. Infertile couples should be guided and counselled to incorporate mental health screening and treatment in their routine check-up.

Imagining motherhood and becoming a mother after egg freezing. An anthropological study in the French context

This paper examines how women accessing social egg freezing (SEF), medical egg freezing (MEF), and egg sharing (ESH) imagine becoming a mother (normative motherhood) in contrast to how they become a mother (reproductive trajectory). It uses data collection from 43 semi-structured in-depth interviews with French women who have had their eggs cryopreserved in France and abroad, five of whom have had children. It was found that most of the women interviewed associate motherhood with heterosexual coupledom, the nuclear family, and a normalized desire for biogenetic motherhood. Nevertheless, ontological disruptions caused by infertility, singlehood, or illness introduce the possibility that they will be unable to have children as expected, which leads them to imagine (and consider) both medical and non-medical ways of having a child. Women’s narrations of alternative paths toward motherhood describe a fragmentation of motherhood into genetic, biological, and social components, which are combined and hierarchized in unexpected ways. I argue that, although alternative reproductive trajectories might modify the kinship ties between the parties involved, they do not necessarily defy normative motherhood. To my knowledge, this is the first empirical study conducted among French women undertaking egg freezing. It seeks to contribute to a growing corpus of empirical research that analyzes egg freezing and its links with motherhood. Second, it mobilizes an innovative approach by examining similarities between SEF, MEF, and ESH. Furthermore, it proposes that women who freeze their eggs for medical reasons or in exchange for an egg donation also inscribe their egg freezing procedure within a heteronormative, biogenetic ideal of motherhood, and a normalized desire for a nuclear family. Finally, it contributes to analyzing the decision-making processes of women who become a mother after egg freezing.

Exploring reproductive trajectories of youths of Oromia, Ethiopia: A life course approach.

In the context of continuous cultural, social, and economic changes happening around the globe, the predictable patterns of the life course of the past observed over successive birth cohorts will not remain stable across generations. In this study, three reproductive role indicators-first sexual encounter, first marriage, and first birth-for three synthetic birth cohorts were used to identify and characterize the reproductive trajectories of youths. In our analysis, for the sake of comparison with global literature, we considered youths to be between ages 15 and 24. The analysis was conducted using data extracted from the 2005, 2011, and 2016 Ethiopian Demographic Health Survey for Oromia National Regional State. Three synthetic birth cohorts of youths of birth years between 1975 and 1989 were constructed for the analysis. A sequence analysis based on dynamic hamming distance with partition around medoids technique was employed to extract the typologies of reproductive trajectories of youths. In addition, discrepancy analysis and a sequence regression tree analysis were employed to characterize the identified typologies of trajectories. Data management was done using STATA 14 and all analyses were carried out using R software. The study identified four different typologies of reproductive trajectories among the youth. The sex of respondents was the primary discriminating factor of the typologies of reproductive trajectories. The findings support the notion of changing norms in reproductive behavior among the less educated youth irrespective of sex. The discriminating power of education was stronger for female youth in urban areas than rural females. It implies that the postponement of reproductive role assumption was stronger among educated female youths residing in urban than their rural counterparts. Normative reproductive practices such as early marriage and adolescent fertility are still common practices that require efforts of communities and local government bodies to ameliorate these practices. Results of the study indicate that less educated youth should be targeted in programs that aim at improving youth empowerment (i.e., training and employment opportunities) as well as their sexual and reproductive health.

Struggling with Primary Infertility: Psychological Well-Being and Associated Factors in North Indian Women

The study aimed to understand the effect of primary infertility on the psychological well-being of women. In addition, the study has assessed the impact of socio-demographic variables, reproductive trajectories and lifestyle variables on psychological well-being independently and in light of their dynamic interaction among North Indian women. This study was conducted among 250 infertile women with primary infertility attending the Gynaecology OPD and 250 age-matched fertile women from Delhi. Pretested quantitative interview schedule and WHO-5 perceived well-being scale were used for data collection. The results depicted that infertile women were found to have higher prevalence of poor psychological well-being than fertile women. Of all the variables, education, duration of infertility, physical activity, exercise, sleep pattern and family structure were significantly associated with the psychological well-being of infertile women. Infertility is a major cause of the decline in psychological well-being in infertile women. In most hospitals and infertility clinics, women are treated for infertility, but their psychological well-being is often ignored. To improve the psychological well-being of women dealing with primary infertility, infertility education and awareness, physical activity and family counselling must be integrated into the infertility treatment.

The ART clock: Temporal limits to assisted reproduction.

Conceptualizations of the ‘biological clock’ in popular imaginary in the USA centre on the temporal limits of fertility, with assisted reproductive technology (ART) an increasingly proposed answer to these constraints (at least in the public imaginary). In this study, I analyse how surrogates in the USA understand their own bioavailability for others’ reproductive needs in the commercial ART market vis-à-vis their own reproductive trajectories. Based on interview data with gestational surrogates, I propose a new concept of the ‘ART clock’ to capture how time shapes the experiences of reproductive workers in the US fertility clinic. My findings point to four important ART time-related issues: (i) women desiring to extend their own ‘biological clocks’ via surrogacy; (ii) significant time being needed to achieve and sustain third-party pregnancy; (iii) women extending their total reproductive time via repeat surrogacy ‘journeys’; and (iv) temporal constraints to surrogacy reproduction regarding time of year, the day-to-day time effort, the number of surrogacy journeys, the total number of pregnancies, and surrogates’ age and the ages of their children. Each of these aspects point to important ways that reproductive desire and time shape the labour of reproductive workers, highlighting temporal constraints to assisted reproduction and limits to ART as a solution to delayed reproduction and the biological clock.

The observed pattern and hidden process of female reproductive trajectories across the life span in a non-human primate.

Age-specific fertility trajectories are fundamental to understanding population structure and the evolutionary ecology of diverse life histories. However, characterizing reproductive ageing has been difficult with cross-sectional data, where senescence especially late in life can be confounded by selective disappearance. Addressing such challenge requires longitudinal data tracking the reproductive life span of known individuals, but such data are rare, especially for very long-lived species such as primates. We analyse the entire life span trajectory of annual fertility, from reproductive maturity to death, for 673 free-ranging female rhesus macaques, Macaca mulatta, on Cayo Santiago, Puerto Rico. Using generalized linear mixed-effects models (GLMMs), we first tested if time to death explains the ageing pattern independently of and additionally to chronological age, and if so, whether there is interaction between them. While GLMM captures the patterns in the data well, it is not a generative model. For example, given the GLMM and an individual's reproductive trajectory up to a given age, we cannot directly predict the probability of reproduction or death in the next year. For this reason, we further fitted a hidden Markov chain model (HMM) which allows just such a prediction, and additionally helps infer the process underlying the observed trajectory. We show that, after accounting for individual differences in fertility, reproductive ageing exhibits both age-dependent decline and also an abrupt terminal decline independently of age at death. We infer from the HMM that the underlying process of reproductive trajectory is where individuals cycle between reproductive bouts until they enter an irreversible frail condition that constrains fertility. The findings provide valuable insights into the longitudinal progression of reproductive trajectories in primates, by revealing both age-dependent and age-independent patterns and processes of ageing, and contribute to a growing body of literature on reproductive ageing and senescence across animal taxa.

Improving assessment of demand for postpartum tubal ligation among publicly insured women in Texas

ObjectiveTo assess an alternative method for estimating demand for postpartum tubal ligation and evaluate reproductive trajectories of low-income women who did not obtain a desired procedure. Study designIn a 2-year cohort study of 1700 publicly insured women who delivered at 8 hospitals in Texas, we identified those who had an unmet demand for tubal ligation prior to discharge from the hospital. We classified unmet demand as explicit or prompted based on survey questions that included a prompt regarding whether the respondent would like to have had a tubal ligation at the time of delivery. We assessed persistence of demand for permanent contraception, contraceptive use, and repeat pregnancies among all study participants who wanted but did not get a postpartum procedure. ResultsSome 426 women desired a postpartum tubal ligation; 219 (51%) obtained one prior to discharge. Among the 207 participants with unmet demand, 62 (30%) expressed an explicit preference for the procedure, while 145 (70%) were identified from the prompt. Most with unmet demand still wanted permanent contraception 3 months after delivery (156/184), but only 23 had obtained interval procedures. By 18 months, the probability of a woman with unmet demand conceiving a pregnancy that she would likely carry to term was 12.5% (95% CI: 8.3%–18.5%). ConclusionsThe majority of unmet demand for postpartum tubal ligation among publicly insured women in Texas was uncovered via a prompt and would not have been evident in clinical records or from consent forms. Women unable to obtain a desired procedure had a substantial chance of pregnancy within 18 months after delivery. ImplicationsEstimates of unmet demand for postpartum tubal ligation based on clinical records and consent forms likely underestimate desire for permanent contraception. Among low-income women in Texas, those with unmet demand for postpartum tubal ligation require improved access to effective contraception.

Heterogeneity in ‘High Fertility’ Societies. Insights From Compositional Demography

Demographic transition theory has been conducive to a rather dichotomous view of global fertility: traditional versus modern, high versus low fertility. The knowledge that high fertility could be achieved by subpopulations with different characteristics and reproductive behaviors somehow vanished from (historical) demographers' attention. This study unpacks heterogeneity in a 'high fertility' society, i.e. 19th-century Zeeland, the Netherlands. Sequence and cluster analysis were employed to distinguish groups with disparate reproductive trajectories with data from Genlias/LINKS including 15,014 full birth histories and 87,204 observed live births over the period 1811–1911. Multilevel binomial logistic regression models of membership of the two discerned high fertility subgroups were then estimated. The 'Traditional 1' subpopulation, with 10.5 children per woman on average, was composed of skilled, unskilled, and farm workers living in rural areas. Couples married early and were characterized by large spousal age gaps. The 'Traditional 2' subpopulation had on average 7.2 children per woman, more often lived in towns, married significantly later, and had more equal gender relations. Compositional demography, revealing subpopulations with divergent cultures of marital self-restraint and reproductive management, not only nuances previous (historical) demographic findings, but may well offer more tools to develop family planning and reproductive health policies than the demographic transition model does.

Socio-Ecological Challenges as Modulators of Women's Reproductive Trajectories

Amenorrhea, anovulatory cycles, miscarriages, and other reproductive outcomes are often seen as pathological. Life history theory, in contrast, treats those outcomes as adaptations that helped women optimize the timing of reproductive ventures across our evolutionary history. Women's bodies adjust their reproductive strategies in response to socio-ecological conditions, a process mediated by the hypothalamic-pituitary-adrenal axis (HPAA). Here, we review the links between socio-ecological conditions, HPAA activity, and the pace of women's reproductive transitions such as puberty, age at first birth, interbirth interval, and perimenopause. We also discuss the HPAA's role as a modulator of reproductive function: It not only suppresses it but may also prime women's bodies for future reproductive ventures. We conclude by reviewing challenges and opportunities within our subfield, including the need for transdisciplinary teams to develop longitudinal studies to improve our understanding of women's reproductive trajectories and outcomes from the moment they are conceived.

Unravelling the role of epigenetics in reproductive adaptations to early-life environment.

Reproductive function adjusts in response to environmental conditions in order to optimize success. In humans, this plasticity includes age of pubertal onset, hormone levels and age at menopause. These reproductive characteristics vary across populations with distinct lifestyles and following specific childhood events, and point to a role for the early-life environment in shaping adult reproductive trajectories. Epigenetic mechanisms respond to external signals, exert long-term effects on gene expression and have been shown in animal and cellular studies to regulate normal reproductive function, strongly implicating their role in these adaptations. Moreover, human cohort data have revealed differential DNA methylation signatures in proxy tissues that are associated with reproductive phenotypic variation, although the cause-effect relationships are difficult to discern, calling for additional complementary approaches to establish functionality. In this Review, we summarize how adult reproductive function can be shaped by childhood events. We discuss why the influence of the childhood environment on adult reproductive function is an important consideration in understanding how reproduction is regulated and necessitates consideration by clinicians treating women with diverse life histories. The resolution of the molecular mechanisms responsible for human reproductive plasticity could also lead to new approaches for intervention by targeting these epigenetic modifications.

Reproductive trajectories and social-biological dimensions in parenthood: Portuguese version of the Meaning of Parenthood scale.

Background:Public meanings attributed to parenthood may shape individuals’ family planning and how involuntary childlessness is supported by governmental policies. This study aimed to evaluate the influence of reproductive trajectories and gender in the meanings attributed to parenthood, and to assess the psychometric characteristics of the Portuguese version of the Meaning of Parenthood (MOP) scale.Methods:The sample comprised 754 participants: 246 young adults without children; 51 fathers and 159 mothers of adolescent children conceived spontaneously; and 149 infertile heterosexual couples. The scale was self-administered. Higher scores indicate attributing greater importance to parenthood to fulfill identity needs at individual, marital and social levels. Psychometric characteristics were analyzed through exploratory factor analysis; Cronbach alpha (α) assessed internal consistency.Results:Two dimensions of the MOP scale emerged, with good internal consistency (α ≥ 0.70): biological (importance of parenthood to fulfill reproductive needs as a biological being); social (importance of parenthood arising from social reproduction). Young adults attributed less importance to parenthood to fulfill both biological and social needs. The biological dimension was valued more than the social dimension in all subsamples; men highly valued the biological dimension compared to women.Conclusions:Family planning needs to focus on a reasonable balance between biological and social dimensions of parenthood. The reinforcement of public policies providing the necessary conditions for human reproduction is essential to reverse declining fertility rates.

Influencia de las creencias de género en la trayectoria sexual y reproductiva de las mujeres jóvenes mexicanas

The objective of this work is to study how gender believes influence different sexual and re-productive trajectories of women once controlled by social origin stratum, the schooling years reached and other variables of interest. Using the National Survey of Determinant Factors of Adolescent Pregnancy 2017 (Encuesta Nacional de los Factores Determinantes del Embara-zo Adolescente —Enfadea 2017), we estimated a gender believes index and constructed three groups of women, one with gender believes that are more traditional, other intermediate and another with gender relieves less traditional. Through logistic regression models, we analyzed the influence of gender believes on age at sexual debut, use of contraception at the first intercour-se, and age of women at first birth born alive. To have less traditional believes influence women to initiate sexual debut at an earlier age and use contraception in that act, independently of the social origin stratum and years of schooling. Gender believes were not associated to having a child before age 20.

Young men and abortion: the male perspective on unplanned pregnancies.

This is a social-anthropological study that situates abortion as an event inscribed within the broader framework of heterosexual sexuality, gender relationships, contraceptive and reproductive control. Its objective was to reveal the network of social relationships that engender negotiation and decision-making processes surrounding the interruption of unplanned pregnancies and the manners of carrying out abortions based on narratives on the affective-sexual, contraceptive and reproductive trajectories of women and men from different social classes and generations. The focus of this article is young men's position in the face of pregnancy and abortion. We adopt a relational gender perspective in order to analyze the phenomenon. The empirical material comprises 13 in-depth interviews with lower- and middle-class men aged between 18 and 27 years living in Rio de Janeiro, Brazil. The complexity of the power relations established between the couple, their family members and friends engenders different possible outcomes with regard to male participation in the event: after-the-fact awareness of the abortion, due to not having been consulted; consensual participation in pregnancy and abortion-related decision-making; disagreement between the couple, with the woman's decision prevailing over the man's objections; the woman's decision being coerced by her partner. Male participation in the sphere of reproduction and abortion is a gap in the scientific literature that must be confronted. To take on the tension that abortion creates between genders, between female reproductive autonomy and male responsibility, is a central task for those who research the subject in the social sciences and health fields.

Environmental stressors may cause unpredicted, notably lagged life-history responses in adults of the planktivorous Atlantic herring

Here we challenge traditional views on the direction of change in teleost body condition and reproductive traits in response to abiotic and biotic factors by studying the data-rich, planktivorous Norwegian spring-spawning herring (NSSH), a member of the abundant Atlantic herring (Clupea harengus) stock complex. To test potential influential factors, we focused on the last twenty years, i.e. a period with ocean warming, a transient but significant drop in zooplankton biomass, and accelerating interspecific competition resulting from primarily Atlantic mackerel (Scomber scombrus) entering these high-latitude waters in large quantities, “the new mackerel era” in the Nordic Seas. Adult NSSH concurrently allocated relatively less to growth in length than weight resulting in higher body condition. Growth likely decreased in warmer waters under stiff prey competition to support reproductive costs. Condition and reproductive responses were not only immediate but were also lagged by three seasons, corresponding to the period when new oocytes are produced. Furthermore, fecundity increased in warmer waters while egg size dropped. Hence, fine-tuned trade-off mechanisms were apparent and varied. We demonstrate that evaluations of reproductive trade-offs based on pooled data are misleading; poor- and good-condition NSSH followed different reproductive trajectories. These findings emphasize difficult-to-predict trends in life-history traits should be tracked longitudinally by the individuals and their aggregate cohort, as they are linked to complex overarching environmental phenomena, like ecosystem carrying capacity and climate fluctuations.

Changing gender relations, declining fertility? An analysis of childbearing trajectories in 19th-century Netherlands

BACKGROUND A long-standing and still unresolved debate has developed on whether the historical fertility transition was caused by ‘spacing’ (increasing the time between births) or by stopping (terminating childbearing at younger ages). Moreover, there is little consensus about the relative importance of gender relations in effecting reproductive change. OBJECTIVE First, we wish to shed new light on the stopping versus spacing debate by applying a sequence analysis approach, allowing us to describe changes in complete childbearing trajectories. Second, we want to understand the association between gender relations, among other factors, and reproductive trajectories during the historical fertility decline. METHODS We use longitudinal data from GENLIAS, a dataset constructed from linked civil registers of the province of Zeeland, the Netherlands, covering the period 1811‒1911. We employ cluster and sequence analysis to identify different types of childbearing trajectories and logistic regression to estimate their correlates. RESULTS We identified five often-experienced trajectories: two high-fertility traditional trajectories (differing in the length of the reproductive phase), a ‘Stoppers’ trajectory, a ‘Late Starters’ trajectory, and an ‘Almost Childless’ trajectory. Our results show that stopping was the way through which couples controlled their fertility during the early phase of the historical fertility transition in Zeeland, the Netherlands. Although couples with more egalitarian relationships had a higher likelihood to follow a Stoppers trajectory rather than the highest-fertility trajectory, stopping was most clearly linked to birth cohort and social class. CONTRIBUTION Our paper extends the literature on the process of the historical fertility decline and its determinants via a detailed empirical examination of childbearing trajectories and the conditions under which these trajectories took place. With our sequence analysis approach we add both substantively and methodologically to long-standing debates.

Needs of parents of very preterm infants in Neonatal Intensive Care Units: A mixed methods study

ObjectivesTo explore needs of parents of very preterm infants hospitalised in Neonatal Intensive Care Units according to their socioeconomic position, obstetric history and infant’s characteristics. MethodologySequential explanatory mixed methods study. Individual quantitative questionnaires (n = 118 mothers; 89 fathers) during infants’ hospitalisation; couples-based semi-structured interviews (n = 26) four months after childbirth (July 2013–June 2014). SettingAll level III public neonatal intensive care units in North Portugal. ResultsMothers valued more information needs than fathers and their overall scores were mainly influenced by age and educational level, while fathers’ needs perceptions were influenced by previous children. Despite gender differences, the assurance and proximity needs of parents apply across sociotechnical environments. Qualitative findings added the following needs: instrumental support from the government; regular emotional support from psychologists and social workers; enhancement of privacy to assure family-centred information and comfort; and availability of peers and health professionals as mediators in the provision of coherent information. ConclusionsThe promotion of family-friendly and gender-equality policies is crucial to support family integrated healthcare services. This study raises awareness for developing sensitive conceptual frameworks and instruments to assess parents’ needs considering their socioeconomic position and reproductive trajectories, as well as privacy and regular emotional support in the neonatal intensive care unit.