Significant Decline In Fertility Research Articles

O-207 Comparison of the pregnancy outcomes of transferring frozen embryos versus fresh embryos among advanced maternal age women: a nationwide analysis of 232,942 cycles

Abstract Study question Are there differences in pregnancy outcomes when comparing frozen embryo transfer versus fresh embryo transfer among aged women? Summary answer Frozen embryo transfer yields lower live birth rate for women aged 35-39, but higher rate for women ≥40 compared to fresh embryo transfer. What is known already Advanced maternal age was defined as over 35 years old, while recent literature lifted the threshold to 40. An increasing number of women are postponing childbirth, but reproductive issues become more common after the age of 35, with a significant decline in fertility, particularly after 40, even with IVF. Advanced age affects pregnancy rates, prompting some clinicians to prefer fresh embryo transfer to achieve pregnancy quickly. However, it may be less effective with potential negative effects of ovarian stimulation on endometrial receptivity. Frozen embryo transfer is seen as a better strategy, but data specific to advanced maternal age is lacking. Study design, size, duration This cohort study analyzed the Human Fertilization and Embryology Authority anonymized data from 2011 to 2018 in the United Kingdom. This comprised of a total of 232,942 cycles with advanced maternal age, in which 65,066 patients undergoing frozen embryo transfer cycles, and 167,876 patients undergoing fresh embryo transfer cycles. Participants/materials, setting, methods Data on women with advanced maternal age undergoing IVF/ICSI cycles were analyzed to compare live birth rate and miscarriage rate. The cycles with patients’ age <35, donor oocyte / embryo, PGT, or without embryo to transfer were excluded. Log-binominal regression analysis was performed adjusting for patient age, cause of infertility, number of embryos transferred, year of treatment, and IVF or ICSI cycle. Main results and the role of chance We analyzed data from 232,942 cycles with patients age ≥35, and found that FET cycles exhibited a higher live birth rate than that of fresh embryo transfer cycles (25.5% vs. 24.9%, RR, 1.03; 95% CI, 1.01–1.123). Miscarriage rate (4.6% vs. 3.3%, RR, 1.41; 95% CI, 1.35–1.48) was also different. However, the adjusted RR (aRR) of live birth rate was 0.91; 95% CI, 0.88–0.93, after adjusting for potential confounders. For those patients aged 35-39, live birth rate (28.4% vs. 29.7%, aRR, 0.86; 95% CI, 0.83–0.88) following FET cycles was lower than that of fresh embryo transfer cycles. While FET cycles showed a higher rate of miscarriage (4.6% vs. 3.2%, aRR, 1.83; 95% CI, 1.70–1.98). When patients age≥40, FET cycles showed a higher rate of live birth (18.2% vs. 14.0%, aRR, 1.24; 95% CI, 1.16–1.32) and miscarriage rate (4.7% vs. 3.4%, aRR, 1.72; 95% CI, 1.52–1.94). Besides the live birth rate was sharply decreased than patients aged 35-39 both in FET and fresh embryo transfer cycles. Limitations, reasons for caution The conclusion of the present study might be limited by the anonymous nature of the dataset. Further randomized trials may be required to provide direct evidence for the best embryo transfer strategy for the advanced age women. Wider implications of the findings The study shows that FET exhibited a higher live birth rate in women aged ≥ 40, but lower for those aged 35-39 than fresh embryo transfer. Additionally, FET demonstrated a higher miscarriage rate. Therefore, it is necessary to tailor the embryo transfer strategy for advanced maternal age women. Trial registration number not applicable

Adapting public policies to current demographic trends

About most of types of crises we have got very few details about how they are starting, how they are developing or about their impact on immediate or long term. Either is the COVID-19 pandemic (nobody was able to anticipate the start of the pandemic, although such risk was known as probable, as well as the predictions about its evolution were extremely diverse), about the Ukrainian war or about the economic crisis which already is made visible by an increasing inflation and employment, but particularly about the cumulative effect of these crises, we are confronted with a high degree of uncertainty and with the difficulty to plan and implement a response. The article brings into discussion another type of crises, the family and child policy crisis, of which beginning was known (or rather ignored) but of which effects on long term are clearly identifiable. An important consequence, the demographic crisis, strongly tied to the child and family deficit protection, has built during a three decade period, the National Institute of Statistics (2021) showing that in 2060 the Romanian population will fall to 14.54 million people, because of significant fertility decline and because of an increasing emigration. Basically, the population of Romania was in 2021 slightly below to the population registered in 1966, although during the last over three decades of the communist regime was implemented an aggressive pro-natalist policies. The article aims to identify the main features of the family policies and those targeting the elderlies into the context of a sharp demographic decline.

Lycium barbarum berry extract improves female fertility against aging-related oxidative stress in the ovary.

Reproductive aging in female mammals is characterized by ovarian senescence, leading to a significant fertility decline. Lycium barbarum berry, or goji berry, is a food and medicine that appears in various formulas for treating infertility in traditional Chinese medicine. We investigated the function of an aqueous extract of Lycium barbarum berry (LB extract) to improve health status, fertility, and offspring development during female aging. Aged female mice were supplemented with LB extract, and its effects on fertility, locomotor activity, and offspring development were assessed. The results demonstrated that LB extract significantly increased pregnancy and live birth rates in naturally aged female mice. It also effectively improved aged animals' locomotor activity. Moreover, LB extract promoted the growth and development of offspring delivered from the aged animals and reduced the offspring's anxiety. During aging, fertility-related hormones gradually decline. However, the decline of anti-Müllerian hormone (AMH) and estradiol (E2) in the serum of aged mice was restored by LB extract supplementation. Immunohistochemical analysis revealed that the levels of oxidation and the inflammatory IL-6 in intra-ovarian cells were reduced by LB extract, while the antioxidant-associated proteins peroxiredoxin 4 (PRDX4) and nuclear factor erythroid 2-related factor 2 (NRF2) were increased. Bioinformatics analysis revealed a decline in egg PRDX4 expression with age across various species. This suggests that the antioxidant function protected by LB extract through PRDX4 may consistently promote fertility enhancement by improving ovarian function across different species. Importantly, LB extract did not induce significant adverse effects on aged female mice and their offspring. These findings highlight the potential of LB as a protective agent against ovarian oxidative stress, which preserves ovarian function and improves fertility rates in naturally senescent females.

Understanding Female Labour Force Participation and Domestic Work in India: The Role of Co-residence and Household Composition

Despite a remarkable increase in girls’ educational enrolment and a significant decline in fertility over the last few decades, India witnessed a substantial decline in women’s labour force participation. This article investigates the nexus between family composition and women’s participation in domestic work and the labour force in India overtime. Domestic work participation of women with secondary and middle level of education has increased; however, it has declined among women with graduate degrees. This study finds evidences that the presence of the elderly women, not the elderly men, encourages other adult women’s engagement in labour force participation as against their domestic participation. This analysis also observes that the gender composition of elderly members within the household influence women’s labour force participation. It is also observed that higher educational level among women counters the adverse effect of family care burden and creates a supportive environment for women’s participation in the labour force.

Trends and factors associated with declining lifetime fertility among married women in Kenya between 2003 and 2014: an analysis of Kenya demographic health surveys

BackgroundGlobally, fertility has declined in the last three decades. In sub-Saharan Africa Including Kenya, this decline started more recent and at a slower pace compared to other regions. Despite a significant fertility decline in Kenya, there are disparities in intra- and interregional fertility. Reduction in lifetime fertility has health benefits for both the mother and child, thus it is important to improve women and children health outcomes associated with high fertility. The study, therefore evaluated the factors associate with change in lifetime fertility among married women of reproductive age in Kenya between 2003 and 2014.MethodsThe study used the Kenya Demographic and Health Survey (KDHS) datasets of 2003, 2008 and 2014. Analysis of variance (ANOVA) was used to calculate the mean number of children ever born and to assess the change in fertility across different factors. Poisson regression model with robust standard errors was used to study the relationship between number of children ever born (lifetime fertility) and independent variables. A Poisson-based multivariate decomposition for the nonlinear response model was performed to identify and quantify the contribution of demographic, socioeconomic and reproductive correlates, to the change in lifetime fertility between 2003 and 2014.ResultsThe study included 3,917, 4,002, and 7,332 weighted samples of women of reproductive age in 2003, 2008, and 2014, respectively. The mean number of children born declined from 3.8 (95% CI: 3.6–3.9) in 2003 to 3.5 (95% CI: 3.4–-3.7) in 2008 and 3.4 (95% CI: 3.3–3.4) in 2014 (p = 0.001). The expected number of children reduced with the age at first sexual intercourse, the age at first marriage across the survey years, and household wealth index. Women who had lost one or more children in the past were likely to have increased number of children. The changes in the effects of women’s characteristics between the surveys explained 96.4% of the decline. The main contributors to the change in lifetime fertility was the different in women level of education.ConclusionThe lifetime fertility declined by one-tenth between 2003 and 2014; majorly as a result of the effects of characteristics of women in terms of level of education. These highlights a need to implement education policies that promotes women education focuses on gender equality and women empowerment. Continuous strengthening of the healthcare systems (access to quality antenatal care, skilled delivery, and postpartum care) to reduce child mortality is essential.

Adolescent Reproductive Health: The Role of Agency and Autonomy

The world is experiencing the largest cohort of adolescents in its history, and there are about 1 billion youngsters in this age group, most of whom belong to the developing countries. Worldwide, the adolescent age group is gaining prominence for researchers, policy-makers and donors. This issue is more important for Pakistan where about one-third of 150 million Pakistanis are in the age range of 10-24 years [Pakistan Census Organisation (2001)]. In Pakistan, the fertility transition has just begun [Sathar and Casterline (1998)], and we will have the largest cohort of young people in next five years. With a TFR of 4.1 which represents a significant decline in fertility in the past two decades for about two children [Pakistan (2003)], still we have a large population base. Nearly 33 percent of the population is aged 10-24, and ready to enter marriage and childbearing. Adolescents represents as a “bulge” in the population pyramid of Pakistan that will have serious implications at a variety of levels.

Fertility Awareness and Attitudes Among Women Embarking on a Career in Medicine

Background: Previous international studies suggest professional women are more likely to delay childbearing whilst pursuing career goals. Due to prolonged education and training pathways, female medical students may be particularly at risk of fertility difficulties from delayed childbearing. Aim: To explore, among female medical students, the understanding of age-related fertility decline, attitudes toward prophylactic fertility interventions, and beliefs about potential effects of childbearing on training and career opportunities. Method: Cross-sectional online survey of female medical students at The University of Queensland, Brisbane, Australia. Results: The average response rate was 81% (n=113). 95% of respondents were aged 18 to 29, and most (98%) did not have children. 72% intend to have children; 24% within five years, and over 60% intending to delay for 10-15 years. 62% of respondents intend to undertake specialty training, 29% planning to delay childbearing until after training. Of these, 50% perceive that having children sooner would negatively impact career prospects or compromise financial security. Half of respondents reported their fertility knowledge as sound or high. Age of significant fertility decline was well understood, although 90% overestimated the chance of spontaneous pregnancy at age 30. 88% respondents recognise oocyte cryopreservation in their 20’s as a fertility preservation option, though only 28% would consider this in next 10 years with 21% not considering it at all. Respondents strongly believe they should be informed of age-related fertility decline (100%) and of fertility preservation options (98%). 79% believe medical students should seek individualised assessment. Conclusion: Future fertility is important to these at-risk women, who intend to undertake a prolonged education and training pathway. Despite reasonable understanding of age-related fertility decline, most intend to delay childbearing, perceiving financial and career disadvantages of earlier childbearing. Information about age-related fertility decline and fertility preservation strategies is strongly desired by this group.

Landscape-ecological investigations mapping of V. V. Dokuchayiv KHNAU arboretum’s territory

Formulation of the problem. This article briefly describes the main problems that arise during landscape and ecological investigation of territories. On the example of V.V.Dokuchayiv KHNAU’s arboretum the comparative and ecological method of estimating the soil conditions for the forest-based effect, i.e. species composition and productivity of indigenous forest vegetation groups is considered. The forest represents a system of vegetation and habitat. From the ecological point of view it is a reflection of the environment, as its forestry effect. The objective is also to justify measures aimed at solving urgent landscape and environmental problems, namely, transformation and pollution of the natural environment, the development of morphodynamic processes. Soils, as the element of the landscape, are an important block of ecosystems whose destruction has a multidimensional value for the stability of the natural environment. Aggregate soil transformation has traditionally been evaluated as progressive. However, scientific analysis suggests that extensive farming, inappropriate chemical fertilization and fetishization of pesticides have led to a significant decline in fertility, and in some cases, its loss due to the development of erosion of natural soil cover on large areas. Such processes stimulate soil microflora to decompose organic contaminants and promote the absorption of harmful substances by the plant. The landscape-ecological approach is currently used in solving many scientific problems: both theoretical and practical. The purpose of the article. The purpose of this work was to study the landscape and ecological structure of the forest massif, to identify the relationship between the components of landscapes on the example of the V.V. Dokuchayiv KHNAU’s arboretum by mapping the territory. Methods. The authors’ own achievements as well as the research results of domestic and foreign investigators made the methodical basis for the article. Results. The content of heavy metals on the territory of the arboretum is investigated, a ranking of factors influencing the distribution of concentrations of pollutants has been carried out and the type of ecological situation is determined by means of mapping methods. Modern and ecological methods of disturbed territories’ restoration with the help of phytotherapeutic technologies, which are much cheaper and safer, are offered. When implementing phytoremediation methods, there is less secondary pollution, physical and granulometric composition of soils does not deteriorate, biological activity does not decrease, and productivity is kept constant. This technology is most convenient for cleaning of moderately polluted soils. Scientific novelty and practical significance. One of the main mechanisms for regulating the ecologization of land resources is the identification, evaluation and implementation of the maximum possible reserves for increasing the efficiency of this process. This is reduction of unproductive losses in the mode of use and conservation of resources and the possibility of using the basic solution as a scientific and technological progress. Digital terrain models are designed for interactive visualization and have an effect of presence on the ground. Such models are used to substantiate measures to optimize land use in order to restore and stabilize the ecological situation, assess the natural recreational potential of the territory, monitor the components of the environment, predict transformation and degradation processes and environmental phenomena development.

What Has Driven the Great Fertility Decline in Developing Countries since 1960?

Several developing countries are currently experiencing a significant fertility decline, however, academic economists have paid little attention to this transition. This paper seeks to explain the fertility transition by infant mortality, urbanisation, income, culture and educational attainment of females and males using annual data for 92 developing countries over the period 1960–2014. External instruments are used to deal with endogeneity. The results suggest that increasing per capita income, improved female education and increasing secularisation have been important determinants for declining fertility in the developing world.

THE DEMOGRAPHIC DIVIDEND IN SUB-SAHARAN AFRICA: TWO ISSUES THAT NEED MORE ATTENTION

Abstract:In mid-2016, the population of Sub-Saharan Africa (SSA) was almost 1 billion people. By 2050, the population of the region will probably reach 2.1 billion people [Population Reference Bureau (2016)]. In 2100, SSA's population could be almost 4 billion people [United Nations (2015)]. This rapid demographic increase would translate into a possible quadrupling of the current SSA population by the end of the century (unless fertility would decline sharply in the near future). Nonetheless, the region has embarked on its demographic transition, i.e., the shift from high to low crude birth rates and crude death rates, albeit this process has occurred in SSA at a slower pace than in the rest of the developing world. In particular, the decline of fertility has been slower in SSA than in the other regions of the world. The rapid population growth and the occurrence of a demographic transition in the region have generated discussions on the prospects for SSA to open a demographic window of opportunity and capture a first demographic dividend. However, two crucial dimensions, which have so far been rather neglected, need more attention. First, one will need to define with more accuracy the sub-populations of the working-age adults and their young and older dependents, therefore refining the calculation of the dependency ratio. In particular, one will need to assess the population of the young dependents as well as the population of adults who are actually working. Second, it will be also necessary to examine the conditions required to trigger a faster and significant fertility decline in the region. This is most important because the relationship between the active adults and their dependents is predicated by the fertility decline, which will bring the changes to the age structure.

Fertility is below replacement in Harar Health and Demographic Surveillance System (Harar HDSS), Harar town, Eastern Ethiopia.

BackgroundPopulation growth is determined by fertility, mortality and migration rates. Fertility is the prime determinant of population growth, which is highly associated with family planning, literacy, urbanization, and expansion of health system. In many part of Africa, its level is more than twice the replacement level. In Ethiopia, a significant decline in fertility mainly in the urban setting has been reported over the past decade, yet there is a paucity of information on the level of the decline. Therefore, this analysis aims to assess the level of fertility in Harar Health and Demographic Surveillance System (Harar HDSS) Eastern Ethiopia.MethodsHarar HDSS is an urban HDSS located in the city of Harar, eastern Ethiopia. It was established in 2011. All the population under surveillance are followed regularly and updated every six month for any change in the population demographic characteristics. Data were collected on a face-to-face interview to record demographic and socio-economic characteristics. Data were entered into customized HRS-2 software used for capturing longitudinal data and exported to computational software for analysis. For this analysis fertility data of the year 2013 were used. Fertility levels were analyzed using descriptive statistics.ResultsThe total population of Harar HDSS in 2013 was 30,055. Of these, 15,701 (52.2 %) were females and 14, 354 (47.8 %) were males. The crude birth rate and general fertility rate for the year 2013 were 20.3 and 64 births per 1000, respectively. In 2013, the Total Fertility Rate (TFR) was 1.9 births per women of reproductive age. The 25 to 29 age group has the highest age-specific fertility rates (128.1 births per 1000 women), followed by the 20 to 24 year old women (89.3 births per 1000 women).ConclusionTotal fertility rate was relatively low. However, there were a significant number of births among adolescent women. Improving and sustaining access for reproductive health care for young women is highly recommended.

Gender gaps in Spain: policies and outcomes over the last three decades

We document recent trends in gender equality in employment and wages in Spain. Despite an impressive decline in the gender gap in employment, females are still less likely to work than males: about 76 % of working age males and 63 % of working age females were employed in 2010. If females work they are more likely to be employed part time and with temporary contracts. The large increase in female employment, from 28 % in 1977 to 63 % in 2010, was accompanied by a significant decline in fertility. The gender gap in wages, after controlling for worker and job characteristics as well as for selection, is high. It was about 20 % in 2010, quite close to its value in 1994. Furthermore, the gender gap in wages is driven mainly by differences in returns to individual characteristics. While women are more qualified than men in observable labor market characteristics, they end up earning less. There have been several important policy changes that try to help families reconcile family responsibilities with market work. The existing literature suggests that households do react to incentives generated by different policies and policy changes are at least partly responsible for changes in female labor supply. In recent decades, the large inflow of immigrants, who provided relatively cheap household services, allowed more educated women to enter the labor market. Policy challenges, however, remain.

The Long‐Term Fertility Impact of the Navrongo Project in Northern Ghana

This study assesses the long-term fertility impact of the Community Health and Family Planning Project of the Navrongo Health Research Centre in Ghana and addresses policy debates concerning the role of family planning programs in rural Africa. Conducted in a remote traditional area on Ghana's northern border, the study tests the hypothesis that convenient family planning service delivery can induce and sustain reproductive change in a societal context that would not be expected to foster demographic transition. By 1999, results indicated that significant fertility decline arose in the early years of the project, associated with the combination of services provided by community nurses and social mobilization activities focused on men. When project strategies were scaled up, social mobilization components were neglected. As a consequence, the long-term impact of scaled-up operations was negligible. Results suggest that initial effects met the need for child spacing without introducing a sustained demographic transition.

Economic value of children and fertility preferences in a fishing community in Ghana

Although anecdotal evidence suggests that fertility levels in fishing communities, in Ghana, are very high, the influence of economic and cultural factors on fertility preferences in such communities has not been adequately explored. This article examines the fertility preferences of men and women living at Akplabanya, a fishing community in Ghana. Data were collected from a sample of 354 respondents. The findings of the study show that demand for labour, expectations of long term security, and gendered power relations have contributed to high fertility levels and preferences in the study area. It has been concluded that significant fertility decline in the area will only occur when fertility preferences of men have changed. Family planning programmes must therefore target both men and women. Improving economic status of women will also go a long way to bring about fertility transition in rural communities in Ghana.

P1-181 Mortality and epidemiological transition in Bangladesh: lessons and experiences to the developing countries in the new millennium

BackgroundThis study aims to examine the stages of mortality and epidemiologic transition in Bangladesh where detailed studies are not well documented but significant decline in fertility and mortality have been...

Chronic Disease Burden and the Interaction of Education, Fertility, and Growth.

This study considers the eradication of hookworm disease from the American South as a test of the quantity-quality (Q-Q) framework of fertility. Eradication was principally a shock to the price of quality because of three factors: hookworm (i) depresses the return to human-capital investment, (ii) had a very low case-fatality rate, and (iii) had negligible prevalence among adults. Consistent with the Q-Q model, we find a significant decline in fertility associated with eradication. Relative sizes of fertility and human-capital responses to hookworm indicate that the Q-Q mechanism is of a similar magnitude to secular co-movements in these same variables.

The male biological clock is ticking: a review of the literature.

The term biological clock is usually used by physicians and psychologists to refer to the declining fertility, increasing risk of fetal birth defects and alterations to hormone levels experienced by women as they age. Female fecundity declines slowly after the age of 30 years and more rapidly after 40 and is considered the main limiting factor in treating infertility. However, there are several scientific reports, chapters in books and review articles suggesting that men may also have a biological clock. The aim of our study was to conduct a review of the literature, based on the Medical Literature Analysis and Retrieval System Online (Medline), to evaluate the male biological clock. After adjustments for other factors, the data demonstrate that the likelihood that a fertile couple will take more than 12 months to conceive nearly doubles from 8% when the man is < 25 years old to 15% when he is > 35 years old. Thus, paternal age is a further factor to be taken into account when deciding on the prognosis for infertile couples. Also, increasing male age is associated with a significant decline in fertility (five times longer to achieve pregnancy at the age of 45 years). Patients and their physicians therefore need to understand the effects of the male biological clock on sexual and reproductive health, in that it leads to erectile dysfunction and male infertility, as well as its potential implications for important medical conditions such as diabetes and cardiovascular diseases.

Fertility policy in Ceausescu's Romania.

This study tests a model for the impact that Ceausescu's pro-natalist policies had on the Romanian fertility rate between 1967 and 1989. Using time-series analysis the authors' findings show that the Ceausescu regime continually struggled with the Romanian population to increase the national birthrate. As a result the regime's policies, there was a significant increase in overall fertility between 1967 and 1989, when the Ceausescu regime was overthrown. Reasons are offered as to why Romania pursued such policies and was able to make them work, while other Eastern and Central European regimes proved to be less able to sustain drives to increase national fertility. This article also presents a model of what has happened to the Romanian fertility rate since 1989, showing that there has been a significant decline in fertility in the post-Communist period.

Can family-planning programs “cause” a significant fertility decline in countries characterized by very low levels of socioeconomic development? New evidence from Bangladesh based on dynamic multivariate and cointegrated time-series techniques, 1965–1991

Unlike most empirical works on fertility analysis, this study investigates the question as to whether family-planning programs can “cause” a significant fertility decline in a country characterized by very low levels of socioeconomic development. The analysis is based on the application of the following dynamic time-series techniques in a multivariate context: cointegration, vector error-correction modeling, variance decompositions, and impulse response functions. These four dynamic tools are recently developed and hitherto untried in fertility analysis in the context of a poor developing economy such as Bangladesh. Our findings appear to be consistent with the new theoretical view that holds that fertility decline may result from either of two distinct developmental phases, one short-term and the other long-term. According to this view, the second phase (comprising the “sufficient” condition for fertility decline) incorporates the conventional view that in the long term, fertility decline may result from a complex dynamic interaction with organized family planning and significant socioeconomic structural change. In contrast, the first phase (comprising the “necessary” condition for fertility decline) may not need such significant structural change in order to effect fertility decline in the short term. All it may require is a predominantly client-oriented, affordable, persuasive, and well-organized family-planning program—a program that is firmly supported by the political and social elite at all levels of that society, as well as being adapted to the sociocultural realities of the vast masses of the people of that region.

Reproductive change in Bangladesh: Evidence from recent data

This analysis pertains to an examination of fertility trends, differences, contraceptive use, and fertility preferences in Bangladesh. Data were obtained from the 1969 National Impact Survey of Family Planning; the 1975 and 1989 Bangladesh Fertility Surveys; and the 1983, 1985, and 1991 Contraceptive Prevalence Surveys. Age specific fertility rates (ASFR), current pregnancy rates, and the mean number of children ever born (CEB) are the estimated fertility measures. The P/F ratios show a significant fertility decline since 1983. Total marital fertility declined from 7 births in the 1960s to 5.2 in the late 1980s. The average number of CEB declined from 4.3 in 1969 to 3.7 in 1991. The percentage of pregnant women declined from 13.3 to 10.6. The ASFR declined primarily among older married women. Fertility declined among all groups including landowners and landless, the educated and the uneducated, rural and urban populations. The extent of decline varies by group. The total marital fertility rate (TMFR) declined more for the educated and the urban populations. Chittagong region had the higher fertility regardless of the period. TMFR was lower among contraceptive users compared to nonusers. The increase in contraceptive use was from 4 to 40% between 1969 and 1991. The following factors affected the extent of fertility decline: contraceptive use, reduced child mortality concomitant with extended lactation and amenorrhea, increased malnutrition, and/or improvements in child survival. Fertility was depressed under conditions of increased poverty, which may stimulate contraceptive use and lead to malnutrition and subfecundity. The higher Chittagong fertility pattern is not explained by regional comparisons of pregnancy wastage, stillbirths, and induced abortion. Desire for no more children increased from 46 to 58% during 1969-91. The average preferred family size is declining. High density and deep-seated poverty explain fertility decline in regions other than Chittagong. Demand for contraception may increase with increases in family planning home visits and educational opportunities.