Completed Family Size Research Articles

O-105 Contribution of ART to fertility rates and family size

Abstract In the last three decades declining fertility has become an increasing global trend. One-half of the global population today lives in countries where the period Total Fertility Rate is below 2.1 births per woman. Many countries in Europe and Asia are experiencing “ultra-low” fertility rates of 1.0-1.4 births per woman. This decline in births creates both social and economic challenges. In addition, most countries have gone through a long period of increasing average age at birth. The shift in births at older ages has been accompanied by a concomitant decline in completed family size. As the average age at having children has increased over time, the proportion of women experiencing difficulty in achieving a pregnancy has also increased, with assisted reproductive technology (ART) treatments becoming increasingly important in counteracting this decline. However, the demographic impact of ART widely varies across countries, with the proportion of babies born as a result of ART, ranging from almost 10% of birth in in some European countries to < 1% in Latin America and 2% in the USA. ART is increasingly being raised as a potential policy tool to increase fertility. While ART can broaden the range of possible responses to low fertility rates, there are a number of challenges in quantifying contribution to fertility rates. There are also a number of important unintended consequences that need to be taken into account when trying to estimate their effectiveness as a policy tool to increase fertility. In this presentation, the evidence for the contribution of ART to total and age-specific fertility rates in different settings will be summarized and compared with other pronatalist policies. The contribution of ART and other forms of fertility treatment to completed family size and childbearing timing will also be described and discussed. Assisted reproduction is making a modest and increasing contribution to the fertility rate of high-income countries, but its potential impact should not be overestimated.

Lifehistory Trade-Offs Influence Women’s Reproductive Strategies

ObjectiveIn a UK national census sample, women from the upper and lower socioeconomic (SES) classes achieve parity in completed family size, despite marked differences in both birth rates and offspring survival rates. We test the hypothesis that women adopt reproductive strategies that manipulate age at first reproduction to achieve this.MethodsWe use a Monte-Carlo modeling approach parameterized with current UK lifehistory data to simulate the reproductive lifehistories of 64,000 individuals from different SES classes, with parameter values at each successive time step drawn from a statistical distribution defined by the census data.ResultsWe show that, if they are to achieve parity with women in the higher socioeconomic classes, women in lower socioeconomic classes must begin reproducing 5.65 years earlier on average than women in the higher SES classes in order to offset the higher class-specific mortality and infertility rates that they experience. The model predicts very closely the observed differences in age at first reproduction in the census data.ConclusionsOpting to delay reproduction in order to purse an education-based professional career may be a high risk strategy that many lower SES women are unwilling and unable to pursue. As a result, reproducing as early as possible may be the best strategy available to them.

Mother’s Satisfaction with Delivery Services and Intended Future Utilization at Federal Teaching Hospital, Gombe, North-Eastern, Nigeria

Background: Maternal death reduction could be achieved through the utilization of hospital delivery services. In Nigeria, unfortunately delivery in health facilities where skill birth attendants exist is reported to be only 39%. Maternal satisfaction with hospital services will encourage utilization. Aim of the study: The study was designed to assess the satisfaction of mothers’ and their intention to utilize delivery services in subsequent pregnancies at the Federal Teaching Hospital Gombe, North-East, Nigeria. Methods: This was a descriptive, cross-sectional study conducted at the postnatal ward of the hospital amongst 250 women within 48 hours after childbirth. Data was collected with the use of a pretested, semi structured questionnaire and analysis done with SPSS statistical software version 25. Results: Overall satisfaction with delivery services was 84.4% with only 15.6% dissatisfied. Total satisfaction with the cleanliness of the facility was 92.8%, interpersonal relationship 84.8%, information provided 74.4% and technical aspects of care 82.8%. As many as 78.4% of women will utilize the facility in future for delivery services. The major reason amongst this category being satisfaction with services (76.5%). Those who do not intend to utilize facility in the future were 21.6% amongst which 27.8% gave reasons as completed family size and only 22.2% would not because of dissatisfaction. Satisfaction was only statistically related to ethnicity (P value=0.02) and none amongst obstetric variables tested. Conclusion: Majority of the women were satisfied with delivery services rendered and would utilize the facility in the future. There is need to sustain and further improve upon the quality of services.

Childbirth timing and completed family size by the mode of conception—the role of medically assisted reproduction: a population-based cohort study in Australia

With declining total fertility rates to below replacement levels amongst all high-, middle- and low-income countries, coupled with increasing use of medically assisted reproduction (MAR) treatments globally, we describe the impact of these treatments on completed family size and childbearing timing in a country with unlimited publicly funded access to MAR. We utilised a unique longitudinal propensity score-weighted population-based birth cohort that included nulliparous mothers who gave birth after all major forms of MAR treatments (assisted reproductive technologies [ART], ovulation induction [OI], and intrauterine insemination [IUI]) and after natural conception (reference category) in Australia, 2003-2017. We followed first-time mothers over their reproductive lifespan (15-50 years). The primary outcome was completed family size (i.e., the mean cumulative number of children per mother of our cohort) and the fertility gap (i.e., adjusted difference in completed family size between MAR conceptions and the reference). Our cohort includes 481,866 first-time mothers, mean follow-up of 13.8 years. ART mothers (n=25,296) were six years older (mean age: 34.6 years) than mothers who conceived naturally (28.7 years (reference)) while OI/IUI mothers were only 2.2 years older (31.0 years) than the reference. ART mothers had up to 27% smaller completed family size (2.54 children) compared to OI/IUI mothers (2.98 children) and natural conception mothers (3.23 children). ART mothers who resided in the lower socioeconomic areas were less likely to reach a similar family size to the natural conception mothers (fertility gap of 0.83 fewer children per ART mother compared to natural conception mothers) than ART mothers who resided in the higher socioeconomic areas (0.43 fewer children). Greater awareness of the limitations of MAR treatment to resolve childlessness and achieve desired family size is needed. Furthermore, with policymakers increasingly turning to MAR treatment as a tool to reverse declining fertility rates, their potential impact should not be overestimated. Australian National Health and Medical Research Council.

Female Employment and Fertility: Further Investigation of an Ambivalent Association

"This study of the relationship between female employment and fertility is based on a survey of 1,000 ever-married women in Karachi, [Pakistan]. A distinct pattern of differentials in actual performance and in desired fertility is observed across working and non-working women.... Women in higher status occupations marry much later than and have half the completed family size of those women working in lower status occupations. The fertility of non-working women lies somewhere in between these two groups. Some reasons for the fertility differentials found are identified in variations in point of entry into the labour force relative to the stage in child-bearing, in expectations from sons in old age support, and in relative facility in seeking means of fertility control. Working women in higher status occupations also have better chances of their children surviving, whereas women in lower status occupations suffer a greater toll of child deaths."

Alcohol consumption at age 18-25 and number of children at a 33-year follow-up: Individual and within-pair analyses of Finnish twins.

BackgroundDo drinking patterns in late adolescence/early adulthood predict lifetime childlessness and number of children? Research on this question has been only tangentially relevant and the results inconsistent. The designs used to date have been compromised by genetic and environmental confounds that are poorly controlled; covariate effects of smoking and education that are often ignored; males being understudied; population‐based sampling rare, and long‐term prospective studies with genetically informative designs yet to be reported.MethodIn a 33‐year follow‐up, we linked the drinking patterns of >3500 Finnish twin pairs, assessed at ages 18–25, to registry data on their eventual number of children. Analyses distinguished associations of early drinking patterns with lifetime childlessness from those predictive of family size. Within‐twin pair analyses used fixed‐effects regression models to account for shared familial confounds and genetic liabilities. Childlessness was analyzed with Cox proportional hazards models and family size with Poisson regression. Analyses within‐pairs and of twins as individuals were run before and after adjustment for smoking and education, and for oral contraceptive (OC) use in individual‐level analyses of female twins.ResultsBaseline abstinence and heavier drinking both significantly predicted lifetime childlessness in individual‐level analyses. Few abstinent women used OCs, but they were nonetheless more often eventually childless; adjusting for smoking and education did not affect this finding. Excluding childless twins, Poisson models of family size showed heavier drinking at 18–25 to be predictive of fewer children in both men and women. Those associations were replicated in within‐pair analyses of dizygotic twins, each level of heavier drinking being associated with smaller families. Among monozygotic twins, associations of drinking with completed family size yielded effects of similar magnitude, reaching significance at the highest levels of consumption, ruling out familial confounds.ConclusionsCompared to moderate levels of drinking, both abstinence and heavier drinking in late adolescence/early adulthood predicted a greater likelihood of lifetime childlessness and eventual number of children. Familial confounds do not fully explain these associations.

A study on socio-demographic and obstetric profile, contraceptive use and reasons for medical termination of pregnancy among women attending medical termination of pregnancy clinic in Purba Medinipur district of West Bengal, India

Background: Induced abortion contributes significantly to maternal morbidity and mortality in developing countries yet women still seek repeat induced abortion in-spite of the availability of contraceptive services. The objective of this study was to identify the socio-demographic and obstetric profile of the mother’s seeking abortion as well as causes for seeking abortion.Methods: This is a cross-sectional study among selected women undergoing medical termination of pregnancy (MTP) at Tamluk district hospital and Haldia sub divisional hospital (SDH) of Purba Medinipur district, West Bengal. Results: A total of 52 women participated in the study. Among the study subjects, majority (53.83%) of the women were between 26-35 years of age. 88.46% of participants were Hindu by religion and belonged to nuclear families (80.76%). Common reasons given by the mothers for terminating of the pregnancy were previous baby too young (32.69%) and completed family size (28.84%) and contraceptive failure (28.84%).Conclusions: Unmet need of contraception is still an issue in respect to unwanted pregnancy. So focused attention from Front line workers like ANM, ASHA is required to meet the unmet need of contraception.

Measuring Independent and Controlled Effects of Age at First Marriage and Age at First Birth on Completed Family Size among Women Aged 45-49 in Zambia

The link between age at marriage and first birth in explaining completed family size is not always direct, due to heterogeneity in circumstances, that compel individual women to marry or initiate childbearing at a particular age. We analyzed data for 1020 women aged 45-49 in 2014 of the 1965-1969 birth cohort from the 2013-14 Zambia Demographic and Health Survey (ZDHS).

A community-based, cross-sectional study of gender egalitarianism: A promising scenario from an urban field practice area attached to a teaching institute from Central India.

Gender-based discrimination is more predominant in India. In spite of various laws, gender inequality is an evil that plagues society even today. This is an important challenge for meeting our Sustainable Development Goals. This cross-sectional study was carried out in an urban field practice area. Study subjects were married women and their husbands in the age-group of 15-49 years along with their under-five children. Gender egalitarianism was assessed for factors like education, employment and media exposure. Factors which were studied for revealing gender egalitarianism among children included sex ratio, immunization status, nutritional status and health care expenditure. Completed family size and preference for the sex of the child were enquired about to assess the inclination towards male gender of the baby. Anthro software was used for statistical analysis. Gender egalitarianism was found with regards to education. However, significant difference was noted in the employment status of men and women. Overall, sex ratio was in favor of girls. Though gender inequality was evident from the results, it was more in favor of girls. There was no evidence of gender bias for immunization of children. It was observed that more boys were stunted than girls and almost equal proportion of boys and girls were wasted. Factors like high literacy, control over income, access to financial resources made women more empowered and such empowered women were less likely to show son preference. Hence, there was no gender inequality among children in the present study.

The impact of early pregnancy complications on completed family size-A nationwide, registry-based cohort study with 40 years of data.

The impact of early pregnancy complications on completed family size is unknown. Here, we hypothesize that early pregnancy complications and adverse outcomes may influence family size. In this nationwide, registry-based study we included all 458475 women born 1957-1972 who lived in Denmark from age 20-45years with at least one registered pregnancy. The main outcome of the study was number of children per woman by age 45, estimated using a Generalized Linear Mixed Model. Exposures were: (a) total number of pregnancy losses experienced (0, 1, 2, ≥3); (b) highest number of consecutive pregnancy losses (0, 1, 2, ≥3); (c) sex of firstborn child; (d) outcome of first pregnancy (live birth, stillbirth, pregnancy loss, ectopic pregnancy, or molar pregnancy). Number of live births was negatively influenced by maternal age and adverse first pregnancy outcomes, especially ectopic pregnancies. A 30-year-old woman with a first ectopic pregnancy was expected to have 1.16 children (95% CI 1.11-1.22) compared with 1.95 children (95% CI 1.86-2.03) with a first live birth. Three or more consecutive losses also decreased number of live births significantly: 1.57 (95% CI 1.50-1.65) compared with 1.92 (95% CI 1.84-2.0) with only live births. The total number of pregnancy losses had no effect before the age of 35years. Sex of firstborn had no effect. Previous pregnancy history has a significant effect on number of children per woman, which is important at both individual and societal levels. Pathophysiological research of adverse pregnancy outcomes should be an urgent priority as the causes remain poorly understood.

Preferences, Partners, and Parenthood: Linking Early Fertility Desires, Marriage Timing, and Achieved Fertility

In the United States, underachieving fertility desires is more common among women with higher levels of education and those who delay first marriage beyond their mid-20s. However, the relationship between these patterns, and particularly the degree to which marriage postponement explains lower fertility among the highly educated, is not well understood. We use data from the National Longitudinal Survey of Youth 1979 cohort to analyze differences in parenthood and achieved parity for men and women, focusing on the role of marriage timing in achieving fertility goals over the life course. We expand on previous research by distinguishing between entry into parenthood and average parity among parents as pathways to underachieving, by considering variation in the impact of marriage timing by education and by stage of the life course, and by comparing results for men and women. We find that women with a bachelor’s degree who desired three or more children are less likely to become mothers relative to women with the same desired family size who did not attend college. Conditional on becoming mothers, however, women with at least a bachelor’s degree do not have lower completed family size. No comparable fatherhood difference by desired family size is present. Postponing marriage beyond age 30 is associated with lower proportions of parenthood but not with lower parity among parents. Age patterns are similar for women and men, pointing at social rather than biological factors driving the underachievement of fertility goals.

Écarts de fécondité en fonction du niveau d’instruction : le rôle de la religion en Grande-Bretagne et en France

La fécondité baisse et l’infécondité augmente généralement avec le niveau d’instruction des femmes. On ne sait pas vraiment si un niveau d’études supérieures implique un comportement reproductif identique chez les femmes selon les confessions et les pratiques religieuses. Cette étude utilise des données issues de l’Enquête par panel auprès des ménages britanniques (BHPS) et du volet français de l’enquête Generations and Gender (GGS) ou Erfi, afin d’explorer les interactions entre la religion (mesurée par la pratique, l’appartenance à la religion catholique en France, au protestantisme et au catholicisme en Grande-Bretagne), le niveau d’instruction et la fécondité des femmes nées entre les années 1920 et 1960. En Grande-Bretagne, un niveau d’études élevé diminue plus souvent les probabilités de maternité chez les femmes appartenant à une religion que les autres, qu’elles soient ou non pratiquantes (cet effet d’interaction n’est pas retrouvé en France). Mais dans les deux pays, la religiosité atténue la relation négative entre le niveau d’instruction et la taille des familles. Alors que, pour les femmes sans appartenance religieuse, la relation est globalement négative, on constate une relation en U chez les catholiques pratiquantes. Les disparités de descendance finale selon l’appartenance et la pratique religieuses sont plus prononcées chez les femmes les plus instruites, certainement à cause de perceptions différentes de la valeur et du coût des enfants.

Child marriage among boys in high-prevalence countries: an analysis of sexual and reproductive health outcomes

BackgroundWhile the determinants and impacts of child marriage among girls have been well documented, little research exists on the practice among boys. This paper explores the sociodemographic profile of men who married by age 18 and assesses whether they are more or less advantaged than their peers in terms of their sexual and reproductive health outcomes.MethodsThis analysis used the most recent data from nationally representative household surveys for the 15 countries with the highest prevalence of marriage by age 18 among men aged 20–24 at the time of the survey. The prevalence of child marriage was then explored for the full cohort of men aged 20–49 through descriptive statistics and bivariate analysis. Available reproductive health indicators were explored, comparing men who married during childhood and men who married in adulthood. For the youngest and oldest cohorts, the total number of children fathered and the total ideal number of children were compared based on whether men married by age 18.ResultsFor this subset of countries, the prevalence of child marriage among men aged 20–24 ranges from 8.4 to 27.9%. The practice appears most common among respondents living in the poorest households and in rural areas, and with no education or only primary schooling. Men who married as children appear less likely to have comprehensive knowledge of HIV than their peers who married in adulthood. Little difference among men who married by age 18 and those who married in adulthood was observed regarding knowledge or use of modern methods of contraception. In almost all countries with data, the odds of having fathered three or more children among men aged 20–29 are higher for those who married as children compared to their peers. In four countries, the odds of exceeding one’s ideal family size among men aged 40–49 also appear higher among those who married during childhood compared to men who married at older ages.ConclusionThese results highlight the need for further research to identify drivers of the practice and short- and long-term outcomes for men who married during childhood, specifically concerning fatherhood, fertility preferences, and completed family size.

A study of Socio-demographic factors and fertility in a village of Western Maharashtra

Background: In India rural population was reported to be 66%.there is gap in fertility of rural and urban population.Worldwide, fertility rates have fallen from an average of about six children per woman in the 1950s to fewer than threetoday. Total fertility rate (TFR) gives approximate magnitude of the completed family size. Objectives: To describe sociodemographicfactors and ascertaining relationship of fertility with socio-demographic factors in a rural area of Maharashtra.Results: A total 292 families were interviewed from Dahitane village; Majority Head of family were Hindu males (90%).About 93% population resided in their own houses in that 63% houses were semi-pucca. Houses having electricity supply, inhouse water connection and in-house latrines were 91%, 39% and 61% respectively. Total fertility rate (TFR) was found tobe 1.71 and not significantly associated with socioeconomic class and female literacy. Conclusions: The present studyshowed betterment in water supply and sanitation facility in rural dwellings in spite of the predominance of semi-puccahouse.

A Five–year review of female sterilization at the Lagos university teaching hospital, Lagos.

Background: Over the decades, female sterilization has become a highly effective, convenient, simple and safe method of long term contraception, attributable to technological and medical advances.Objective: This study aims at determining the uptake, indications, timing and surgical techniques of female sterilization in LUTH.Methodology: A retrospective study involving all female clients who had sterilization done at the Lagos University Teaching Hospital between January 2010 and December 2014. Clinical data were retrieved from the case files and analyzed with SPSS version 19. one hundred and eighteen clients were eligible, however only 115 case files could be located. Available case files had adequate information for the study.Results: There were 8,695 deliveries with 115 cases female sterilization, resulting in an incidence of 13 per 1000 births. The mean age at sterilization was 37.9 years. Completed family size was the main indication. Ninety percent of the clients had a postpartum procedure and Pomeroy's method was used in 76.5% of the clients.Conclusion: Female sterilization still has a role to play in family planning in our environment. Majority of the procedure were performed during planned caesarean section.Keywords: female sterilization, contraception, family planning, Pomeroy, tubal ligation.

Prevalence, and Pattern of LARC Use in Immediate Postpartum Period at Jimma University Medical Center, Ethiopia [18F

INTRODUCTION: Postpartum family planning (PPFP) is defined as the prevention of unintended pregnancy and closely spaced pregnancies through the first twelve months following childbirth. Immediate postpartum period is particularly favorable time to provide LARC methods and postpartum provision of LARC is safe and effective. Despite the advantages of LARCs, they are infrequently used in Ethiopia. METHODS: A cross-sectional study was conducted on 393 women who gave birth at Jimma University Medical Centre (JUMC) from November 12, 2016 to January 21, 2017. Data were collected by face-to-face interview and record review using pre-tested questionnaire and analysed using SPSS 20. Logistic regression was used to identify associated factors for LARC method use. RESULTS: Prevalence of LARCs use among immediate postpartum mothers was 53.2% and more than three quarter (78.0%) of participants used Implanon. The most common reported reasons for not using LARC were preference of other method (25.5%). Having more than four alive kids (95% CI: 1.15-5.95), high monthly income (95% CI: 1.08-7.20), planning to delay next pregnancy by more than two years (95% CI: 1.60-9.28), previous experience of LARC use (95% CI: 1.30- 7.20), completed family size (95% CI:1.12- 3.15), and most importantly receiving counselling during antenatal care (ANC) follow up and before delivery (95% CI 1.01- 4.73) were associated with immediate postpartum LARC use. CONCLUSION: Utilisation of immediate postpartum LARC methods use among counselled mothers was high compared to other low income countries reviewed. The need for providing counselling during ANC follow up and delivery to increase utilisation of immediate postpartum LARC use is emphasised.

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

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

Is fertility associated with the number of siblings of the couple? Evidence from India

The influence of family on an individual’s fertility has long been an important topic of interest in fertility research. Although studies conducted mostly in developed countries found a significant bearing of fertility of the parents on the fertility of the children, there is a lack of formal research around this topic in India. The present study analyses the effect of sibling size of husband and wife on the completed family size of women using information of 5506 ever-married women aged 45–49 years incorporated in the India Human Development Survey-II (2011–2012). Inferential statistics, bivariate, Chi-square and Poisson regression were used as the methods of analysis. The unadjusted estimates of Poisson regression reveal sibling size of women (IRR: 1.02; p < 0.001) and husband (IRR: 1.01; p < 0.001) have a positive correlation with the completed family size of women. However, in the adjusted model, the effect of sibling size especially of husband diminishes gradually in the presence of socio-economic covariates of the women.

La préférence pour les fils dans une société de métayers

Les préférences quant au sexe des enfants et leur lien avec la fécondité ont souvent, voire exclusivement, été étudiées dans des populations transitionnelles ou post-transitionnelles. L’essentiel des études sur le sujet concernent des pays asiatiques, où le patriarcat et la discrimination liée au sexe étaient deux caractéristiques culturelles favorisant une préférence pour les fils. À l’inverse, l’attention s’est très peu focalisée sur les populations prétransitionnelles, dont on considérait que les préférences quant au sexe des enfants étaient satisfaites parce que la taille moyenne des familles complètes y était importante. Mais la société prétransitionnelle des métayers italiens présente les mêmes caractéristiques culturelles que certaines sociétés asiatiques contemporaines : familles patriarcales, fortes inégalités entre les sexes et division stricte des tâches domestiques en fonction du sexe, conduisant à la survalorisation des fils. Cet article analyse la relation entre la répartition par sexe des enfants survivants et la fécondité dans une population de métayers toscans au milieu du xix e siècle, à partir d’une analyse longitudinale des biographies de fécondité des femmes ayant vécu à Casalguidi entre 1819 et 1859.

Benefits from delay? The effect of abortion availability on young women and their children

While much is now known about the effects of the arrival of the contraceptive pill on the fertility choices and other outcomes of women, there has been less study of the effects of abortion availability. Abortion was made widely available within week 12 of gestation to teenage women in Oslo several years before the rest of Norway. I use a differences-in-differences approach to examine the effects on teen childbearing, fertility at older ages, educational attainment, and labor market outcomes of the affected women. I also study several outcomes for the first-born children of these women. I find that abortion availability delayed fertility but did not reduce completed family size. It also resulted in higher educational attainment. Children of mothers who had access to abortion are also found to have better outcomes.