The demographic effects of a contraceptive programme

Abstract The calculation of the number of births prevented for each item of contraceptive service provided entails the integration of a variety of factors relating to the potential fertility of users and the duration and effectiveness of use. This article differs from previous essays of this kind in that estimates of future potential fertility are based not on fertility rates but on age-specific means of inter-live birth intervals, modified by periods of use overlapping post-partum sterility, and by the probabilities attached to the development of permanent sterility and to the successful adoption of extra-programme birth control. In the first three years after acceptance of intra-uterine contraception by some 9,000 postpartum women of several ethnic origins in Singapore, it is calculated that about 4,800 births were prevented.     

The Effect of Parental Education on Marital Fertility in Developing Countries

The effects of parents' education on marital fertility are analysed with data from 38 Surveys in the WFS programme, and a two-parameter model in which the age-dependent level of fertility and a duration-dependent slope of fertility are estimated. The level parameter reflects post-partum infecundity and, in some populations, contraceptive spacing of births. The slope parameter reflects parity-specific birth control. The effects of the husband's and of the wife's education are estimated, both before and after adjustment for other socio-economic factors. The schooling of the wife emerges as a more decisive influence on fertility than that of the husband, with substantial net effects even after controlling for urban-rural residence, husband's socio-economic status and wife's employment. In Latin America and the Arab states, monotonic declines in marital fertility are found, as the level of the wife's education increases. However, in many Asian and African populations, the highest fertility is observed among women with moderate exposure to schooling, because the relaxation of traditional spacing mechanisms is not matched by increased birth control. This regional diversity cannot be explained convincingly by national levels of economic development or efforts made to popularize contraception, but appears to relect ill-understood cultural factors.     

Total fertility rate,women's education,and women's work: What are the relationships?

This paper presents the results of a statistical study, using cross-national data, on the relationships between total fertility rate and women's level of education and women's labor participation. Aggregate data on seventy-one countries were collected from numerous sources. Eight variables related to women's fertility, mortality, economic status, labor participation, and education are analyzed using multivariate linear regression analyses. Two models are considered. The first model regresses five variables on total fertility rate: per capita Cross National Product (GNP), percentage of women ages 15 to 19 who are married, female life expectancy at birth, calories available as a percentage of need, and percentage of married couples using contraception. The second model includes two additional regressors: the average number of years of schooling for women, and the percentage of women in the labor force. These seven variables are regressed on total fertility rate. Although the data are crude, the results of the analyses suggest that the model which incorporates women's level of education and women's labor participation captures the data better than the smaller model. The full model suggests that the percentage of women in the labor force is directly related to total fertility rate, whereas the average number of years of education for women is indirectly related to total fertility rate.     

A dynamic model of the reproductive process

Summary A dynamic deterministic model of the reproductive process is presented. The model describes and analyses the effect of intermediate fertility variables on fertility. The intermediate fertility variables which are the inputs to the model, include the duration of post-partum amenorrhea, fecundability, incidence of spontaneous and induced abortion, contraceptive use and effectiveness, the distribution of age at first marriage and the age specific risks of marital disruption and remarriage. To test the validity of this model, it is fitted to data obtained from reproductive histories of 512 marriages occurring during the first half of the eighteenth century in Canada.     

Dynamics of contraceptive use and breastfeeding during the post-partum period in Peru and Indonesia

This paper examines the interaction between contraceptive use and breastfeeding in relation to resumption of intercourse and duration of amenorrhea post-partum. We used data from the month-by-month calendar of reproductive events from Demographic and Health Surveys (DHS) in Peru and Indonesia. The analyses show that breastfeeding women were less likely than non-breastfeeding women to have resumed sexual intercourse in the early months post-partum in both countries. In Peru, but not in Indonesia, breastfeeding women had a significantly lower odds than non-breastfeeding women of adopting contraception. Although the likelihood of contraceptive adoption was highest in the month women resumed menstruation in both countries, about ten per cent of subsequent pregnancies occurred to women before they resumed menses. These results emphasize the importance of integrating breastfeeding counselling and family planning services in programmes serving post-partum women, as a means of enabling those who wish to space their next birth to avoid exposure to the risk of a pregnancy that may precede the return of menses.     

Risk-taking and contraceptive behavior among unmarried college students

The contraceptive behavior of sexually active, never-married college women was examined using multiple regression analyses. Use of an effective method of contraception was highly situation-specific: length of relationship and frequency of intercourse were the variables most highly correlated with use of effective contraception, followed by method of contraception used at first coitus and knowledge of reproduction. Failure to use effective contraception was not associated with low estimates of pregnancy risk, nor with high utility of pregnancy, nor with uniquely high willingness to seek abortion. The results of the present study suggest that use or non-use of effective contraception is mediated by the predictability of sexual intercourse.We would like to thank Ira H. Bernstein for his assistance with computer programming and data analysis. Reprints are available from Ms. Irene Steeger, Center for Population and Family Health, Columbia Unviersity, New York.     

Fertility levels and trends in Indonesia

Summary Fertility estimates from the 1973 Indonesian Fertility Mortality Survey are presented and compared with estimates from the 1971 population census. Although there are some differences, on the whole the two sources are remarkably consistent, indicating the same regional differentials: highest fertility in Sumatra (T.F.R. in rural areas around 7.0), followed by West Java and Sulawesi, Bali, then Central and East Java (T.F.R. in rural areas around 50). Coale's Index of Overall Fertility (If) is 39 per cent higher in rural Sumatra than in rural East Java. Fertility in urban areas is somewhat below rural fertility in all regions. The age pattern of fertility in Sumatra, Sulawesi and West Java is consistent with Henry's notion of 'natural fertility', and indeed the survey data show these regions to be almost innocent of deliberate practice of contraception. The lower fertility levels in Central and East Java appear to be related to patterns of extended lactation and post-partum abstinence, though modern contraception promoted by the national family planning programme is also on the increase. Though lower than elsewhere, both actual fertility and stated ideal family size in Central and East Java are well above the levels needed to achieve replacement levels of fertility.     

Female status and fertility behaviour in a Metropolitan Urban area of Bangladesh

The paper examines hypotheses that certain aspects of status of married women such as (i) decision-making power; (ii) employment status and (iii) educational status, are positively associated with use of contraception and inversely related to fertility performance. The study is based on 1,130 women of reproductive age (15-49) who are currently married and living with their husbands and reported to be fecund. The data are drawn from a cross-section of working and non-working women of Dacca City. The hypothesis that each of the above status variables is related to fertility behaviour (measured as current use of contraception and number of children ever-born) is confirmed, with the sole exception of the relationship between female employment status and fertility behaviour. Female participation in the labour force has little or no effect on use of contraception, particularly among those who belong to higher education and income groups. However, in the lower education and income groups, fertility and use of contraception vary with work experience. The findings clearly point out the need to improve the status of women in order to achieve a breakthrough in the use of contraception and a reduction in fertility.     

New insights into the Far Eastern pattern of mortality

This paper investigates the consequences of using different economic status proxies on the estimated impact of economic status and other determinants of fertility. Using micro survey data from Ghana and Peru, we find that the proxies for income that best predict fertility are a principal components score of the ownership of consumer durable goods and a simple sum of ownership of these durable goods. Furthermore, the choice of the proxy generally has a minor influence on the predicted effects of the control variables. We compare the results from using a restricted set of proxies, such as those available in the Demographic and Health Surveys, with the results obtained using a lengthier set of proxies. Our results suggest implications beyond fertility analyses by providing researchers with an awareness of the sensitivity of microanalyses to the treatment of economic status. Our results also suggest practical recommendations for the collection of survey data.     

Economic status proxies in studies of fertility in developing countries: Does the measure matter?

This paper investigates the consequences of using different economic status proxies on the estimated impact of economic status and other determinants of fertility. Using micro survey data from Ghana and Peru, we find that the proxies for income that best predict fertility are a principal components score of the ownership of consumer durable goods and a simple sum of ownership of these durable goods. Furthermore, the choice of the proxy generally has a minor influence on the predicted effects of the control variables. We compare the results from using a restricted set of proxies, such as those available in the Demographic and Health Surveys, with the results obtained using a lengthier set of proxies. Our results suggest implications beyond fertility analyses by providing researchers with an awareness of the sensitivity of microanalyses to the treatment of economic status. Our results also suggest practical recommendations for the collection of survey data.     

An empirical study of the effects of socioeconomic development on fertility rates

Recent studies by Adelman and by Friedlander and Silver, which have investigated whether regression equations derived from cross-section data can be used to predict the impact of socioeconomic development on changing levels of fertility, are reviewed critically. Regression analyses based on data for 57 countries c. 1960 show that fertility (gross reproduction rate) varies cross-sectionally with region as well as with level of development (as measured by per capita income, percent labor force in primary sector, expectation of life, illiteracy rate). Using equations derived from the cross-section study and time-series data for five European countries during the period that their fertility rates fell, it is shown that predictions about past fertility changes are in error. The results suggest caution in the use of cross-section relations to predict the course of fertility in developing countries.     

Contraceptive overlap with post-partum anovularity

Abstract Contraceptive use in the early post-partum months is, for the majority of women, without any direct protective value because, whilst not ovulating, they are not exposed to the risk of pregnancy. This does not, of course, imply that contraception should be delayed until signs of the resumption of ovulation appear, as for many women the first sign of such resumption is pregnancy. There are, besides, logistic and psychological reasons which make early post-partum contraception advisable. It does, however, demand that any calculation of the demographic effects of contraceptive use should make due allowance for this null period of use.     

Contraceptive overlap with post-partum anovularity

Contraceptive use in the early post-partum months is, for the majority of women, without any direct protective value because, whilst not ovulating, they are not exposed to the risk of pregnancy. This does not, of course, imply that contraception should be delayed until signs of the resumption of ovulation appear, as for many women the first sign of such resumption is pregnancy. There are, besides, logistic and psychological reasons which make early post-partum contraception advisable. It does, however, demand that any calculation of the demographic effects of contraceptive use should make due allowance for this null period of use.     

中国生育率转变的因素分析

阐述了中国生育率由传统的高出生率向近代的低出生率转变的原因,利用邦加兹生育率模式和多元回归分析分别对生育率转变的避孕、人工流产等生物人口学因素,以及都市人口比率、计划生育率等社会经济的因素进行了论述。     

Education,employment, and fertility in Kinshasa and prospects for changes in reproductive behavior

This paper examines fertility behavior of women in Kinshasa, Zaire's capital city with a population of roughly four million. We look at relationships linking women's education, employment, and fertility behavior (children ever born, age at first marriage, contraception, abortion, breastfeeding, and postpartum abstinence), using data from a 1990 survey of reproductive-age women. Other things equal, there are significant differences by educational attainment and by modern sector employment in lifetime fertility and in most of the proximate determinants as well. The results suggest that modern contraception and abortion are alternative fertility control strategies in Kinshasa, with abortion appearing to play an important role in contributing to the observed fertility differentials by education and employment. The dramatic increases that have taken place in women's access to secondary and higher education are likely to reduce fertility in the future, while the effects of Zaire's current economic and political crisis are uncertain. Our findings are consistent with some of the arguments of Caldwell et al. (1992) on a new type of fertility transition in sub-Saharan Africa. If Zaire seeks to lower fertility, policy efforts should be made to soften the impact of economic crisis on school enrollments and enhance opportunities for young women to remain in school, at least well into the secondary level. Policy should also seek to promote more effective marketing and delivery of modern family planning services, so as to induce women to substitute modern contraception for abortion as a means of controlling their fertility.     

The post-partum non-susceptible period: Development and application of model schedules

Summary The duration of the post-partum non-susceptible period is a major determinant of birth intervals in populations with relatively low levels of contraception. Since it depends largely on the length of breast-feeding, it may change rapidly with socio-economic development. Its study is, however, seriously hampered by the limited and defective nature of most data that can be obtained. In the absence of intensive, large-scale prospective studies, sizeable reporting errors and/or sampling fluctuations are almost inevitable. A system of model schedules that summarise the underlying regularities found in empirical schedules is proposed. With a logit transformation, observed schedules of breast-feeding can be related to a standard breast-feeding schedule by just two parameters. Similarly, observed schedules of post-partum amenorrhoea can be related to a standard amenorrhoea schedule. The two systems provide a means of obtaining relatively robust estimates of the duration of lactation or amenorrhoea from partial and flawed data. Several applications of the models for estimation problems, for simulation purposes and for the analysis of the relationships between breast-feeding, amenorrhoea and post-partum abstinence are discussed.     

Differential fertility in central India: A path analysis

This study is one of the few multivariate analyses of the relations of several demographic and socioeconomic variables to fertility and the use of contraception. For fertility, 56 of the 92 hypothesized paths are found to be significant at the .05 level or better. The five variables having a significant and direct effect on fertility, as shown by their path coefficients (p), are: duration of marriage (p= .721), spouse’s cohort (p= ?.093), spouse’s age at marriage (p = .052), caste (p = ?.071), and number of siblings of husband (p = .050). p] The use of contraception is affected by, in order of importance, the spouse’s education (p = .267), the husband’s education (p = .099), the husband’s income (p= .089), and surplus children, i.e., number of living children exceeding ideal number of children (p = .059). Child mortality, which is linked to number of living children and thus indirectly to surplus children, is affected by, in order of importance, the number of children ever born (p = .723), the husband’s education (p = \t-.166), the spouse’s absence by death or separation (p = .084), and family structure (p = \t-.035). p] The advantages and disadvantages of path analysis for this type of research are briefly mentioned.     

The synthesis economic fertility model: a latent variable investigation of some critical attributes

"This study uses Nicaraguan data to estimate a latent variable system of reduced-form demands for births, infant mortality, contraception, nutrition and breastfeeding. The estimates support some of the synthesis extensions to the standard fertility model, such as the concurrent increase of contraception, health, nutrition and fertility and decline in breastfeeding with income increases from initial low levels.... The initial stages of development may experience an increase in family size despite an increase in contraceptive use...as well as a profertility impact of reduced breastfeeding." Data are from a survey of women aged 15-45 that was conducted in Nicaragua from 1977 to 1978.     

The relationship of family planning to savings and consumption in Taiwan

This study relates fertility behavior to modern economic behavior, namely, saving and consumption of modern durables, for a sample of couples in Taiwan. It uses only couples who say they want no more children, and these couples are further classified by current use of contraception and by whether or not they already had excess fertility. Couples who are successful fertility planners, i.e., those who have no unwanted children and are current users of contraception, are distinctive with regard to modern economic behavior as compared to couples who do not use contraception or have excess fertility. Successful planners are more likely to save and to have more modern durables; these differentials remain when adjustments are made for the effects of family income, wife’s age, wife’s education, and duration of marriage. It seems that the kind of planning behavior which enables a couple to successfully plan their family size also enables them to manage their economic affairs so that they can save and enjoy more modern consumption goods.     

Modelling Marital Fertility by Age and Duration: An Empirical Appraisal of the Page Model

Page's model of marital fertility by age and duration is fitted by maximum likelihood techniques to data from 38 of the 41 developing countries that participated in the World Fertility Survey. The results indicate that the model does an excellent job of capturing variations in fertility patterns, with only two parameters. Moreover, national-level estimates of the parameter representing the degree of control of marital fertility correlate reasonably well with the proportion using contraception. On the other hand, estimates of the parameter representing the level of natural fertility correlate well with the duration of breastfeeding and with a measure of contraceptive use for spacing, but also show substantial regional variation. The paper closes with comments on several extensions and applications of the model.