Family planning and fecundity

Abstract A computerized probability model of family-building, FERMOD, is described and then utilized in an investigation of relations between family planning and fecundity as applying to white couples of the contemporary United States. Models of this type that formulate reproductive performance as a stochastic process permit one to explore relations that are not directly observable and in this manner to secure at least partial answers to questions not subject to investigation by survey research alone. Two main questions are addressed concerning the dependence of family planning success upon fecundity: (1) How quickly does spacing control deteriorate when natural fecundability is taken at progressively lower values or when the risk of pregnancy wastage is set at progressively higher values? (2) What is the distribution of unsought births among couples of average fecundity when they practise contraception with specified effectiveness and have stipulated spacing and family size goals?     

The quiver is full: metonymy and affiliation in 19 Kids and Counting’s depiction of pregnancy loss in advanced maternal age

Abstract

This investigation into the cultural dynamics of gendered, aging bodies attends to a mediated representation of what contemporary biomedicine defines as pregnancy in “advanced maternal age” (AMA). We offer a feminist rhetorical analysis of an episode of TLC’s 19 Kids and Counting entitled “A Duggar Loss,” where 45-year-old matriarch Michelle Duggar experiences pregnancy loss. In the episode, age is reconfigured in discussions of AMA pregnancy through a metonymic substitution and slippage of risk discourses, pre-natal self-care, and technological interaction. Moreover, “A Duggar Loss” mobilizes strategies of expansive affiliation around and through reproductive choice, which appears to align with feminist principles of reproductive autonomy despite the family’s ties to the Quiverfull Movement. This work contributes to feminist studies of aging bodies by suggesting that representations of advanced maternal age pregnancy remain a central, yet undertheorized subject in formulating powerful trans-ideological affiliations that can undermine progressive reproductive politics.     

Integrating reproductive health services into family planning programs

A recent Population Council publication, Reproductive Health Approach to Family Planning, discusses integration of reproductive health into family planning programs in a series of edited presentations that Council staff and colleagues gave at a 1994 meeting of the US Agency for International Development (USAID) cooperating agencies. The presentations reflect the Council's view that family planning programs ought to help individuals achieve their own reproductive goals in a healthful manner. The report discusses four areas of reproductive health: reproductive tract infections (RTIs), including sexually transmitted diseases; prevention and treatment of unsafe abortion; pregnancy, labor, and delivery care; and postpartum care. Christopher Elias (Senior Associate, Programs Division) argued that family planning programs ought to provide services that target RTIs, given that these illnesses afflict a significant proportion of reproductive-age women. The family planning community has an ethical responsibility to provide services to women who experience an unwanted pregnancy. They must have access to high-quality postabortion care, including family planning services. Professional midwives are ideally suited to serve as integrated reproductive health workers trained to combat the five major maternal killers: hemorrhage, sepsis, pregnancy-induced hypertension, obstructed labor, and unsafe abortion. This was demonstrated in a highly successful Life-Saving Skills for Midwives program undertaken in Ghana, Nigeria, and Uganda, and soon to start in Vietnam in conjunction with the Council's Safe Motherhood research program. Family planning services should be viewed as part of a comprehensive set of health services needed by postpartum women, which include appropriate contraception, maternal health checks, well-baby care, and information about breastfeeding, infant care, and nutrition. Family planning programs should incorporate breastfeeding counseling into their services. When programs aim to help individuals meet their own reproductive goals in a healthful manner, this implies that services will not increase clients' risk of morbidity.     

Environmental Effects on Family Size Preferences and Subsequent Reproductive Behavior in Nepal

This study investigates the relationship between environmental degradation and men and womens family size preferences and subsequent reproductive behaviors in Nepal. We draw on unique environmental data at the local level, household and individual-level survey data and individuals reproductive behavior over a 3 year time period in Western Chitwan Valley, Nepal. Results from Ordinary Least Squares (OLS) and logistic regression models show that poorer environmental quality and greater reliance on publicly owned natural resources are associated with higher family size preferences and higher rates of pregnancy. The analyses provide support for the vicious circle argument that environmental degradation can lead to rising population growth via positive effects on fertility. As environmental conditions decline and when households rely on public lands for natural resources, men and women desire larger family sizes and women are more likely to get pregnant in the near future.     

Focus on family planning measures

A blueprint for responsible parenthood titled "The Tokyo Initiative" was drawn up at a conference sponsored jointly by the Japan Science Society and the Population Crisis Committee in April 1977. Representatives of several U.N. agencies and nongovernmental organizations participated. The blueprint urges additional resources to make family planning services available in rural areas and unserved areas of cities. Expanded social and economic roles for women were also recommended since it was felt that unless women were allowed to participate in family and community decision-making, "programs for responsible parenthood will be doomed to failure." Adolescents should be educated about reproductive behavior, stressing the adverse effects of early pregnancy. Integrated family planning services which serve the cause of infant and child health and total responsibility for program design be placed as close as possible to people affected. The conference then issued a call for action to implement these family planning objectives.     

Probability models for family building: An analytical review

Considerable literature now exists on stochastic models for the reproductive history of a cohort of couples. These models are of varying complexity and the relationships between separate treatments are not always clear. A classification system for such models is proposed, followed by a historical review of models for family building and for logically related processes. Models, differing only in treatment of time as discrete or continuous, are presented in detail for the simple case where the prob ability of conception is constant, and all conceptions lead to live births which are associated with a fixed nonsusceptible period. Analysis of different treatments is facilitated by introducing the notion of the time when a conception is recorded. Emphasis is placed on results for the probability of a recording at a specified time t, the probability of r recordings by time t, and the expected number of recordings in time t. Differences between the discrete and continuous time models are made explicit. It is shown that results for these models can be derived using renewal theory techniques, which are presented. More complex models based on renewal theory and allowing for several pregnancy outcomes or for variability in parameters are briefly described, followed by generalized models which allow parameters to vary with time. Applications of family building models are summarized.     

The Structure of Pregnancy Intervals by Planning Status

Measures of pregnancy intervals are reported for data from the 1975 National Fertility Study in the United States. The structure of such intervals is aggregated into its components by planning status. A measurement model is devised to infer from a survival function some dimensions of the initial distribution of respondents by propensity to experience the event in question. It is adaptable to the study of reproductive intention as well as fecundability and contraceptive effectiveness. The model is applied to the study of the dependence of such behaviour in a given interval on the planning status of the previous pregnancy. Planning status is sequentially well-ordered. Those previously successful with contraceptive use are less likely to fail than those who had previously failed; those who had previously used contraception, whether successful or not, are less likely to fail than those who had not previously used. The credibility of the findings is prejudiced less by the form of model than by the reliability of the basic data.     

Reproductive goals and achieved fertility: A fifteen-year perspective

A measure of underlying family size preference obtained for a sample of Detroit married women in 1962 is related to their fertility over a 15-year follow-up period. The data represent completed fertility. The I-scale preference measure used differs from the conventional single-valued statement of number of children wanted; it is a more fine-grained measure reflecting the respondent's utility for children as evidenced by her entire preference order. The scales are found to be consistently predictive of fertility over the 15-year prospective period, net of other variables usually associated with differential fertility. The results for the just-married sample, in which preferences and expectations are not confounded with the number of children already born, are particularly striking, with underlying preference much better than expected family size as a predictor of fertility over the entire reproductive cycle. The question of prediction for continuous and discontinuous marriages is discussed.     

Improvement of contraception during the course of marriage

Contraceptive effectiveness is conventionally measured by a pregnancy rate, which reveals little about the way in which pregnancy risks vary among couples. In this paper a technique is presented for estimating curves of pregnancy risk. The technique is applied to data from the Family Growth in Metropolitan America study for purposes of estimating how much these couples would have to Improve their initial contraception In order to realize, by contraception alone, the calibre of family limitation claimed by respondents late in their childbearing period. A very substantial improvement Is estimated as necessary.

It Is also argued that the notable increase In contraceptive effectiveness before and after second birth, observed for couples desiring only two children is attributable mainly to a more regular practice of contraception. Changes Iin method preference, decline in average fecundabillty and increased contraceptive skill are viewed as secondary factors.     

The prediction of fertility among catholics: A longitudinal analysis

A longitudinal analysis of the reproductive behavior of a sample of Catholics who were participants in the 1965 NFS and reinterviewed in 1969 is reported in this paper. Fertility over the period studied varied systematically with the additional number of children intended in 1965. In addition, this study has documented a predictive role for method of contraception and the experience of premarital pregnancy. Women using less effective methods and those premaritally pregnant had higher fertility over the interval net of controls for other variables in the analysis, including life-cycle stage and 1965 intentions. Surprisingly, the planning status of the last pregnancy before 1965 was not found to have any independent association with subsequent fertility.     

Pregnancy status and unwanted births

Pregnancy status was examined in this study of 590 rural and 377 urban married women 15-45 years old from the northern Mindanao region of the Philippines. Pregnancy status was measured in terms of a Likertlike format of 32 statements pertaining to opinions on physical appearance, health concerns during pregnancy, attitudes of husbands and family members, and social activities during pregnancy. 16 items were identified by factor analysis as appropriate indicators. Status is related to the social benefits derived from the pregnancy period as a benefit with costs. Perception of pregnancy is related to unwanted births. Principal component analysis lead to the characteristics of SELF, which reflects feelings about self and how others relate to her pregnancy; WANT, which indicates the desires that influenced her pregnancy; and OTHERS, which reflects her feelings about how others treat her. Pregnancy Status Index Scores (PSINDEX) was a computation of the sum of scores for each variable divided by the number of items answered. The Eigenvalue for the 3 components accounted for 51.3% of the variance. The results showed that rural women had higher evaluations for all 3 components of PSINDEX, which means that pregnancy is seen as a beneficial means to improve marital and social relations as well as personal importance. SELF was the moist important category for both urban, (4.54) and rural women (4.65). Urban residents who considered SELF more important tended to be younger, less well educated, less modern, and less socially well off. In the bivariate analysis, findings indicated that rural women who were lower socioeconomically and had less education had a higher regard for pregnancy and a more positive attitude. Stepwise regression analysis revealed that PSINDEX, number of live births, number of years married, and a woman's educational attainment had significant effects on unwanted births. The maximum likelihood estimates indicated a good fitting model with an index of .997 and Chi square with 10 degrees of freedom of 6.80 (P.44). Among rural residents, the number of live births (path of .505) and pregnancy status (path of .109) had a direct effect on unwanted births. The higher the score on PSINDEX the lower the probability of having 1 or more unwanted births. In urban areas, education had a direct effect on unwanted births. Women who had been married longer, had less education, and fewer children were associated with pregnancy as an important factor in unwanted births. The rural model explained only 29% of the variance, while for the urban model 61%. Further exploration is recommended.     

Unseemly and unwomanly behaviour: Comparing women’s control of their fertility in Australia and England from 1890 to 1970

From 1890 to 1970 Australian women’s use of female-controlled birth control methods was higher than that of English women. The latter primarily depended upon withdrawal and condoms. Use of these male-controlled methods of contraception is associated with low levels of female sexual pleasure, and the belief that husbands should initiate sexual activity and should control their wives’ fertility. I argue that higher use of female methods gave white Australian women greater sexual and reproductive autonomy throughout this period. The view that they were in a less desirable position than women in other Anglo cultures needs to be examined more closely.     

Rethinking Historical Reproductive Change: Insights from Longitudinal Data for a Spanish Town

A set of linked reproductive histories taken from the Spanish town of Aranjuez between 1871 and 1950 is used to address key issues regarding reproductive change during the demographic transition. These include the role of child survival as a stimulus for reproductive change, the use of stopping and/or spacing strategies to achieve reproductive goals, and the timing of change. Straightforward demographic measures are used and robust results are achieved. Initial strategies of fertility limitation are shown to exist but are inefficient, are mostly visible during the latter part of the reproductive period, are designed mostly to protect families from the effects of increases in child survival, and are based almost entirely on stopping behavior. As mortality decline accelerates, strategies become much more efficient, are visible at the outset of married life, include spacing behavior, and eventually lead to important declines in completed family size. The results of this study have implications for our understanding of the demographic transition both in historical Europe and in other regions of the world.     

Causes of death to women of reproductive age in two developing countries

Data on cause of death are deficient for most developing countries. Nevertheless, it is important for policy makers to have access to such information to plan the use of resources and to evaluate health programs. In this study, deaths among women of reproductive age (15 to 49) in two areas in developing countries were located, and family members were interviewed. Local physicians reviewed the completed interviews and determined the cause of death.Complications of pregnancy and childbirth were the cause of 23% of the deaths in Menoufia, Egypt and Bali, Indonesia. In Egypt, the first cause of death was circulatory system disease (28%), followed by complications of pregnancy and childbirth (23%), and trauma (14%, primarily burns). In Indonesia, complications of pregnancy and childbirth was the first cause of death, followed by infectious disease (22%, primarily tuberculosis), and circulatory system disease (13%).Although the method of data collection was unorthodox, findings for Menoufia are comparable to data from other sources for the country as a whole. There are few data with which to compare our findings for Bali, but their similarity to the data from the Egyptian study lends credence to their quality.     

The pattern of birth spacing during Taiwan's demographic transition

This paper considers the impact of an extended family structure on the fertility behavior of married women in Taiwan. A sequential duration model is applied to identify the differences in fertility behavior during the early and latter stages of a woman's reproductive period. Heterogeneity adjustments which correct the respondent-specific characteristics are also implemented. It is found that living with the husband's parents has an impact on the wife's fertility only at the early stage of her childbearing period, and that the subjective son preferences together with the objective fact of no son in the previous 2 births do force a wife to expedite her third birth. These results are robust across different cohorts during the demographic transition and under different specifications of hazard functions. We thank an anonymous referee for his or her valuable comments and suggestions. Responsible editor: Junsen Zhang.     

A new estimate of permanent sterility by age: sterility defined as the inability to conceive

The proportion of couples permanently sterile beyond a certain age is an important component of the reproductive process. Unless medical assistance is used, this age is the upper bound of the fecund period. Most estimates of sterility by age of the woman have been derived from natural fertility populations, in which the number of births and the timing of the last birth (of the complete reproductive history) were not controlled by the couples. Because data on these populations do not include pregnancies not ending in a live birth, the sterility estimates apply to the proportion of couples unable to conceive and to have a live birth. For this reason, it is useful to have an estimate of sterility based on the risk of conceiving, independently of the fate of the pregnancy. Using this new estimate, sterility increases with age much more slowly than with most previous estimates.     

Factors affecting rural women's utilisation of continuum of care services in remote or isolated villages or Pakistan – A mixed-methods study

IntroductionAn effective continuum of care for pregnancy and childbirth connects women and girls with essential reproductive and maternity care services. This study aimed to estimate the continuum of care utilisation rate of women who lived in remote and isolated regions of Pakistan and explored factors that influence women's utilisation of reproductive and maternity care services.MethodsA mixed-methods study was conducted in five rural villages of Sindh, Pakistan. A cross-sectional survey with 669 women who gave birth between July 2010 and September 2014 investigated women's maternity-care service utilisation during pregnancy, childbirth, and in the postpartum period. In-depth interviews with 15 women explored their maternity-care experiences with health providers.ResultsOnly 6.4% of 669 women participants reported to have completed the continuum of care for their last pregnancy. Skilled birth attendants, including health professionals, were used by 56.1% for antenatal care, 40.8% for both antenatal and childbirth, 22.3% for antenatal, childbirth and postnatal, and only 6.4% reported using all pregnancy-related and postpartum services. Limited knowledge about affordable health services, poor health literacy, and access to health services was associated with women's fragmented utilisation of maternity care. A lack of respectful maternity-care was also identified as a major barrier to women's utilisation of primary health care facilities, especially for childbirth.ConclusionThe existing primary health structure in Pakistan provides a good foundation to deliver continuity of care services; however, health services utilisation for reproductive and maternity care remains suboptimal in women who live in geographically remote regions of Pakistan.     

Women's use of complementary and alternative medicine in pregnancy: A search for holistic wellbeing

BackgroundA number of studies have found increased use of complementary and alternative medicine (CAM) during pregnancy and birth. However, little is known about women's motivation in seeking CAM during pregnancy or their experiences of use in relation to their pregnancy and childbirth journey.MethodsA narrative study sought to explore the meaning and significance of CAM use in pregnancy from the perspective of CAM users. Narrative style interviews were conducted with 14 women who had used a range of CAMs during pregnancy and birth. Data analysis focussed on the meaning and significance of CAM use in pregnancy and a number of core themes emerged.FindingsThis paper focusses on the theme which illustrates the meaning behind women's use of CAM in pregnancy and childbirth as one of seeking holistic wellbeing.ConclusionParticipants engaged with CAM as a way of fulfilling their physical, emotional and spiritual needs during pregnancy. Use of CAM signified women's desire to be proactive in health seeking behaviours.     

The Impact of Family Planning on Fertility in a Rural Area of East Pakistan

This pape revaluates a family planning pilot project conducted by the Pakistan Academy for Rural Development in Comilla, East Pakistan. The evaluation is based upon an analysis of the extent to which adoption of conventional contraceptives (condoms and foam tablets) has reduced fertility in selected villages of the Comilla-Kotwali precinct, during the years 1962-66.The study was carried out by comparing adopter and non-adopter rates of pregnancy and analyzing the trends in pregnancy reduction that resulted from adoption. The findings indicate that (1) although the pregnancy rate of adopters has increased steadily throughout the time period, in 1966 the rate is still less than half of what was expected had adoption not occurred; (2) contraceptive use-effectiveness decreases with length of time of use; and (3) pregnancy reduction has been declining since 1964.     

Birth rate of Beijing population drops nearly 60% in 20 years

The birthrate of the Beijing (China) population dropped by 60% in the last 20 years. Consequently, population reproduction is characterized by a pattern of low birthrate, low mortality rate, and a low growth rate. The birthrate of the Beijing population was 36.30/1000 in 1950 and rose to 43.41/1000 in 1963. During the 1950-63 period, the average annual birthrate of Beijing population reached 36.71/1000 and the number of births was 2.23 million. Since the beginning of the 1970s, the rapid population growth has been effectively checked by great efforts made in practicing family planning. Over the 1970-83 period, the average annual birthrate dropped to 14.9/1000 and the number of births totaled 1.75 million. With the advance of the family planning effort, particularly acceptance of the concept of practicing family planning for the modernization drive, the people's reproductive notion has changed for the better. At this time, more and more men and women of reproductive age have broken away from the influence of old ideas such as "the earlier the couples have their sons, the soonner they will be helped." By 1982, the average age at 1st marriage was 25.8 years for males and 24.7 years for females. This was a remarkable change as compared with the 1960s. According to the 1982 population census, Beijing women over 60 years had 4.83 children, while those in the age groups 55-59, 50-54, 45-49, 40-44, 35-39, 30-34, and 25-29 has 4.81, 4.50, 3.72, 2.95, 2.32, 1.58, and 0.57 children respectively. Today, 0.66 million couples in Beijing volunteer to have only 1 child.