Why the rise in adolescent fertility rates in the Dominican Republic in the 1990s?

Despite concern over high pregnancy rates and levels of risk for sexually transmittedinfections, adolescent fertility rates in the Dominican Republic have not changed substantially since the early 1980's, and actually increased during the early to mid 1990s. The present study was undertaken to assess the factors contributing to the recent rise in fertility among Dominican adolescents. The findings suggest that although contraceptive use among adolescents and young adults has increased, this has been more than offset by ominous trends on other determinants of fertility. Among these are declines in mean age at first sex and first marriage/union without a commensurate decline in mean age at first contraceptive use, and stubbornly high discontinuation rates for oral contraceptives andcondoms. There is also some evidence that rates of induced abortion among adolescents may have increased, without which adolescent fertility rates would have been even higher. Demand for children among Dominican adolescents remains strong, suggesting that efforts to reduce the current high prevalence of risky sexual behaviors need to influence social norms in order to be successful.     

Strength of fertility motivation and contraceptive use in Nepal

The study's purpose was to test whether new survey questions on strength of fertility motivation, included in Nepal's 1986 Fertility and Family Planning Survey, enable improved prediction of current contraceptive use. Intent to use contraception in the future was also tested, over and above the effects of socioeconomic background. While controlling selected demographic and socioeconomic background characteristics of the respondents, the authors found the effect of the strength of fertility motivation on current contraceptive use to be substantial and highly significant statistically. Nevertheless, the background factors largely captured the effect of motivational strength on current use when motivational strength was deleted from the model, inasmuch as measures of global fit declined only slightly as a consequence of the deletion. These findings indicate that respondents' demographic and socioeconomic background characteristics affect motivational strength, so that motivational strength does not have a large independent effect on use. These results raise the question of whether strength of fertility motivation can be affected by educational efforts mounted by family planning programs to increase contraceptive use. The analysis shows that strength of motivation does have some independent effect on contraceptive use, and it is quite possible that this independent effect could be enhanced by educational programs operating independently of the socioeconomic characteristics of program recipients. Because the 1986 survey lacks relevant data, we have not been able to explore this possibility empirically.     

Emotional Variation and Fertility Behavior

Emotional influences on fertility behaviors are an understudied topic that may offer a clear explanation of why many couples choose to have children even when childbearing is not economically rational. With setting-specific measures of the husband-wife emotional bond appropriate for large-scale population research matched with data from a long-term panel study, we have the empirical tools to provide a test of the influence of emotional factors on contraceptive use to limit fertility. This article presents those tests. We use long-term, multilevel community and family panel data to demonstrate that the variance in levels of husband-wife emotional bond is significantly associated with their subsequent use of contraception to avert births. We discuss the wide-ranging implications of this intriguing new result.     

Determinants of fertility and the unmet need for family planning in Indonesia

Indonesia's fertility has declined to an average of slightly more than 3 children/woman. The islands of Java and Bali have the lowest birth rates. Indonesia's family planning program has been a model of innovation, flexibility, and community involvement, and has been effective in reducing fertility, changing family preferences, and increasing contraceptive use. Fertility decline is also determined by factors other than contraceptive use, as provinces in Jakarta and East Java has low fertility and low contraceptive use. Recent research by Suyono and Palmore found that among cohorts of women in Jakarta lowest fertility rates were explained by greater nonexposure to pregnancy in an unmarried state or by a divorced or widowed status, and by infecundity. In East Java, fertility determinants were the same with the possible addition of lower coital frequency. The study estimated nonexposure due to marriage, infecundity, and contraceptive use. Policy considerations, however, are concerned with the exposed state of the percentage of time women are currently married, fecund, not using contraceptive, and sexually active. Suyono and Palmore also calculated the percentage of time spent in the exposed state by province. The estimates ranged from 12% in Yogyakarta to 25% in West Java and the Outer Islands. Exposed was further divided into groups with a manifest, latent, and no current need. Women with a manifest need for family planning are those who are aware of their contraceptive needs to stop or postpone childbearing and not using. Manifest need was highest in high fertility areas: 12% in Central Java, 13% in West Java, and 12% in the Outer Islands. Programs targeting these women should focus on wider availability of information and services. Women with latent needs are unaware of their need for family planning and are not using contraception. These women were also concentrated in high fertility areas. The percentage of years spent in the latent unmet need state was estimated at 23-24% in West Java and the Outer Islands. Program emphasis should be on education and motivation to show how family size can be controlled. Women with current need can be educated toward future acceptance.     

Explaining regional fertility variations in the Philippines

Analysis of the 1993 National Demographic Survey in the Philippines has uncovered regional variations in fertility-related behavior. The total fertility rate ranged from 2.8 in Manila to 5.9 in Bicol and averaged 4.1 for the entire country, but contraceptive prevalence rates were not highly correlated with total fertility (Manila showed the fifth highest prevalence, and Bicol the fifth lowest). This lack of correlation may be caused by the mix of contraceptive methods chosen with a high proportion of women using ineffective methods (40% of all currently married women of reproductive age [MWRA] were using contraceptives, but only 25% were using the most effective methods). Thus, low fertility was associated with use of the most effective methods regionally. Fertility also was lower in regions where women spent more time unmarried. Infecundity added to the discrepancy (Bicol had the lowest regional infecundity rate in the country). The total protection rate, which can be derived from three factors (contraceptive usage, time spent unmarried, and infecundity), accounts for must of the regional variation. Unmet need for contraception was found in 26% of currently MWRA, and another 12% were using ineffective methods. In designing effective family planning programs, policy-makers must understand the various factors that contribute to high levels of fertility in different regions and must be flexible enough to plan regionally-specific strategies. As the government decentralizes programs and resource management decisions, local-level analysis will be increasingly important.     

Decision-Making Patterns and Contraceptive Use: Evidence from Uganda

Literature on the effect of decision-making patterns on contraceptive use often does not (1) distinguish between women participating in decisions and controlling them, and (2) account for effects of common decision-making patterns within the community. In Uganda where high fertility persists, both of these factors may be relevant to adoption of contraception. We used data from the 1995/96 Negotiating Reproductive Outcomes (NRO) Study which surveyed 1,750 women in 78 communities located in two districts in Uganda. We assessed the effects of individual and community factors on the adoption of modern contraceptive methods using multilevel logistic regression. We included measures of decision-making patterns at both the individual and community levels that distinguished husband-dominated, joint, and wife-dominated decision-making patterns. Contraceptive use is 29% more likely in communities where women more commonly have unilateral control over household decisions. This strong effect of normative decision-making patterns within the community is net of individual education and community education, both of which had strong and significant effects. Less traditional gender roles as measured by normative decision-making patterns seem to support more innovative fertility behavior. Community decision-making patterns matter importantly for contraceptive use in this low contraceptive prevalence setting and need to be assessed elsewhere. Further, women’s influence is inadequately measured where joint decision-making and wife-dominated decision-making are considered together.     

Asian-Pacific round of WFS activities

The primary aim of the World Fertility Survey (WFS) program is to assist countries to acquire the scientific information that will permit them to describe and interpret the fertility of their populations. A 2nd purpose is to increase national capacities for fertility and other demographic survey research, particularly in developing countries; while a 3rd objective is to collect and analyze data on fertility which are internationally standardized and therefore permit comparisons between 1 country and another. The WFS studies are generally single-round surveys of households selected to provide a national probability sample, with information collected from eligible women with the help of a carefully designed individual questionnaire. The recommended WFS questionnaire consists of 7 sections: 1) respondent's background; 2) maternity history; 3) contraceptive knowledge and use; 4) marriage history; 5) fertility regulation; 6) work history; and 7) current husband's background. For countries wishing to investigate certain topics in greater depth, various modules have been developed by WFS which can be incorporated into the questionnaire. So far, 35 developing countries and 17 developed countries have been participating in the WFS program, including 14 ESCAP countries. 11 of these countries (Bangladesh, Fiji, Hong Kong, Indonesia, Japan, Malaysia, Nepal, Pakistan, Republic of Korea, Sri Lanka, and Thailand) have already completed their 1st report and many have begun activities with regard to the 2nd-stage analysis of the WFS data. 3 of these, Nepal; Sri Lanka; and Indonesia; have also held seminars to discuss the survey findings and further analyze the WFS data.     

An Analysis of Fertility Differentials by Religion in Kerala State: A Test of the Interaction Hypothesis

In a revelation of overall decline to below replacement fertility in the Kerala state of India, it was generally found that fertility among Muslims is higher and contraceptive prevalence lower than among Hindus and Christians. This paper examines the interaction between religion and other socioeconomic factors, that is, whether the effect of religion on fertility remains constant across other factors. The analysis is based on the data from the National Family Health Survey-1 in Kerala. The analysis found that large Hindu-Muslim fertility differences at a low level of education do not persist at higher levels. For contraceptive use, wider gaps are found at a middle level of education and at a medium level of standard of living than at lower and higher levels. This indicates that couples at different socioeconomic settings make different decisions in spite of belonging to the same religion. The fact that fertility of Muslims at higher levels of socioeconomic status is low, and not much different than the fertility of other religions, suggests that the observed fertility gap between Hindus/Christians and Muslims is a passing phenomenon.     

Why are uneducated women in India using contraception? A multilevel analysis

While women's education continues to be strongly associated with lower fertility in India, an important feature of India's current fertility transition is the spread of contraceptive use among uneducated women. Indeed, changes in their fertility are now making the major contribution to the country's overall fertility decline. We use multilevel statistical procedures to investigate the variation in contraceptive use among uneducated women across India. The analysis suggests that, while many of the expected socio-economic variables play their part, there are also considerable diffusion effects in progress, many of which operate at levels beyond the uneducated women's own individual circumstances. For example, we find significant relationships with others' use of contraception and others' education. Mass media exposure also emerges as an important diffusion channel. The multilevel analysis also reveals significant clustering of contraceptive use at different levels, much of which is accounted for by the variables included in the models.     

A components method for measuring the impact of a family planning program on birth rates

One of the major goals of family planning programs worldwide has been to reduce the level of fertility in hopes of slowing the rate of natural increase and promoting social and economic development. Such programs have now been in existence for sufficient lengths of time to have had an impact on fertility levels. In general countries with organized family planning programs, marked declines in fertility levels have been observed. The extent to which such declines may be credited to organized programs has not been rigorously measured because an appropriate research methodology has been lacking. This paper describes one method of directly linking declines in fertility levels to the contraceptive protection experienced by a population. The contribution of organized family planning programs is estimated by decomposing the amount of total contraceptive protection into within-program and outside-program sources.     

The demographic transition in southern Africa: Another look at the evidence from Botswana and Zimbabwe

Botswana and Zimbabwe have been acclaimed as being on the vanguard of the demographic transition in sub-Saharan Africa. This paper examines the comparability of the CPS and the DHS data for each country and finds that part of the observed decline in aggregate fertility rates in both countries can be attributed to differences in sample composition. Women of the same cohort tend to be better educated in the second survey relative to the first. This fact explains part—but not all—of the observed fertility decline; for example, it appears to account for up to half the observed decline among women age 25–34 in 1984 in Zimbabwe.     

Fraught with Ambivalence: Reproductive Intentions and Contraceptive Choices in a Sub-Saharan Fertility Transition

Demographic studies that search for signs of fertility transition in sub-Saharan Africa rarely examine the complex gamut of individual aspirations and misgivings, hopes and frustrations, failures and triumphs that accompany the emerging declines of fertility rates in the subcontinent. This study draws upon qualitative data collected in peri-urban areas of Maputo, Mozambique’s capital and largest metropolis, to explore contradictory meanings and feelings surrounding changes in fertility intentions and contraceptive choices. It argues that although changes in these two aspects of reproductive life are interrelated, they are predicated on distinct types and configurations of external pressures and psychological apparatus, which is often manifested as a puzzling disjunction between fertility preferences and contraceptive use. This disjunction can be further reinforced by persistent gender divisions in reproductive views and strategies. Informal social interaction plays an important role in building societal consensus over fertility matters, but because such interaction deals with reproductive intentions and contraceptive use through largely different mechanisms, it may also help accentuate the intentions-contraception disjunction. This study’s findings therefore call upon both researchers and policymakers to attend more closely to the multidimensionality of fertility transitions in sub-Saharan societies and specifically to the complexities underlying such popular notions as “unmet need for family planning,” “spacing” versus “limiting” births, or “spousal communication” on reproductive matters.     

The roles of individuals' socioeconomic characteristics and the government family planning program in China's fertility decline

This paper explores answers to the following two questions: first, did individuals' socioeconomic characteristics play any role in the rapid fertility decline that occurred in China during the 1970's? Secondly, if the rapid fertility decline during the 1970s is mostly a result of the government policy, as many have perceived, to what extent was the government policy effective? Using the 1982 Chinese 1/1000 fertility survey data for Hebei province of China, this paper examines variation in fertility among women of two age cohorts by linking their fertility outcome with their socioeconomic background and earlier reproductive experiences. In addition, this paper assesses the effect of government policy by comparing the determinants of fertility outcome between two cohorts of women and by studying the factors affecting their current contraceptive use. The findings reveal that the individual's socioeconomic background was important in explaining earlier fertility variation. Government policy, although powerful enough to override most of the effect of socioeconomic factors on fertility, was not able to eliminate differences in contraceptive behavior among Chinese women.     

Do statements about desired family size predict fertility? the case of Taiwan, 1967–1970

The predictive accuracy of respondents' statements about their future fertility is examined, using interview data from a longitudinal study conducted in Taiwan. Two measures of preference are found to be highly intercorrelated; and regardless of which one is used, Taiwanese women are shown to predict their subsequent fertility at least as well as U.S. women. The preference measures are also predictive of rates of contraceptive use and abortion. While demographic and social characteristics are correlated with fertility in expected directions, statements about wanting more children prove to be highly predictive of subsequent fertility for both modern and less advanced segments of the population.     

Understanding stalling demographic transition in high-fertility countries: a case study of Guatemala

The debate surrounding the use of period, cohort, and tempo-adjusted measures has framed most of the recent studies evaluating the utility of macro-level fertility indicators. Period measures are susceptible to distortions, due to birth timing changes, but there is currently no universally accepted adjustment technique. Recent comparative analyses have offered some insights but only as applied to the low-fertility developed world setting. The utility of different types of measures in the high fertility context is unclear. Furthermore, regional variation in the pace of fertility transition is characteristic of many less developed countries and is rarely incorporated into macro-level analyses. The purpose of this analysis is to evaluate macro-fertility indicators at the regional and national levels in a high-fertility country, Guatemala, using the four most recent survey data sets. The results support the use of macro-level period indicators and adjusted period indicators of fertility in developing country contexts.     

Sex preference and fertility: what is the link?

It is argued that investment in programs for changing attitudes toward sex preference may not have the greatest impact on reducing fertility or increasing fertility control. Arnold's new method of analysis of determining sex preference was applied to data from a 1977 Egyptian survey of 36,000 rural households in Menoufia Governorate. Findings indicated that couples increased their use of modern contraceptives in direct proportion to an increase in the number of sons. Arnold determined that a large majority of all couples would have at least one boy early in their childbearing years. Thus sex preference would not have a large effect on fertility. Arnold's analysis among 27 countries found that without any sex preference, contraceptive usage would increase by an average of less than 3.7 percentage points. Arnold found that sex preference was strongest in Asia, particularly in South Korea and Taiwan that already have reduced fertility levels. In Africa, where fertility is high, the total elimination of sex preference would have only a 2.9 percentage point difference in contraceptive use. Sex preference had small effects on the percent of women who practice contraception, the percent who desire no more children, and the average number of additional children wanted. For example, in Bangladesh having no sex preference would show a percentage difference of 1.6 percentage points for contraceptive use, 4.7 percentage points difference for women desiring no more children, and -0.1 percentage point difference for the average number of additional children wanted. The effect of having no sex preference was strongest in India compared with Bangladesh, Indonesia, Nepal, the Philippines, Thailand, Ghana, Kenya, Costa Rica, Haiti, Paraguay, and Peru. The effect of no sex preference in India would have the respective percentage point effect of 3.7, 8.9, and -0.2. Public policy should be directed to information, education, and communication with other social goals.     

Community-level determinants of contraceptive use in the Philippines: A structural analysis

We use household and community data from the Philippines to estimate a multilevel model of contraceptive use. We go beyond previous efforts in this field by developing a structural model that recognizes joint endogeneity and the temporal ordering of variables, by considering a wider range of community influences on fertility behavior, and by employing an econometric procedure allowing for a multilevel error structure. The results suggest that there are significant effects on fertility behavior of community-level family planning services, labor-market conditions, and infrastructure development. These results provide insights regarding the structural determinants of contraceptive use and fertility that are useful for drawing policy implications.     

The contribution of HIV to fertility decline in rural Zimbabwe, 1985-2000

HIV-related sub-fertility has been reported for those populations in sub-Saharan Africa in which contraceptive use is low. We use data from a retrospective survey in rural Zimbabwe and multivariate logistic regression models to show that recent birth rates and current pregnancy rates are also lower among HIV-positive women than among HIV-negative women in those African populations where contraceptive use is high. The fertility reduction is smaller than where contraceptive use is low because age at first sexual intercourse is later and birth rates at older ages are already low. Nevertheless, total fertility is approximately 8.5 per cent lower and HIV-associated sub-fertility may account for as much as one-quarter of fertility decline in Zimbabwe since the late 1980s. Mechanisms for HIV-associated sub-fertility in rural Zimbabwe include more frequent widowhood and divorce, reduced coital frequency, increased amenorrhoea, and possibly, pelvic inflammatory disease. Miscarriage appears to be a less important factor than elsewhere possibly because syphilis is rare.     

Recent trends in Tanzanian fertility

This paper provides an assessment of the nature and magnitude of Tanzania's recent fertility decline, using robust methods for the identification of fertility trends. A decline in Tanzanian fertility began some time in the late 1970s or early 1980s. The pattern of decline exhibits similarities to patterns identified some years ago in Zimbabwe and Kenya. The decline has been especially marked in urban areas. It has been accompanied by a rapid rise in contraceptive prevalence from the very low levels before 1990 to just under 20 per cent of currently married women of reproductive age. Although falling marital fertility associated with a rise in contraceptive use is the main contributor to the decline in fertility, a rise in the average age at marriage has also made a (smaller) contribution, as has the AIDS epidemic. The fact that fertility is declining in Tanzania raises questions about the social and economic requirements for fertility transitions to begin in sub-Saharan Africa.     

Attitudes About Children and Fertility Limitation Behavior

The relationship between attitudes and individual behavior is at the core of virtually all demographic theories of fertility. This paper extends our understanding of fertility behavior by exploring how psychic costs of childbearing and contraceptive use, conceptualized as attitudes about children and contraception, are related to the transition from high fertility and little contraceptive use to lower fertility and wide spread contraceptive use. Using data from rural Nepal, I examine models of the relationship between multiple, setting-specific attitudes about children and contraception and the hazard of contraceptive use to limit childbearing. Specific attitude measures attempt to capture the relative value of children versus consumer goods, the religiously based value of children, and the acceptability of contraceptive use. Findings demonstrate that multiple measures of women’s attitudes about children and contraception were all independently related to their fertility limitation behavior.