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.     

Effects of Lactation on Post-partum Amenorrhoea: Re-estimation Using Data from a Longitudinal Study in Guatemala

In this paper we re-estimate the effects of breastfeeding patterns on the timing of resumption of menses after controlling for maternal nutrition and maternal stressor variables. The analysis shows that simple hazard models, used on data from a longitudinal study in Guatemala, provide estimates of effects on timing of resumption of menstruation that are (a) comparable to others discussed in the recent literature and (b) generally consistent with hypotheses relating patterns of lactation, maternal nutritional status, and maternal stressors to processes that accelerate (decelerate) resumption of anovulatory cycles.     

Estimation of Adult Mortality From Orphanhood Before and Since Marriage

The prevalence of intentional control of reproduction increases in developing countries in which there is rapid modernization, and there are also important changes in breastfeeding practices. The effects of increased contraception and reduced breastfeeding on the pace and level of fertility and on the patterns and levels of infant and early childhood mortality are in opposite directions. In this paper we propose a technique to estimate the net effects of such changes on the natural rate of increase, and to assess the gross contribution of the various components of change. Applications of the technique to Latin American countries indicate that changes in fertility due to higher contraceptive prevalence are dominant, but that they are partially offset by the indirect effects on fertility of changes in breastfeeding. Likewise, changes in breastfeeding have the strongest direct impact on infant mortality, but are partially offset by the beneficial effects of a more favourable pace of childbearing induced by higher contraceptive prevalence.     

The fertility impact of changes in the timing of childbearing in the developing world

This study examines the role of tempo effects in the fertility declines of less developed countries. These effects temporarily inflate the total fertility of a population during periods when the age at childbearing declines and deflate it when childbearing is postponed. An analysis of data from the World Fertility Surveys and the Demographic and Health Surveys demonstrates that fertility trends observed in many less developed countries are likely to be distorted by changes in the timing of childbearing. In most countries women are delaying childbearing, which implies that observed fertility is lower than it would have been without tempo changes. This pattern is most clearly documented in Taiwan, where accurate birth statistics from a vital registration system make it possible to estimate the tempo components of fertility annually from 1978 to 1993. The small but unexpected rise in the total fertility of Colombia in the early 1990s is attributed to a decline in the negative tempo distortion that prevailed in the 1980s. Similar interruptions of ongoing fertility declines may occur in the future in other countries when existing negative tempo effects are removed.     

Breastfeeding women and family planning programs: special needs and opportunities

Although breastfeeding makes a major contribution to fertility control and child spacing in many developing countries, the implications of this are not widely recognized. Terminology may be part of the reason. Contraception may imply something modern, whereas the contraceptive effect of breastfeeding is a natural biological mechanism. Also, many family planning program managers are educated in the West, where breastfeeding is of little contraceptive importance. Regardless of where they were educated, they may consider the pregnancy-postponing effects of breastfeeding as mythology, or may consider breastfeeding as sufficiently effective at the individual level. Breastfeeding as a family planning method cannot be "delivered" to women by family planning methods, and requires an educational approach rather than a clinical or medical approach. A women might use breastfeeding more confidently in avoiding an unplanned pregnancy if she begins using a contraceptive method as soon as she resumes menses, when she begins giving her baby food supplements, or by 6 months post partum--whichever comes first. She can achieve high effectiveness in avoiding pregnancy by keeping the baby nearby and feeding on demand, feeding frequently, sleeping near the baby and maintaining nightfeedings, not giving the baby bottles or pacifiers, and giving the baby only breastmilk for at least 4 months. Breastfeeding can only be used by new mothers and cannot be used to postpone the 1st birth. Nor is it appropriate for women who have attained their desired family size, or who wish to avoid or postpone pregnancy at any cost.     

Economic blessings seen in Z.P.G

According to S.F. Singer and Bradley W. Perry in their study published by the Joint Economic Committee of Congress, the U.S. and its individual workers will be better off economically if population growth is reduced to zero. Making use of a computer, the researchers tested 3 fertility rates in mathematical models simulating the U.S. economy, population, and resources. They found that decreased childbearing would lead eventually to a smaller overall Gross National Product, but the share of economic welfare per person would increase. Lower fertility would have the following advantages according to Singer and Perry: 1) reduced requirements for business investment to keep up with an expanding labor force; 2) reduced depletion of and demand for the finite amounts of natural resources, resulting in lower costs and less need for marginal resources; 3) smaller expenditures for pollution control and less degradation of the environment; 4) a higher proportion of Americans in the usual working ages; and 5) smaller expenditures therefore, for schooling and child care, but without significantly increased medical expenditures for the elderly. The lower fertility option tested by computer was a completed fertility rate of 1.7 children/woman, along with net immigration of 400,000. This option would lead to an end of population growth in 50 years.     

An analysis of major proximate determinants of our fertility]

The sample survey of fertility, in Shanghai city and Shanxi and Hebei provinces of China in 1985, provided plentiful data about fertility, marriage, contraceptive usage and breastfeeding in terms of The World Fertility Survey Model. The data, along with Bongaarts' model, was utilized to analyze the relation between several proximate determinants and fertility changes. When comparing these three geographic areas, the largest difference was breastfeeding and the smallest one was non- contraceptive usage. It was very different from the results of The World Fertility Survey in developing countries in 1977. The difference of marriage indexes among three areas was close to that of breastfeeding; but for the effects on induction of fertility, marriage index surpassed breastfeeding. There were two models showing effective efficacy on fertility decline. One was the Shanghai model, in which much more effect came from marriage delay, accounting for 71%; another was the Hebei model, induction of fertility was caused by contraceptive usage, about 53%. Both indicated that the major factor affecting fertility decline was the family planning program. Otherwise, it seemed to indicate that different factors such as social, economic development indirectly decreased fertility through family planning programs.     

The private and societal economic costs of teenage childbearing: The state of the research

The most significant individual costs of teenage childbearing are associated with truncated educations and lost human capital investment. Among the most significant direct public costs are the expenditures of just three government programs: AFDC, Food Stamps, and Medicaid. An important public cost of teenage childbearing overlooked by many researchers is the cost to U.S. productivity of large numbers of undereducated and impoverished mothers in the work force, and the intergenerational transfer of this impoverishment to their children. Any restrictions on abortion will likely increase unwanted teenage fertility, and its associated costs, particularly among the disadvantaged.     

Migration and fertility in the Philippines: Hendershot's selectivity model revisited

A demographer compared 1983 data on 5092 currently married migrant and nonmigrant women living in the Philippines to determine whether migration was still selective in terms of fertility behavior or not. Fertility was basically the same between migrant and nonmigrant women in their early reproductive years, but clear differences existed between older migrants and nonmigrants as indicated by children ever born (CEB). In fact, migration did not significantly affect cumulative fertility at all (correlation ratio=.03). Moreover its effect was further reduced when the researchers controlled for age and duration of marriage. Besides level of education and contraceptive use status contributed more to explanations of fertility differentials (correlation ratio=.09 for both) than did migration. The mean number of CEB adjusted for all variables fell with level of education from 4.18 for those with primary education to 3.63 to those with college education. This result identified education as a means to reduce high fertility in the Philippines. On the other hand, the mean was higher among women who ever used contraception than it was for those who never used it (4.21 vs. 3.72). Apparently considerable family size motivated mothers to use contraception. Since women who migrated to cities tended to be in the beginning of their reproductive period, considerable natural increase could occur in urban areas. Therefore the Philippines needed to devise a strategy for reducing fertility among migrant women as well as strategies for other groups such as professional/career oriented women and women who remained at home to tend to children and/or the home.     

Recent changes in Negro fertility

Crude birth rates for the Negro population of the United States indicate that fertility declined while Negroes remained in the South and them climbed in the last twenty-five years as Negroes became urbanized. Cohort rates show more precisely the effects of the Depression upon childbearing as well as the magnitude and persistence of the post-Depression rise in fertility. More Negro women now become mothers, average family size has increased, and the proportion of women bearing six, seven, or eight children has risen. Negro fertility has risen despite the urbanization of Negroes and improvements in their socio-economic characteristics. Negro fertility rates present the paradox of falling when demographic transition theory would predict the maintenance of high rates and then rising when a decline would be expected. Urbanization does not appear to have reduced Negro fertility. Traditionally, urban living has dampened childbearing in two ways—first, health conditions in cities were inferior to those of rural areas, and thus urbanization affected fecundity adversely; second, city residents are more likely to know about and adopt birth control than rural residents. Negroes migrated to cities at the very time when diseases were being controlled and when public health and welfare facilities were being expanded to serve all residents. This has contributed to higher Negro fertility rates. If fertility rates are to fall because of family planning, not only must birth control be available but there must be a desire to limit family size. Such a desire may be linked to opportunities for social mobility. Negroes have not been assimilated into urban society as previous in-migrant groups were, and opportunities for mobility have been restricted. For these reasons Negroes may be slow to adopt stable monogamous families and the intentional control of fertility.     

Why is contraceptive use inversely associated with lactational amenorrhoea? Qualitative and quantitative insights from Bangladesh

Over the past 15–20 years observations in many parts of the world have revealed a negative association between the natural protection afforded by lactational amenorrhoea and contraceptive uptake. This paper uses qualitative and quantitative data to explore the possible explanations for this nagative association in two Bangladeshi populations, one urban and one rural. The findings suggest that a subconscious substitution of contraceptive protection for natural protection against pregnancy is the most likely explanation. It appears that shorter durations of exclusive breastfeeding have led to earlier resumption of menses which in turn prompts the use of contraception. However, other mechanisms appear to play a subsidiary role, at least in the rural population. Moreover, changes in breastfeeding cannot be viewed as totally independent of the promotion of modern family planning. Evidence suggests that family planning staff are poorly equipped to support breastfeeding, and may often encourage the early introduction of supplements. There is a need to consider ways of promoting exclusive breastfeeding as well as ensuring ready access to contraception when fecundity resumes postpartum. Only such an integrated approach is likely to ensure that both negative effects on child health and unwanted pregnancies are avoided.     

Birth delays skew developing world's fertility figures

This article explains that birth delays skew developing world's fertility figures. When successive groups of women who have delayed childbearing start having children, the rapid fertility decline stalls. Such change in the timing of childbearing skews the total fertility rate (TFR). Analysis of the tempo component of TFR trends in Taiwan suggests that tempo effects reduced its TFR by about 10% in the late 1970s and early 1990s and by about 19% in the late 1980s. In Colombia, on the basis of increasing mean maternal age at childbirth between the 1970s and the late 1980s, tempo distortions of the TFR during the most of the 1980s seem likely. Moreover, many developing countries are now experiencing rapid fertility declines that are in part attributable to tempo changes. These changes have accelerated past fertility transitions, but they also make these countries vulnerable to future stalls in fertility when the delays in childbearing end. Since fertility reductions caused by tempo effects lead to real declines in birth rates and hence in population growth, countries that wish to reduce birth rates can take actions that encourage women to delay marriage and the onset of childbearing.     

Employment first,then childbearing: Women's strategy in post-socialist Poland

Poland experienced a rapid fertility decline after the end of the socialist regime in 1989. At the same time, it became much more difficult, especially for women, to act on their determination to find and keep paid employment. To investigate whether women postponed childbearing until they found a job, we undertook a simultaneous estimation of transitions to childbirth and entry to and exit from employment. The results reveal a strong incompatibility between childbearing and employment, but also that employment does not function as a barrier to childbearing but rather that it is an important precursor when women plan how to reconcile their intentions to work and to have children. We conclude that better prospects for women's employment could result in increased fertility.     

Family influences on family size preferences

Several studies have demonstrated important effects of parents’ childbearing behavior on their children’s childbearing preferences and behavior. The study described here advances our understanding of these family influences by expanding the theoretical model to include parental preferences, siblings’ behavior, and changes in children’s preferences through early adulthood. Using intergenerational panel data from mothers and their children, we test the effects of both mothers’ preferences for their own fertility and mothers’ preferences for their children’s fertility. Although both types of maternal preferences influence children’s childbearing preferences, mothers’ preferences for their children’s behavior have the stronger and more proximate effects. Mothers’ preferences continue to influence their children’s preferences through early adulthood; siblings’ fertility is an additional determinant of children’s family size preferences.     

Future population growth: researchers in three countries quantify causes and propose policies

This article discusses Population Council analyses conducted by social scientists from India, Kenya, and the Philippines. These scientists agreed that population momentum would continue to increase population size, and that governments must strengthen and create a range of economic, health, and social programs and policies to slow population growth. Multiple approaches will be needed. John Bongaarts is credited with being the first to identify the key role of population momentum and to decompose growth into unwanted fertility, high desired fertility, and population momentum. Unwanted fertility is responsible for about 19% of projected population growth in India, 26% in Kenya, and 16% in the Philippines. High wanted fertility accounts for 20% of future growth in India, 6% in Kenya, and 19% in the Philippines. Population momentum can account for under 50% or over 90% of growth. Unwanted fertility can be addressed by fulfilling unmet need and increasing knowledge of methods, reducing the fear of side effects and disapproval, and eliminating poor service. Family planning programs need to be strengthened and integrated with maternal and child health services. Preferred and actual family sizes can be reduced by lowering infant mortality by means of increasing infant and child health services and girls' educational attainment. Population momentum can be addressed by delaying age at marriage and childbearing through improving social conditions. Investments in human development through education, training, and income generation can create the conditions for slowing population growth. Countries should decompose population growth into its components of unwanted and high wanted fertility and population momentum as a means of distributing resources most effectively.     

Happiness and Childbearing Across Europe

Using happiness as a well-being measure and comparative data from the European social survey we focus in this paper on the link between happiness and childbearing across European countries. The analysis motivates from the recent lows in fertility in many European countries and that economic wellbeing measures are problematic when considering childbearing. We find significant country differences, though the direct association between happiness and childbearing is modest. However, partnership status plays an important role for both men and women. Working fathers are always happier, whereas working mothers are not, though mothers?? happiness tends to increase with household income.     

How parenthood experiences influence desire for more children in Australia: A qualitative study

The low-fertility debate in developed countries has focused on the limits to family size posed by the financial costs of raising children, and difficulties combining work and family. Little attention has been given to the physical and socio-psychological experiences of conception, pregnancy, birth and early parenthood, and their potential effect on parity progression. Womens rising education and workforce participation rates are often seen as key factors in fertility decline, offering attractive alternatives to motherhood, but research suggests that they also undermine levels of knowledge, confidence and interest in motherhood. Demographers have made almost no link between people having fewer children than they might otherwise have had and their previous childbearing and childrearing experiences. Interviews conducted in South Australia in 2003–04 with parents of both small and large families show that fertility and family size are influenced both negatively and positively by experiences of having had children. The paper argues that if low fertility rates are to be stabilized or raised in developed countries, then researchers and policymakers must consider the physical and socio-psychological costs of having children for parents, and provide support mechanisms so that experiences of parenthood contribute as little as possible to fertility gaps and delayed fertility.     

Another Child? Fertility Ideals,Resources and Opportunities

Low fertility in most developed countries has prompted policy concern in relation to labour market supply, pensions, and expenditure on health and welfare services as well as policy debate about both the cost of children and the opportunity costs of parenthood. The extent to which family policy interventions can be effective in slowing or reversing fertility decline is much debated. This paper, based on a fertility module of the Scottish Social Attitudes Survey 2005, examines the current fertility, and ideal and expected fertility of a nationally representative sample of 455 parents of reproductive age and focuses on whether they plan to have another child. It compares the characteristics of those who intend to have another child with those who do not, and how parents with one child differ from those with more children. It addresses three questions about family size: (1) fertility ideals, (2) resources and the economic implications of childbearing, and (3) opportunities for childbearing and the effects of a late start on fertility expectations. It concludes that, despite a sustained period of low fertility in Scotland, childbearing ideals are robust and explanations of low fertility must derive from difficulties in realising those ideals. Difficulties in realising fertility aspirations are associated less with resources than with opportunities for childbearing, especially the timing of first birth. Those who delay their first birth are less likely to realise their ideal family size, and their lower fertility is associated with the opportunity costs of childbearing in terms of foregone qualifications, careers and earnings.     

Mothers’ attitudes and beliefs about infant feeding highlight barriers to exclusive breastfeeding in American Samoa

BackgroundIn American Samoa, initiation of breastfeeding is almost universal but exclusive breastfeeding, a promising target for obesity prevention, is short in duration.Aims(1) To examine American Samoan mothers’ feeding experiences and attitudes and beliefs about infant feeding and (2) to identify potential barriers to exclusive breastfeeding.MethodsEighteen semi-structured interviews were conducted with American Samoan mothers at 16–32 days postpartum. Interviews focused on mother's knowledge and beliefs about infant feeding, how their infants were fed, why the mother had chosen this mode of infant feeding, and how decisions about feeding were made within her social surroundings. A thematic qualitative analysis was conducted to identify salient themes in the data.FindingsIntention to exclusively breastfeed did not predict practice; most women supplemented with formula despite intending to exclusively breastfeed. The benefits of breastfeeding were well-recognized, but the importance of exclusivity was missed. Formula-use was not preferred but considered an innocuous “back-up option” where breastfeeding was not possible or not sufficient for infant satiety. Identified barriers to exclusive breastfeeding included: the convenience of formula; perceptions among mothers that they were not producing enough breast milk; and pain while breastfeeding. The important support role of family for infant feeding could be utilized in intervention design.ConclusionThis study identified barriers to exclusive breastfeeding that can be immediately addressed by providers of breastfeeding support services. Further research is needed to address the common perception of insufficient milk in this setting.