Birth-interval dynamics in rural Bangladesh and maternal weight

This article reports on the results of a study conducted in rural Bangladesh on the influence of maternal weight on the components of birth intervals, including gestation and intrauterine mortality, the duration of postpartum amenorrhea, and the duration of waiting time to conception (the menstrual interval). When biological factors (including maternal age, parity, and supplementation practices) and behavioral variables, including religion, education, and occupation, were controlled, maternal weight was found to be related to the risk of intrauterine mortality and to the probability of resuming menses in the postpartum period. The implications of these findings for policies and programs in developing countries are discussed.     

Changes in fertility patterns can improve child survival in Southeast Asia

This analysis of 1988 Philippine Demographic Survey data provides information on the direct and indirect effects of several major determinants of childhood mortality in the Philippines. Data are compared to rates in Indonesia and Thailand. The odds of infant mortality in the Philippines are reduced by 39% by spacing children more than two years apart. This finding is significant because infant mortality rates have not declined over the past 20 years. Child survival is related to the number of children in the family, the spacing of the children, the mother's age and education, and the risks of malnutrition and infection. Directs effects on child survival are related to infant survival status of the preceding child and the length of the preceding birth interval, while key indirect or background variables are maternal age and education, birth order, and place of residence. The two-stage causation model is tested with data on 13,716 ever married women aged 15-49 years and 20,015 index children born between January 1977 and February 1987. Results in the Philippine confirm that maternal age, birth order, mortality of the previous child, and maternal education are directly related to birth interval, while mortality of the previous child, birth order, and maternal educational status are directly related to infant mortality. Thailand, Indonesia, and the Philippines all show similar explanatory factors that directly influence infant mortality. The survival status of the preceding child is the most important predictor in all three countries and is particularly strong in Thailand. This factor acts through the limited time interval for rejuvenation of mother's body, nutritional deficiencies, and transmission of infectious disease among siblings. The conclusion is that poor environmental conditions increase vulnerability to illness and death. There are 133% greater odds of having a short birth interval among young urban women than among older rural women. There is a 29% increase in odds for second parity births compared to third or higher order parities. Maternal education is a strong predictor of infant survival only in the Philippines and Indonesia. Adolescent pregnancy is a risk only in Indonesia. Socioeconomic factors are not as important as birth interval, birth order, and maternal education in determining survival status.     

Famine,Maternal Nutrition and Infant Mortality: A Re-examination of the Dutch Hunger Winter

During the Dutch Hunger Winter (1945), a unique, documented example of mass famine in an industrialized population, total reproductive loss (fetal and infant mortality) among most exposed mothers remained relatively low. This is explained by highly favourable fetal mortality and unfavourable infant mortality. The author traces the pattern of low fetal mortality to the higher levels of ‘embodied health status’ of famine mothers. The high infant mortality of the famine area testifies to the severity of the food and fuel shortage, yet another factor held down the rate of stillbirth. This other factor, it is argued, has a socio-economic character, it is the intrinsic ‘embodied’ nutritional status of the regional population, arising from favourable opportunities for growth and development among successive generations of mothers. This explanation highlights the importance of maternal vitality, (a synthetic, historically variable and culturally determined phenomenon) as a neglected feature of historical demography.     

Prospective study of birth interval dynamics in rural Bangladesh

Abstract A group of 209 married, fecund women in rural Bangladesh were studied prospectively for 24 months from 1969 to 1971 to define some of the biological and sociological factors relating to fertility performance. These women were selected from a larger study population of 112,000 that had been followed with a daily house-to-house vital registration programme since 1966. The selected women were interviewed bi-weekly and were asked questions about menstruation, pregnancy, lactation, husband's occupational absences, and monthly urine tests for pregnancy were taken. The results for 193 non-contracepting women revealed that the seasonal pattern of births previously observed in this population could be associated with a corresponding seasonal pattern of conceptions and that this was due to a seasonal trend in fecundability. The highest conception rates were in the coolest months of the year. Post-partum lactational amenorrhoea was very prolonged, averaging 17 months for women with a surviving child. The appearance of the first post-partum menstrual flow (onset of ovulation) also had a seasonal trend which could not be adequately explained. The median waiting time to conception, once menstruation had resumed was eight months. This interval was influenced by seasonal fluctuations, as well as by the age of women and by husbands' absences. The foetal wastage rate was 15·0 per 100 conceptions, with 62 per cent of the foetal losses occurring during the second month of gestation. Overall, the average birth interval was 33 months, with the prolonged lactational amenorrhoea accounting for almost 45 per cent of this interval. From the Department of Population Dynamics, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Maryland 21205.     

The Level and Age Pattern of Mortality in Bandafassi (Eastern Senegal): Results From a Small-Scale and Intensive Multi-Round Survey

The data collected in the Bandafassi demographic study in Eastern Senegal, a small-scale intensive and experimental follow-up survey of a population of about 7,000 in 1983, were analysed to derive an estimated life table. The use of multi-round surveys, combined with anthropological methods to estimate ages and collect genealogies, has resulted in unusually reliable data. Taking into account the uncertainty of the estimates due to the small size of the population, mortality was high, with life-expectancy at birth close to 31 years; a pattern of infant and child mortality close to that observed in other rural areas of Senegal, with a very high level or mortality between ages six months and three years; a seasonal pattern in child mortality with two high-risk periods, the rainy season and the end of the dry season; an adult mortality pattern similar to that described in model life tables for developed countries; no significant difference by sex or ethnic group. The Bandafassi population study and a few similar studies suggest that one possible way to improve demographic estimates in countries where vital registration systems are defective would be to set up a sample of population laboratories where intensive methods of data collection would continue for extended periods.     

Mothers’ Marital Status and Type of Delivery Medical Care in Guatemala

The use of modern medical care for child delivery in rural Guatemala is low relative to other Latin American countries. In the previous literature, factors such as a woman’s age, education, ethnicity, religious affiliation and income are found to be important determinants of the type of delivery medical care she receives. This study hypothesizes that a woman’s marital status influences her decision as well. Using a binomial logit framework, the study finds that unmarried women are more likely to see a modern medical provider in delivery than married women, even after controlling for demographic, socioeconomic, and husbands’ characteristics. Therefore, unmarried women seem to make more informed decisions in terms of their attitudes in childbearing and maternal health relative to their married counterparts. As a result, both economic as well as social developments seem necessary to induce changes in the high incidence of maternal mortality and morbidity in Guatemala.     

A Model of Age-specific Fecundability

A new model of the behavioural and physiological causes of age-specific variation in marital fecundability is presented. Total fecundability is decomposed into a series of susceptibility factors (the length of ovarian cycles, the length of the fertile period within each cycle, the probability that a cycle is ovulatory, and the likelihood that an act of unprotected intercourse within the fertile period results in conception) and an exposure factor reflecting the effect of duration of marriage on coital frequency. The impact of intra-uterine mortality on effective fecundability is also modelled. Data on western women, from which standard age curves of fecundability are estimated, suggest that any decline in fecundity between ages 30 and 40 is attributable to changes, not in the ability to conceive, but in the capacity to carry a pregnancy to term. Sensitivity tests suggest that the most important potential sources of inter-population variation in fecundability are intra-uterine death and the incidence of anovulatory cycles.     

Prospective study of birth interval dynamics in rural Bangladesh

A group of 209 married, fecund women in rural Bangladesh were studied prospectively for 24 months from 1969 to 1971 to define some of the biological and sociological factors relating to fertility performance. These women were selected from a larger study population of 112,000 that had been followed with a daily house-to-house vital registration programme since 1966. The selected women were interviewed bi-weekly and were asked questions about menstruation, pregnancy, lactation, husband's occupational absences, and monthly urine tests for pregnancy were taken. The results for 193 non-contracepting women revealed that the seasonal pattern of births previously observed in this population could be associated with a corresponding seasonal pattern of conceptions and that this was due to a seasonal trend in fecundability. The highest conception rates were in the coolest months of the year. Post-partum lactational amenorrhoea was very prolonged, averaging 17 months for women with a surviving child. The appearance of the first post-partum menstrual flow (onset of ovulation) also had a seasonal trend which could not be adequately explained. The median waiting time to conception, once menstruation had resumed was eight months. This interval was influenced by seasonal fluctuations, as well as by the age of women and by husbands' absences. The foetal wastage rate was 15·0 per 100 conceptions, with 62 per cent of the foetal losses occurring during the second month of gestation. Overall, the average birth interval was 33 months, with the prolonged lactational amenorrhoea accounting for almost 45 per cent of this interval.      

Significance and effect of the population census]

A summary of topics on which the Chinese government is seeking further information through the 1982 census is provided. Topics to be covered include total population; fertility, mortality, and growth rates; urban and rural population distribution; population projections, including age, sex, and marital status characteristics; labor force size; and minority population estimates.     

Reproductive patterns and child mortality in guatemala

In this paper, we investigate the association of child mortality with maternal age, parity, birth spacing, and socioeconomic status, in a sample of Guatemalan children who were included in a public health intervention program. Our results indicate that maternal age, birth order, and the length of the previous and following birth intervals all have a significant impact on the risk of child mortality and that these associations cannot be accounted for by differences in breastfeeding, socioeconomic status, or the survival status of the previous child.     

Famine,Disease, and Mortality Patterns in the Parish of Borshevka,Russia, 1830–1912

Scholars have projected a dismal image of nineteenth-century, rural Russia as a society repeatedly punctuated by crop failures, famine, starvation, and epidemics of famine-related diseases. But there has been no rigorous attempt, using appropriate methods, to assess the nature of demographic crises in Russia and their contribution to overall mortality and population growth. The pattern of mortality evident in the parish under examination is distinguished by an extremely high incidence of infant, diarrhoeal diseases and childhood, infectious diseases. This unfavourable disease environment and resulting high rates of infant and early childhood mortality were more closely related to fertility levels, household size, housing conditions, and weaning practices than to annual or seasonal food availability and the nutritional status of the population. In a disease-driven society, the susceptibility to infection and the force of infection can, to a considerable extent, be determined by demographic factors, familial norms, and climatic constraints.     

Famine, disease, and mortality patterns in the parish of Borshevka, Russia, 1830-1912

Scholars have projected a dismal image of nineteenth-century, rural Russia as a society repeatedly punctuated by crop failures, famine, starvation, and epidemics of famine-related diseases. But there has been no rigorous attempt, using appropriate methods, to assess the nature of demographic crises in Russia and their contribution to overall mortality and population growth. The pattern of mortality evident in the parish under examination is distinguished by an extremely high incidence of infant, diarrhoeal diseases and childhood, infectious diseases. This unfavourable disease environment and resulting high rates of infant and early childhood mortality were more closely related to fertility levels, household size, housing conditions, and weaning practices than to annual or seasonal food availablity and the nutritional status of the population. In a disease-driven society, the susceptibility to infection and the force of infection can, to a considerable extent, be determined by demographic factors, familial norms, and climatic constraints.     

Maternal Age and Offspring Adult Health: Evidence From the Health and Retirement Study

Advanced maternal age is associated with negative offspring health outcomes. This interpretation often relies on physiological processes related to aging, such as decreasing oocyte quality. We use a large, population-based sample of American adults to analyze how selection and lifespan overlap between generations influence the maternal age?Coffspring adult health association. We find that offspring born to mothers younger than age 25 or older than 35 have worse outcomes with respect to mortality, self-rated health, height, obesity, and the number of diagnosed conditions than those born to mothers aged 25?C34. Controls for maternal education and age at which the child lost the mother eliminate the effect for advanced maternal age up to age 45. The association between young maternal age and negative offspring outcomes is robust to these controls. Our findings suggest that the advanced maternal age?Coffspring adult health association reflects selection and factors related to lifespan overlap. These may include shared frailty or parental investment but are not directly related to the physiological health of the mother during conception, fetal development, or birth. The results for young maternal age add to the evidence suggesting that children born to young mothers might be better off if the parents waited a few years.     

Health conditions in rural and urban areas of developing countries

The poor quality and meagre supply of data prohibit conclusions as to the relationship of health status to rural-urban residence in underdeveloped countries. Demographic indicators of health, specifically infant mortality and average life expectancy, do not seem to vary systematically according to rural-urban residence in the less developed countries ofAsia, Africa and Latin America. Further differences between rural and urban areas in availability of health services and facilities do not always conform with apparent differences between the areas in health status. However, nutritional standards, housing conditions, and sanitation, water supply and other pertinent environmental circumstances account to some extent for differences observed in health status between rural and urban inhabitants of these countries.     

A brief introduction to China's family planning programme

China's family planning program is described in reference to its goals, approaches, and achievements. Between 1949-83, China's population increased from 541 million to 1,024,950,000. The population has a young age structure, and the median age is 22.9 years. 80% of the population is rural, and 90% of the population lives in the southeastern region of the country. In view of this demographic situation, the government recognizes the need to control population growth. China's goals for the year 2000 are to increase industrial and agricultural input by 400% and to keep population size below 1.2 billion in order to ensure that per capita income increases. In accordance with these goals, the government, in 1979, began advocating a 1-child policy. To ensure the survival of single children, the government also launched a program to upgrade maternal and child health (MCH). In some rural areas and among certain minority groups, the 1-child restriction is not applied. Family size goals will vary with time. These variations will reflect the need to maintain a balance between economic growth and population growth. A variety of incentives are used to promote the 1-child family. For example, single children receive medical and educational benefits, and in some rural areas, the parents of single children can obtain additional land contracts. Economic disincentives are also used. The government seeks to obtain compliance with the policy primarily through educating the public about the consequences of uncontrolled population growth. All channels of the mass media are used to deliver the messages, and the publicity campaign is especially intensive in rural areas. A comprehensive plan to provided family planning and population education for middle school students is currently being implemented. Each local area develops its own fertility control plan. This plan is then incorporated into the nation's overall plan and the overall plan is implemented from above. Family planning workers bring free contraceptives directly to the people, and family planning motivators are found in almost all villages, neighborhood committees, factories, and military units. As a result of these efforts, China made great strides in controlling population growth and improving MCH during the last decade. The birth rate declined from 27.93 to 18.62, and the total fertility rate declined from 4.01 to 2.48. 124 million couples were practicing contraception by the end of 1983. 41% used IUDs, 37.4% relied on tubal ligation, 12.9% relied on vasectomy, 5.1% on oral contraceptives, and 1% on other methods. The quality of maternal and child care also improved. 92.7% of all deliveries are now performed by trained midwifes. Infant and maternal mortality rates declined considerablely in recent years. Currently the respective rates are 35.68/1000 live births and 0.5/1000 live births. In 1983 alone, the gross national agricultural and industrial output increased by 46.1%. Since 1979 per capita income increased annually by 18.3% among rural residents and by 10.7% among urban workers. China controls and operates its own population program, but in recent years, it increased its cooperation with UN Fund for Population Activities, other UN agencies, and nongovernment agencies. China recently completed its 3rd national census, and demographic research institutes have been established in 10 universities.     

The impact of childhood mortality on Fertility in six rural Thanas of Bangladesh

In this article, we examine the relationship between child mortality and subsequent fertility using prospective longitudinal data on births and childhood deaths occurring to nearly 8000 Bangladeshi mothers observed over the 1982-1993 period, a time of rapid fertility decline. Generalized hazard-regression analyses are employed to assess the effect of infant and child mortality on the hazard of conception, with controls for birth order and maternal age and educational attainment. Results show that childhood mortality reduces the time to subsequent conception if the death occurs within a given interval, representing the combined effect of biological and volitional replacement. The time to conception is also reduced if a childhood death occurs during a prior birth interval, a finding that signifies an effect of volitional replacement of the child that died. Moreover, mortality effects in prior birth intervals are consistent with hypothesized insurance (or hoarding) effects. Interaction of replacement with elapsed time suggests that the volitional impact of child mortality increases as the demographic transition progresses. This volitional effect interacts with sex of index child. Investigation of higher-order interactions suggests that this gender-replacement effect has not changed over time.     

Perspectives on antenatal education associated with pregnancy outcomes: Systematic review and meta-analysis

BackgroundMany studies on the relation between maternal health and infant health, including the effect of structured antenatal education, have been published and expanded over the years.AimInvestigate the impact of various antenatal education programmes on pregnancy outcomes to aid the development of future guidelines related to maternal and foetal health.MethodsBibliographic databases (Cochrane, PubMed, EMBASE, CINAHL, Korean Studies Information Service System) were searched up to November 2018, following the PICO criteria: population (pregnant women), intervention (antenatal education), comparison (not specified), and outcome (maternal and foetal outcome including physical or mental health components).FindingsWe included 23 eligible studies consisting of 14 controlled trials and 9 observational studies. The maternal physical outcomes depending on participation in antenatal education were not significantly different; however, the caesarean birth rate was lower in the antenatal education group (relative risk, RR, 0.90; 95% confidence interval, CI, 0.82–0.99), as was the use of epidural anaesthesia (RR, 0.84; 95% CI, 0.74–0.96). The maternal mental health outcomes of stress and self-efficacy significantly improved in the antenatal education group, although there was no difference in anxiety and depression. The foetal outcomes of birth weight or gestational age at birth were also not different between the groups.ConclusionAntenatal education can reduce maternal stress, improve self-efficacy, lower the caesarean birth rate, and decrease the use of epidural anaesthesia; however, there is limited evidence of its effects on maternal or foetal physical outcomes. Therefore, antenatal education should be standardised to elucidate its actual mental and physical health effects.     

Lee-Carter估计模式推算中国农村老年人口死亡率的研究

死亡率的估算与人口老龄化密切相关,中国60岁及以上老年人口主要集中在农村地区,本文运用Lee-Carter模型对农村分性别单岁组的死亡率数据进行建模,预测出农村人口死亡率与期望寿命的发展趋势。     

The International Parliamentary Assembly on Population and Development held in Mexico City

The International Parliamentary Assmebly on Population and Development took place on August 15-16, 1984, with the participation of more than 300 parliamentarians from 60 countries. The aim was to promote an exchange of views on population programs and policies among parliamentarians, and to support the recommendations adopted by the UN International Conference on Population. The assembly held discussion in 3 subcommittees on the subjects of 1) policies of population and development; 2) the legal and social status of women; and 3) the improvement of family planning service. On population policy, parliamentarians generally agreed that policy formulation is the prerogative of each sovereign country, stressing that such policies and programs should be integrated with social and economic development. The developing countries stronly demanded that a new international economic order be established and international aid increased to help them in solving the popultion problem. Concerning the status of women, the assembly unanimously agreed that both men and women should not only be legally equal, but should also have de facto equality for employment, education and social life. Attention should be given particularly to the rights and status of rural women. Examples of how the status of Chinese women has improved were offered by Chinese representative and were appreciated by the assembly. On improving family planning services, participants urged provision of information about birth control to people of marriageable age and of access to contraceptives to eligible couples; moreover, they advocated the strengthening of medical care for women and children and the lowering of infant and maternal mortality rates. Dr. Qian Xinzhong described the priorities and goals of family planning programs in China. Finally, the assembly unanimously adopted the "Action Plan," whose contents embody independence, respect for national sovereignty, and the spirit of cooperation and conformity to the interest of the international community, particularly the developing nations.     

High foetal mortality and birth intervals

Abstract Studies of birth intervals have generally separated the process into: (1) the period of infertility following a pregnancy termination; (2) the length ofthe interval from the end of the infertile period to the next conception (which reflects the probability of conception), and (3) the average duration of pregnancy for both live births and foetal deaths.(1) Empirically derived intervals between successive live births average from 19 to 30 lunar months(2) (Table 1), depending upon the population studied and the birth order.(3) Estimates of conception rates using birth intervals data require some estimate of the extent to which foetal wastage increases the birth interval.