The Effects of Breastfeeding and Nutrition on Fecundability in Rural Bangladesh: A Hazards-Model Analysis

Data taken from the ‘Determinants of Natural Fertility’ study, Bangladesh, are used with multivariate hazard models to study variations in fecundability between women, especially the relationship between nutritional status, breastfeeding practices, and the monthly probability of conceiving. It is found that fecundability varies both between women of a given age and, for a particular woman, by age. The variation is related to four variables: separation, which affects coital frequency; age, which represents biological changes; lactation practices; and the duration of amenorrhoea. Nutrition above famine or starvation levels is not a significant determinant of fecundability. The most surprising finding is the effect of the pattern of breastfeeding on fecundability: as a menstruating woman begins to wean her child, her probability of conceiving increases as her serum prolactin, which inhibits ovulation, decreases. Thus, those menstruating women who are most likely to conceive are those who have completely weaned their infants in the very recent past.     

Nutrition and Fertility in Bangladesh: Breastfeeding and Post Partum Amenorrhoea

From 1975 to 1980 a prospective study a nearly 2,500 married, fertile women was conducted in Matlab, Bangladesh at the International Centre for Diarrhoeal Disease Research. Women were interviewed at monthly intervals to collect information on nutritional and reproductive status, in order to study the factors associated with natural fertility. The median duration of amenorrhoea for women with no child deaths was 15.5 months, with older women and those of higher parities recording longer durations than younger women or those of lower parities. Median duration of amenorrhoea for women with six or more years of education was 8.4 months compared to 16.4 months among women with no education. When classified by weight at pregnancy termination, average duration of amenorrhoea of women weighing less than 38 kg was 17.6 months compared to 13.6 months among women weighing more than 44 kg. Proportional hazards analyses show that mother's education, parity, month of birth, supplementation practices and nutritional status were significantly associated with the probability of resuming menstruation.     

Breastfeeding Patterns and Determinants in the Near East: An Analysis for Four Countries

Few detailed studies of the determinants of breastfeeding behaviour have been carried out, especially in the Middle East. We provide a comparative investigation of patterns and determinants of breastfeeding in four Middle East countries (Egypt, Jordan, Tunisia and Yemen) based on WFS data. Differences in factors influencing ever-breastfeeding, continuing breastfeeding from very short to moderate durations, and extending breastfeeding into the second year are observed, indicating ‘structural shifts’ in the determinants of breastfeeding. Differences between countries are also found which can only roughly be associated with differences in modernization and urbanization. Lack of consistently negative effects of women's education and work status variables is attributed to the extremely low levels of both in the region. Interesting results are observed regarding effects of pill use and sex of child (boys being breastfed longer), suggesting the need for thorough studies to explain these findings further.     

Supporting women to achieve breastfeeding to six months postpartum – The theoretical foundations of a successful program

BackgroundAlthough the benefits of breastfeeding to six months are well-established, only about half of Australian women succeed. The factors associated with successful breastfeeding are rarely translated into effective interventions. A new educational and support program, called the Milky Way program has been demonstrated to be effective in supporting women to achieve prolonged breastfeeding. In the Milky Way program, breastfeeding is considered an embodied performance which requires an engaged combination of body, mind and spirit. This paper aims to explain how the two theories that informed the program were used to better enable women's long term breastfeeding success.MethodThe theory of self-efficacy is first described as a way to develop women's cognitive processes to organise and execute the course of actions to breastfeed for a longer period of time. Birth territory theory is then presented. This theory discusses women as embodied selves; an essential concept for breastfeeding success. Birth territory theory also describes the effects of the holistic environment on the woman and explores the effects of power that is used in the environment. This power can be used integratively to strengthen the woman's breastfeeding confidence and success or, disintergratively which reduces her confidence and undermines her success.ConclusionStrategies based on self-efficacy theory are helpful, but are not sufficient to promote breastfeeding to six months. Health educators also need to foster the woman's connection to, and trust in, her body and her baby's body to breastfeed spontaneously. Being aware of environmental impacts on how the woman and baby breastfeed; and using one's own power integratively is crucial to women being able to achieve prolonged breastfeeding.     

Continuity of women's work,breastfeeding, and fertility in Ghana in the 1980s

Much of the inconsistency that has appeared in studies of the effect of women's work on fertility in less developed countries has been attributed to the varying accessibility of employment in the modern sector. The analysis presented in this paper shows that continuity of work matters more than sector of work. It also confirms that, even in a setting of low contraceptive prevalence, increased fecundity associated with the less intense breastfeeding practices of working women do not result in shorter birth intervals. The influence of women's work on fertility control is likely to be underestimated if the effects of sporadic versus continuous work are conflated, or if fecundity differentials by work status are unmeasured.     

Sofia Coppola

Sofia Coppola is currently one of the most discussed female filmmakers in Hollywood and one of the most prominent “indie” directors working over the last decade. Coppola has also divided critics, especially with her third and fourth features, Marie Antoinette and Somewhere both drawing heavy criticism. This article draws on a range of popular and scholarly sources in order to chart the different narratives that construct Coppola's public image, including the style of her filmmaking. I focus on perspectives of Coppola's work, investigating how the director's biographical details have become bound up with the reception of her films in ways that dismiss her films as too preoccupied with frivolity and privilege. Coppola's important position as a female director of independent features, specifically her unique position as a successful woman working in the masculinized arena of independent Hollywood, and her place within a lineage of women's cinema, is frequently elided in discussions of her success and style. It is the question of Coppola's status as a female director, the ambivalent process by which this status is acknowledged and disavowed in the reception of her work, that is most compelling for feminist film theory.     

Fertility and socio-economic status in Rural Bangladesh: Differentials and linkages

Summary Socio-economic differentials in fertility are examined by using data collected from a daily registration system covering over 100,000 persons in rural Bangladesh during the period 1968 to 1970. The findings indicate that fertility was generally higher among women in the higher than in the lower socio-economic groups. Several factors associated with high socio-economic status and their relation with the intermediate variables are discussed as providing the linkages with high fertility. These include, health status, breastfeeding, the enforcement of 'purdah' and migration.     

Demographic aspects of lactation and postpartum amenorrhea

Interrelations between lactation and post-partum amenorrhea are studied from the reports of about 5,000 married women included in a 1966 Follow-up Survey of Acceptors of an Intrauterine Device (IUD) in Taiwan. The length of post-partum amenorrhea and of breastfeeding are positively associated. On an average, breastfeeding delayed the resumption of menstruation by about 7 months. The association between lactation and amenorrhea is not accounted for by differences in mother’s age, parity, education and her place of residence. A multiple regression analysis suggests that (1) age affects amenorrhea both directly and through lactation, (2) parity has no independent effect on either lactation or amenorrhea, and (3) education and place of residence affect amenorrhea mainly through the cultural variations in the practice of breastfeeding.     

Lactation and fertility in Rural Bangladesh

Summary Analysis of data from various phases of a study of post-partum amenorrhoea in Bangladesh illustrated good aggregate consistency of response on menstrual status, but less individual consistency on duration of post-partum amenorrhoea. Using life table techniques, the median duration of amenorrhoea was calculated as 19.9 months for women with births between February and September 1974. There were substantial seasonal variations in duration, with the median decreasing from 21.5 months for women with February births to 16.9 months for those with September births. By contrast, the median duration of post-partum amenorrhoea varies by only two months for women in the lowest and highest quartiles of weight and weight for height. The seasonal pattern was similar for all weight groups.     

Population planning in Asia in the 1970s

Analysis of data from various phases of a study of post-partum amenorrhoea in Bangladesh illustrated good aggregate consistency of response on menstrual status, but less individual consistency on duration of post-partum amenorrhoea. Using life table techniques, the median duration of amenorrhoea was calculated as 19.9 months for women with births between February and September 1974. There were substantial seasonal variations in duration, with the median decreasing from 21.5 months for women with February births to 16.9 months for those with September births. By contrast, the median duration of post-partum amenorrhoea varies by only two months for women in the lowest and highest quartiles of weight and weight for height. The seasonal pattern was similar for all weight groups.     

Reliability of reasons for early termination of breastfeeding: application of a bivariate probability model with sample selection to data from surveys in Malaysia in 1976-77 and 1988-89

Although extensively collected, data on people's reasons for their behaviour provided retrospectively have been met with some scepticism on the grounds that they may be subject to biases and errors that jeopardize their usefulness. This study investigates, for a sample of 1,327 births, the reliability with which women in Peninsular Malaysia recalled, at intervals 12 years apart, reasons for not initiating or for stopping breastfeeding less than 3 months after a birth. Overall, we find low to moderate reliability of recall. Levels of reliability are relatively high for some reasons (the child died and no or insufficient milk) but low for some others (child ill, breastfeeding inconvenient). Results from selection models show that reliability does not vary with the length of time since the child's birth but is inversely related to socio-economic status (proxied by education and employment). Social status, social norms, and health-related factors appear to be significant influences on women's consistency of reporting.     

The Effects of Intrauterine Malnutrition on Birth and Fertility Outcomes: Evidence From the 1974 Bangladesh Famine

This article uses the Bangladesh famine of 1974 as a natural experiment to estimate the impact of intrauterine malnutrition on sex of the child and infant mortality. In addition, we estimate the impact of malnutrition on post-famine pregnancy outcomes. Using the 1996 Matlab Health and Socioeconomic Survey (MHSS), we find that women who were pregnant during the famine were less likely to have male children. Moreover, children who were in utero during the most severe period of the Bangladesh famine were 32 % more likely to die within one month of birth compared with their siblings who were not in utero during the famine. Finally, we estimate the impacts of the famine on subsequent pregnancy outcomes. Controlling for pre-famine fertility, we find that women who were pregnant during the famine experienced a higher number of stillbirths in the post-famine years. This increase appears to be driven by an excess number of male stillbirths.     

Demographic consequences of the 1984–1985 Ethiopian famine

This article analyzes demographic responses to the 1984-1985 Ethiopian famine and compares them with Bongaarts and Cain's (1982) hypothesized responses. After briefly describing the data collection, I estimate the age distribution and the age-specific mortality and fertility rates of Ethiopian famine victims in a resettlement area and compare these with mortality estimates for the 1972-1973 Bangladesh famine and with fertility estimates from the 1981 Ethiopian demographic survey. The results show that the mortality rate among Ethiopian famine victims was about seven times higher than the rate among the Bangladesh victims and that the Ethiopian famine-related mortality was general and not a function of household socioeconomic variables. The data also show a 26 percent lower total fertility rate among famine victims.     

The Contraceptive Role of Breastfeeding

We review (1) neuro-hormonal mechanisms by which breastfeeding postpones the return of ovulation and menstruation after birth, and (2) various statistical procedures used to analyse this effect in human populations. This review reveals that the biology and the statistical procedures are incompatible. We propose a statistical approach, compatible with present knowledge of physiology, that differentiates between ovulation-inhibiting mechanisms at birth and the weakening of these inhibitions thereafter, so that it is possible to investigate the effects on these mechanisms due to breastfeeding and to other determinants such as mother's age. An empirical test with typical recall data indicates that full breastfeeding postpones ovulation longer than does supplemented breastfeeding, and that both have stronger contraceptive effects than has previously been thought.     

On the Demography of South Asian Famines Part II

Part I of this paper (published in the last issue) was focused on demographic responses to three major famines which occurred in late nineteenth-century India. Part II deals with the 1943–44 famine in Bengal and the 1974–75 famine in Bangladesh. The paper presents important and hitherto unanalysed demographic data on the Bengal famine. Drawing on the analysis of Part I, it argues that because of flaws in the data which have been used, there is a need to reconsider some of the judgements which have been made about the demographic consequences of both the 1943–44 and 1974–75 famines. It is contended that some serious misconceptions have arisen concerning short-term demographic responses to famine. Finally, possible implications for famines in other parts of the world are discussed.     

Intra-uterine Mortality and Maternal Nutritional Status in Rural Bangladesh

This paper is an investigation of the relationship of a maternal nutritional status with intra-uterine mortality in a population of chronically malnourished rural Bangladeshi women. First, life-table techniques are used to compare the level of intra-uterine mortality in this population with levels reported in other studies. Then the relationships of maternal nutritional status, age, parity, foetal loss and season of conception with intra-uterine mortality are examined in a multivariate analysis. The results indicate foetal mortality in rural Bangladesh to be markedly higher than in other populations where living conditions and health care are superior. Maternal nutritional status, maternal age and season of conception all appear to be related significantly to foetal mortality.     

It takes a mother to practise breastfeeding: Women's perceptions of breastfeeding during the period of intention

BackgroundIn the Netherlands, 81% of mothers initiate breastfeeding. After one month the percentage of mothers still breastfeeding drops, despite positive intentions. Little is known about women's perceptions of breastfeeding during the period of intention.AimThis qualitative study aimed to gain insight into these perceptions among first-time mothers from middle and high socioeconomic backgrounds in the northern part of the Netherlands.MethodsWe used the theory of planned behaviour as the deductive model. In 2008, 16 in-depth interviews were conducted with 8 mothers who intended to breastfeed. The interviews were conducted at two time points (prepartum and postpartum) and covered the same period (that is, from the time when the intention was formed until after childbirth). The interviews were transcribed verbatim and analysed using grounded theory.FindingsFive inductive themes were identified: combining breastfeeding with work, learning about breastfeeding, making arrangements for childbirth, reflecting on the intention, and becoming a mother. During the extended period of intention, the women anticipated breastfeeding, but were cautious in expressing their intentions. They felt that the experience of becoming a mother would be critical to their breastfeeding outcomes.ConclusionThe theory of planned behaviour has been widely used in breastfeeding research. However, the period of intention is relatively long for breastfeeding. Rather than recommending an intensification of antenatal breastfeeding education, recommendations must incorporate the awareness that practising breastfeeding should not be considered the continuous outcome of the intention to do so – it takes a mother to practise breastfeeding.     

The North Korean famine and its demographic impact

The North Korean famine began in 1995 and its ill effects, while peaking in the late 1990s,undoubtedly linger. Recent conjectures on excess deaths caused by the famine range widely from about 200,000 to 3 million or more. This article assesses the demographic impact of the famine with greater rigor than has previously been attempted and describes the unique setting in which the famine occurred. The analysis begins with a pair of population projections based on mortality statistics from two sources. Given their contradictory implications, the analysis turns to less direct evidence of famine‐related mortality. That evidence includes China's demographic experience during the Great Leap Forward and recent measurements of child malnutrition in North Korea. Crosscountry comparisons translate this malnutrition into corresponding levels of infant mortality. The article concludes that famine‐related deaths in North Korea from 1995 to 2000 most likely numbered between 600,000 and 1 million.     

Sex Differentials in Childhood Feeding,Health Care,and Nutritional Status in India

Strong preference for sons in South Asia is well documented, but evidence on female disadvantage in childhood feeding, health care, and nutritional status is inconclusive. This article examines sex differentials in indicators of childhood feeding, health care, and nutritional status of children under age 3 by birth order and sex composition of older living siblings. Data are from India's 1992–93 and 1998–99 National Family Health Surveys. The analysis finds three reasons for inconclusive evidence on female disadvantage in aggregate analyses. First, discrimination against girls is limited to the relatively small fraction of children of certain birth orders and sex compositions of older siblings. Second, discrimination against girls when boys are in short supply and discrimination against boys when girls are in short supply cancel each other to some extent. Third, some discrimination against girls (e.g., in exclusive breastfeeding at 6–9 months) is nutritionally beneficial to girls. Separate analyses for North and South India find that gender discrimination is as common in the South as in the North, where son preference is generally much stronger.     

Using Changes in Life Satisfaction and Health to Predict the Survival Status Among Older Men and Women in Taiwan

Despite policies aimed at decreasing old-age income inequality, such as Social Security and Supplemental Security Income, research consistently finds that later-life poverty is highly concentrated among women. While the early-life economic disadvantages of motherhood are well established, little work has examined whether these disadvantages persist into later life. Life course research consistently demonstrates the relationship between early-life choices and later-life inequality, but few studies have examined whether the reproductive phase of a woman's life is associated with her later-life income. Using data from the 2003 wave of the National Longitudinal Survey of Mature Women cohort, this research examines whether women's age at first birth and parity are associated with her later-life income within the context of marriage. From a set of multivariate analyses, I find that despite a marginal statistically significant effect, substantively for the women in this cohort the effects of childbearing are not particularly consequential for later-life income. The results suggest that as women age the economic penalties associated with motherhood are less important to financial well-being than are other factors.