Seasonal Patterns of Reproduction in Matlab,Bangladesh

In Bangladesh twice as many births occur in December as in July. This paper examines the seasonal patterns of the risks of conception, fetal loss and return of menses post partum in a longitudinal study of 2,300 women in 14 villages of Matlab, Bangladesh. Life tables were estimated for each month of entry event and then ‘period’ life tables were constructed with the risks for a given calendar month. Confirming the results of earlier studies, risks of resumption of menses were higher in November and December, regardless of time elapsed since the last birth. Similarly, there are increased conception risks in the period from February to April for all fecundable women. The time of lowest fetal loss and stillbirth risks is in the cool season, though this variation makes only a minor contribution to the overall seasonality of births. The pattern of fecundability estimated from data on coital frequency did not match the pattern estimated from reported conceptions; these discrepancies imply possible seasonal changes in other parameters of fecundability besides intercourse.     

Postamenorrheic versus postpartum strategies of contraception

The postpartum strategy of inserting an intra-uterine device shortly after a birth essentially eliminates the risk of conceiving again before starting contraception but maximizes the overlap between wearing time and postpartum anovulation when protection is not needed. In contrast, the postamenorrheic strategy of delaying insertion until right after the woman’s first menses all but removes overlap with anovulation but allows a chance of conception before start of contraception because sometimes an ovulation precedes the first menstruation. In this paper some algebra is developed and utilized to see which of the two strategies delays the next conception longer. The postamenorrheic strategy is found to have a slight advantage over the postpartum approach for a wide range of fecundability levels, lengths of anovulation, and rates of continuation of IUD. However this slight advantage presupposes that insertions are taking place at the exact time prescribed. When a progressively larger factor of procrastination is introduced, the advantage rapidly passes from the postamenorrheic to the postpartum approach. An explanation for the differing sensitivity of the two insertion strategies with respect to procrastination is derived from the results of an earlier analysis.     

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.     

Family planning for new mothers in the Philippines

From November 1997 to February 1998, a survey was conducted to evaluate postpartum family planning (FP) services in the Philippines. Data were gathered from records at 86 clinics in 28 provinces and from interviews with 338 FP providers and 3452 clients who began to use FP within 6 months of delivery. Only 7% of women began using FP within 6 months of delivery, and most postpartum attention was devoted to child care issues. Among the women surveyed, most resumed sexual intercourse at 2.4 months postpartum and experienced a return of menses at 4.4 months postpartum despite breast feeding for 6.2 months. The most commonly recommended method to space births was the IUD followed by the injectable contraceptive. Very few providers recommended use of barrier methods. The results indicate that many breast-feeding women are receiving hormonal contraceptives too soon and that IUD insertion may not be occurring at the ideal time postpartum. While a significant percentage of providers recommended use of the lactational amenorrhea method (LAM) and 16% of the women relied on it, the providers lacked sufficient understanding of LAM. In addition, many women switched or discontinued methods. The study led to the recommendations that postpartum FP services be promoted as an essential part of maternal-child health care and that FP providers receive improved training about contraception and LAM.     

Longitudinal analysis of the effects of infant-feeding practices on postpartum amenorrhea*

The Cebu Longitudinal Health and Nutrition Survey is used to examine the effect of various components of infant-feeding patterns on return of menses postpartum. The results show that factors such as active suckling, the use of two breasts versus one, breast-feeding on demand versus on a fixed schedule. and the feeding of other milks and of nonnutritive or low-caloric other liquids can be important under selected circumstances. Discrete-time logistic hazards modeling is used to estimate the weekly probability of return to menses.     

Hutterite fecundability by age and parity: Strategies for frailty modeling of event histories

Effective fecundability declines with age and parity. Furthermore, women differ in their effective fecundability: some women have persistently low or high monthly chances of live-birth conception. Estimates are presented concerning the magnitude of these effects in a natural-fertility population: 406 Hutterite women in North America who had 3,206 births, largely in the 1940s and 1950s. The estimates are based on models that incorporate the effects of persistent heterogeneity and that use the full information provided by multiple-spell duration data. In addition, hazards rather than probabilities are modeled, piecewise linear hazard functions are used, and age and parity effects are decomposed systematically. These methods permit the development of more elaborate models of changing fecundability and of heterogeneity in postpartum amenorrhea.     

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.     

Pregnancy nutrition knowledge and experiences of pregnant women and antenatal care clinicians: A mixed methods approach

Background

Dietary intake of pregnant women do not appear to meet the dietary recommendations. Nutrition knowledge and practices of pregnant women and their antenatal care clinicians are factors that may be influential on dietary intakes of pregnant women.

Translation and factor analysis of structural models of Edinburgh Postnatal Depression Scale in Serbian pregnant and postpartum women – Web-based study

BackgroundThe Edinburgh Postnatal Depression Scale (EPDS) is well accepted for detecting symptoms of postnatal depression. The aim of this study was to examine psychometric properties and to evaluate structural models of the Serbian translation of EPDS in pregnant and postpartum women.MethodsThe original English version of the EPDS was translated into Serbian, and checked by means of back-translation. Data were collected via an anonymous online questionnaire posted on a Serbian website devoted to pregnancy topics. The study sample included 201 women (76 pregnant, 125 postpartum). The internal consistency of the scale was measured by Cronbach's α coefficient. Principal component analysis was used to determine scale dimensions while confirmatory factor analysis was used to evaluate model fit.FindingsCronbach α coefficient was 0.84 and 0.83 in pregnant and postpartum women, respectively, which indicated good internal consistency of the Serbian EPDS. Three dimensions of the scale were revealed in both groups of women. Goodness of fit indices described good and excellent model in pregnant and postpartum women, respectively. High level of depression symptoms (score ≥13) was recorded in 27.6% and 24.8% (p > 0.05) of pregnant and postpartum women, respectively. Moderate level of depression symptoms (score 10–12) was recorded in 21.1% and 16.8% (p > 0.05) of pregnant and postpartum women, respectively.ConclusionThe Serbian translation of the EPDS showed good consistency and good model characteristics in pregnant and postpartum women. However, cut-off values, sensitivity and specificity of the scale should be determined in the further studies with more representative samples of women.     

Structural Change in Life Cycle Fertility During the Fertility Transition: France Before and After the Revolution of 1789

This paper explores the hypothesis that the fertility transition in France entailed a structural change in behaviour from natural to controlled fertility. We define the hypothesis in terms of an empirically estimable model of lifetime fertility. The model produces separate estimates of the three main proximate determinants: the hazard rate of conception for ovulating women, the timing of ovulation resumption after a birth, and permanent sterility. Fertility control is defined as responsiveness of the conception hazard to number of surviving children. We demonstrate key features of the model by simulated family histories. The historical application provides support for the transition hypothesis in the south of France, and mixed results for the north. We also find strong evidence of persistent couple-specific heterogeneity even after controlling for unobserved heterogeneity in fecundability. We suggest how future research might improve the model.     

A joint model of marital childbearing and marital disruption

Married couples with children appear to be less likely to end their marriages than childless couples, especially when the children are young. Although this suggests that children affect the chances that their parents will divorce, the process may not be so simple: the chances that the marriage will last also may affect couples’ willingness to make the commitment to the marriage implied by having children. This paper uses data from the Panel Study of Income Dynamics (PSID) to test the hypothesis that the risk of disruption faced by a married woman affects the chances that she will conceive and bear a child. The model used takes into account the simultaneous relationships between marital dissolution and marital fertility by including the hazard of disruption as a predictor of timing and likelihood of marital conception, and by including the results of previous fertility decisions as predictors of disruption of the marriage. We find that the hazard of disruption has strong negative effects on the hazard of marital childbearing, lengthening the intervals between births and decreasing the chances that a child will be born. This effect appears to be strongest for women who have had at least one child, either before or during the current marriage, although it is also large for childless women. Explicitly including the hazard of disruption in models of marital childbearing has sizable and important effects on many predictors of fertility.     

Predictors of postpartum depression service use: A theory-informed,integrative systematic review

ProblemPostpartum depression affects many women globally, yet rates of treatment use are low. A comprehensive view of factors associated with treatment use, from women’s and providers’ perspectives, based on a theoretical model is lacking.BackgroundSeveral studies examined various factors associated with postpartum depression service use; however, each study focused on a small number of factors.AimThis study describes a systematic literature review based on the Behavioral Model of Health Service Use. The purpose of this article is to review and synthesize the available literature regarding factors associated with women’s mental health service use for postpartum depression from women’s and healthcare providers’ perspectives, and provide a comprehensive integrative view of the subject.MethodsThree electronic databases were searched, and 35 studies published up to 2018 in English language journals met inclusion criteria for review. Factors associated with postpartum depression service use were classified according to the Behavioral Model of Health Service Use’s constructs.FindingsService use for postpartum depression is a function of a woman’s predisposition to use mental health services; individual, familial, and communal factors which enable or pose barriers to use of mental health services; and the woman’s perceived or evaluated need for treatment. In addition, societal determinants impact the woman’s decision to seek help directly or through impacting the health and mental health care service system’s resources and organization.ConclusionThis review illustrates key factors for researchers and practitioners to consider when treating postpartum women and developing interventions to enhance postpartum depression treatment use.     

A non‐linear model of fecundability,postpartum amenorrhea,and sterility*

This paper proposes a convolution model of fecundability, controling for the effects of postpartum amenorrhea and unobserved heterogeneity in fecundability. Simulation analysis was used to assess the validity and reliability of estimates derived from the model. Analysis showed that the model captured the mean and standard deviation of age at the onset of sterility in simulated populations where sterility followed either a Gompertz, a gamma, or a lognormal distribution. The model performed well when sterility was specified by either a lognormal or a gamma distribution. The model also accurately estimated fecundability and postpartum amenorrhea. Next, the model was found to fit data from 17th and 18th century French Canadian birth histories. In this French Canadian sample the mean age at sterility was found to be 46.3 years using a gamma model. The decline in fecundability was almost linear after age 30. Thus, fecundability at age 40 had declined to about one‐third of that observed at age 30. Variability in individual fecundability was quite high. For example, women with fecundability one standard deviation above the mean had about 2.3 times as high fecundability as women one standard deviation below the mean.     

Evaluating the impact of conditional cash transfer programs on fertility: the case of the Red de Protección Social in Nicaragua

Evaluating the impact of poverty-reduction programs on fertility is complicated given that changes in incentives to have children take time to be incorporated into decision making and evaluation periods are usually quite brief. We explore the use of birth spacing as a short-run indicator of the impact of poverty-reduction programs on fertility. The data come from a Nicaraguan conditional cash transfer program that offers incentives for poor households to invest in children??s health, nutrition, and education. We estimate a stratified Cox proportional hazard model and find that the program decreased the hazard of a birth, indicating an increase in birth spacing.     

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.     

Relationship between sarcopenia and fracture risks in obese postmenopausal women

It is known that obesity is inversely correlated with fracture risk. It remains unclear if a low muscle mass (sarcopenia) modulates the relationship between obesity and bone mass density. Twenty-seven obese women were matched for total fat mass (+/- 0.5 kg) and age (+/- 4 yrs) and divided in 3 equal groups: class II sarcopenic, class I sarcopenic, and nonsarcopenic. Body composition (DXA) and dietary intake were measured. Our results suggest that obesity may offer some protection against osteoporosis, even in sarcopenic postmenopausal women. However, further studies are needed to examine the actual implication of these results on a clinical standpoint.     

Gender Differences in Physical Performance,Body Composition,and Dietary Intake in Homebound Elders

ABSTRACT

Considering that the most vulnerable subgroup of elders for poor nutritional status and functional decline is the increasing number of home-bound women, we examined gender differences in physical performance, body composition, and dietary intake in a randomly recruited sample of 345 home-bound elders (81% women, 48% black > 65% income < $750/month). After controlling for demographic and health-related factors, the results from multivariate analyses indicated that women were more likely than men to report the lowest nutrient intake and were 2.9 times more likely to be at the worst level of overall physical performance. These results suggest a heightened vulnerability of homebound older women to poor physical performance, low dietary intake, and increased Body Mass Index (BMI). Prospective research is now needed to examine the interrelationships between physical performance, dietary intake, and body composition among the growing homebound older population.     

“Doing the month” and postpartum depression among Chinese women: A Shanghai prospective cohort study

BackgroundThe Chinese postpartum custom of “doing the month” characterized by generous social support available through the traditional cultural practices was considered to protect women from postpartum depression in early puerperium.MethodsThis study used data from the Shanghai Birth Cohort, a study of 2615 postpartum women from Shanghai, China, that was conducted between 2013 and 2016. Detailed information on the traditional “doing the month” practices and the on the Edinburgh Postnatal Depression Scale scores was collected from questionnaires administered on the 42nd day after childbirth. Logistic regression models were used to examine the association between the adopting traditional puerperium practices and postpartum depression.ResultsThe estimated prevalence of postpartum depression in women from the Shanghai area in China was 11.8% (n = 308) at six weeks postpartum. Women who went outside their homes during the first month postpartum showed higher risks of postpartum depression compared with those who never left the house (1–2 times: OR = 1.9, 95% CI = 1.4–2.4; 3–5 times: OR = 2.3, 95% CI = 1.5–3.5; ≥6 times: OR = 2.5, 95% CI = 1.2–5.1). Women with average sleep of 6 h or less per night were more likely to suffer from postpartum depression compared with those who slept 8 h (6 h: OR = 1.7, 95% CI = 1.2–2.4; less than 6 h : OR = 3.3, 95% CI = 2.2–5.0). Women who opened the house windows most of the time exhibited decreased risks of postpartum depression compared to those who never or rarely opened the windows (often: OR = 0.6, 95% CI = 0.4–0.9; always: OR = 0.4, 95% CI = 0.3–0.7).ConclusionsOur results suggested that not all the activities of “doing the month” provided protection against developing PPD. This study emphasized the need for flexibility to fit and adjust the ritual into the modern life to enhance the positive effects of traditional practices on maternal health.     

Evaluating the impact of conditional cash transfer programs on fertility: the case of the Red de Protección Social in Nicaragua

Evaluating the impact of poverty-reduction programs on fertility is complicated given that changes in incentives to have children take time to be incorporated into decision making and evaluation periods are usually quite brief. We explore the use of birth spacing as a short-run indicator of the impact of poverty-reduction programs on fertility. The data come from a Nicaraguan conditional cash transfer program that offers incentives for poor households to invest in children’s health, nutrition, and education. We estimate a stratified Cox proportional hazard model and find that the program decreased the hazard of a birth, indicating an increase in birth spacing.     

Gender difference in physical performance, body composition and dietary intake in homebound elders

Considering that the most vulnerable subgroup of elders for poor nutritional status and functional decline is the increasing number of homebound women, we examined gender differences in physical performance, body composition, and dietary intake in a randomly recruited sample of 345 homebound elders (81% women, 48% black, > 65% income < $750/month). After controlling for demographic and health-related factors, the results from multivariate analyses indicated that women were more likely than men to report the lowest nutrient intake and were 2.9 times more likely to be at the worst level of overall physical performance. These results suggest a heightened vulnerability of homebound older women to poor physical performance, low dietary intake, and increased Body Mass Index (BMI). Prospective research is now needed to examine the interrelationships between physical performance, dietary intake, and body composition among the growing homebound older population.