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.     

Pregnancy termination intervals in a rural area of Bangladesh

Pregnancy termination intervals, i.e., live birth to live birth (LB-LB), live birth to fetal loss (LB-FL), and fetal loss to live birth (FL-LB), are analyzed prospectively between 1966 and 1970 in a rural population (117,000) of Bangladesh. Results indicate that the mean LB-LB interval was almost 30 months, the LB-FL interval 27 months, and the FL-LB interval 18 months. In addition, postpartum amenorrhea was estimated to be about 13-14 months, and the time added by a fetal loss toa LB-LB interval about 15 months. No relationship was found between LB-LB intervals and the number of living or dead children.     

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.      

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.     

Climate-related migration in rural Bangladesh: a behavioural model

Research into the climate change and migration nexus has often focussed solely on how people move in response to the impacts of variability and change in climate. This notion often ignores the nature of migration as a tried and tested livelihood choice amid a variety of socio-economic and environmental opportunities and limitations. This paper closely looks at the behavioural aspects of migration decision-making in Bangladesh in the context of changes in its economy, and, increasingly, exposure to the impacts of climate variability and change. We find that villagers in areas particularly affected by increasing climatic stresses and shocks are diversifying their traditional livelihood strategies by migrating. Environmental factors, including climatic stresses and shocks, often make such shifts even more necessary. Although the migrants’ primary motivation is better income, in effect, migration becomes an effective form of adaptation. Based on a qualitative study in three geographically distinct places of Bangladesh, we propose that migration is a socially acceptable behaviour that occurs in the context of perceived environmental change and climate variability. Migration decisions are mediated by a set of ‘behavioural factors’ that assesses the efficacy of different responses to opportunities and challenges, their socio-cultural acceptance and the ability to respond successfully. This understanding has policy relevance for climate change adaptation, in terms of both how migrants are perceived and how their movements are planned for.     

Neo-natal and post-neo-natal mortality in a rural area of Bangladesh

Abstract An analysis of neo-natal and post-neo-natal mortality in 132 villages (population of 117,000) of Matlab thana indicates the following: (i) Neo-natal deaths accounted for 60% of the infant mortality rate of 125. This proportion was unexpectedly high since previous research had maintained that in countries with infant mortality rates over 100, neo-natal deaths account for less than one-third of all infant deaths. Since the present findings on the proportions of neo-natal deaths correspond exactly with results from an earlier registration system in East Pakistan, it is suggested that the long-accepted proposition, 'less developed' areas are characterized by lower proportions of neo-natal deaths than 'more developed' areas, be re-examined. (2) The infant death rate accounts for 36% of all deaths in the population. If the infant death rate were reduced by half the result would be a decrease in the current crude death rate from 16 to 13. Although this reduction would appear to be small, in the context of a current high growth rate of 3% (from 1966-67 to 1968-69) it exerts a sizeable impact. For example, it would take a reduction of eight points in the crude birth rate of 46 just to achieve a growth rate 2·5% under these circumstances. Obviously, continued efforts in death control without an effective birth control programme will perpetuate high rates of growth. (3) Neo-natal and post-neo-natal mortality exhibited the -expected 'U' shaped pattern with parity, and generally varied as expected with age and family size, except in the oldest age group and largest family size where the risk was smaller than in the preceding groups. An explanation for these findings is presented, based on the effect that births to high-parity women with low child mortality have upon the total neo-natal and post-neo-natal mortality rates. It was found that these births exhibit a much lower mortality risk than births to women of comparable parities and higher child mortality, and that their numbers account for the lower risk to the births in the oldest age group and largest family size. It was concluded that women with a combination of high parity and low child mortality most probably represent a group with superior socio-economic and or health conditions which contribute to the lower risk of neo-natal and post-neo-natal death.     

Change in worker/nonworker ratios for women

Effects of age, birth year, and observation year on work behavior are estimated by minimum logit chi-square regression, using data from Current Population Surveys. Most of the observation-year effect is captured by indicators of the business cycle. Further, a model which permits the cycle effects to vary by age is preferred over any additive model. The ratio for young women is most depressed relative to that for older women when times are "good".     

Traditional values prevail as education and contraception enter rural Bangladesh

This article discusses the findings of demographer Sajeda Amin, who examines the impact of large-scale social changes on family dynamics and living arrangements in two rural villages in Bangladesh. Amin focused on changes in dowry, education, living arrangements, and landlessness in 1991, 1995, and 1996. Education had the strongest impact on delaying marriage and childbearing and a weak impact on the adoption of contraception or desire for more children. Social changes did not effect traditional living arrangements. Dowry to the husband has replaced bride price, which is cash or valuables given to the wife's family. This shift is attributed to a marriage squeeze where the numbers of women outnumber men. Instead of shifting the age at marriage between girls and men, these communities continued to undervalue women and shifted the pricing system onto the girls' families. The dowry system has led to parents seeking grooms within the extended family, which custom dictates as worthy of a lower dowry, or within the village. The dowry system also leads to abuses, such as the prospects of multiple dowries through divorce. Amin's research finds that Bangladeshi girls benefit from advanced schooling through the delay in marriage and childbearing. Delays in marriage and childbearing have an immediate impact on population growth. However, the increased educational advancement for girls must include increased work opportunities. By combining education with work, the impact becomes long lasting and the economic benefits will encourage increased enrollment. Education serves an important role in defining women as valuable resources that can be a household asset rather than a liability.     

The effect of divorce on child survival in a rural area of Bangladesh

The data for this study come from Matlab, a rural area of Bangladesh, where a continuous registration of demographic events has been maintained by the International Centre for Diarrhoeal Disease Research, Bangladesh since 1966. A total of 11,951 first marriages of Muslims that took place in the area between 1975 and 1987 were followed until the end of 1989, to examine the relationship between parental marriage breakdown and survival of first live-born children. The impact of divorce on survival of children during infancy and childhood was examined, using hazard analysis. Other independent variables included age of mother at birth, and mother's education, year of birth, sex of children, and residence at the time of childbirth. It is shown that the net odds of death among children of divorced mothers in infancy and childhood were respectively 3.2 and 1.4 times higher than those of mothers whose marriages continued. The paper also discussed the possible mechanisms which link divorce and child survival.     

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.     

Reproductive histories of Chinese women in rural Taiwan

In the summer of 19 5 3, a 3 % sample of the households in a rural area of Taiwan was enumerated. Special attention was paid to the fertility histories of women and, among other information, dates of births of live-born children to women living at the survey date were obtained. The data were extracted from registration records, occasionally checked by personal interview.

Women aged 45–64 had borne an average of 7.1 children. The oldest cohorts (women over 65 at survey) appeared to have a lower fertility. This is in part due to the reduction in the incidence of early widowhood, caused by the improved mortality of men since the beginning of the century.

The data are further analysed by parity and age at marriage.

Tabulations of the intervals between births of successive order, show that these remain constant with increasing birth order at about 2.7 years. The age at the last confinement was about 40 years.     

Demographic crisis: The impact of the Bangladesh civil war (1971) on births and deaths in a rural area of Bangladesh

Summary In Matlab Bazaar Thana the Cholera Research Laboratory has registered the births, deaths and migrations in a population of approximately 125,000 since 1966. Although this rural area was not the scene of any significant armed encounters, striking changes in birth and death rates were registered during and after the conflict. Birth rates did not change during the relatively brief period of the civil war, but a small decline was registered for one year after the war. Fertility rates which had been declining slightly and irregularly in the pre-war baseline period may have increased slightly during the war and fell substantially in all age groups in the year following the war. The crude death rate, which rose by 37 per cent during the war, was a very sensitive reflection of the administrative and economic problems. Overall infant mortality rose by only 15 per cent over pre-war levels because all of the increase was observed in the post-neo-natal component, which traditionally accounts for less than one-third of the total infant mortality in Bangladesh. Children and older adults accounted for the majority of excess deaths which were largely attributed to acute diarrhoeas and other gastro-intestinal causes. The death rate at ages 1-4 rose by 43 per cent and at ages 5-9 soared to 208 per cent above pre-war baseline rates. All increases in age-specific mortality rates fell to baseline levels during the year following the war, except the 5-9-year age group, in which rates continued to be high largely because of deaths due to dysentery.     

Family matters: The impact of kin on the mortality of the elderly in rural Bangladesh

This study uses high quality longitudinal data on kin availability, proximity, and marital status from the Matlab surveillance area in rural Bangladesh to explore the impact of kin members on the survival of the elderly over a six year period. The results - from discrete time hazard models- suggest that the presence of a spouse, sons, and brothers substantially improves survivorship, but with differing effects by the sex of the elderly and the number of sons and brothers. This study offers little support of any of the following as mechanisms by which kin affect the survival of the elderly: changes in the economic status of the elderly as proxied by land holdings; improved access to instrumental support as proxied by the marital status of sons; decreases in social isolation as proxied by proximity of kin.     

Importance of fatalism in understanding mammography screening in rural elderly women

This study examined the relationship between demographic factors and other correlates of fatalism, and assessed the impact of fatalistic beliefs on the participation in breast cancer screening in rural women. The subjects were 220 women aged 50 and over recruited from 6 large rural counties in South Carolina. Data were collected using a demographic questionnaire and the revised Powe Fatalism Inventory. Results show significant associations between fatalism and increased age (p = 0.005), race (p = 0.0001), doctor recommendation (p = .0034) and decreased educational level (p = 0.001). Fatalism was associated with noncompliance with mammography screening in univariate analysis among African-American women (OR = .362; 95% CI: 1.11, 11.8). After adjusting for possible confounders (age, education, and doctor recommendation), fatalism was not significantly associated with noncompliance with screening. These results illustrate age, race, and education may be important predictors of fatalism and that fatalism may be one barrier that has previously gone unmeasured and unchallenged in understanding screening behavior in older women.     

Strengthening resources for midlife and older rural women who experience intimate partner violence

ABSTRACT

Little is known about midlife and older women who experience intimate partner violence living in rural places and their resource needs. Guided by a strengths perspective, we provided insights into resources that midlife and older women use, or would like to use, in their journey in leaving an abusive partner. Eight women who had left an abusive partner participated in a face-to-face interview. They drew on a wide variety of paid and unpaid resources, while each woman had a unique set of resources that contributed to her being able to make such a significant life transition. It is clear that we need to have a variety of formal and informal resources available to older women experiencing intimate partner violence (IPV) in rural places, and new forms of resources need to be developed. Our results also indicate that increased efforts are needed in improving both public and professional education regarding older rural women and IPV.     

Ultrasonometric profiling of incidence and risk of osteoporosis in rural women

BACKGROUND: It is estimated that over 200 million people worldwide have osteoporosis. The prevalence of osteoporosis is continuing to escalate with the increasingly aging population. The major complication of osteoporosis is an increase in fragility fractures leading to morbidity, mortality, and decreased quality of life. This investigation profiled the incidence and risk of osteoporosis in adult women from a rural setting using ultrasonic bone scanning technology. METHODS: Between 2001 and 2005, adult female subjects (n = 323) in the age range of 40-87 were drawn from an independent, community dwelling, convenience sample. Bone mineral density T-scores were evaluated using heel ultrasonometry. Demographic and risk factor data, Merck Osteoporosis Evaluation SCORE questionnaire data, and the Osteoporosis Risk Assessment questionnaire data were analyzed. RESULTS: Results of these scans indicate that 25% of the total population had a T-score < or = -1.0, implying a 1.5- to 2.0-fold increase in risk ratio of hip or spinal fracture for each standard deviational decrease. Age at menopause and weight had a positive correlation with T-scores. While the overall scores on the Merck SCORE questionnaire were inversely correlated to T-scores, no significant correlation was found between the Osteoporosis Risk Assessment questionnaire and T-score data. Additionally, women who had taken estrogen had significantly higher T-scores (p = 0.038) than those who had not. CONCLUSION: That approximately 25% of this sample has low bone mass or osteoporosis underscores the importance of early screening in order to develop preventative awareness and provide education on bone health management. This finding has particularly important ramifications, since the sample was rural women, who typically have limited access to diagnostic bone density procedures.     

Reporting of fertility events by men and women in rural Gambia

We conducted a survey of male and female fertility in rural villages in The Gambia and compared men and women's reports of recent pregnancy events in the aggregate and of children ever born for matched couples. Despite widespread polygyny and sex differences in fertility, men's and women's reports were similar. Small sex differences in reports of recent stillbirths and neonatal deaths were found. For matched couples, husbands reported 0.23 more children ever born than their wives on average, but discordant reporting had little effect on recent marital fertility rates. Modeling of discordant reports indicates that fertility reports are more likely to be underestimated by both men and women for their earliest marriages. Reliable fertility data can be collected from men in this population.     

Age Misstatement for Young Children in Rural Bangladesh

Age data for 3,393 children, six years of age and under, in rural Bangladesh are analyzed for the level and pattern of age misstatement. Random error, age heaping at whole years, and preferences for particular ages are found in the data. Variation in age reporting is discovered to increase monotonically with age. Systematic errors in age misstatement display modest overstatement for the first four years of life and more pronounced understatement for ages 4, 5, and 6. Age misstatement is examined for its effect on one indicator often used in nutritional surveillance—weight-for-age of children. The impact of the various types of age misstatement (a) increases the difficulty of interpreting weight-for-age and (b) obscures accurate understanding of malnutrition in Bangladeshi children.