Effects of education on reproductive behavior: lessons from Pakistan

Evidence from the Pakistan Demographic and Health Survey 1990/91 (PDHS) and a 1987 study by Zeba A. Sathar and Karen Oppenheim on women's fertility in Karachi and the impact of educational status, corroborates the correlation between improved education for women and fertility decline. PDHS revealed that current fertility is 5.4 children/ever married woman by the end of the reproductive period. 12% currently use a contraceptive method compared to 49% in India, 40% in Bangladesh, and 62% in Sri Lanka. The social environment of high illiteracy, low educational attainment, poverty, high infant and child and maternal mortality, son preference, and low status of women leads to high fertility. Fertility rates vary by educational status; i.e., women with no formal education have 2 more children than women with at least some secondary education. Education also affects infant and child mortality and morbidity. Literacy is 31% for women and 43% for men. 30% of all males and 20% of all females have attended primary school. Although most women know at least 1 contraceptive method, it is the urban educated woman who is twice as likely to know a source of supply and 5 times more likely to be a user. The Karachi study found that lower fertility among better educated urban women is an unintended consequence of women's schooling and deliberate effort to limit the number of children they have. Education-related fertility differentials could not be explained by the length of time women are at risk of becoming pregnant (late marriage age). Fertility limitation may be motivated by the predominant involvement in the formal work force and higher income. The policy implications are the increasing female schooling is a good investment in lowering fertility; broader improvements also need to be made in economic opportunities for women, particularly in the formal sector. Other needs are for increasing availability and accessibility of contraceptive and family planning services and increasing availability and accessibility of contraceptive and family planning services and increasing knowledge of contraception. The investment will impact development and demography and is an adjunct to child health an survival.     

Determinants of fertility and the unmet need for family planning in Indonesia

Indonesia's fertility has declined to an average of slightly more than 3 children/woman. The islands of Java and Bali have the lowest birth rates. Indonesia's family planning program has been a model of innovation, flexibility, and community involvement, and has been effective in reducing fertility, changing family preferences, and increasing contraceptive use. Fertility decline is also determined by factors other than contraceptive use, as provinces in Jakarta and East Java has low fertility and low contraceptive use. Recent research by Suyono and Palmore found that among cohorts of women in Jakarta lowest fertility rates were explained by greater nonexposure to pregnancy in an unmarried state or by a divorced or widowed status, and by infecundity. In East Java, fertility determinants were the same with the possible addition of lower coital frequency. The study estimated nonexposure due to marriage, infecundity, and contraceptive use. Policy considerations, however, are concerned with the exposed state of the percentage of time women are currently married, fecund, not using contraceptive, and sexually active. Suyono and Palmore also calculated the percentage of time spent in the exposed state by province. The estimates ranged from 12% in Yogyakarta to 25% in West Java and the Outer Islands. Exposed was further divided into groups with a manifest, latent, and no current need. Women with a manifest need for family planning are those who are aware of their contraceptive needs to stop or postpone childbearing and not using. Manifest need was highest in high fertility areas: 12% in Central Java, 13% in West Java, and 12% in the Outer Islands. Programs targeting these women should focus on wider availability of information and services. Women with latent needs are unaware of their need for family planning and are not using contraception. These women were also concentrated in high fertility areas. The percentage of years spent in the latent unmet need state was estimated at 23-24% in West Java and the Outer Islands. Program emphasis should be on education and motivation to show how family size can be controlled. Women with current need can be educated toward future acceptance.     

Social and economic factors in Hong Kong's fertility decline

Abstract In both developed and underdeveloped areas, many attempts have been made to alter the course of fertility through family planning intervention. Doubtless the availability of such services facilitates birth control for those who already desire to use it. Whether or not such exogenous interventions have any independent effect upon the operation of endogenous forces in the economy and society is, however, more problematical. Where fertility declines have been observed, family planning services have often been made widely available only after the decline in fertility had already set in. Nonetheless, observers have often attempted to attribute some fraction of the continuing decline in fertility to the operation of family planning activities. One especially notable case is that of Hong Kong, which provides some of the more persuasive evidence about the independent effects of family planning intervention.     

The child survival hypothesis

Summary Because of current interest in the child survival hypothesis, we have reviewed available evidence bearing upon the relationships of infant and child mortality to fertility and contraceptive behaviour. The evidence is drawn from time series data for local and national vital events, from special in-depth studies of the infant mortality-fertility relationships in family formation, and from service statistics from health and family planning programmes. As a result of this review, we suggest five clarifications which should be made in redefining the child survival hypothesis and assessing its potential programme implications. The child survival hypothesis states that improved child survival will contribute to increased family planning motivation and consequent fertility decline. The evidence presented here suggests that the effect is not automatic and probably not a necessary pre-condition for fertility decline. There is certainly not a reflexive one-to-one replacement, but a partial effect may still be important. In the clearly demonstrated reduction in inter-pregnancy intervals after a child death, the major component is undoubtedly the removal of the biological protection of lactational amenorrhoea. A separate but somewhat smaller effect has been demonstrated in situations where lactation did not seem to have been the explanation. It is expected that increased child survival will contribute to fertility decline mainly in countries experiencing rapid mortality decline and population growth. The replacement of children who die is probably not so much 'volitional' as a result of alterations in sub-conscious expectations. It is apparent that in traditional agrarian populations, few direct and manipulable means of influencing motivation for fertility limitation are available, and, therefore, it must be stressed that integrated health and family planning programmes do provide opportunities for immediate programme development. By making parents aware of improved changes of survival through health services in which they develop confidence, the spontaneous linkages between mortality and fertility can presumably be reinforced. Family planning services must be provided as an essential initial step in programme development, but they can be made more effective, as well as politically more acceptable if appropriately integrated with maternal and child health and nutrition services.     

Adolescent fertility: worldwide concerns

There is growing concern over the adverse health, social, economic, and demographic effects of adolescent fertility. Morbidity and mortality rates ar significantly higher for teenage mothers and their infants, and early initiation of childbearing generally means truncated education, lower future family income, and larger completed family size. Adolescent fertility rates, which largely reflect marriage patterns, range from 4/1000 in Mauritania; in sub-Saharan Africa, virtually all rates are over 100. In most countries, adolescent fertility rates are declining due to rising age at marriage, increased educational and economic opportunities for young women, changes in social customs, increased use of contraception, and access to abortion. However, even if fertility rates were to decline dramatically among adolescent women in developing countries, their sheer numbers imply that their fertility will have a major impact on world population growth in the years ahead. The number of women in the world ages 15-19 years is expected to increase from 245 million in 1985 to over 320 million in the years 2020; 82% of these women live in developing countries. As a result of more and earlier premarital sexual activity, fostered by the lengthening gap between puberty and marriage, diminished parental and social controls, and increasing peer and media pressure to be sexually active, abortion and out-of-wedlock childbearing are increasing among teenagers in many developed and rapidly urbanizing developing countries. Laws and policies regarding sex education in the schools and access to family planning services by adolescents can either inhibit or support efforts to reduce adolescent fertility. Since contraceptive use is often sporadic and ineffective among adolescents, family planning services are crucial. Such programs should aim to reduce adolescents' dependence on abortion through preventive measures and increase awareness of the benefits of delayed sexual activity. Similarly, sex education should seek to provide a basis for intelligent, informed decision making. Programs tailored to reach teenagers in schools, recreational centers, and the workplace have particular potential.     

Sub-Saharan Africa: population pressures on development

The population of sub-Saharan Africa, estimated at 434 million in 1984, is expected to reach 1.4 billion by 2025. The birth rate, currently 48/1000 population, continues to increase, and the death rate, 17/1000, is declining. Rapid population growth has curtailed government efforts to provide adequate nutrition, preserve the land base essential for future development, meet the demand for jobs, education, and health services, and address overcrowding in urban areas. Low education, rural residence, and low incomes are key contributors to the area's high fertility. Other factors include women's restricted roles, early age at marriage, a need for children as a source of security and support in old age, and limited knowledge of and access to modern methods of contraception. Average desired family size, which is higher than actual family size in most countries, is 6-9 children. Although government leaders have expressed ambivalence toward development of population policies and family planning programs as a result of the identification of such programs with Western aid donors, the policy climat is gradually changing. By mid-1984, at least 13 of the 42 countries in the region had indicated that they consider current fertility rates too high and support government and/or private family planning programs to reduce fertility. In addition, 26 countries in the region provide some government family planning services, usually integrated with maternal and child health programs. However, 10 countries in the region do not support family planning services for any reason. Unfortunately, sub-Saharan Africa has not yet produced a family planning program with a measurable effect on fertility that could serve as a model for other countries in the region. Social and economic change is central to any hope of fertility reduction in sub-Saharan Africa. Lower infant and child mortality rates, rising incomes, higher education, greater economic and social opportunities for women, and increased security would provide a climate more conducive to fertility decline. Given the limited demand, great sensitivity must be shown in implementing family planning programs.     

The need for family planning

The purpose of this paper is to examine the evidence on the need for family planning. The available evidence on current levels of unmet need for contraceptives, fertility preferences, and the non-contraceptive benefits of family planning is reviewed. I argue that expansion of family planning programs is still needed. These programs provide couples with tools to reach their desired family size; can significantly impact maternal and child mortality by decreasing fertility and optimizing child spacing; and by decreasing fertility, slow population growth. It is therefore imperative to continue to expand the provision of family planning services.     

Family Planning and Women’s and Children’s Health: Long-Term Consequences of an Outreach Program in Matlab, Bangladesh

We analyze the impact of an experimental maternal and child health and family planning program that was established in Matlab, Bangladesh, in 1977. Village data from 1974, 1982, and 1996 suggest that program villages experienced a decline in fertility of about 17 %. Household data from 1996 confirm that this decline in “surviving fertility” persisted for nearly two decades. Women in program villages also experienced other benefits: increased birth spacing, lower child mortality, improved health status, and greater use of preventive health inputs. Some benefits also diffused beyond the boundaries of the program villages into neighboring comparison villages. These effects are robust to the inclusion of individual, household, and community characteristics. We conclude that the benefits of this reproductive and child health program in rural Bangladesh have many dimensions extending well beyond fertility reduction, which do not appear to dissipate rapidly after two decades.     

Increasing contraceptive use in Bangladesh: The role of demand and supply factors

This article analyzes the determinants of contraceptive use in Bangladesh, focusing on the roles of demand for additional children and of family planning service supply. Data from the Matlab Family Planning Health Services Project are used to examine the contributions of these factors to the difference in prevalence of modern contraceptive use between the project area and a control area served by the government family planning and health programs. Results of multivariate analysis deriving from the Easterlin synthesis framework show the importance of family planning supply factors in reducing psychic and resource costs of fertility regulation and in activating latent demand for contraception. Demand for birth limiting and for birth spacing emerge as important explanatory factors; demand for birth spacing is greater in the project area, and both demand measures exert a stronger effect on contraceptive behavior in that area.     

Emotional Variation and Fertility Behavior

Emotional influences on fertility behaviors are an understudied topic that may offer a clear explanation of why many couples choose to have children even when childbearing is not economically rational. With setting-specific measures of the husband-wife emotional bond appropriate for large-scale population research matched with data from a long-term panel study, we have the empirical tools to provide a test of the influence of emotional factors on contraceptive use to limit fertility. This article presents those tests. We use long-term, multilevel community and family panel data to demonstrate that the variance in levels of husband-wife emotional bond is significantly associated with their subsequent use of contraception to avert births. We discuss the wide-ranging implications of this intriguing new result.     

Another Child? Fertility Ideals,Resources and Opportunities

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

Couple childbearing plans and births in Sweden

We use data from a nationally representative sample of Swedish couples to estimate effects of partners’ childbearing plans on the rate of subsequent childbearing. Only 11% of the couples in this sample expressed plans in opposite directions (plan to have a child versus not to have a child), but 24% had differing levels of certainty about their plans. Of the couples in which both partners said they definitely planned to have another child, 44% had a child within two years. If neither partner planned to have another child, less than 2% of couples had a birth. The figure was 6% if the partners had opposing childbearing plans. Thus, both men and women exerted veto power over further childbearing. Disagreements were equally likely to be resolved in favor of the woman as of the man, and effects of partners’ plans on the birth hazard did not depend on the couple’s gender arrangements, family ideologies, or marital status. We discuss these results in the context of Sweden’s public support for gender equality and for childrearing, its pervasive contraceptive regime, and its high rates of cohabitation. We also argue for the collection of data from partners in future family and fertility surveys.     

How female education affects reproductive behavior in urban Pakistan

Although Pakistan remains in a pretransitional stage (contraceptive prevalence of only 11.9% among married women in 1992), urban women with post-primary levels of education are spearheading the gradual move toward fertility transition. Data collected in the city of Karachi in 1987 were used to determine whether the inverse association between fertility and female education is attributable to child supply variables, demand factors, or fertility regulation costs. Karachi, with its high concentration of women with secondary educations employed in professional occupations, has a contraceptive prevalence rate of 31%. Among women married for less than 20 years, a 10-year increment in education predicts that a woman will average two-fifths of a child less than other women in the previous 5 years. Regression analysis identified 4 significant intervening variables in the education-fertility relationship: marriage duration, net family income, formal sector employment, and age at first marriage. Education appears to affect fertility because it promotes a later age at marriage and thus reduces life-time exposure to the risk of childbearing, induces women to marry men with higher incomes (a phenomenon that either reduces the cost of fertility regulation or the demand for children), leads women to become employed in the formal sector (leading to a reduction in the demand for children), and has other unspecified effects on women's values or opportunities that are captured by their birth cohort. When these intervening variables are held constant, women's attitude toward family planning loses its impact on fertility, as do women's domestic autonomy and their expectations of self-support in old age. These findings lend support to increased investments in female education in urban Pakistan as a means of limiting the childbearing of married women. Although it is not clear if investment in female education would have the same effect in rural Pakistan, such action is important from a human and economic development perspective.     

A welcome family planning service center

The Family Planning Service Center of Luohu District was organized by the Family Planning Committee of the district to help couples of child bearing age and 1-child families to overcome their difficulties. The services provided by the center include: distributing contraceptives, and providing consultation on birth control, contraception, healthy births and better upbringing, and maternal and child care. A peculiar feature of the center is that one sees many young and middle-aged people of both sexes going in and out of the place at all hours of the day and night. Workers from the center even go to offices and factories to provide services and distribute contraceptives. In close cooperation with neighborhood family planning centers, the center has also set up offices to distribute contraceptives and give advice. It is estimated that in Luohu District, at present, 90% of the couples of childbearing age are current users of contraceptives. In the city, the proportion of 1-child families is quite large. As a rule in China, preschool children are looked after by their grandparents. Living separately from their parents, however, many couples in the city find it difficult to find someone to care for their children. The center also provides assistance in finding child care help. The center has also invited experts and medical personnel to give 10 lectures on child nutriology, child psychology, birth control, contraception and pregnancy health.     

More choices of birth control approaches

In rural Zhejiang Province, China, family planning intermediaries are appointed for each village to introduce comprehensive measures of birth control to the people. With an education level of junior middle school at least, they are mostly working women of high prestige in their villages. After appointment as intermediaries, these women are trained for 1-2 weeks in health stations or maternal and child health care stations in towns. Back in the villages, they take over responsibility for distributing monthly contraceptives as needed by women of childbearing age. The intermediaries also explain the advantages and disadvantages of different kinds of contraceptives to newly wedded women and give them guidance and recommendations. Intermediaries also can provide simple treatment for complaints caused by contraceptive use. For example, if women complain of nausea while 1st taking oral contraceptives (OCs), the intermediaries will give them vitamin B6. When intermediairies encounter difficulties, such as women who cannot use OCs for a long time because of a liver ailment, they refer the people to health stations or send for a doctor. The number of induced abortions has declined because of the fact that a vast number of women of childbearing age in rural areas now obtain appropriate contraceptives in time. Generally, each intermediary is assigned to be in charge of 15-20 households, making a regular monthly visit to each of these families. The contraceptives they distribute are from town governments, which give them a certain amount of annual subsidies.     

Does low fertility call for new policies in some Asian countries?

Over the past 2 decades, Japan, China, Singapore, Hong Kong, and South Korea have completed a demographic transition from high birth and death rates and runaway population growth to reduced fertility and mortality and population growth approaching replacement levels. Among the outcomes of fertility decline, 3 have particularly far reaching effects: 1) Changes in family types and structures. Marriage and family formation are postponed, childbearing is compressed into a narrow reproductive span that begins later and ends earlier, and higher-order births become rare. Large families are replaced by small ones, and joint and extended families tend to be replaced by nuclear families. 2) Shifts in the proportions of young and old. Declining fertility means that the population as a whole becomes older. Decreases in the proportion of children provides an opportunity to increase the coverage of education. Increases in the proportion of the elderly means higher medical costs and social and economic problems about care of the aged. 3) Changes in the work force. There is concern that low fertility and shortages of workers will cause investment labor-intensive industries to shift to countries with labor surpluses. Another outcome may be an increase in female participation in the work force. The potential consequences of rapid fertility decline have sparked debate among population experts and policy makers throughout Asia. Current family planning programs will emphasize: 1) offering a choice of methods to fit individual preferences; 2) strengthening programs for sexually active unmarried people; 3) encouraging child spacing and reproductive choice rather than simply limiting the number of births; 4) making information available on the side effects of various family planning methods; 5) providing special information and services to introduce new methods; and 6) promoting the maternal and child health benefits of breast feeding and birth spacing.     

Attitudes About Children and Fertility Limitation Behavior

The relationship between attitudes and individual behavior is at the core of virtually all demographic theories of fertility. This paper extends our understanding of fertility behavior by exploring how psychic costs of childbearing and contraceptive use, conceptualized as attitudes about children and contraception, are related to the transition from high fertility and little contraceptive use to lower fertility and wide spread contraceptive use. Using data from rural Nepal, I examine models of the relationship between multiple, setting-specific attitudes about children and contraception and the hazard of contraceptive use to limit childbearing. Specific attitude measures attempt to capture the relative value of children versus consumer goods, the religiously based value of children, and the acceptability of contraceptive use. Findings demonstrate that multiple measures of women’s attitudes about children and contraception were all independently related to their fertility limitation behavior.     

PPAT works with private clinics and industrial enterprises

Doctors from private clinics have responded to an effort by the Planned Parenthood Federation of Thailand (PPAT) to enlist their voluntary services in support of family planning goals. The private doctors will provide contraceptive services at a nominal cost to the public or free to those who cannot pay. Representatives of PPAT, the Labor Department, the Health Department, and 31 industrial factories in Parthum Thani province met last year to work to find ways of including family planning services as part of workers' welfare in every factory. The participants recommended that family planning services should be officially included as part of workers' welfare. The National Population Clearinghouse/Documentation Center has established its home office at Bangkok. Documentary collection activity is focusing on 5 subject areas: family planning, population/demogrpahy, maternal/child health, nutrition, and primary health care. The Center has already begun to translate selected materials from English into Thai.     

Mother's education and effect of son preference on fertility in Matlab,Bangladesh

This analysis follows earlier research that hypothesized and substantiated that, in a society with strong son preference, its effect on fertility would be conditional on the level of contraceptive use. Present analysis of the prospective fertility experience of 22,819 women of reproductive age during 3.5 years in Matlab, Bangladesh, shows that this effect is higher among mothers with postprimary schooling versus those with primary or no education. The higher effect conforms with the known positive relationship of contraceptive use with maternal schooling. However, this increase when contrasted with the idea that education promotes modern values, including gender equality, suggests that education in Matlab, with its traditional slant, is not resistant to son preference. In a poor, traditional society with low status for women, schooling alone is not enough to motivate women to abandon low esteem for daughters though schooling promotes child survival. But if preference for smaller family size increases, promoted by education including such modern values as gender equality, then sex preference, although it cannot be completely removed, will have minimal effect on fertility as in most developed countries.Abbreviations DSS demographic surveillance system - ICDDR,B International Centre for Diarrhoeal Disease Research, Bangladesh - MCH-FP maternal/child health and family planning - SPEF sex preference effect on fertility     

The international family planning movement

Over the past 3 decades, the number of women using family planning has increased 6-fold to over 400 million married women of childbearing age. The evolution of behavior and attitudes toward using birth control among third world couples reflects the goals and hard work of an international network of individuals, governments and organizations. This article follows the progression of this movement, from early opposition in developed as well as developing countries, to the present day, when birth control is practiced by a slight majority of the world's women of childbearing age. Among world regions, contraceptive use ranges from about 17% in Africa to 75% in Asia. In some African countries, however, family planning is still a foreign concept, and fewer than 5% of women use any birth control. International organizations played a crucial role in spread of family planning by providing training for developing country professionals, funding actual family planning programs and helping to evaluate programs. But the success of a country's family planning program also was dependent upon a national commitment, and often on a strong socioeconomic setting. The private sector has had a limited role except in some countries, notably in Latin America, but its involvement is likely to expand in the future. Also, as financial support from the US and international organizations wanes, national governments will cover a larger share of the cost. The worldwide increase in the practice of family planning has led to fertility declines in many third world countries, slowing rapid population growth rates. For individuals, family planning has been a liberating influence, allowing them to participate more fully in the shift from traditional to modern society.