Statistical modeling of selected aspects of the childbearing process with application to world fertility survey countries∗

The childbearing process should be monitored in developing countries experiencing high population growth rates and high levels of maternal and infant mortality. A mathematical model for estimation of certain aspects of the childbearing process, which requires only data on age‐specific fertility rates, is developed. Synthetic maternal childbearing indices, namely, mean ages at first and last birth, length of reproductive life span, inter‐birth spacing, and proportion of childless women, in addition to the well‐known mean age at childbearing, for the WFS countries are obtained using the proposed model. The indices are free from age truncation effects, and, under certain assumptions, provide information about a cohort's completed fertility before the women stop reproducing. The effects of women's residence and education on fertility are also examined.     

Starting age and subsequent birth intervals in cohabitational unions in current danish cohorts, 1975

This paper presents some main results of an investigation by life table methods of birth interval data in cohabitational unions (marriages as well as consensual unions) in current Danish cohorts. Our results confirm previous findings that an early age at the start of recorded exposure to childbearing risk is indicative of a rapid pace and high level of subsequent fertility. The analysis modifies previous results and adds several new details regarding cohort trends and the effect of parity at the start of reported cohabitation. For each parity within a period of cohabitation, fertility differentials by reported starting age seem to have diminished from our older cohorts (of age up to 49 years in 1975) to our younger ones (of age less than 30 years in 1975). There are indications of a dramatic change in childbearing behaviour following the arrival of novel attitudes to non-marital cohabitation and childbearing in Denmark about 1967.     

Reproductive patterns and child mortality in guatemala

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

A Gompertz model for birth interval analysis

During recent years birth intervals have been analysed on a life table basis. This method retains both closed and open intervals, and so reflects behaviour that deliberately avoids the next birth entirely. When life tables are prepared separately for each birth order, markedly different patterns of movement toward the next birth can appear from one parity to the next. This is illustrated for Korean survey data, with historical trends given across marriage cohorts.

A Gompertz model is found to fit the family of curves that show the cumulative proportion giving birth within each interval closely. Its three parameters have direct intuitive interpretations, one being equal to the parity progression ratio and the other two controlling the pace of childbearing before and after the point of peak activity within the interval. The model is useful for interpolation and projection, and provides an efficient summary of the otherwise cumbersome detail given in a life table. Testing against additional data sets is suggested.     

Production,Reproduction, and Education: Women,Children, and Work in a British Perspective

This article reviews findings of studies by the author and colleagues on relationships between women's work and the reproduction of the British population based on data for female birth cohorts 1922–70. The studies address three questions: (1) How do children affect women's paid work and lifetime earnings? (2) How does women's employment affect the quantity of children born? (3) How does women's employment affect the “quality” of children? The answers are affected by the woman's educational attainment. On question 1, childrearing may often halve lifetime earnings, but seldom for the well educated. By contrast, any effects from employment to childbearing are most apparent in the late motherhood of the well educated. Child quality, as assessed by indicators of child development, benefits from maternal education and suffers little from maternal employment. The economic advantages for children in dual‐career families are thus unabated. A widening gulf between mothers will tend to polarize the life chances of their children, unless there are more options to combine employment and childrearing, especially including good‐quality child care for those who cannot afford the market price. Education is a powerful influence, but does not alone solve all issues of equity, whether between families or between sexes.     

Changes in fertility patterns can improve child survival in Southeast Asia

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

Family Planning and Child Health Care: Effect of the Peruvian Programa de Salud Reproductiva y Planificación Familiar, 1996–2000

Our study estimates the effects of exposure to a family planning program which promoted surgical contraception for the first time in Peru on women's use of birth control methods and their children's health. While a broad program, the Programa de Salud Reproductiva y Planificación Familiar forced many indigenous women to undergo sterilization. We compare provinces affected by the program earlier with provinces affected later, before and after the policy. Overall, the results indicate that women in treated areas were more likely to use both temporary and permanent contraceptive methods and their children were less likely to die within their first year of life, partly due to longer breastfeeding. However, we observe heterogeneity by ethnicity. In treated provinces, nonindigenous children benefited from the policy regardless of their mothers’ choice of contraceptive method, while there were few positive impacts for indigenous children whose mothers underwent sterilization. This suggests that coercive or aggressively implemented family planning programs may not confer health benefits on children.     

Economic Development,Gender Inequality,and Demographic Outcomes: Evidence from India

This article examines the determinants of fertility, child mortality, and female disadvantage in child survival in India, using a district‐level panel data set linking 1981 and 1991 censuses. The results question the dominant view that variables directly related to women's agency (specifically, the female literacy rate and the female labor force participation rate) have played the crucial roles here. Instead, variables reflecting the general level of development and modernization are shown to have had the greatest effect in reducing fertility and child mortality during the period of the study. Both economic development and women's agency are seen to have had significant effects in reducing the female disadvantage in child survival. The results suggest, however, that with continued economic development, the two women's agency variables lose their significance in influencing this disadvantage. The policy implications of these findings are considered.     

The effects of breastfeeding and pace of childbearing on mortality at early ages

The effects of the pace of childbearing and breastfeeding practices on infant mortality have rarely been considered together. In this paper, we design and use a set of methodological tools to test a variety of hypotheses postulating the effects of breastfeeding and pace of childbearing on mortality in infancy and early childhood, the mechanisms through which those effects operate, and the contingencies that strengthen or weaken them. The strong effects of both length of breastfeeding and the pace of childbearing on the risks of child death suggest that neither of them exerts an impact on mortality totally mediated by the other. Social and demographic factors (such as age of child, education of mother, and region of residence) also condition the impact of breastfeeding and pace of childbearing on mortality.     

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.     

The Risk of an Unwanted Birth: The Changing Context of Contraceptive Sterilization in the U.S.

Life-table estimates indicate that one-quarter of U.S. women intend no more births by age 25, one-half by age 27, and three-quarters by age 30. The resulting long period at risk of unwanted fertility is argued to be an important underlying dimension of the revolution in attitudes to and practice of sterilization. Life-table estimates are then considered of the timing of sterilization after the last wanted birth. Almost one-quarter of all couples select sterilization within the first year after they have had the number of children they desire. Recent experience would imply that four-fifths of all couples will eventually use contraceptive sterilization. In order to examine the determinants of men's and women's sterilization, logistic regression is used with a polytomous dependent variable: sterilization of the woman, sterilization of the man, or no sterilization within four years of the last wanted birth. Covariates considered are age and parity at last wanted birth, year and duration of marriage at last wanted birth, wife's and husband's education, wife's and husband's religion, whether residence is in a central city, region, pill-use history and timing-failure histories before the last wanted birth, and unwanted birth. Large and significant effects are found for most of these variables, and these effects change in interpretable ways between early innovative behaviour and sterilization during the most recent period when it was widely accepted.     

Death Clustering,Mothers' Education and the Determinants of Child Mortality in Rural Punjab,India

In this paper the behavioural factors which make for continuing high levels of child mortality in rural Punjab, despite favourable conditions in terms of nutrition, income, women's literacy and health care facilities are examined. A major factor is that inadequate attention has been paid to improved health care practices within the home. Women's autonomy, social class, and mothers' education significantly influence child survival. One of the pathways by which mothers' education affects child survival is through improved child care. In this society, a woman's autonomy is lowest during that part of her life-cycle which also contains her peak childbearing years: this perverse overlap raises child mortality. The risk of dying is distributed very unevenly amongst children, as the majority of child deaths are clustered amongst a small proportion of the families. The death-clustering variable remained significant even after several possible biological and socio-economic reasons for clustering had been controlled. It is argued that this clustering of deaths is partly due to the poor basic abilities of some mothers and other carers.     

Maternal mental health in Australia and New Zealand: A review of longitudinal studies

AimThe aim of this paper is to describe the factors that impact on the mental health of Australian and New Zealand (NZ) women in the perinatal period (pregnancy and the year following birth), and to determine the impact of perinatal mental health on women's subsequent health by summarising findings from prospective longitudinal studies conducted in Australia and NZ.MethodsA systematic search was conducted using the databases, Scopus, Medline, PsychInfo and Health Source to identify prospective longitudinal studies focused on women's social and emotional health in the perinatal period. Forty-eight papers from eight longitudinal studies were included.ResultsThe proportion of women reporting depressive symptoms in the first year after birth was between 10 and 20% and this has remained stable over 25 years. The two strongest predictors for depression and anxiety were previous history of depression and poor partner relationship. Importantly, women's mood appears to be better in the first year after birth, when compared to pregnancy and five years later. Becoming a mother at a young age is by itself not a risk factor unless coupled with social disadvantage. Women report a high number of stressors in pregnancy and following birth and the rate of intimate partner violence reported is worryingly high.ConclusionMidwives have an important role in the identification, support and referral of women experiencing mental health problems. As many women do not seek help from mental health services, the potential for a known midwife to impact on women's mental health warrants further examination.     

Childbearing traditions of Indian women at home and abroad: An integrative literature review

BackgroundThe percentage of overseas-born mothers giving birth in Australia has increased to 31.5% in 2012 and Indian women represent 10% (the highest proportion). It is important for midwives in Australia to be aware of the childbearing traditions of Indian women and how these influence Indian women birthing in Australia.AimTo explore childbearing practices in India and Indian women's experience of giving birth abroad; and to discuss the relevant findings for midwives working with Indian women in Australia.MethodAn integrative literature review was employed. 32 items, including 18 original research articles were thematically reviewed to identify commonly occurring themes relating to Indian women's childbearing traditions.FindingsFive themes relating to traditional childbearing practices of women birthing in India were identified. These themes included diversity and disparity; social context of childbirth and marriage; diet based on Ayurveda; pollution theory and confinement; and finally, rituals and customs.ConclusionIndian women giving birth abroad and by implication in Australia experience a transition to motherhood in a new culture. While adjusting to motherhood, they are also negotiating between their old and new cultural identities. To provide culturally safe care, it is essential that midwives reflect on their own culture while exploring what traditions are important for Indian women.     

The TFR and birth control]

Total fertility rate if (TFR) is a simple an straight forward measure of women's fertility. However, it is difficult to use the TFR as a target measure in FP programs. If TFR level is set as a target for a particular year, how can women's fertility be regulated to achieve this target? The following analysis suggests a simple model to control the proportion of birth parity. First, the TFR is decomposed into a parity- specific TFR. The parity-specific TFR can be worked out using coefficients of the regression models calculated from data of previous fertility surveys. Once the TFR is given, the parity-specific total fertility can be calculated using a model with coefficients from empirical data. Then the number of births of each parity may be calculated from the parity-specific TFR using the female age structure in a particular year, the survival probability, and the standard fertility model for each parity. When the number of surviving children of each women at child-bearing age is known, the desired proportion of births of each parity can be calculated using the standard birth probability during a years. From these models, it would be possible to calculate how many women can have their first child/year, and how many can have the second. Thus, family planning organizations would be in a position to formulate a birth quota on the basis of the above information.     

Who decides the position for birth? A follow-up study of a randomised controlled trial

BackgroundPhysical benefits are suggested for women and their babies when women adopt an upright position of their choice at birth. Available care options during labour influence women's impressions of what intrapartum care is. This indicates that choice of birth positions may be determined more by midwives than by women's preferences.QuestionThe aims of this study were to investigate factors associated with adherence to allocated birth position and also to investigate factors associated with decision-making for birth position.MethodAn invitation to answer an on-line questionnaire was mailed.FindingsDespite being randomised, women who gave birth on the seat were statistically significantly more likely to report that they participated in decision-making and that they took the opportunity to choose their preferred birth position. They also reported statistically significantly more often than non-adherers that they felt powerful, protected and self-confident.ConclusionsMidwives should be conscious of the potential impact that birth positions have on women's birth experiences and on maternal outcomes. Midwives should encourage women's autonomy by giving unbiased information about the birth seat. An upright birth position may lead to greater childbirth satisfaction. Women's experience of and preferences for birth positions are consistent with current evidence for best practice.     

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.     

Fertility Decline,Girls’ Well-being,and Gender Gaps in Children’s Well-being in Poor Countries

The influences of recent dramatic declines in fertility on girls’ and boys’ well-being in poorer countries are understudied. In panels of 67–75 poorer countries, using 152–185 Demographic and Health Surveys spanning 1985–2008, we examined how declining total fertility and women’s increasing median age at first birth were associated with changes in girls’ well-being and gender gaps in children’s well-being, as reflected in their survival, nutrition, and access to preventive healthcare. In adjusted random-effects models, these changes in fertility were associated with gains in girls’ survival at ages 1–4 years, vaccination coverage at ages 12–23 months, and nutrition at 0–36 months (for women’s later first childbearing). Declining total fertility was associated with similar gains for boys and girls with respect to vaccination coverage but intensified gender gaps in mortality at ages 1–4 years and malnutrition at ages 0–36 months, especially in higher-son-preference populations. Later increases in women’s median age at first birth—reflecting more equitable gender norms—were associated with declines in these gaps. Promoting equitable investments in children through family planning programs in higher-fertility societies is warranted.     

The impact of women's status on infant mortality rate: A cross-national analysis

A number of prior studies have attempted to account for cross-national differences in infant mortality rate using a variety of economic, demographic, and health related variables. These studies have given relatively little attention to the impact of predictors measuring the status of women. The present study, based on a sample of 96 less developed countries circa 1990, tests a series of hypotheses derived from gender stratification theory and industrialism theory. Evidence is presented of an inverse relationship between the status of women and infant mortality rate. The present study shows that it makes a difference whether we use relative or absolute measures of women's status and it shows that in addition to women's educational status, other dimensions of women's status particularly economic status and autonomy are also important predictors of infant mortality rate.     

Son preference, use of maternal health care, and infant mortality in rural China, 1989-2000

This study assesses the effects of socio-economic conditions and the interaction between son preference and China's one-child family planning policy on the use of maternal health care services and their effects on infant mortality in rural China, using nationally representative data from the 2001 National Family Planning and Reproductive Health Survey. The results show that while the use of maternal health care services has continued to increase over time, large gaps still exist in the use of these services and in infant survival by mother's education, community income, and parity. Further improvements in the reproductive health of all women and in infant survival will require effective reduction of the obstacles to the use of maternal health care among those women in rural China who are less educated, poor, and of higher parity.