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PubMed2002

Monitoring contraceptive continuation: links to fertility outcomes and quality of care.

This study examines the fertility consequences of contraceptive discontinuation, describes cross-national variation in continuation rates, and assesses the usefulness of the contraceptive discontinuation rate as a summary outcome indicator of quality of care. In the 15 countries included in this analysis, the total fertility rate would be between 28 and 64 percent lower if the births following discontinuations that were not the result of a desire to become pregnant had not occurred. The all-method discontinuation rate for quality-related reasons emerges as the most likely candidate for a summary measure of quality of care. Within a year of starting use of a method, between 7 and 27 percent of women cease to practice contraception for reasons related to the quality of the service environment. The results imply that as fertility declines, family planning programs would profit from a shift in emphasis from providing methods to new clients toward providing services to reduce discontinuation rates.

Adolescent↗

PubMed1996

Hainan focuses on improving backward situation.

As the southernmost province of China, Hainan has an area of 32,200 sq. km and had a population of 7.11 million by 1994. Its economy was far from developed before it became a separate province from Guangdong in 1988. As the largest Special Economic Zone of China, Hainan has seen an economic boom in recent years. Family planning had not been stressed much in Hainan until the 1980s. From the 1970s to the 1980s the average birth rate in the province declined slowly from 23.92/1000 to 21.21/1000. The total fertility rate reached 2.67 in 1994. In order to improve the general backward situation, the provincial leaders decided to take several measures: establish and improve the existing agencies for family planning management at all levels and restore those which had been rescinded; strengthen the numbers of family planning staff at township and village levels, ensuring they are well-trained, and more financial input should be secured; the mass media should be made full use of to energetically promote the information, education and communication (IEC) program and increase people's population awareness and willingness to practice family planning.

Asia↗

PubMed1996

Infant mortality: some international comparisons.

Comparison of infant mortality rates (IMRs) among the world's countries requires assessment of completeness and accuracy of data. The United Nations Statistical Office classifies as "C", complete, meaning at least 90% of events are actually recorded, 1994 data supplied by 80 governments, comprising one fourth of the world's population, ie, 1,450,000,000 people, and as incomplete the other three fourths, 4,180,000,000. All the "C" countries officially accept the World Health Organization definition of a live birth (any product of gestation showing any sign of life), but it has been argued that some countries routinely report as stillbirths infants counted as live births in the United States (US), thus understating their IMRs. In 1994, 22 countries had IMRs varying from 4.2 for Japan to 8.0 for the US, a remarkable achievement in the light of IMRs of 124.0 and 60.0 for these two countries in 1930. Compensating for possible underreporting of live births by excluding all deaths in the first hour of life would reduce the US IMR to about 7, still higher than 17 other countries. Between 1930 and 1994 the IMR in the US declined more slowly than several other countries, particularly during the time period 1951 through 1965, when the US rate declined by 16% and the Japanese rate, for instance, declined by 68%. Between 1983 and 1994, decline in Puerto Rico was slower than in Chile, Cuba, and the US. IMRs in all the "C" countries are lower than the US rate was in 1930. IMRs in most of the world, estimated from surveys and special studies, vary from 27 to 190. Correlation studies suggest that a high rate of teenage pregnancies has relatively little effect on IMRs but that high total fertility rates are accompanied by high infant mortality.

Adolescent↗

PubMed1992

Blurred edges to population policies.

Fertility is now below replacement level in most European countries, especially the industrialized ones. In the last 20 years, several countries have developed or improved pronatalist programs containing incentives that are designed to motivate couples to have a 2nd and especially a 3rd child, to maintain a stable population. The WHO Sexuality and Family Planning Unit called a short consultation on this subject last October. What actually constitutes a pronatalist population program and the connections between public policies and private reproductive behavior were not very clear. Nor is it easy to assess the longer--term demographic effects of pronatalist policies or what influences their effectiveness. The outcome usually reflects the country's history, cultural and religious traditions, changes in lifestyle, and the value given to the family and children. Incentives are defined as monetary or nonmonetary inducements to voluntary reproductive behavior that conforms to specified population policies. They may be small or large, in cash or kind, parity-specific or income-linked, immediate or developed, one-time or incremental, or any combination of these. Disincentives are negative sanctions that are either incurred or thought likely as a result of violating the policy. But both incentives and disincentives are difficult to define. Pronatalist policies designed to encourage early marriage and larger families, thereby raising the future total fertility rate should not be confused with traditional social welfare policies designed simply to ease the burden of childbearing. Some policies have both demographic and social welfare aims. Strong pronatalist policies may be linked with restrictions on contraceptive availability and legal abortion. Moreover, other public policies affecting social security, education, employment, housing, regional planning and the emancipation of women may unintentionally influence demographic behavior. Population policies are the product of politics. Often written in ambiguous language and intended to affect society as a whole, they still depend for their outcome on microlevel changes in a couple's perceptions of the costs and benefits of having children. In theory, they can be carried out in many ways but in practice such policies are severely limited by administrative, political, technological, economic, and ethical constraints. One difficulty is that governments is rarely enunciate precise goals. Their approach may range from noninterference in private reproductive behavior to total coercion using controls ranging from traditional cultural influences to imposition of fertility regulations. In some countries, fertility rates have increased briefly (in terms of period rates) following introduction of pronatalist policies. However, it is not clear how the rates were influenced, particularly in the case of parities 1, 2, and 3. A forthcoming report will describe experiences in Bulgaria, France, Germany, Sweden, and Norway.

Developed Countries↗

PubMed2002

The influence of the Chinese zodiac on fertility in Hong Kong SAR.

The annual total of births in Hong Kong SAR fell substantially in the past 20 years; hence the total fertility rate (TFR) followed the downward trend and dropped to a low of 0.9 below replacement level in 2000. Despite the long-term downward trend, short-run increases in the annual total of births and the TFR were exhibited. Such temporary fertility increases are identified in the Dragon Years of 1988 and 2000. The phenomenon of fertility changes associated with zodiacal animal years is examined in this paper with a view to gaining some insight into whether Chinese cultural preferences and folklore beliefs might have influenced prospective parents' reproductive behaviour. The paper explains the underlying philosophy of the Chinese astrological tradition and discusses how zodiacal preferences affect fertility between 1976 and 2000. The paper also explores why zodiacal influences on Chinese fertility before 1976 did not exist. It is unquestionable that the Dragon Year preference exerts an influence on fertility of modern Chinese populations through zodiacal birth-timing motivations. Birth rate rise in the Dragon Year is due to changes in timing of births that will have little effect on cumulative fertility.

Actuarial Analysis↗

PubMed1994

Annual summary of vital statistics--1993.

A new low in the infant mortality rate was reached again in 1993, at 828.8 deaths per 100,000 live births, a decline of 2% from 848.7 in 1992. Births, marriages, and divorces were all lower, both in number and rate. Deaths and the death rate, however, both increased and, more significantly, the age-adjusted death rate increased. A likely explanation is the occurrence of influenza epidemics in early and late 1993. The rate of natural increase declined 8%, to a level of 6.9 per 1000 population. Final figures on births for 1992 indicate that, for the first time in many years, birth rates to teen-agers declined more among black mothers than white. Increase in birth rate among older mothers continued at a somewhat slower rate than recently; older mothers tended to be better educated than the general population in their age groups. Total fertility rates were higher among mothers of Hispanic origin than among non-Hispanic blacks who, in turn, had higher rates than non-Hispanic whites. Among Hispanics the highest rates were in those of Mexican origin. Unlike recent years, birth rates to unmarried mothers did not increase in 1992. Prenatal care coverage improved, with more mothers seeking care early and fewer receiving late or no care. Electronic and fetal monitoring was performed on more than three-quarters of all births and ultrasound on more than half. Life expectancy decreased slightly, in contrast to recent years. Among major causes of death, increases were recorded in 1993 for chronic obstructive pulmonary diseases, pneumonia and influenza, and HIV infection, the latter having the largest percentage increase. Internationally, infant mortality rates in most other industrialized countries declined further in 1992. Comparatively, as in 1991, 21 other countries had infant mortality rates lower than the United States.

Cause of Death↗

PubMed2006

Multistate cohort models with proportional transfer rates.

We present a new, broadly applicable approach to summarizing the behavior of a cohort as it moves through a variety of statuses (or states). The approach is based on the assumption that all rates of transfer maintain a constant ratio to one another over age. We present closed-form expressions for the size and state composition of the cohort at every age and provide expressions for other useful summary measures. The state trajectories, or life course schematics, depict all the possible size and state configurations that the cohort can exhibit over its life course under the specified pattern of transfer rates. The two living state case and hierarchical multistate models with any number of living states are analyzed in detail. Applying our approach to 1997 U.S. fertility data, we find that observed rates of parity progression are roughly proportional over age. Our proportional transfer rate approach provides trajectories by parity state and facilitates analyses of the implications of changes in parity rate levels and patterns. More women complete childbearing at parity 2 than at any other parity, and parity 2 would be the modal parity in models with total fertility rates (TFRs) of 1.40 to 2.61. Increases in parity progression rates to parities 4 and above have little effect on a cohort's TFR, while changes in childlessness have a substantial impact.

Adult↗

PubMedDate not supplied

Proximate determinants of fertility and policy implications in Beijing.

Data from a 1982 sample survey of 3,830 married women below age 50 in a district of Beijing City are applied to the Bongaarts model of the proximate determinants of fertility. A total fertility rate (TFR) of 0.75 births per woman is estimated from the model, compared with a TFR of 1.24 actually observed from the survey. The estimated TFR (0.75) results from the assumed total fecundity (TF) of 15.30 births per woman being inhibited by the indexes of the proximate determinants of fertility, most notably non-marriage (.280), contraception (.315), and induced abortion (.586). The effects of two other proximate determinants, lactational infecundability and spousal separation, were negligible. Comparative data from other countries confirm that the study area has very low levels of fertility and marriage, a very high prevalence of induced abortion, and a small effect of lactational infecundability. The extremely low level of fertility was, thus, achieved through a high level of induced abortion. Future research needs and policy implications associated with the study are discussed.

Abortion, Induced↗

PubMed1989

Demographic consequences of the 1984-1985 Ethiopian famine.

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

Adolescent↗

PubMed2006

Epilepsy in India: nuptiality behaviour and fertility.

PURPOSE: The study was conducted to assess the marital status and fertility in adults with epilepsy. METHODS: The study group consisted of 240 subjects with epilepsy aged 15 and above, Unmarried males (m) 55, unmarried females (f) 73 and married males 48, married females 64. Data was collected according to standard protocol regarding age, sex, age at marriage and onset of seizure, effect of epilepsy on marriage, type of seizure and control, fertility pattern and abortions. The study group was followed up for 30 months. The data was compared with latest available state and national data using Student's 't'-test, chi square, Fisher Z-test. RESULTS: The mean age of married subjects was 26.19 + 6.2 years and of the unmarried was 24.94 +/- 7.1 years. People with epilepsy had significantly (p < 0.05) higher mean age at marriage, significantly (p < 0.05) lower rate of marriage (m 46.6% f 46.72%), significantly (p < 0.05) higher divorce rate and withheld marriage. Females compared to males had higher divorce rate (f 5.84%) and withheld marriage (m 5.45% f 10.96%). The marriage rate of subjects with onset of epilepsy in the first decade (m 38.71% f 34.09%) and second decade (m 33.33% f 35.42%) was significantly lower (p < 0.05) than that of subjects with age at onset of epilepsy greater than 20 years (m 66.67% f 71.11%). Subjects with epilepsy not in remission had significantly (p < 0.05) higher mean age at marriage, lower marriage rate and lower fertility per person-year of marriage than those in remission. Majority (95.54%) did not disclose epilepsy before marriage. Total fertility rate (TFR) in males (4.56) and females (5.45) with epilepsy was comparable to general population. Abortions per pregnancy were 4.76%. CONCLUSION: Subjects with epilepsy had lower marriage prevalence rate, delayed marriage (especially females), withheld marriage and higher divorce rate compared to general population. Marriage rate was lower in people with age at onset of epilepsy less than 20 years and in whom seizures were not in remission. Majority of people with epilepsy did not disclose epilepsy before marriage. Though fertility was not affected in people with epilepsy as compared to general population, males had lower fertility than females.

Adolescent↗

PubMedDate not supplied

A matter of life and death for Manitoba's children: an overview of birth rates and mortality rates.

OBJECTIVE: To determine the fertility and child mortality rates for Manitoba. METHODS: Fertility and mortality rates were derived from the Population Health Research Data Repository and Vital Statistics, for 1994 through 1998. Data are presented by 12 Regional Health Authorities (RHAs), 12 Winnipeg Community Areas (CAs) and by income quintile. Each indicator is correlated with PMR (the age- and sex-adjusted premature mortality rate, i.e., death before age 75) and SEFI (Socioeconomic Factor Index, a standardized composite index), both considered proxies for overall health and socioeconomic well-being of populations. RESULTS: Manitoba's total fertility rate was 1.77 children per woman, ranging from 1.62 to 3.15 by RHA, and 1.21 to 2.30 by Winnipeg CA. Manitoba's infant mortality rate was 6.6/1000 (or 5.5/1000 excluding < 500 g or < 20 weeks gestation), ranging from 4.5 to 10.2 by RHA (4.2 to 9.8 exclusive), and 3.7 to 8.4 by Winnipeg CA (2.7 to 6.7). There was a gradient of infant mortality by income quintile (p < 0.001), with double the rate comparing lowest to highest. Child mortality rates varied geographically and by gender, with northern children at greatest risk. Injury was the leading cause of death (52% for ages 1 through 9, 75% for ages 15 to 19). CONCLUSION: Fertility rates, as well as infant and child mortality rates, were positively associated with PMR and SEFI, with substantial geographical variation.

Adolescent↗

PubMed2002

Demographic impact of AIDS in a low-fertility urban African setting: projection for Addis Ababa, Ethiopia.

The study estimated the potential demographic impact of acquired immunodeficiency syndrome (AIDS) in a low-fertility urban setting in sub-Saharan Africa. The prevalence of human immunodeficiency virus (HIV) projected using a deterministic mathematical model was put into the AIDS Impact Model (AIM) of the SPECTRUM Policy Modelling System to estimate the potential demographic impact ofAIDS in Addis Ababa, Ethiopia. Demographic indicators from 1984 (the start of the HIV epidemic in Ethiopia) to 2024, including and excluding the HIV epidemic, were compared. Addis Ababa is experiencing a demographic transition in which the total fertility rate has declined from 3.8 to below replacement level over the last 20 years. The prevalence of HIV is predicted to stabilize at 10% in adults, resulting in a total number of people living with HIV at 200,000 and a cumulative number of deaths due to AIDS at 50,000. About 60% of adult deaths can be attributable to AIDS by 2000. The epidemic is predicted to reduce life expectancy by 10 and 17 years in 2000 and 2024 respectively, and to turn to negative, the rate of natural increase after 2009. Accordingly, the rate of natural increase will be -0.18%, -0.35%, and -0.71% per annum by 2009, 2014, and 2024 respectively. Population growth is expected to continue with or without HIV, as a result of high net in-migration, although data for migration are scanty. In a low-fertility urban society of Africa, this study shows the potential for the HIV/AIDS epidemic to turn the rate of natural increase to negative.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Teenage childbearing: structural determinants in developing countries.

Data for a sample of 50 developing countries are analysed to investigate the social correlates of the teenage birth rate. Of five major factors considered as predictors of national birth rates (socioeconomic development, family planning programmes, women's status, the sex ratio, and marriage patterns), regression analyses reveal that only the average age at marriage for women has a significant effect on the teenage birth rate. In contrast, all variables except the sex ratio and the average age at marriage for women have a significant effect on the total fertility rate.

Adolescent↗

PubMedDate not supplied

Sex ratio at birth, polygyny, and fertility: a cross-national study.

The sex ratio at birth may reflect frequency of intercourse that affects the timing of conception. If so, cross-national variation in polygyny and fertility might account for country differences in secondary sex ratios. Consistent with the timing of intercourse hypothesis, the birth sex ratios of 148 countries declined with total fertility rates and polygyny intensity, and increased with contraception use in correlational analysis. Regression analysis confirmed that polygyny was a negative predictor of the sex ratio (and contraception was a positive predictor), with level of economic development and mother's age controlled, but the effects disappeared with total fertility added to the equation. The sex ratio evidently declines with increases in fertility because more children are born at a later birth order when frequency of intercourse is lower.

Birth Order↗

PubMed2004

Successful testicular sperm extraction in Korean Klinefelter syndrome.

OBJECTIVES: To evaluate the clinical features of Korean Klinefelter syndrome (KS) and the outcome of intracytoplasmic sperm injection using fresh testicular spermatozoa obtained by testicular sperm extraction from these infertile men. Most patients with KS have a nonmosaic 47,XXY karyotype, and about 3% of males with KS are mosaic (46,XY/47,XXY). Great variability is present in the clinical findings. Testicular sperm extraction in conjunction with intracytoplasmic sperm injection has been performed in men with KS in the hope of finding spermatozoa, and some men with KS have had sperm retrieved successfully and achieved pregnancy. METHODS: From January 2000 to January 2002, 42 azoospermic patients were diagnosed with KS after cytogenic evaluation. The karyotypes for all patients were determined by cytologic analysis, including the evaluation of more than 30 peripheral blood lymphocyte metaphases. The patients underwent history and physical examination. The testicular volume was measured using an orchidometer. Semen analysis was performed twice according to the methods recommended by the World Health Organization. Their hormonal profile was also assessed. RESULTS: Our study groups consisted of 36 patients with KS, 11 with mosaic and 25 with nonmosaic KS. Testicular sperm extraction was performed in all 36 patients. In 10 patients (27%), mature sperm were found in the wet preparation and were used for intracytoplasmic sperm injection. No statistically significant correlation was found between sperm extraction and age, serum follicle-stimulating hormone, serum testosterone, or testicular volume. The sperm retrieval rate of the patients with mosaic and nonmosaic KS was 54.5% and 16%, respectively. Intracytoplasmic sperm injection using fresh testicular spermatozoa resulted in a total fertilization rate of 50%. CONCLUSIONS: In our study, patients with mosaic KS had a greater rate of successful sperm retrieval than did those with nonmosaic KS. However, age, serum follicle-stimulating hormone, testosterone level, and testicular volume had no statistically significant relationship with successful sperm retrieval. Testicular sperm obtained from patients with KS induced fertilization and delivery of chromosomally normal children.

Adult↗

PubMedDate not supplied

Abortion in Vietnam: measurements, puzzles, and concerns.

This report summarizes current knowledge about abortion in Vietnam, drawing upon government statistics, survey data, and fieldwork undertaken by the author in Vietnam throughout 1993 and part of 1994. The official total abortion rate in Vietnam in 1992 was about 2.5 per woman, the highest in Asia and worrisome for a country with a still-high total fertility rate of 3.7 children per woman. Vietnamese provinces exhibited substantial variation in both the rate of abortion and the type of procedures performed. Among the hypotheses explored to explain Vietnam's high rate of abortion are the borrowing of family planning strategies from other poor socialist states where abortion is common; current antinatal population policies that interact with a lack of contraceptive alternatives; and a rise in pregnancies among young and unmarried women in the wake of recent free-market reforms. Because family-size preferences are still declining, abortion rates may continue to increase unless the incidence of unwanted pregnancy can be reduced, a goal that Vietnamese population specialists are seeking to achieve.

Abortion, Legal↗

PubMed2003

Hindrances to family planning program: findings from Banke, Nepal.

Reducing population growth through programs is a high priority for many developing countries. Why particularly in the rural regions of these countries, do these initiatives fail? Using a case study of a recent initiative in rural Nepal between 1998 and 2002 as an example, this opinion piece discusses possible reasons for such failure and recommends that a broader strategic approach is necessary, particularly in relation to empowering women in these communities. Banke district, Nepal, is mainly rural, consisting of 47 villages. Scarcity of family planning provisions is a dominant problem in most parts of the district. District Public Health Office (DPHO), the major family service provider lacks resources and technical capabilities. In recent years, non-government organizations (NGOs) have been collaborating and coordinating their efforts with DPHO in order to cover the larger section of the district population. A local NGO called Banke Mahila Arthick Swawlamban Sangathan (BMASS) provided family planning services in 5 of the 47 villages of Banke district, Nepal, from 1998 through 2002. Outreach activities and clinical services were the two major components of BMASS family planning program. Outreach activities included door-to-door/mass counseling, street drama, and condom distribution. Clinical services that included counseling, testing, temporary sterilization, and referrals for permanent sterilization were provided through a centrally located static clinic and mobile clinics. BMASS family planning program had almost no impact in the target villages. There was no significant increase in contraceptive use, people's motivation to limit fertility, and number of people preferring a smaller family size. The contraceptive prevalence rate increased by less than 2% after 2 years of family planning program intervention. More than 80% of the family planning clients were reported to have discontinued contraceptive use within six months. The mean age of women at the time of first child delivery (16.2 years), total fertility rate (six children per woman), and the birth intervals (13-18 months) were reported to be the same for both periods: before and two years after family planning program intervention. Further assessment of the local factors revealed that women's lack of control over fertility and higher number of desired children could have hindered the community's response to BMASS family planning program. In the target villages a woman's fertility is dependent upon the preference of husbands and in-laws. The women in general are not empowered to voice their opinion with regards to delaying fertility, spacing child-births, and limiting the number of children to be born to them. Higher number of desired children in the target villages is the outcome of low cost of child rearing and high benefits from the children. Children not only contribute significantly in household economy and provide old age security to their parents, but also consume less. To be effective, family planning programs need to be integrated into broader societal reforms that address rural economic development and the role of women in society.

Journal Article↗

PubMed1983

Oral contraceptive steroids do not promote the development or growth of prolactinomas.

Seventy women with prolactinomas, age 19-38 years, were studied in order to evaluate a possible relationship between the use of steroidal oral contraceptives (o.c.) and the development of prolactin-producing adenomas. Sixty-seven patients were admitted for investigation because of menstrual bleeding disturbances and three patients because of galactorrhea. Forty-three patients (61%) had used o.c. Thirty-six out of forty-three women (83%) experienced their menstrual disturbances and/or galactorrhea when using o.c. or immediately after discontinuing the pill. Patients who had used o.c. had shorter duration of symptoms, lower S-prolactin levels and less pronounced enlargement of the sella turcica. These tendencies indicate that o.c. lead to an earlier manifestation of clinically latent prolactin-producing tumours. With or without previous o.c., the patients showed a low total fertility rate, indicating a notably long, clinically undiagnosed period of disease. The accumulated usage of o.c. by the women with prolactinomas was not higher than among the total female population of the same age in Sweden. Furthermore, patients on o.c. for several years did not show a more advanced form of the disease than women who had not taken the pill. Thus, the present study provides no support for the hypothesis that o.c. promote the growth of prolactin-producing pituitary adenomas.

Adenoma↗