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PubMedDate not supplied

Attitude towards family planning in Dharan, east Nepal: implications for the family planning programme.

A survey of the knowledge, attitude and practice of family planning was conducted in Dharan, Nepal. The town offers a full range of family planning services free of charge. There was a strong desire to limit family size; 52.5% of couples were currently using some modern method of family planning. Of the current users, 62.3% had been sterilized, including 92.3% of those in the lowest socioeconomic group. Health risks and incompleteness of the family were the most common reasons for non-use of contraception, the latter reason reflecting ignorance of the temporary nature of some methods. There was a strong preference for male children and couples rarely used contraception until at least one so had been born. Even in this prosperous town where couples were highly motivated towards family planning and all methods were readily available, there was heavy reliance on sterilization. This is typical of Nepal and has largely been responsible for the failure of the family planning programme--as most couples choosing sterilization are in the older age group and have completed a relatively large family. If Nepal is to succeed in meeting its target of reducing the total fertility rate (i.e., births per woman) from the current 5.8 to 4 by the year 2000 it will need not only to expand services but actively to promote temporary methods of contraception, particularly the more reliable longer acting reversible methods such as Depo-Provera, Norplant and intrauterine contraceptive devices.

Adolescent↗
PubMed1991

Components of stably high fertility in three areas of west Africa.

The constancy of fertility levels in Ghana, Senegal and southwest Nigeria since 1970 is separated into its nuptiality and marital fertility elements. The age-specific changes in the two components are examined and these show that the apparent stability in observed total fertility rates is essentially the outcome of the offsetting impact of increased marital fertility below age 25 and above age 40, over the effect of the increasing proportion of women remaining single up to 25 yr of age. Continuity in traditional fertility behaviour and stable nuptiality has remained operative over the broad middle segment of the reproductive lifespan of women in the three areas. The paper thus concludes that West Africa is likely to continue to display stably high fertility for many years into the next century. The social and cultural conditions behind this trend are discussed with special reference to the continued high demand for children and the low and only slowly rising contraceptive prevalence level.

Adolescent↗
PubMed1995

Epidemiological transition in Latin America: the case of Chile.

To describe Chile's stage of epidemiological transition, a descriptive study of the changes to the demographic and economic profile of this country during the last 20 years is presented. The decline in the total fertility rate from 3.4 in 1970 to 2.6 in 1992 and the important decrease in general and infant mortality rate has led to an increase of life expectancy of 8 years for men and 9 years for women. This has resulted in changes to the age structure and causes of mortality and morbidity of the population. A reduction of 82% in the proportion of deaths among children < 1 year and a 73% increase of mortality amongst those 65 years and older can be observed. In line with these changes non-communicable diseases have increased from 53.7% of all deaths in 1970 to 74.9% in 1991. In the same period mortality rates from cardiovascular causes have decreased from 189.6 to 161.1 per 100,000 population, whilst their relative proportion of all causes has increased from 22.3% to 29%. High prevalence of risk factors should lead to a significant increase of chronic diseases in future years. Regarding morbidity, a high incidence rate for tuberculosis persists together with an increase of infections of the digestive system and of sexually transmitted diseases. A decrease in the rates of diseases preventable by immunisation has been noted. It is concluded that, as defined by population mortality statistics, Chile is in a post-transition stage but with a persistence of some infectious diseases corresponding to a transitional stage of development.

Adolescent↗
PubMed2002

The impact of the changing marital structure on fertility of Hong Kong SAR (Special Administrative Region).

Hong Kong SAR has experienced an especially rapid fall in fertility over the course of just two decades. The total fertility rate (TFR) fell steadily from the replacement level (i.e. two children per woman) to 0.83 in 1999, which is the lowest in the world. (United Nations Population Division. Replacement migration: is it a solution to declining and ageing populations? United Nations, New York, 2000.) An important question is whether the dramatic decline in the TFR results from a decline in the fertility of married women or from changes in the proportion ever married. Are married women having fewer children, or are there simply fewer married women of prime childbearing age? In this paper, the effects of the changing marital structure on the conventional TFR are identified so that the underlying trends in fertility can be assessed. The study shows that the large decline in the TFR between 1981 and 1999 was in great part distorted by tempo effects, distortions caused by changes in the timing of childbearing and the changing marital structure. Without the distortion induced by the decreasing proportion of women marrying in the prime childbearing years, the decline in fertility was essentially less significant over the 20-year period. A continuation in the downward trend in the proportion married is a strong probability in the light of marriage habits prevalent among the population. This will exert a continuing downward driving force on the TFR. Hong Kong will experience its fertility rate decline further in the short to medium term. The study investigates the effect of long-lasting below-replacement level fertility with a view to gaining some analytical insight into the situation should the population experience such a striking demographic process.

Adult↗
PubMed2006

Interest of pentoxifylline in ICSI with frozen-thawed testicular spermatozoa from patients with non-obstructive azoospermia.

Selection for intracytoplasmic sperm injection (ICSI) of viable frozen-thawed testicular spermatozoa obtained from patients suffering from non-obstructive azoospermia is very often long, difficult and sometimes impossible. The purpose of this study was to determine if the use of pentoxifylline (PF) could facilitate this selection in stimulating sperm motility. From January 2000 to December 2004, 108 ICSI cycles with non-obstructive azoospermia were performed. From these 108 cycles, in 64 cycles where no motile spermatozoa were observed or when the time search per spermatozoa was above 20 min, 1.5 mmol/l PF was used for 10 min, whereas the 44 other ICSI cycles were performed using spontaneously motile spermatozoa (control group). In all cases, PF either initiated the motility when no motile spermatozoa were observed, or stimulated the motility, reducing dramatically the time search per spermatozoa. The total fertilization rate was 54.2% versus 66.7% in the control group (P < 0.02). Twenty-nine pregnancies out of the 64 PF cycles (45.3% per cycle) occurred, including 20 deliveries of 23 healthy children and eight ongoing pregnancies, whereas 12 pregnancies were obtained in the control group (27.3% per cycle), including nine deliveries of 13 healthy children. In conclusion, in 100% of cycles pentoxifylline allows the selection of viable frozen-thawed testicular spermatozoa with the same outcome after ICSI as that observed with fresh ejaculated spermatozoa.

Adult↗
PubMed2006

Sibling oocyte submission to IVF and ICSI in unexplained infertility patients: a potential assay for gamete quality.

In order to reduce total fertilization failure in unexplained infertility, sibling oocytes were submitted to both conventional IVF and intracytoplasmic sperm injection (ICSI). Two groups of ICSI embryos were compared in unexplained infertility patients: those derived from ICSI when IVF had failed to fertilize, and those derived from ICSI while their sibling oocytes were fertilized by IVF. The outcome of oocytes fertilized exclusively by ICSI (essential ICSI, n = 749) was compared with those fertilized both by IVF and ICSI (non-essential ICSI, n = 957) in all IVF patients treated for unexplained infertility at the Hadassah Hospital (1999-2002). The latter group was further subdivided into ICSI and IVF embryos. Total fertilization rate was 54%. Fertilization rates by ICSI were lower in the essential ICSI compared with the non-essential ICSI group, at 65 and 73% (P < 0.025). Pregnancy rates per embryo transfer in the essential ICSI group (49%), ICSI derived embryos group (55%) and IVF derived embryos (44%) from the non-essential ICSI group, were similar. Implantation rates were lower in the essential ICSI group as compared with the non-essential ICSI group (21 versus 32% respectively; P < 0.05) and 26% for IVF embryos. In conclusion, essential ICSI was associated with lower fertilization and implantation rates.

Adult↗
PubMed1990

Fertility preferences among Malaysian women: an analysis of responses to the new population policy.

About 10% of 3887 ever-married women included in the 1984-85 Malaysian Population and Family Survey revealed that they were influenced by the new population policy to desire more children than they had originally wanted. These women were more likely to be rural Malays from the lower socioeconomic class. Ideal family size was more than four children. Children are desired for economic benefits and emotional support. The natality of the Malays has risen since 1980: their total fertility rate has increased while their contraceptive prevalence rate has dropped sharply. Coupled with a decline in the crude death rate, the present fertility preferences and behaviour of the Malays will render the target of the population policy more attainable than is reflected by the survey data.

Adult↗
PubMed1991

Changes in contraceptive use and fertility: El Salvador, 1978-88.

In El Salvador from 1978 to 1988, contraceptive use among married women 15-44 years of age increased from 34% to 47%, and the total fertility rate declined from 6.3 to 4.6 children per woman. Most of this change took place from 1978 to 1985. Sterilization is the most prevalent method used, but nearly one-half of the women who are sterilized did not use any contraception before their operation. Few young couples use reversible methods of contraception to space births or delay the start of childbearing. On average, women wait 8 years after marriage and have nearly three children before they use contraception.

Adolescent↗
PubMed1995

Fertility and family planning in African cites: the impact of female migration.

This study uses data from thirteen Demographic and Health Surveys to examine effects of female migration on fertility in African cities. Contrary to expectations, migration from villages and towns in the 1980s and 1990s reduced total fertility rates in African cities by about one birth, from an estimated average of 5.55 in the absence of migration to 4.59. New arrivals experience much lower fertility in their first few years in cities than long term residents of similar age and parity. This results from the initial unmarried status of most migrants, high levels of spousal separation among new arrivals who are married, dramatic increases in use of modern methods of contraception after 2 years in cities, and continuation of traditionally long durations of postpartum abstinence. Accommodation of additional migrants thus appears consistent with efforts to reduce fertility in cities. Moreover, prospects for increased contraceptive prevalence in Africa may depend heavily on changes in population distribution that influence the demand for children, specifically movement to cities.

Africa↗
PubMed2002

Reproduction in high altitude Aymara: physiological stress and fertility planning?

Reproductive characteristics at high altitude are described based on the reproductive histories of 720 Aymara women, collected in 1998 and 1999 in a group of twelve peasant communities at a mean altitude of 4000 m in the Bolivian Altiplano. The reproductive pattern is shaped by a late onset of childbearing, associated with a rather short reproductive span and large birth intervals. Environmental conditions could explain the particularly late age at menarche of rural girls compared with their urban counterparts, whereas the age at first birth is likely to be under cultural control. The short reproductive span appears to result from a large mean interval between last birth and menopause, which is essentially determined by cultural decisions. The birth intervals, which are longer than in many traditional societies, could be the result of a slower restoration of postpartum fecundability induced by the hard way of life inherent in the Altiplano (including poor sanitary and nutritional conditions and high workload), perhaps aggravated by hypoxia. However, a secular trend in fertility is perceptible, towards earlier menarche, earlier age at first birth, increasing reproductive span and a slight increase in live births and surviving offspring, which is probably the result of a slow improvement in living conditions. The existence of birth control on the one hand, and a total fertility rate averaging six live births among the couples who do not practise contraception on the other, are other arguments against the hypothesis of a low natural fecundity in these Aymara groups.

Adolescent↗
PubMed2004

Recent trends and components of change in fertility in Nepal.

The objectives of this article are, first, to provide improved estimates of recent fertility levels and trends in Nepal and, second, to analyse the components of fertility change. The analysis is based on data from Nepal's 1996 and 2001 Demographic and Health Surveys. Total fertility rates (TFR) are derived by the own-children method. They incorporate additional adjustments to compensate for displacement of births, and they are compared with estimates derived by the birth-history method. Fertility is estimated not only for the whole country but also by urban/rural residence and by woman's education. The own-children estimates for the whole country indicate that the TFR declined from 4.96 to 4.69 births per woman between the 3-year period preceding the 1996 survey and the 3-year period preceding the 2001 survey. About three-quarters of the decline stems from reductions in age-specific marital fertility rates and about one-quarter from changes in age-specific proportions currently married. Further decomposition of the decline in marital fertility, as measured by births per currently married woman during the 5-year period before each survey, indicates that almost half of the decline in marital fertility is accounted for by changes in population composition by ecological region, development region, urban/rural residence, education, age at first cohabitation with husband, time elapsed since first cohabitation, number of living children at the start of the 5-year period and media exposure. With these variables controlled, another one-third of the decline is accounted for by increase in the proportion sterilized at the start of the 5-year period before each survey.

Adolescent↗
PubMed2002

Survey on maternal mortality in Swaziland using the sisterhood method.

Monitoring and evaluating maternal mortality in African countries is impossible without specific and reliable data and indicators. This study of maternal mortality using the 'Sisterhood Method' was undertaken in Swaziland. The crude data on 'sisterhood mortality' were obtained from the 1993-94 Multi-Purpose Household Survey carried out by the Central Statistics Office and Ministry of Health of Swaziland. A total fertility rate of 6.36, as given in the 1986 Swaziland census, was used in estimating these indicators. Prior to this study, the maternal mortality rate (MMR) in Swaziland (based only on health facility data) was considered to lie within the range of 107-125 maternal deaths per 100 000 live births. Use of the 'Sisterhood Method' allowed a more precise estimate of maternal mortality for the general population of Swaziland. The study revealed the estimated MMR to be 229 and the life-time risk of maternal death to be 1 in 69. These values were most probably stable throughout the 6- to 7-year period before the survey.

Adult↗
PubMed1994

Microinjection: choice of embryo transfer technique.

Subzonal sperm microinjection (SUZI) is indicated in severe oligoasthenozoospermia, in which the total count of motile sperm is inadequate for in vitro fertilization (IVF), and in cases with repeated failure of fertilization. Sperm for microinjection are selected following centrifugation on a Percoll gradient and stimulation with pentoxifylline and 2-deoxyadenosine. Motile sperm (2-10 per egg) are injected into the perivitelline space and fertilized oocytes are then cultured for two days prior to transfer into the Fallopian tube (tubal embryo stage transfer, TEST) or uterus. During 1992, SUZI results showed a total fertilization rate of 30% (19% were 2 pronuclear, 11% were polyspermic), a transfer rate of 55% and pregnancy rates of 15.2% per transfer and 8.3% per cycle. Recent pregnancy data in mild-moderate male factor infertility showed that gamete intrafallopian transfer (GIFT) results were consistently superior to TEST or IVF, suggesting a beneficial effect of the tubal environment on fertilization and early embryonic development. Accordingly, the combination of SUZI followed by the immediate transfer of injected oocytes into the Fallopian tube, the MIFT procedure, was explored. An initial study of 21 consecutive microinjection candidates showed a clinical pregnancy rate of 24% per cycle. Information regarding fertilization and polyspermy rates was available from supernumerary oocytes in 90% of patients. A randomized, controlled trial comparing MIFT with SUZI or TEST in severe male factor infertility is required to confirm the improved pregnancy rate in MIFT cycles.

Embryo Transfer↗
PubMed2006

Contraceptive use, fertility, and unsafe abortion in developing countries.

OBJECTIVES: Despite a substantial rise in contraceptive use around the world, unplanned pregnancies and induced abortion continue to occur. Each year an estimated 19 million abortions are carried out outside the legal system, often by unskilled practitioners or under unhygienic conditions. This paper explores the relationship between contraceptive prevalence and unsafe abortion in developing regions with different levels of fertility. These relationships manifest the extent to which the desire to regulate fertility is addressed by contraception or by unsafe abortion, where access to safe abortion is legally restricted. METHODS: Secondary analysis of estimates of unsafe abortion, total fertility rate and contraceptive prevalence, by geographical regions. RESULTS: High levels of unsafe abortion persist even where contraceptive prevalence is increasing and fertility is declining. It appears that a high dependence on sterilization for limiting family size may by be preceded by reliance on unsafe abortion, where abortion is restricted, for birth spacing. CONCLUSIONS: The reliance on unsafe abortion could be reduced during fertility transition by improving women's access to reversible contraceptives for spacing births as well as to sterilization for terminating childbearing. Expanding contraceptive choices and a balanced method mix can serve as an effective strategy to prevent unsafe abortion where reliance on sterilization to limit childbearing is not preceded by the use of reversible modern methods for spacing and where access to safe abortion is restricted by law. The intriguing association between contraceptive method choice and the incidence of unsafe abortion deserves further exploration.

Abortion, Illegal↗
PubMed2005

Aging in Asia: a cultural, socio-economical and historical perspective.

Asia has about 60% of the world population and population aging is occurring more rapidly in Asia than in Western countries. The group aged 65 years and above will increase from 207 million in 2000 to 857 million in 2050, a staggering increase of 314%. The diversity in economic, demographic, religious, cultural and geo-political factors in Asia is unparalleled by any other continent, and is, in part, contributory to the rapid rise in population aging. By 2050, those under 15 years old will have shrunk from 30% in 2000 to 19%, while those aged 65 years and above will increase from 6% to 18%. In addition, the gender divide still persists with 100 elderly women to 70 elderly men. These projected demographic changes pose three major challenges: 1) how best to address the rising population of the group aged 65 years and above, 2) how to address the shrinking population of the young as well as the working adults, and 3) how to address the problems arising from the disproportionate increase in older women than men. From now to 2050, it will be expeditious for each country in Asia to look into ways of reversing the decline in total fertility rates (TFRs) and restore to replacement levels. If not, at least introduce measures to halt its free fall. Due to the complexity of factors that have influenced the fall in TFRs in Asia, it will be a daunting task to reverse this fall. There is no "single size fits all" solution to this complex problem. Research work in this short-term strategy in addressing the aging population is urgent. In the longer term, the East-West Centre have suggested four modalities, 1) establish policies and programmes that enhance traditional Asian systems of family support for the elderly; 2) introduce policy reform that encourages the elderly who are still capable of remaining in the work force; 3) create institutions and systems that support high levels of personal saving; and 4) formulate public programmes, including pension schemes and national healthcare systems. We need to work while there is time.

Aged↗
PubMedDate not supplied

Fertility attitudes and behavior of Saudi Arabian students enrolled in U.S. universities.

Although fertility declines have taken place in several Arab countries, the Arab nations are growing rapidly. In Saudi Arabia, the total fertility rate (TFR) is 7.1, and the growth rate is 3.5 per cent per year, among the highest in the world. This research examines the structural determinants (indirect indicators) of fertility attitudes and behavior among Saudi Arabian students studying in American universities. Specifically, this study examined the relationship between fertility attitudes and behavior, and background characteristics which included age, religiosity, education, income, length of stay in the U.S., and wife's age and wife's education. Results indicate a highly significant effect of religiosity as a major positive determinant of fertility attitudes. However, the major determinant of fertility behavior, the number of children respondents had, was wife's education which was negatively related with family size.

Adult↗
PubMedDate not supplied

Analysis of contraceptive discontinuation in six developing countries from durations of use at survey.

We conduct a cross-national study of contraceptive discontinuation among currently married nonsterilized contracepting women in Bolivia, Egypt, Kenya, Sri Lanka, Thailand, and Zimbabwe using the Demographic and Health Surveys (DHS). Since the DHS contains no true completed epochs of contraceptive use, the distribution of use times at survey is used to approximate the distribution of the completed epochs using the renewal theorem. Two techniques based on this approximation are used. The first technique uses local linear regression smoothing of a histogram estimate of the use time at survey pdf which is converted into an estimate of the discontinuation probability function. The second technique poses a proportional hazards Weibull distribution for the discontinuation probability function which is then converted into a model for the use times at survey. This second technique is used to model the observed variations in use across countries while controlling for other sociodemographic factors such as children ever born, age, and education, as well as a variable which encodes knowledge of the fertility cycle. Pill discontinuation probabilities range from 0.12 to 0.47 in the first year. IUD discontinuation probabilities range from 0.18 to 0.53 in the first year. Discontinuation probabilities in Egypt over all methods are in agreement with those reported in Ali and Cleland (1995). Logged relative risks of pill discontinuation range from -0.94 (Sri Lanka) to 0 (Kenya), while logged relative risks of IUD discontinuation range from -0.53 (Sri Lanka) to 0.41 (Zimbabwe). The ordering of risks of pill discontinuation among the six countries considered is in agreement with the ordering of total fertility rates excerpted from Westoff (1991).

Contraception Behavior↗
PubMedDate not supplied

How big are educational and racial fertility differentials in the U.S.?

Using pooled data from the 1980, 1985, 1990 and 1995 CPS and 1988 and 1995 NSFG surveys, we show that shifts in fertility timing have occurred disproportionately for the more educated and for whites (compared to the less educated and to African Americans). Such timing shifts imply that the underlying period quantum of fertility is considerably higher for college-educated women and for whites than suggested by the standard total fertility rate. Applying the Bongaarts-Feeney model (1998), we decompose observed racial and educational differences in age-order-specific fertility rates and TFR into tempo and quantum components. We find that a modest part of educational differences and a substantial part of racial difference in period fertility can be attributed to differential changes in tempo. Analysis by race and education shows a clear interaction: higher fertility among African Americans is confined to the less educated.

Adolescent↗