Variation in wealth and educational drivers of fertility decline across 45 countries

Understanding the association between family planning and fertility reduction in Southeast Asia: a scoping review

OBJECTIVES

We aimed to explore and understand the extent and type of evidence on fertility reduction and its association with family planning (FP) in Southeast Asia.

DESIGN

Scoping review, following the methodological principles developed by Arksey and O'Malley and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines for reporting.

DATA SOURCE

We searched PubMed/MEDLINE, ProQuest, EBSCO, Scopus, Web of Science, Google Scholar and reference lists of relevant articles between 1 January 2012 and 31 December 2022. Only open-access articles in English were considered.

STUDY SELECTION

For inclusion, observational studies were selected for eligibility based on the original articles investigating the uptake of FP on women aged 15-49 years and its association with fertility decline in Southeast Asian (SEA) countries.

DATA EXTRACTION AND ANALYSIS

Two reviewers screened the records independently for eligibility and extracted all data. The specific details of the studies, including data on the authors, year of publication, setting, study design, aims/objectives of the study, specific intervention, outcomes and main findings, were reported.

RESULTS

We retrieved 615 articles and retained 12 articles included in the analysis. Of these, 11 were quantitative studies and 1 was qualitative study. The frequently reported strategy of FP was the use of contraception. FP not only allows women to control their birth by spacing and limiting their pregnancies but also delay their first childbirth by using contraceptive methods.

CONCLUSION

Our review suggests that the FP programmes aiming at reducing fertility should have a specific focus on improving the uptake and continuation of FP services.

Racial and Temporal Differences in Fertility-Education Trade-Offs Reveal the Effect of Economic Opportunities on Optimum Family Size in the United States

Contemporary trends in low fertility can in part be explained by increasing incentives to invest in offspring's embodied capital over offspring quantity in environments where education is a salient source of social mobility. However, studies on this subject have often neglected to empirically examine heterogeneity, missing out on the opportunity to investigate how this relationship is impacted when individuals are excluded from meaningful participation in economic spheres. Using General Social Survey data from the United States, I examine changes in the relationship between number of siblings and college attendance for White and Black respondents throughout the 1900s. Results show that in the early 1900s, White individuals from larger families had a lower chance of completing four years of college education than those from smaller families, whereas the likelihood for Black individuals was more uniform across family sizes. These racial differences mostly converged in the later part of the century. These results may help explain variations in the timing of demographic transitions within different racial groups in the United States and suggest that the benefits of decreasing family size on educational outcomes may be conditional on the specific economic opportunities afforded to a family.

Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios.

METHODS

To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values-a metric assessing gain in forecasting accuracy-by comparing predicted versus observed ASFRs from the past 15 years (2007-21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline.

FINDINGS

During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63-5·06) to 2·23 (2·09-2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137-147), declining to 129 million (121-138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1-canonically considered replacement-level fertility-in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7-29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59-2·08) in 2050 and 1·59 (1·25-1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6-43·1) in 2050 and 54·3% (47·1-59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions-decreasing, for example, in south Asia from 24·8% (23·7-25·8) in 2021 to 16·7% (14·3-19·1) in 2050 and 7·1% (4·4-10·1) in 2100-but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40-1·92) in 2050 and 1·62 (1·35-1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction.

INTERPRETATION

Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world.

FUNDING

Bill & Melinda Gates Foundation.

Number of children ever-born and its associated factors among currently married Ethiopian women: evidence from the 2019 EMDHS using negative binomial regression

BACKGROUND

Ethiopia's population is growing at about 2.7% annually with a fertility rate of 4.1 births per woman. However, as per the knowledge of the researcher, not enough studies have been done in Ethiopia to identify factors associated with women's fertility levels.

OBJECTIVE

To assess the number of children ever born and its associated factors among currently married reproductive-age Ethiopian women.

METHOD

Data of 5613 currently married women were extracted from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). Stata version 14 was used for data extraction, processing, and analysis. Descriptive data were summarized using descriptive statistics. A multivariable negative binomial regression was used for the inferential analysis. Incidence rate ratio (IRR) and its 95% CI were respectively used to measure the associations and their statistical significance.

RESULT

The median number of children ever born per currently married Ethiopian woman was 3 with an iterquarter range of 4 (1-5) children. Age of a woman at her first birth (aIRR = 0.958, 95% CI: 0.954, 0.961), being protestant (aIRR = 1.128, 95%CI: 1.068, 1.193), being Muslim (aIRR = 1.096, 95% CI: 1.043, 1.151), and being from other religious groups than Orthodox Christianity (aIRR = 1.353, 95% CI: 1.036, 1.766) are positively associated with bearing more children. On the other hands, completing primary education (aIRR = 0.664, 95% CI: 0.640,0.689), secondary education(aIRR = 0.541, 95%CI: 0.504,0.582), higher education(aIRR = 0.527, 95%CI: 0.479, 0.580), being from a richest household(aIRR = 0.899, 95%CI: 0.840, 0.962), using modern contraceptive (aIRR = 0.877, 95%CI: 0.847, 0.908), living in the Afar (aIRR = 0.785, 95%CI: 0.718,0.859), Amhara (aIRR = 0.890, 95%CI: 0.718,0.859), Gambella (aIRR = 0.894, 95%CI: 0.820,0.974), and Addid Ababa(0.845, 95%CI: 0.760,0.939) are negatively associated with bearing more children.

CONCLUSION

Promoting women's empowerment, encouraging women's academic advancement, and community-based educational intervention are recommended to have optimal and decreased numbers of children.

State-specific fertility rate changes across the USA following the first two waves of COVID-19

STUDY QUESTION

How did the first two coronavirus disease 2019 (COVID-19) waves affect fertility rates in the USA?

SUMMARY ANSWER

States differed widely in how their fertility rates changed following the COVID-19 outbreak and these changes were influenced more by state-level economic, racial, political, and social factors than by COVID-19 wave severity.

WHAT IS KNOWN ALREADY

The outbreak of the COVID-19 pandemic contributed to already declining fertility rates in the USA, but not equally across states. Identifying drivers of differential changes in fertility rates can help explain variations in demographic shifts across states in the USA and motivate policies that support families in general, not only during crises.

STUDY DESIGN, SIZE, DURATION

This is an ecological study using state-level data from 50 US states and the District of Columbia (n = 51). The study period extends from 2020 to 2021 with historical data from 2016 to 2019. We identified Wave 1 as the first apex for each state after February 2020 and Wave 2 as the second apex, during Fall/Winter 2020-2021.

PARTICIPANTS/MATERIALS, SETTING, METHODS

State-level COVID-19 wave severity, defined as case acceleration during each 3-month COVID-19 wave (cases/100 000 population/month), was derived from 7-day weekly moving average COVID-19 case rates from the US Centers for Disease Control and Prevention (CDC). State-level fertility rate changes (change in average monthly fertility rate/100 000 women of reproductive age (WRA)/year) were derived from the CDC Bureau of Vital Statistics and from 2020 US Census and University of Virginia 2021 population estimates 9 months after each COVID-19 wave. We performed univariate analyses to describe national and state-level fertility rate changes following each wave, and simple and multivariable linear regression analyses to assess the relation of COVID-19 wave severity and other state-level characteristics with fertility rate changes.

MAIN RESULTS AND THE ROLE OF CHANCE

Nationwide, fertility dropped by 17.5 births/month/100 000 WRA/year following Wave 1 and 9.2 births/month/100 000 WRA/year following Wave 2. The declines following Wave 1 were largest among majority-Democrat, more non-White states where people practiced greater social distancing. Greater COVID-19 wave severity was associated with steeper fertility rate decline post-Wave 1 in simple regression, but the association was attenuated when adjusted for other covariates. Adjusting for the economic impact of the pandemic (hypothesized mediator) also attenuated the effect. There was no relation between COVID-19 wave severity and fertility rate change following Wave 2.

LIMITATIONS, REASONS FOR CAUTION

Our study harnesses state-level data so individual-level conclusions cannot be inferred. There may be residual confounding in our multivariable regression and we were underpowered to detect some effects.

WIDER IMPLICATIONS OF THE FINDINGS

The COVID-19 pandemic initially impacted the national fertility rate but, overall, the fertility rate rebounded to the pre-pandemic level following Wave 2. Consistent with prior literature, COVID-19 wave severity did not appear to predict fertility rate change. Economic, racial, political, and social factors influenced state-specific fertility rates during the pandemic more than the severity of the outbreak alone. Future studies in other countries should also consider whether these factors account for internal heterogeneity when examining the impact of the COVID-19 pandemic and other crises on fertility.

STUDY FUNDING/COMPETING INTEREST(S)

L.G.K. received funding from the National Institute of Environmental Health Sciences (R00ES030403), M.C. from the National Science Foundation Graduate Research Fellowship Program (20-A0-00-1005789), and M.L. and E.S. from the National Institute of Environmental Health Sciences (R01ES032808). None of the authors have competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Future emissions of greenhouse gases, particulate matter and volatile organic compounds from municipal solid waste burning in India

Waste generation projections for the 21st century are important for the investigation of long-term global environmental problems, and greenhouse gas emissions associated with waste management. This paper presents future waste generation and open waste burning projections for India, which are consistent with the scenarios in the shared socio-economic pathways (SSPs) database. India's waste generation will increase to 547 Tgy^-1 and 828 Tgy^-1, by 2030 and 2050, respectively, if India's waste generation rates converge to those of developed economies under the fossil fuel based economic growth projections of SSP5. This will increase open waste burning emissions by 140 % and 110 % over 2015 levels by 2030 and 2050, respectively. Business-as-usual projections predict a waste generation of 268 ± 14 Tgy^-1 by 2030 and 356 ± 34 Tgy^-1 by 2050 and elimination of waste burning other than landfill fires by the mid-2040s. Aggressive promotion of source segregation and treatment of biodegradable waste under a sustainable development scenario (SSP1) can advance this transition despite higher income growth and reduce waste burning from 68 (45-105) Tgy^-1 in 2015 to 21-48 Tgy^-1 and 2-22 Tgy^-1 of waste burning by 2030 and 2050, respectively. The failure of programs targeted at this waste component would result in 31-60 Tgy^-1 and 26-108 Tgy^-1 of waste burning by 2030 and 2050, respectively. For the SSP5 income trajectory a failure to successfully source segregate and treat biodegradable waste would almost double open waste burning by 2050.

Association of undernutrition and female infertility in East Africa: Finding from multi-country demographic and health surveys

Introduction

Infertility is one of the public health problems affecting a significant number of women in the reproductive age group. Although female fertility is predominantly affected by gynecological and systemic diseases, lifestyle and nutritional factors also play an important role in secondary female infertility. Therefore, this study aimed to determine the pooled prevalence of secondary female infertility and its association with undernutrition using nationwide data from the Demographic and Health Surveys (DHS) of eastern African countries.

Methods

The data of ten East African countries that comprise a weighted sample of 38,020 women data were accessed from measure DHS. Data processing and analysis were performed using STATA 15 software. A multilevel mixed-effect logistic regression model was fitted to examine the association between undernutrition and secondary infertility. Variables with a p-value < 0.05 were declared as significant factors associated with secondary infertility. Model comparison was done based on Akaike and Bayesian Information Criteria (AIC and BIC). To measure variation (random effects), Community-level variance with standard deviation and intra-cluster correlation coefficient (ICC) was used.

Result

The proportion of women who have secondary infertility was 16.32% with 95%CI (15.96, 16.69), of which 26.94% were undernourished. This study found that being undernutrition (AOR = 1.74; 95%CI: 1.54-1.98) and overweight (AOR = 1.72; 95%CI: 1.62-1.86) were significantly associated with secondary infertility. Women aged >35 years (AOR = 3.47; 95%CI: 2.66-4.55), and rural residents (AOR = 1.16; 95%CI: 1.02-1.37) are other factors that are positively associated with secondary infertility. However, primary education (AOR = 0.87; 95%CI: 0.77-0.97) and richer wealth index (AOR = 0.84; 95%CI: 0.73-0.97) are protective factors for secondary infertility.

Conclusion

This study indicated that there is a strong association between secondary infertility and undernutrition growing in Eastern Africa. Therefore, Health information dissemination and awareness creation on the impact of malnutrition on infertility should be given to the community and health care providers. Given this, it may lead to integrating nutrition counseling into both clinical settings for infertility management as well as national dietary guidelines for individuals of reproductive age.

Fertility Decision-Making in the UK: Insights from a Qualitative Study among British Men and Women

Scholars are interested in better understanding the low fertility observed in higher income countries. While some people are choosing to have smaller families, countries also report a ‘fertility gap’, which is the proportion of people who end up with fewer children than originally desired. This paper investigates some causes of the fertility gap in the UK. We amassed qualitative data from seven focus groups conducted among men and women of reproductive age with different educational backgrounds. These focus groups suggest that social support is an influential factor for Britons thinking about having children, although discussions differed in terms of whether this was support from partners or parents. Discussions with university-educated women featured themes of career opportunity costs, and non-university men contributed insights on the financial burden of parenthood. This exploratory study provides up-to-date material on unwanted childlessness and the low fertility in the UK, and highlights the merit of using qualitative methods in understanding the fertility gap.

Behavioral Ecology of the Family: Harnessing Theory to Better Understand Variation in Human Families

Researchers across the social sciences have long been interested in families. How people make decisions such as who to marry, when to have a baby, how big or small a family to have, or whether to stay with a partner or stray are questions that continue to interest economists, sociologists, demographers, and anthropologists. Human families vary across the globe; different cultures have different marriage practices, different ideas about who raises children, and even different notions of what a family is. Human behavioral ecology is a branch of anthropology that is particularly interested in cultural variation of family systems and how these differences impact upon the people that inhabit them; the children, parents, grandparents. It draws on evolutionary theory to direct research and generate testable hypotheses to uncover how different ecologies, including social contexts, can explain diversity in families. In this Special Issue on the behavioral ecology of the family, we have collated a selection of papers that showcase just how useful this framework is for understanding cultural variation in families, which we hope will convince other social scientists interested in family research to draw upon evolutionary and ecological insight in their own work.

Fertility intentions and outcomes in Indonesia: Evolutionary perspectives on sexual conflict

Differential fertility preferences for men and women may provide insights into human sexual conflict. We explore whether pairbonded couples have different preferences for future offspring, which socioecological factors are associated with these preferences, and who achieves their desired fertility over time. We utilise the Indonesia Family Life Survey (IFLS), a longitudinal survey which collected data from 1993 to 2015, to compare desired future fertility for 9655 couples and follow couples who had divergent preferences. The majority of couples (64.8%) want the same number of future offspring. In 20.7% of couples, husbands want more future offspring than their wives, while the reverse occurs in 14.5% of couples. Living in villages with the husband's or the wife's parent(s) is associated with having divergent preferences for future offspring, where there is a higher likelihood that women prefer more offspring than their husbands. When examining fertility outcomes, women, particularly those who marry at older ages, are more likely to achieve their desired preference. Contrary to previous research, we do not find that living near one's natal kin or having increased autonomy increases an individual's likelihood of achieving desired fertility outcomes.

Cultural change beyond adoption dynamics: Evolutionary approaches to the discontinuation of contraception

Numerous evolutionary mechanisms have been proposed for the origins, spread and maintenance of low fertility. Such scholarship has focused on explaining the adoption of fertility-reducing behaviour, especially the use of contraceptive methods. However, this work has yet to engage fully with the dynamics of contraceptive behaviour at the individual level. Here we highlight the importance of considering not just adoption but also discontinuation for understanding contraceptive dynamics and their impact on fertility. We start by introducing contemporary evolutionary approaches to understanding fertility regulation behaviours, discussing the potential for integrating behavioural ecology and cultural evolution frameworks. Second, we draw on family planning studies to highlight the importance of contraceptive discontinuation owing to side-effects for understanding fertility rates and suggest evolutionary hypotheses for explaining patterns of variation in discontinuation rates. Third, we sketch a framework for considering how individual flexibility in contraceptive behaviour might impact the evolution of contraceptive strategies and the demographic transition. We argue that integrating public health and evolutionary approaches to reproductive behaviour might advance both fields by providing (a) a predictive framework for comparing the effectiveness of various public health strategies and (b) a more realistic picture of behaviour by considering contraceptive dynamics at the individual level more explicitly when modelling the cultural evolution of low fertility.

Disentangling wealth effects on fertility in 64 low- and middle-income countries

Studies have shown mixed associations between wealth and fertility, a finding that has posed ongoing puzzles for evolutionary theories of human reproduction. However, measures of wealth do not simply capture economic capacity, which is expected to increase fertility. They can also serve as a proxy for market opportunities available to a household, which may reduce fertility. The multifaceted meaning of many wealth measures obscures our ability to draw inferences about the relationship between wealth and fertility. Here, we disentangle economic capacity and market opportunities using wealth measures that do not carry the same market-oriented biases as commonly used asset-based measures. Using measures of agricultural and market-based wealth for 562,324 women across 111,724 sampling clusters from 151 DHS surveys in 64 countries, we employ a latent variable structural equation model to estimate (a) latent variables capturing economic capacity and market opportunity and (b) their effects on completed fertility. Market opportunities had a consistent negative effect on fertility, while economic capacity had a weaker but generally positive effect on fertility. The results show that the confusion between operational measures of wealth and the concepts of economic capacity can impede our understanding of how material resources and market contexts shape reproduction.