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Borges ALV, Roman Lay AA, Duarte LS, Chofakian CBDN, Hall JA, Barrett G. Changes in contraceptive use during the second COVID-19 lockdown in Brazil: A web-based survey. Contraception 2024; 131:110359. [PMID: 38159791 DOI: 10.1016/j.contraception.2023.110359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE We assessed contraceptive use changes during the second lockdown due to COVID-19 in Brazil and their associated factors. STUDY DESIGN This was a longitudinal web-based study in which 725 non-pregnant Brazilian women aged 18 to 49 completed an online structured survey about their contraceptive practices in two rounds in 2021. Multivariate multinomial logistic regression was used to analyze factors associated with contraceptive use changes during COVID-19. RESULTS Sixty percent reported they changed their contraceptive use during COVID-19, especially starting to use a method or switching to a more effective one (32%). In adjusted analysis, women who were ambivalent about a future pregnancy were more likely to switch to a more effective method (adjusted odds ratio [aOR] 2.33, 95% CI 1.42-3.83) and to stop using contraceptive (aOR 3.64, 95% CI 1.91-6.91). Women with a partner were less likely to switch to a more effective method (aOR 0.61, 95% CI 0.39-0.93) and to stop using contraceptive (aOR 0.53, 95% CI 0.31-0.93), but more likely to switch to a less effective method (aOR 2.25, 95% CI 1.16-4.34). Age was also associated with contraceptive use changes. CONCLUSIONS Contraceptive use among Brazilian women during COVID-19 depended on their age and partnership status. During the period of the highest peak in the number of cases and deaths in the country, ambivalence towards a future pregnancy increased changes in contraceptive use. IMPLICATIONS Contraceptive changes were observed during a two-wave web-survey in Brazil depending on women's age and partnership status. Ambivalence towards a future pregnancy increased changes in contraceptive use and should be considered in future studies regarding sexual and reproductive health and COVID-19 as well as in family planning program implementation.
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Affiliation(s)
| | | | | | | | | | - Geraldine Barrett
- EGA Institute for Women's Health, University College London, London, UK
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Marteleto LJ, Maia AG, Rodrigues CG. Climate and fertility amid a public health crisis. POPULATION STUDIES 2023; 77:437-458. [PMID: 37581317 DOI: 10.1080/00324728.2023.2228288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/07/2022] [Indexed: 08/16/2023]
Abstract
One line of enquiry in demographic research assesses whether climate affects fertility. We extend this literature by examining the ramifications of climate conditions on fertility over a period of public health crisis in a highly unequal, urban middle-income country. We use monthly data for Brazil's 5,564 municipalities and apply spatial fixed-effects models to account for unobserved municipal heterogeneity and spatial dependence. Findings suggest that increases in temperature and precipitation are associated with declines in births. We also show that changes in response to climate conditions became greater during the Zika epidemic, particularly in urban areas. Combined, findings highlight the value of understanding the intersections between climate and fertility across geographic boundaries and during this public health crisis. Epidemics have become more important in people's lives with the recurring emergence of novel infectious disease threats, such as Zika and Covid-19.
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Charles CM, Souza Neto LA, Soares CF, Souza Araújo T, Torezzan C, Lima EEC, Munezero A, Bahamondes L, Souza RT, Costa ML, Cecatti JG, Pacagnella RC. Preterm births prevalence during the COVID-19 pandemic in Brazil: results from the national database. Sci Rep 2023; 13:14580. [PMID: 37666901 PMCID: PMC10477268 DOI: 10.1038/s41598-023-37871-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/28/2023] [Indexed: 09/06/2023] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic impacted the health systems between and within countries, and in the course of the pandemic sexual and reproductive health services were the most disrupted. Findings from high-income settings have reported significant changes in preterm birth prevalence during the pandemic period. To understand the possible effects of the COVID-19 pandemic on preterm birth numbers at the Brazilian national level. We compare the number of preterm deliveries during the COVID-19 pandemic period (2020 and 2021) with previous years. We conducted a population-based cross-sectional study taking the period from January 2017 to December 2021 to account. We use individual-level live births data from the Brazilian Live Birth Information System (SINASC), and we estimate the odds ratio (OR) of preterm deliveries using propensity score weighting analysis in Brazil and its regions. During the study period (from 2017 to 2021), about 2.7 million live births were recorded per year, and the missing value for gestational age at delivery was less than 1.5%. The preterm birth prevalence slightly increased during the COVID-19 pandemic compared to the pre-pandemic period (11.32% in 2021 vs 11.09% in 2019, p-value < 0.0001). After adjusting for sociodemographic variables, the OR of preterm births in Brazil has significantly increased, 4% in 2020 (OR: 1.04 [1.03-1.05] 95% CI, p-value < 0.001), and 2% in 2021(OR: 1.02 [1.01-1.03] 95% CI, p-value < 0.001), compared to 2019. At the regional level, the preterm birth pattern in the South, Southeast and Northeast regions show a similar pattern. The highest odds ratio was observed in the South region (2020 vs 2019, OR: 1.07 [1.05-1.10] 95% CI; 2021 vs 2019, OR: 1.03 [1.01-1.06] 95% CI). However, we also observed a significant reduction in the ORs of preterm births in the northern region during the COVID-19 pandemic (2020 vs 2019, OR: 0.96 [0.94-0.98] 95% CI) and (2021 vs 2019, OR: 0.97 [0.95-0.99] 95% CI). Our analysis shows that the pandemic has increased regional variation in the number of preterm births in Brazil in 2020 and 2021 compared to the pre-pandemic years.
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Affiliation(s)
- Charles M'poca Charles
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
- Provincial Health Administration, DPS Manica, Chimoio, Mozambique
| | - Luiz Alves Souza Neto
- Institute of Mathematics, Statistics and Scientific Computing (IMEEC), University of Campinas, Campinas, SP, Brazil
- School of Applied Sciences (FCA), University of Campinas, Campinas, SP, Brazil
| | - Camila Ferreira Soares
- College of Philosophy and Human Sciences (IFCH), University of Campinas, Campinas, SP, Brazil
| | - Tacildo Souza Araújo
- Institute of Mathematics, Statistics and Scientific Computing (IMEEC), University of Campinas, Campinas, SP, Brazil
| | - Cristiano Torezzan
- Center for Population Studies (NEPO), University of Campinas, Campinas, SP, Brazil
| | - Everton Emanuel Campos Lima
- College of Philosophy and Human Sciences (IFCH), University of Campinas, Campinas, SP, Brazil
- Center for Population Studies (NEPO), University of Campinas, Campinas, SP, Brazil
| | - Aline Munezero
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
- Campinas Reproductive Health Research Center (CEMICAMP), Campinas, Brasil
| | - Renato Teixeira Souza
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
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Pesando LM, Dorélien A, St-Denis X, Santos A. Demography as a Field: Where We Came From and Where We Are Headed. CANADIAN STUDIES IN POPULATION 2023; 50:4. [PMID: 38962580 PMCID: PMC11219022 DOI: 10.1007/s42650-023-00076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 06/28/2023] [Indexed: 07/05/2024]
Abstract
This essay provides a series of reflections on the current state of demography as seen by four early-career researchers who are actively engaged in aspects of the discipline as varied as research, teaching, mentorship, data collection efforts, policy making, and policy advising. Despite some claims that the discipline is weakening, we showcase the great potential of the field and outline promising pathways and novel directions for the future. In so doing, we critically assess recent innovations in data quality and availability, stressing the need to "revolutionize" the way that demographic methods are taught by adopting a viewpoint that more closely reflects the rapidly changing, or "fast," nature of global social phenomena such as conflict-related displacements, environmental disasters, migration streams, pandemics, and evolving population policies. We conclude by discussing the relevance of careful demographic analyses for policy making, stressing three main points: (i) the need to make demography more visible and understandable to the public eye; (ii) the importance of engaging and co-creating with local communities to "break" the academic bubble; and (iii) the urge to counteract the spread of misinformation-a phenomenon that has become even more visible in the aftermath of the COVID-19 outbreak.
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Affiliation(s)
- Luca Maria Pesando
- Division of Social Science, New York University, Abu Dhabi, United Arab Emirates
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Audrey Dorélien
- Hubert H. Humphrey School of Public Affairs, University of Minnesota, Minneapolis, MN, USA
| | - Xavier St-Denis
- Institut National de la Recherche Scientifique (INRS), Montréal, Canada
| | - Alexis Santos
- Department of Human Development and Family Studies, Pennsylvania State University, State College, Pennsylvania, PA, USA
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Moreno-Louzada L, Menezes-Filho N. The relationship between staying at home during the pandemic and the number of conceptions: A national panel data analysis. PLoS One 2023; 18:e0289604. [PMID: 37566617 PMCID: PMC10420359 DOI: 10.1371/journal.pone.0289604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
hether the COVID-19 pandemic has changed fertility patterns is still an open question, as social isolation for long periods can impact the number of conceptions in many ways. We combine administrative data on all recent births in Brazil with daily data on individual location to estimate the relationship between the share of individuals staying close to their homes in each week and the number of conceptions in that same week, comparing municipalities with different social isolation patterns during the first semester of 2020. We find that conceptions unequivocally decline when social isolation increases. The effect is stronger for women who are between 21 and 25 years old and more educated, as well as for richer, larger, and more urban municipalities. COVID-19 is likely to change fertility across countries depending on the behavior of the population and on the lock-down measures implemented to fight the pandemic.
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Whitfield B, Marteleto L. Women's Attitudes Towards Abortion in Response to the Zika and COVID-19 Outbreaks in Brazil. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023:1-17. [PMID: 37363355 PMCID: PMC10185939 DOI: 10.1007/s13178-023-00813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 06/28/2023]
Abstract
Introduction Abortion attitudes are influenced by people's socioeconomic and demographic circumstances and can be volatile during times of crisis. Brazil is an interesting case for examining abortion attitudes because of its strict abortion policies, changing religious landscape, high income inequality, and extreme uncertainty generated by the back-to-back Zika and COVID-19 crises. This study seeks to assess Brazilian women's attitudes toward abortion and whether religion and income explain these attitudes in the context of novel infectious disease epidemics. Methods We used data from a population-based sample of 3996 women ages 18-34 in Pernambuco, Brazil, collected during the onset of the COVID-19 pandemic (May-September 2020). We conducted paired t-tests and multivariate-adjusted logistic regression models with adjusted Odds Ratios (aORs) and 95% CIs to assess differences in support for abortion in the case of fetal congenital Zika syndrome (CZS), maternal Zika infection during pregnancy, and maternal COVID-19 infection during pregnancy. Results Significantly more women support the right to abortion in the case of fetal CZS (50%) than in the case of maternal Zika infection (40%) and maternal COVID-19 infection (31%). Support for abortion varies by income and religion. Controlling for other demographic characteristics, high-income women have higher odds of supporting abortion in the case of fetal CZS (aOR = 1.92; 95% CI: 1.25-2.94) and maternal Zika infection (aOR = 2.07; 95% CI: 1.33-3.21) than low-income women. Evangelical women have lower odds of supporting abortion in the case of maternal Zika infection (aOR = 0.65; 95% CI: 0.45-0.93) and marginally lower odds of supporting the right to abortion in the case of maternal COVID-19 infection (aOR = 0.69; 95% CI: 0.47-1.00) than women of other religious affiliations. Conclusions and Policy Implications With increasingly conservative religious groups gaining size in Brazil, we expect to see increasing abortion restrictions. However, this research finds that a sizable portion of women across all incomes and religious affiliations support abortion, particularly in the case of fetal anomalies associated with Zika.
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Affiliation(s)
- Brooke Whitfield
- Population Research Center, University of Texas at Austin, 305 E 23rd St. G1800, Austin, TX 78712 USA
| | - Leticia Marteleto
- Population Research Center, University of Texas at Austin, 305 E 23rd St. G1800, Austin, TX 78712 USA
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Lee DS, Batyra E, Castro A, Wilde J. Human fertility after a disaster: a systematic literature review. Proc Biol Sci 2023; 290:20230211. [PMID: 37161332 PMCID: PMC10170212 DOI: 10.1098/rspb.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Fertility is a key demographic parameter influenced by disaster. With the growing risk of disasters, interest in the fertility response to a disaster is increasing among the public, policy makers and researchers alike. However, a systematic literature review on how disaster affects live birth counts does not yet exist. We reviewed 50 studies retrieved from a systematic search based on a pre-registered protocol. We found an overall negative impact of disasters on fertility. If any, increases in fertility were mostly linked with weather-related physical disasters. We also identified 13 distinct mechanisms which researchers have considered as underlying the fertility effects of disaster. By contrast to the common belief that disasters are more likely to increase fertility in contexts with already high fertility, we found little evidence to suggest that the total fertility rate of the studied populations was an important predictor of the direction, timing or size of fertility impacts. While this may be because no relationship exists, it may also be due to biases we observed in the literature towards studying high-income countries or high-cost disasters. We summarize the methodological limitations identified from the reviewed studies into six practical recommendations for future research. Our findings inform both the theories behind the fertility effects of disasters and the methods for studying them.
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Affiliation(s)
- D Susie Lee
- Centre for Demographic Studies (CED), Barcelona, 08193, Spain
| | - Ewa Batyra
- Fertility and Well-being, Max-Planck-Institute for Demographic Research, 18057 Rostock, Mecklenburg-Vorpommern, Germany
- Centre for Demographic Studies (CED), Barcelona, 08193, Spain
| | - Andres Castro
- Fertility and Well-being, Max-Planck-Institute for Demographic Research, 18057 Rostock, Mecklenburg-Vorpommern, Germany
- Centre for Demographic Studies (CED), Barcelona, 08193, Spain
| | - Joshua Wilde
- Fertility and Well-being, Max-Planck-Institute for Demographic Research, 18057 Rostock, Mecklenburg-Vorpommern, Germany
- Institute of Labor Economics (IZA), 53113 Bonn, Germany
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Marteleto LJ, Dondero M, Koepp A. Scars from a Previous Epidemic: Social Proximity to Zika and Fertility Intentions during the COVID-19 Pandemic. SOCIUS : SOCIOLOGICAL RESEARCH FOR A DYNAMIC WORLD 2023; 9:23780231231184767. [PMID: 37520157 PMCID: PMC10372507 DOI: 10.1177/23780231231184767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
We examine whether women's social proximity to Zika during the Zika epidemic predicts intentions to avoid a pregnancy because of the COVID-19 pandemic either directly or indirectly via subjective assessments of the pandemic. We apply path models on unique microdata from Brazil, the country most affected by Zika and an epicenter of COVID-19, to understand whether a novel infectious disease outbreak left lasting imprints shaping fertility intentions during a subsequent novel infectious disease outbreak. Findings show that Zika social proximity is associated with fertility intentions through an indirect path related to subjective assessment of the COVID-19 pandemic. These findings emerged regardless of whether a woman herself had or suspected she had Zika and speak to the transformative consequences of novel infectious disease outbreaks that go beyond mortality and health.
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Luppi F, Arpino B, Rosina A. Fertility plans in the early times of the COVID-19 pandemic: The role of occupational and financial uncertainty in Italy. PLoS One 2022; 17:e0271384. [PMID: 36480514 PMCID: PMC9731473 DOI: 10.1371/journal.pone.0271384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/29/2022] [Indexed: 12/13/2022] Open
Abstract
This study investigates the association between objective and subjective indicators of economic uncertainty, generated by the COVID-19 health and economic crisis, and young Italians' fertility plans during the 2020. We use unique repeated cross-sectional data, collected at different time points during the pandemic (March and October/November 2020) together with pre-COVID data (2016). The data offer a standard fertility intention question pre- and during-COVID, and also a direct question on whether pre-COVID fertility plans have been confirmed, postponed or abandoned. In March 2020, individuals with more vulnerable occupations show a lower probability of intending to have a(nother) child in the short-term and a higher probability of abandoning their pre-COVID fertility plan; in October 2020 changes in fertility plans do not vary by employment condition. Instead, both in March and October, those who suffered from a negative income shock and those with negative expectations on their future income and occupation are more likely to abandon their pre-pandemic fertility plan compared to their better off counterparts. Overall, economic uncertainty seems to have similarly affected men and women's fertility intentions. Our findings point to the fact that the unequal economic consequences of the pandemic also produced and will produce heterogeneous effects on fertility intentions.
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Affiliation(s)
- Francesca Luppi
- Department of Statistics, Università Cattolica del Sacro Cuore, Milan, Italy
- * E-mail:
| | - Bruno Arpino
- Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
| | - Alessandro Rosina
- Department of Statistics, Università Cattolica del Sacro Cuore, Milan, Italy
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Abstract
The COVID-19 pandemic has taken a large toll on population health and well-being. We examine the consequences of prenatal exposure for infant health, through which the pandemic may have lasting intergenerational effects. We examine multiple pathways by which the pandemic shaped birth outcomes and socioeconomic disparities in these consequences. Analysis of more than 3.5 million birth records in California with universal information on COVID infection among persons giving birth at the time of delivery reveals deep inequalities in infection by education, race/ethnicity, and place-based socioeconomic disadvantage. COVID infection during pregnancy, in turn, predicts a large increase in the probability of preterm birth, by approximately one third. At the population level, a surprising reduction in preterm births during the first months of the pandemic was followed by an increase in preterm births during the surge in COVID infections in the winter of 2021. Whereas the early-pandemic reduction in preterm births benefited primarily highly educated mothers, the increase in preterm births during the winter infection surge was entirely concentrated among mothers with low levels of schooling. The COVID-19 pandemic is expected to exacerbate U.S. inequality in multiple ways. Our findings highlight a particularly enduring pathway: the long-term legacy of prenatal exposure to an unequal pandemic environment.
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Affiliation(s)
| | - Jenna Nobles
- Department of Sociology, University of Wisconsin-Madison, Madison, WI, USA
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Wang Y, Gozgor G, Lau CKM. Effects of pandemics uncertainty on fertility. Front Public Health 2022; 10:854771. [PMID: 36111195 PMCID: PMC9468419 DOI: 10.3389/fpubh.2022.854771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/09/2022] [Indexed: 01/21/2023] Open
Abstract
The COVID-19 pandemic has affected various dimensions of the economies and societies. At this juncture, this paper examines the effects of pandemics-related uncertainty on fertility in the panel dataset of 126 countries from 1996 to 2019. For this purpose, the World Pandemics Uncertainty Indices are used to measure the pandemics-related uncertainty. The novel empirical evidence is that pandemics-related uncertainty decreases fertility rates. These results are robust to estimate different models and include various controls. We also try to explain why the rise in uncertainty during the COVID-19 pandemic has resulted in the fertility decline.
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Affiliation(s)
- Yonglong Wang
- Research Centre of Modern Economic and Management, Zhejiang Yuexiu Univerisity of Foreign Languages, Shaoxing, China
| | - Giray Gozgor
- School of Management, University of Bradford, Bradford, United Kingdom
- Faculty of Political Sciences, Istanbul Medeniyet University, Istanbul, Turkey
- Adnan Kassar School of Business, Lebanese American University, Beirut, Lebanon
| | - Chi Keung Marco Lau
- Department of Economics and Finance, The Hang Seng University of Hong Kong, Shatin, Hong Kong SAR, China
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Schoenaker DAJM, Bennett C, Grieger JA, Harrison CL, Hill B, Enticott J, Moran LJ, Teede HJ, O’Reilly SL, Lim S. Association between pregnancy intention and psychological distress among women exposed to different levels of restrictions during the COVID-19 pandemic in Australia. PLoS One 2022; 17:e0273339. [PMID: 36006931 PMCID: PMC9409515 DOI: 10.1371/journal.pone.0273339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background The COVID-19 pandemic has had a negative impact on the mental health of people globally. Significant concerns about health and access to services among women of reproductive age considering pregnancy may cause psychological distress, and in turn increase health risks during and after pregnancy for mothers and offspring. Objectives To examine the association between pregnancy intention and psychological distress during the COVID-19 pandemic in Australia, and explore if this association differed based on local viral transmission rates and corresponding levels of pandemic restrictions. Methods A nationwide online survey was completed by 849 non-pregnant women aged 18–50 years between 15 October and 7 November 2020. Women were asked about their intention to become pregnant, and psychological distress was assessed using the Kessler Psychological Distress Scale (K10). Multivariable regression analysis examined associations between pregnancy intention and psychological distress. An interaction term was added to the model to examine differences in associations by level of viral transmission rates and lockdown restrictions which was determined based on postcode. Results Pregnancy intention was not associated with experiencing (very) high psychological distress in the overall study population (odds ratio (OR) 1.42, 95% CI 0.94, 2.11). The interaction term (p = 0.09) suggested potential differences by level of restrictions and viral transmission rates. In stratified analysis among women living in a location with strict lockdown restrictions and high viral transmission rates leading up to and during the study, those planning to become pregnant were more likely to experience (very) high psychological distress (OR 3.39, 2.04, 5.65) compared with women not planning to become pregnant. Pregnancy intention was not associated with psychological distress among women exposed to lower levels of pandemic restrictions and viral transmission rates (OR 1.17, 0.74, 1.85). Conclusions Our findings highlight the need to identify and support women planning pregnancy during a public health crisis to mitigate potential short- and long-term intergenerational negative health outcomes associated with psychological distress.
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Affiliation(s)
- Danielle A. J. M. Schoenaker
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- * E-mail:
| | - Christie Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Jessica A. Grieger
- Robinson Research Institute, University of Adelaide, North Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
- Department of Psychiatry, Southern Synergy, Monash University, Clayton, VIC, Australia
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Sharleen L. O’Reilly
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
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Chu K, Zhu R, Zhang Y, Pang W, Feng X, Wang X, Wu C, Sun N, Li W. Fertility Intention Among Chinese Reproductive Couples During the COVID-19 Outbreak: A Cross-Sectional Study. Front Public Health 2022; 10:903183. [PMID: 35801249 PMCID: PMC9253424 DOI: 10.3389/fpubh.2022.903183] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
A decline in the fertility rate has been observed worldwide, which hampers social development severely. Given the impacts of COVID-19 on individuals and society, it is of great significance to investigate the fertility intention of reproductive couples under COVID-19. The convenience sampling method was used to obtain our study sample. The self-administered questionnaire included the following components: sociodemographic characteristics (age, residence, education, occupation, characteristics of the couples, and annual household income), reproductive history (parity, number of children, child gender, and duration of preparing pregnancy), and attitudes toward COVID-19, was distributed online via an applet of WeChat. The results showed that among 4,133 valid questionnaires, 1,091 had fertility intention before COVID-19, whereas 3,042 did not, indicating a fertility intention rate of 26.4% among participating couples. Of the 1,091 couples who had fertility intention before COVID-19, 520 (47.7%) were affected by the outbreak, whereas 571 (52.3%) were not. By multivariable logistic regression analysis, we further found that couples living in Hubei Province, the epicenter in China (OR 2.20, 95% CI 1.35–3.60), and couples who prepared for pregnancy longer before COVID-19 (OR 1.19, 95% CI 1.06–1.33) were more likely to change their fertility intention under the pandemic. In addition, most of the participants reported their fertility intention was affected by the inconvenience of seeking medical service under COVID-19. Therefore, more forms of medical services to provide convenience for patients might be effective ways to reverse the declined fertility intention rate in facing COVID-19.
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Affiliation(s)
- Kun Chu
- Center of Reproductive Medicine, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Obstetrics and Gynecology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Ronghui Zhu
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Yi Zhang
- Center of Reproductive Medicine, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Wenjuan Pang
- Center of Reproductive Medicine, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xu Feng
- Center of Reproductive Medicine, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiang Wang
- Center of Reproductive Medicine, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Cheng Wu
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
- Cheng Wu
| | - Ningxia Sun
- Center of Reproductive Medicine, Second Affiliated Hospital of Naval Medical University, Shanghai, China
- Ningxia Sun
| | - Wen Li
- Center of Reproductive Medicine, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Wen Li
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Da Costa HVV, Vieira do Bonfim C, Fusco W, Moreira MDM, Maciano de Paula Neto F. Impact of the COVID-19 pandemic on the number of births in Pernambuco Brazil. GEOSPATIAL HEALTH 2022; 17. [PMID: 35735943 DOI: 10.4081/gh.2022.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
This study aimed at analysing the potential effects of the COVID-19 pandemic on the time series and spatial patterns of live births in the state of Pernambuco, Brazil, from 2010 to 2021. This is an ecological study that applied intervention analysis in time series, with the goal to identify how projected data behaved in relation to observed data in the months December 2020 to November 2021, i.e. months representing conceptions from March2020 to April 2021. For the state of Pernambuco, a discrepancy up to +5.7% was found between the observed and projected data, while the respective difference for the São Francisco mesoregion showed the opposite trend with maximum discrepancy of -9%. The results did not indicate a clear change in the number of live births but supported the expected continuation of the downward trend of the previous years. Considering the importance of the number of live births in the context of demography, economy and public health, monitoring must be maintained to analyse the possible future impact of the COVID-19 pandemic on live birth projections.
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Affiliation(s)
| | - Cristine Vieira do Bonfim
- Joaquim Nabuco Foundation, Recife, Pernambuco; Postgraduate Program in Collective Health, Federal University of Pernambuco, Recife, Pernambuco.
| | - Wilson Fusco
- Joaquim Nabuco Foundation, Recife, Pernambuco; Postgraduate Program in Demographics, Federal University of Rio Grande do Norte (UFRN), Lagoa Nova, Natal.
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15
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Conception Preferences during COVID-19 Pandemic Lockdowns. Behav Sci (Basel) 2022; 12:bs12050144. [PMID: 35621441 PMCID: PMC9137999 DOI: 10.3390/bs12050144] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background: The COVID-19 lockdowns imposed new challenges to couples who were planning to conceive. In this research paper, we aimed to study the perceptions of women in Jordan during the pandemic regarding fertility behavior, the desire to use assisted reproductive technology (ART) and the awareness and beliefs of potential risks related to conception. Methods: A validated online-based questionnaire was distributed to women from April–May 2020, Statistical analysis was performed using the statistical software SPSS version 22 and R software (2020); p values ≤ 0.05 were considered statistically significant. Results: The total number of participants was 814 women, with 78.2% of the participants (58.7% fertile and 76.6% infertile) believing that pregnancy during the COVID-19 pandemic could be risky. Among them, 16% and 40%, respectively, were trying to conceive during the pandemic, and 97.4% and 89.9%, respectively, were not willing to use ART if needed during the pandemic. Young, nulliparous women who were married for less than one year were significantly associated with the desire to conceive during the COVID-19 pandemic. Conclusion: This study concluded that the fertility behavior of women in Jordan changed during the pandemic, and their desire for natural conception and for using ART declined, as they believed that there were potential risks related to conceiving during the pandemic. However, the effect was greater among the general fertile population than the infertile.
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16
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Ghaznavi C, Kawashima T, Tanoue Y, Yoneoka D, Makiyama K, Sakamoto H, Ueda P, Eguchi A, Nomura S. Changes in marriage, divorce and births during the COVID-19 pandemic in Japan. BMJ Glob Health 2022; 7:bmjgh-2021-007866. [PMID: 35569835 PMCID: PMC9108437 DOI: 10.1136/bmjgh-2021-007866] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/23/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Marriage, divorce and fertility are declining in Japan. There is concern that the COVID-19 pandemic may have accelerated the decrease in marriages and births while increasing the number of divorces. Changes in partnership behaviours and fertility have significant implications for mental health, well-being and population demographics. Methods Japanese vital statistical data were collected for December 2011–May 2021. We used the Farrington algorithm on the daily numbers of marriages, divorces and births (per month) in order to determine whether any given month between January 2017 and May 2021 had a significant excess or deficit. Analyses were conducted at the national and regional levels. Results During the pandemic, significant deficits in the national number of marriages were noted in January 2020, April 2020, May 2020, July 2020, September 2020 and April 2021. Regional marriage patterns reflected national trends. Divorces were noted to be in deficit during April 2020, May 2020 and May 2021 at the country level. Regional analyses mirrored national divorce trends with the exception of Shikoku, which showed no deficits during the pandemic. Significant deficits in the number of total births were noted in December 2020, January 2021 and February 2021. Regionally, birth deficits were concentrated in Chubu, Kansai and Kanto. After the start of the pandemic, no significant excesses in marriages, divorces or births were noted at the national or regional level. Conclusions Marriages and divorces declined during the pandemic in Japan, especially during state of emergency declarations. There were decreased births between December 2020 and February 2021, approximately 8–10 months after the first state of emergency, suggesting that couples altered their pregnancy intention in response to the pandemic. Metropolitan regions were more affected by the pandemic than their less metropolitan counterparts.
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Affiliation(s)
- Cyrus Ghaznavi
- Department of Health Policy and Management, Keio University, Tokyo, Japan .,Medical Education Program, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Takayuki Kawashima
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Department of Mathematical and Computing Science, Tokyo Institute of Technology, Tokyo, Japan
| | - Yuta Tanoue
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Institute for Business and Finance, Waseda University, Tokyo, Japan
| | - Daisuke Yoneoka
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Haruka Sakamoto
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.,Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Peter Ueda
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.,Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Akifumi Eguchi
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, Keio University, Tokyo, Japan.,Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
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17
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Marteleto LJ, Sereno LGF, Coutinho RZ, Dondero M, Alves SV, Lloyd R, Koepp A. Fertility trends during successive novel infectious disease outbreaks: Zika and COVID-19 in Brazil. CAD SAUDE PUBLICA 2022; 38:EN230621. [PMID: 35508025 PMCID: PMC9744098 DOI: 10.1590/0102-311xen230621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/17/2021] [Indexed: 12/14/2022] Open
Abstract
This study aims to estimate fertility trends in Brazil in the 2010s and early 2020s during a period of back-to-back novel infectious disease outbreaks - Zika virus and COVID-19. We use Brazilian Ministry of Health and Association of Civil Registrar data from 2011-2021 to measure general fertility rates at the national and state levels. We also used seasonal ARIMA model to forecast fertility rates by month and state in 2021 and compared these forecasts with observed fertility rates. We find that fertility rates were steady over 2011-2015 with no statistically significant variation, followed by a sharp decline during the Zika outbreak in 2016 followed by a return to pre-Zika levels after the end of the epidemic. Furthermore, to evaluate the effect of the COVID-19 pandemic, we make comparisons with observed and forecast rates from 2020-2021, showing that declines were generally larger for observed than for forecast rates, yet statistically insignificant. We argue that the resurgence of the COVID-19 pandemic in 2021 might lead to further declines, as women might have not had enough time to adjust rebound from either the effects of the Zika epidemic. We also discuss the importance of timely availability of live births data during a public health crisis with immediate consequences for fertility rates.
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Affiliation(s)
| | | | - Raquel Zanatta Coutinho
- Faculdade de Ciências Econômicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | - Ryan Lloyd
- University of Texas at Austin, Austin, U.S.A
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18
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Challenges and Drawbacks of the EU Medical System Generated by the COVID-19 Pandemic in the Field of Health Systems' Digitalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094950. [PMID: 35564345 PMCID: PMC9100197 DOI: 10.3390/ijerph19094950] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 12/10/2022]
Abstract
The COVID-19 pandemic and the digitalization of medical services present significant challenges for the medical sector of the European Union, with profound implications for health systems and the provision of high-performance public health services. The sustainability and resilience of health systems are based on the introduction of information and communication technology in health processes and services, eliminating the vulnerability that can have significant consequences for health, social cohesion, and economic progress. This research aims to assess the impact of digitalization on several dimensions of health, introducing specific implications of the COVID-19 pandemic. The research methodology consists of three procedures: cluster analysis performed through vector quantization, agglomerative clustering, and an analytical approach consisting of data mapping. The main results highlight the importance of effective national responses and provide recommendations, various priorities, and objectives to strengthen health systems at the European level. Finally, the results reveal the need to reduce the gaps between the EU member states and a new approach to policy, governance, investment, health spending, and the performing provision of digital services.
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Rahman Mahfuzur M, Shafiul Alam M, Arif Billah M. Early impact of COVID-19 pandemic on childbearing plan in Bangladesh. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2022; 67:150-163. [PMID: 35799424 DOI: 10.1080/19485565.2022.2094336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has already had many consequences for social life. This paper focused on the early impact of COVID-19 pandemic on pandemic-period childbearing plan that was made before the onset of the pandemic. Data were collected by posting survey questionnaire on social networks in Bangladesh. A total of 384 Bangladeshi men and women of reproductive age were analyzed using descriptive and multivariate logistic regression analyses after adjusting the data by applying sampling weights. One out of every five respondents was found to cancel their pandemic-period pregnancy plan by considering potential crises related to COVID-19 pandemic. Our findings showed that in canceling pandemic-period pregnancy, factors related to the potential crises of the pandemic emerged as more important than some persistent determinants of fertility, fertility intention and non-realization of fertility intention. Infection of COVID-19 to the acquaintance, being teenager, complete stopping and decline in income, and acquaintance's suggestion not to get pregnant during the pandemic played key role in canceling the pandemic-period pregnancy plan. Although it is uncertain if the impact of COVID-19 will substantially be reflected in the future fertility estimates of Bangladesh, the pandemic showed negative impact on pandemic-period childbearing plan during the early months.
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Affiliation(s)
- Md Rahman Mahfuzur
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Shafiul Alam
- Department of Geography and Environmental Studies, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Arif Billah
- Department of Social Work and Counselling, Faculty of Business, Economics and Social Development, Universiti Malaysia Terengganu, Kuala Nerus, Malaysia
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20
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Zanatta-Coutinho R, Branco-Simão A. Abortion in the times of Zika: the perspective of women in two Brazilian municipalities. PAPELES DE POBLACION 2021; 27:33-57. [PMID: 36447797 PMCID: PMC9703644 DOI: 10.22185/24487147.2021.109.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In Brazil, abortion is considered a crime under the Criminal Code since 1940. After the Zika virus epidemic (2015-2017) and the consequent appearance of microcephaly in newborns struck South America, the debate on the decriminalization of abortion in the Brazilian society was reignited. Using data obtained from focus groups comprising women of reproductive age across different socioeconomic strata and two Brazilian cities, we investigated the perceptions of the participants on abortion, especially its use during the Zika epidemic. Although legally criminalized, abortion is prevalent among women, as a way to fulfill their reproductive desire. Criminalization puts the health and lives of women at risk, particularly those with less economic and cultural capital. We also discover the role of friends in women's decision to utilize the procedure. The strong asymmetry of power between men and women contributes to the greater vulnerability of women. The results suggest an urgent need to review the legislation on abortion concerning its criminalization and the option of safer abortion within the scope of the public health service.
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Affiliation(s)
- Raquel Zanatta-Coutinho
- Departamento de Demografia e Centro de Desenvolvimento e Planejamento Regional (Cedeplar), Universidade Federal de Minas Gerais, Brazil
| | - Andréa Branco-Simão
- Departamento de Demografia e Centro de Desenvolvimento e Planejamento Regional (Cedeplar), Universidade Federal de Minas Gerais, Brazil
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21
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Andrade LDMB, Guedes GR, Noronha KVMDS, Santos e Silva CM, Andrade JP, Martins ASFS. Health-related vulnerability to climate extremes in homoclimatic zones of Amazonia and Northeast region of Brazil. PLoS One 2021; 16:e0259780. [PMID: 34762688 PMCID: PMC8584767 DOI: 10.1371/journal.pone.0259780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022] Open
Abstract
Amazonia and the Northeast region of Brazil exhibit the highest levels of climate vulnerability in the country. While Amazonia is characterized by an extremely hot and humid climate and hosts the world largest rainforest, the Northeast is home to sharp climatic contrasts, ranging from rainy areas along the coast to semiarid regions that are often affected by droughts. Both regions are subject to extremely high temperatures and are susceptible to many tropical diseases. This study develops a multidimensional Extreme Climate Vulnerability Index (ECVI) for Brazilian Amazonia and the Northeast region based on the Alkire-Foster method. Vulnerability is defined by three components, encompassing exposure (proxied by seven climate extreme indicators), susceptibility (proxied by sociodemographic indicators), and adaptive capacity (proxied by sanitation conditions, urbanization rate, and healthcare provision). In addition to the estimated vulnerability levels and intensity, we break down the ECVI by indicators, dimensions, and regions, in order to explore how the incidence levels of climate-sensitive infectious and parasitic diseases correlate with regional vulnerability. We use the Grade of Membership method to reclassify the mesoregions into homoclimatic zones based on extreme climatic events, so climate and population/health data can be analyzed at comparable resolutions. We find two homoclimatic zones: Extreme Rain (ER) and Extreme Drought and High Temperature (ED-HT). Vulnerability is higher in the ED-HT areas than in the ER. The contribution of each dimension to overall vulnerability levels varies by homoclimatic zone. In the ER zone, adaptive capacity (39%) prevails as the main driver of vulnerability among the three dimensions, in contrast with the approximately even dimensional contribution in the ED-HT. When we compare areas by disease incidence levels, exposure emerges as the most influential dimension. Our results suggest that climate can exacerbate existing infrastructure deficiencies and socioeconomic conditions that are correlated with tropical disease incidence in impoverished areas.
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Affiliation(s)
- Lara de Melo Barbosa Andrade
- Department of Atmospheric and Climate Sciences, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Gilvan Ramalho Guedes
- Departament of Demography, Center for Development and Regional Planning, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | | | - Cláudio Moisés Santos e Silva
- Department of Atmospheric and Climate Sciences, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Jéferson Pereira Andrade
- Departament de Statistics, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
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22
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Fostik A. COVID-19 and Fertility in Canada: a Commentary. CANADIAN STUDIES IN POPULATION 2021; 48:217-224. [PMID: 34493896 PMCID: PMC8414452 DOI: 10.1007/s42650-021-00054-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
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23
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Marteleto LJ, Dondero M. Navigating women's reproductive health and childbearing during public health crises: Covid-19 and Zika in Brazil. WORLD DEVELOPMENT 2021; 139:105305. [PMID: 35495087 PMCID: PMC9053522 DOI: 10.1016/j.worlddev.2020.105305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
| | - Molly Dondero
- Population Research Center, University of Texas at Austin, United States
- Department of Sociology, American University, United States
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24
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Coutinho RZ, Villanueva A, Weitzman A, Marteleto LJ. Zika virus public health crisis and the perpetuation of gender inequality in Brazil. Reprod Health 2021; 18:40. [PMID: 33588891 PMCID: PMC7883759 DOI: 10.1186/s12978-021-01067-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2015-2017, the Americas experienced a highly consequential epidemics for pregnancy and childbearing. Mainly transmitted by the mosquito Aedes aegypti, but also through sexual intercourse, the Zika virus poses the risk of congenital Zika syndrome to fetus, which includes microcephaly and other child development complications. When a public health crisis taps directly into reproductive health, typically a feminine realm, responses to the emergency may exacerbate deeply-rooted gender norms. This paper investigates the role of gender in two relational contexts: (a) the government-led response to the pandemic in terms of communication campaigns aimed at preventing Zika infections; and (b) an individual level of response to the emergency, concerning women's negotiation with their sexual partners with regard to the prevention of Zika as well as pregnancies. METHODS We conducted content analysis of 94 unique pieces from public health communication campaigns produced by governmental agencies with the goal of promoting Zika awareness. Print and online materials were collected from May 2016 to August 2017, and included TV ads, Internet Pop-ups, and pamphlets. We also analyzed transcripts from 16 focus groups conducted with reproductive-aged women (18-40) in Belo Horizonte and Recife, two large cities differently affected by the Zika outbreak. Women answered open-ended questions connected to the epidemic, in areas such as personal knowledge and experiences with the Zika virus, experiences of their friends and acquaintances, their primary information sources, their perceptions of public health efforts toward containing the outbreak, as well as women's contraceptive use. RESULTS Campaign pieces handling pregnancy and microcephaly were largely gendered. Pieces targeted women, placing on their shoulders the responsibility for protecting a potential fetus from the disease. Importantly, campaigns neglected addressing male's participation on Zika prevention and contraceptive management, while failing to take into account Brazil's large proportion of unplanned pregnancies. Women were placed in a double bind by being expected to prevent both pregnancy and Zika, in a context where gendered power imbalances often translate in women having little power/means for condom negotiation/avoiding unprotected sexual intercourse. CONCLUSION Government and individual responses to the epidemics reinforced gender roles, situating pregnant women as responsible for averting mosquito bites and microcephaly. Further, prevention campaigns largely excluded men. Since low-socioeconomic status women possessed fewer resources to preclude infection, we also found that beyond the gender divide, this subgroup faced more pronounced Zika prevention challenges as they found it harder to negotiate condom use with their sexual partners and often could not access other types of contraceptives resulting in unplanned pregnancies.
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Affiliation(s)
- Raquel Zanatta Coutinho
- Faculdade de Ciências Econômicas, Universidade Federal de Minas Gerais and Center for Development and Regional Planning (Cedeplar), Av. Pres. Antônio Carlos, 6627-Pampulha, Belo Horizonte, MG, 31270-901, Brazil.
| | - Aida Villanueva
- Department of Sociology, University of Massachusetts-Amherst, 910 Thompson Hall, Amherst, MA, 01003, USA
| | - Abigail Weitzman
- The College of Liberal Arts, University of Texas at Austin and Population Research Center, 116 Inner Campus Dr Stop G6000, Austin, TX, 78712, USA
| | - Letícia Junqueira Marteleto
- The College of Liberal Arts, University of Texas at Austin and Population Research Center, 116 Inner Campus Dr Stop G6000, Austin, TX, 78712, USA
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Analysing the intersection between health emergencies and abortion during Zika in Brazil, El Salvador and Colombia. Soc Sci Med 2021; 270:113671. [PMID: 33486425 PMCID: PMC7895814 DOI: 10.1016/j.socscimed.2021.113671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 01/19/2023]
Abstract
The Zika outbreak of 2015-7 is a lens to analyse the positioning of abortion within in global health security. The sequelae of the virus almost exclusively affected newborn children, manifested through Congenital Zika Syndrome (CZS), and a focus on women at risk of, planning or being pregnant. At the global level, debate considered whether Zika would provide impetus for regulatory change for reproductive rights in Latin America, a region with some of the most restrictive abortion regulation in the world. However, regulatory change for abortion did not occur. We analyse why the Zika health emergency did not lead to any changes in abortion regulation through multi-method analysis of the intersection between Zika, health emergencies and abortion in Brazil, Colombia and El Salvador. These case study countries were purposefully selected; each had Zika infected women (albeit with differing incidence) yet represent diverse regulatory environments for abortion. Our comparative research is multi-method: framework analysis of key informant interviews (n = 49); content analysis of women's enquiries to a medical abortion telemedicine provider; and, policy analysis of (inter)national-level Zika response and abortion policies. We consider this within literature on global health security, and the prioritisation of a particular approach to epidemic control. Within this securitized landscape, despite increased public debate about abortion regulatory change, no meaningful change occurred, due to a dominant epidemiological approach to the Zika health emergency in all three countries and prominent conservative forces in government and within anti-abortion rights movements. Simultaneously, we demonstrate that regulation did not deter all women from seeking such service clandestinely. Zika affected reproductive decision making, but did not impact abortion regulation. Epidemiological framing ignored reproductive dimensions of emergency responses. Conservative forces instrumentalized disability concerns to oppose abortion rights. Women sought abortions clandestinely, citing Zika as a justification. Abortion provision must form part of health emergency planning and response.
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The impact of COVID-19 on fertility plans in Italy, Germany, France, Spain, and the United Kingdom. DEMOGRAPHIC RESEARCH 2020. [DOI: 10.4054/demres.2020.43.47] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Zika virus epidemics have potential large-scale population effects. Controlled studies of mice and nonhuman primates indicate that Zika affects fecundity, raising concerns about miscarriage in human populations. In regions of Brazil, Zika risk peaked months before residents learned about the epidemic and its relation to congenital anomalies. This spatiotemporal variation supports analysis of both biological effects of Zika infection on fertility and the effects of learning about Zika risk on reproductive behavior. Causal inference techniques used with vital statistics indicate that the epidemic caused reductions in birth cohort size of approximately one-quarter 18 months after Zika infection risk peaked but 10 months after public health messages advocated childbearing delay. The evidence is consistent with small but not statistically detectable biological reductions in fecundity, as well as large strategic changes in reproductive behavior to temporally align childbearing with reduced risk to infant health. The behavioral effects are larger for more-educated and older women, which may reflect facilitated access to information and to family planning services within high-risk, mosquito-infested urban locations as well as perceptions about the opportunity costs of risks to pregnancy and infant survival.
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Affiliation(s)
- Marcos A Rangel
- Sanford School of Public Policy, Duke University, 302 Towerview Road, Rubenstein Hall, Office 262, Durham, NC, 27708, USA.
- Bureau for Research and Economic Analysis of Development (BREAD), London, UK.
| | - Jenna Nobles
- Department of Sociology, University of Wisconsin-Madison, Madison, WI, USA
| | - Amar Hamoudi
- Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI, USA
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Wenham C, Smith J, Davies SE, Feng H, Grépin KA, Harman S, Herten-Crabb A, Morgan R. Women are most affected by pandemics - lessons from past outbreaks. Nature 2020; 583:194-198. [PMID: 32641809 DOI: 10.1038/d41586-020-02006-z] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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