Significance of beliefs and values in predicting fertility and contraceptive behaviour in Pakistan

Girl child marriage and its effect on fertility in Pakistan: findings from Pakistan Demographic and Health Survey, 2006-2007

Child marriage (before 18 years) is prevalent in Pakistan, which disproportionately affects young girls in rural, low income and low education households. Our study aims to determine the association between early marriage and high fertility and poor fertility health indicators among young women in Pakistan beyond those attributed to social vulnerabilities. Nationally representative data from Pakistan Demographic and Health Survey, 2006-2007, a cross-sectional observational survey, were limited to ever-married women aged 20-24 years (n = 1,560; 15% of 10,023) to identify differences in poor fertility outcomes [high fertility (three or more childbirths); rapid repeat childbirth (<24 months between births); unwanted pregnancy (any ever); pregnancy termination (any stillbirth, miscarriage or abortion ever)] by early (<18) versus adult (≥18) age at marriage. Associations between child marriage and fertility outcomes were assessed by calculating adjusted odds ratios (AORs) using logistic regression models after controlling for demographics, social equity indicators (education, wealth index, rural residence), contraception use, marriage duration and culture-specific factors (husband's desire for more children, son preference). Overall, 50% of ever-married women aged 20-24 years in Pakistan were married before the age of 18 years. Girl child marriage was significantly (p < 0.001) associated with low social equity indicators (poverty, rural residence, and no formal education). Adjusted logistic regression models showed that girl child marriage was significantly associated with high fertility (AOR 6.62; 95% CI 3.53-12.43), rapid repeat childbirth (AOR 2.88; 95% CI 1.83-4.54), unwanted pregnancy (AOR 2.90; 95% CI 1.75-4.79), and pregnancy termination (AOR 1.75; 95% CI 1.10-2.78). Girl child marriage affects half of all ever-married women aged 20-24 years in Pakistan, and increases their risk for high fertility and poor fertility health indicators, highlighting the need of increasing the age of marriage among women in Pakistan. Efforts to eliminate girl child marriage by strict law enforcement, promoting civil, sexual and reproductive health rights for women can help eliminate girl child marriage in Pakistan.

Objects of temporary contraception: an exploratory study of women's perspectives in Karachi, Pakistan

OBJECTIVES

To explore perspectives of three modern contraceptive objects, using an emic approach, among women in a low-income community in Karachi, Pakistan.

DESIGN

A qualitative interview study design was employed, using qualitative content analysis with an inductive approach and manual thematic coding.

SETTING

Shah Faisal Colony, Karachi.

PARTICIPANTS

20 women, potential contraceptive users of reproductive age and living within a health centre catchment, were purposively selected to provide a similar number of non-users (n=5), contraceptive injection users (n=7), pill users (n=4), and intrauterine device users (n=4). One interview was excluded because it was not recorded. No other exclusion criteria were used.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was interpretation of potency and effects of selected family planning objects. Secondary outcome measures were knowledge of family planning and description of therapeutic approaches used and preferred.

RESULTS

Awareness of family planning was high. Women described different therapeutic approaches, stating they generally preferred modern medicine for contraception as it was fastest and most powerful. They reported that fear of some contraceptive objects, particularly injections and intrauterine contraceptive devices, influenced their choices. Women explained their perceptions of how the heating effects of contraceptives could cause unwanted side effects including menstrual irregularities, weight gain and weakness, leading to disease.

CONCLUSIONS

Most women wanted family planning, but remained dissatisfied with the available contraceptives and their effects. While women reported that they relied on modern medicine for contraception, their descriptions of how contraceptives affected their health relied on the hot-cold explanatory idiom of traditional medicine.

Effects of reproduction norms on contraception practice among Muslim women in Amman, Jordan

Based on the authors' interview survey for 275 Muslim women of an ethnically divergent community in Amman, Jordan, this study examined the psychosocial effects of reproduction norms on contraception practice, using the normative interpretations of legal provisions in Islam (hukm). The categorical principal component analysis (CATPCA) reduced the eight items regarding family planning and contraception use to two factors, i.e. the pressures of childbearing and acceptability of contraception use, accounting for 55% of the total variance. Even though the majority of the female subjects were conservative rather than innovative in terms of reproduction norms and significant interrelations were observed between their reproduction norms and contraception practice, approximately 70% of the female subjects who were closely in consonance with the normative interpretations of their religious leader had used contraception. It is thus indicated that religious leaders may play significant roles in increase of contraception practice among Muslim women.

The global problems of child malnutrition and mortality in different world regions

The study of child mortality occupies a special place in the field of demographic research, since it represents the negative component of population growth. Also, the world food problem has become a familiar topic since the end of the World War II. The idea that population growth will sometime in the future outrun food supplies and universal starvation occurs. This study deals with what happened in global and regional variations regarding the child malnutrition and mortality rates. The main objective of the study is to explain and to explore the effect of the social, demographic, economic and health factors on child malnutrition and mortality rates among different regions in the globe. The study includes ten regions of the whole world compared to other studies that covered only one or two regions. Data were collected from various sources. The sample involved 191 countries. These countries divided by regions of world as following. East Southern Africa, West Africa, East Asia and Pacific, South Asia, Eastern Europe and Central Asia, Europe, Middle East, North Africa, North America, and South America. The results of descriptive analysis show that the highest mean rate of child malnutrition was found in South Asia region (57 children per 100), while the smallest mean rate was found in Europe region (just 1 child per 100). In West Africa region, the average of child mortality rate per 1000, 172 children, was the highest among all regions in the world, while in Europe was found to be 14 children per 1000. The results of correlation coefficients reveal that there were positive associations between illiteracy rate, unemployment, poverty, fertility rate, family size, food consumption, maternal mortality rate, population per physician, and child malnutrition and mortality in the whole world regions. Some regions have strong significant associations, such as Sub-Saharan Africa, Asia, and Americas, and other were non-significant association, such as Europe, Middle East, and North Africa. The results suggest that there were negative associations between GNP, household income, protein consumption, and child malnutrition and mortality in all world regions except Europe and Central Asia regions.

Fertility and infant mortality trends in Nicaragua 1964-1993. The role of women's education

OBJECTIVES

To assess trends in fertility and infant mortality rates (IMR) in León, Nicaragua, and to examine the effect of women's education on these trends during 1964-1993, a period of rapid social change.

DESIGN

Cross sectional survey, based on random cluster sampling. A retrospective questionnaire on reproductive events was used.

SETTING

The municipality of León, which is the second largest city in Nicaragua, with a total population of 195,000 inhabitants.

SUBJECTS

10,867 women aged 15-49 years, corresponding to 176,281 person years of reproductive life. Their children contributed 22,899 person years under 12 months of age to the IMR analysis.

MAIN OUTCOME MEASURES

Fertility rate (number of pregnancies per 1000 person years) for specific age groups and calendar periods, total fertility rate, and IMR.

RESULTS

Fertility rates and IMR declined in parallel, especially during the 1980s. However, education specific fertility rates did not decline, but the proportion of educated young women increased from 20% to 46%. This had also an impact on the overall IMR decline, although IMR reduction mainly took place among infants of women without formal education, decreasing from 118 to 69 per 1000 during the observation period.

CONCLUSIONS

In this demographic transition over three decades, fertility and IMR declined simultaneously. The decreasing trend in fertility was mainly explained by an increase in women's education, while the IMR decline seemed to be the result of health interventions, specially targeted to poorer groups of women and their infants. Thus, social differences in fertility rates remained unchanged, while equity in chances of child survival increased.

Factors affecting the most recent fertility rates in urban-rural Bangladesh

This paper reports on a study which has been undertaken using data from the 1989 Bangladesh Fertility Survey (BFS) to determine the significance of influences on the probability of birth in the year preceding the survey. In the survey a total of 11905 ever-married women of reproductive age were asked a battery of questions relating to fertility aspects of women. Variables selected in this study were grouped into demographic, socio-economic, cultural and decision-making variables. Findings from the study indicate that the mother's age, whether contraception has ever been used, the death of a child at any time, whether the woman has ever worked, religion, region of residence, and female independence are the important covariates for explaining recent fertility in Bangladesh. Models are developed for the probabilities of a woman giving birth in urban and rural areas, dependent on her demographic and socio-economic conditions. Also developed are models for contraceptive use in urban-rural Bangladesh. This modelling contributes to a better understanding of fertility changes in Bangladesh and the differentials between urban and rural fertility. It is indicated that a continued fertility decline is likely.