Reconciling discrepancies between registration-based and survey-based estimates of fertility in Mongolia

Sustained and Universal Fertility Recuperation in Kazakhstan

The fertility rates of Kazakhstan have reversed to levels not seen for several decades. The striking fertility increase poses questions regarding the extent to which this new development is shared across socio-demographic groups and the nature of fertility recuperation. The current study employs UNICEF Multiple Indicator Cluster Survey data and event-history modelling to analyse parity progressions to one, two, three, and four children. The results suggest a sustained fertility increase that is not merely associated with the recuperation of delayed first births, but a genuine increase across all birth orders. This pattern is evident for both main ethnicities in Kazakhstan and across educational groups. The gradual increase of higher-order births, especially among ethnic Kazakhs, indicates a reversed fertility transition and also that the previous fertility decline in the 1990s was not part of a general transition towards below-replacement fertility but rather a reflection of economic crisis after the collapse of the Soviet Union.

AFTER FERTILITY'S NADIR? ETHNIC DIFFERENTIALS IN PARITY-SPECIFIC BEHAVIOURS IN KYRGYZSTAN

After a swift decline in the 1990s, the countries of Central Asia have experienced significant fertility increases over the last 15 years. These fertility upturns have remained off the radar of demographers. This study examines the recent fertility increase in Kyrgyzstan, focusing on fertility development by parity and among the main ethnic groups, in order to go beyond classic fertility indicators and national averages. Using a sample from the 2009 Census micro-dataset, sibling progression ratios were computed using information on the relationships and dates of birth of children under the age of 15. The results allow an analysis of the fertility increase by identifying the contribution of parity and ethnic group. It was found that the fertility increase in Kyrgyzstan has been experienced across the main ethnic groups, but their respective share in the population of the country has resulted in distinct contributions to the increase. Between 2001 and 2009, 82.4% of the fertility increase was due to an increase in the fertility of Kyrgyz women. In comparison, Uzbek and Russian women contributed 10.2% and 7.4%, respectively. By accounting for the parity component and ethnic factor, this study adds important disaggregated information, not only on family-building behaviours, but also on the social dimension, which is of prime importance for a better understanding of the demography of Central Asia. The study highlights important information on family-building behaviours, which are essential for the formulation of appropriate and more effective social policies aimed at sustaining and/or increasing fertility.

Fertility and union formation during crisis and societal consolidation in the Western Balkans

Fertility decline in central and eastern Europe (CEE) since the fall of the communist regimes has been driven by both stopping and postponement of childbearing: two processes that have been related to crisis and economic development, respectively. In the Western Balkans these economic and political contexts followed each other in the form of a biphasic transition. I examine whether this sequence triggered fertility responses like those observed elsewhere. Relying on three independent data sources, I cross-validate the levels of, and describe the trends in, union formation and fertility (by birth order) between 1980 and 2010. Results do not reveal widespread declines in fertility to lowest-low levels during the most acute period of crisis. The subsequent postponement of marriage and first birth was also limited, and the two-child family remains the norm. This relative resilience of childbearing patterns compared with other CEE countries is discussed with reference to the institutional context.

Establishment of a Maternal Newborn Health Registry in the Belgaum District of Karnataka, India

Background

Pregnancy-related vital registration is important to inform policy to reduce maternal, fetal and newborn mortality, yet few systems for capturing accurate data are available in low-middle income countries where the majority of the mortality occurs. Furthermore, methods to effectively implement high-quality registration systems have not been described. The goal of creating the registry described in this paper was to inform public health policy makers about pregnancy outcomes in our district so that appropriate interventions to improve these outcomes could be undertaken and to position the district to be a leader in pregnancy-related public health research.

Methods

We created a prospective maternal and newborn health registry in Belgaum, Karnataka State, India. To initiate this registry, we worked with the Ministry of Health to first establish estimated birth rates and define the catchment areas of the clusters, working within the existing health system and primary health centers. We also undertook household surveys to identify women likely to become pregnant. We then implemented monitoring measures to ensure high quality and completeness of the maternal newborn health registry. All pregnant women in the catchment area were identified, consented and enrolled during pregnancy, with follow-up visits to ascertain pregnancy outcomes and mother/infant status at 42-days postpartum.

Results

From 2008 through 2014, we demonstrated continued improvements in both the coverage for enrollment and accuracy of reporting pregnancy outcomes within the defined catchment area in Belgaum, India. Nearly 100% of women enrolled had follow-up at birth and 99% had 42-day follow-up. Furthermore, we facilitated earlier enrollment of women during pregnancy while achieving more timely follow-up and decreased time of reporting from the date of the pregnancy event.

Conclusions

We created a pregnancy-related registry which includes demographic data, risk factors, and outcomes allowing for high rates of ascertainment and follow-up while working within the existing health system. Understanding the elements of the system used to create the registry is important to improve the quality of the results. Tracking of pregnancies and their outcomes is an important step toward reducing maternal and perinatal mortality.