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Kidie AA, Aychiluhm SB, Ayal BG, Kodo TK, Fentie EA, Masresha SA, Boye AT. Women's desire to limit child-bearing and its associated factors in rural Ethiopia: A multilevel analysis. Heliyon 2024; 10:e25372. [PMID: 38327416 PMCID: PMC10847642 DOI: 10.1016/j.heliyon.2024.e25372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Ethiopia ranks twelfth globally and second in Africa by population size. High fertility rates, especially in rural areas, contribute to rapid population growth, impacting the country's economy. The decision of women to control the number of children they have is a crucial factor influencing population growth and contributing to elevated health risks for both women and children.Objective: the purpose of this study was to assess women desire to limit childbearing and its associated factor among rural women in Ethiopia. Methods A cross-sectional survey dataset of Ethiopian demographic and health survey 2016 was used for this study. A total of 12,019 rural women were included in the study. A multilevel binary logistic regression was used to identify the predictors of women's desire to limit childbearing. The adjusted odds ratio with respective 95 % confidence interval was used to declare statistically significant variables. Result In rural Ethiopia, 33.04 % of women had a desired to limit their childbearing. Women in the age group of 25-34 years (AOR = 1.61, 95 % CI = 1.28,2.13), 35-49 years (AOR = 4.96, 95 % CI = 3.64, 6.65), had no children (AOR = 0.06, 95 % CI = 0.04, 0.09), having children 1-3 (AOR = 0.29, 95 % CI = 0.23, 0.36), married (AOR = 0.45, 95 % CI = 0.27, 0.75), living in small peripherals region (AOR = 0.33,95 % CI = 0.24, 0.45) and community level poverty (AOR = 0.72, 95 % CI = 0.57, 0.89) were significant predictors of women's desire to limit the number of children they bear. Conclusion In rural Ethiopia, there is a limited inclination to control childbearing. Older women and those with higher number of children express a stronger desire to limit childbearing. Conversely, married women, from smaller peripheral regions and those residing in areas with a higher community poverty rate are less likely to have a desire to limit childbearing. Thus, promoting education on the advantages of smaller family sizes and offering family planning services could be crucial in fostering women's willingness to limit their childbearing.
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Affiliation(s)
- Atitegeb Abera Kidie
- School of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Setognal Birara Aychiluhm
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birtukan Gizachew Ayal
- School of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tsion Kokeb Kodo
- School of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Elsa Awoke Fentie
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health science, University of Gondar, Gondar, Ethiopia
| | | | - Abayneh Tunta Boye
- School of Medicine, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Brooks N, Grace K, Kristiansen D, Shukla S, Brown ME. Investigating the relationship between growing season quality and childbearing goals. GLOBAL ENVIRONMENTAL CHANGE : HUMAN AND POLICY DIMENSIONS 2023; 80:102677. [PMID: 37250477 PMCID: PMC10209476 DOI: 10.1016/j.gloenvcha.2023.102677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/26/2023] [Accepted: 04/06/2023] [Indexed: 05/31/2023]
Abstract
Agricultural production and household food security are hypothesized to play a critical role connecting climate change to downstream effects on women's health, especially in communities dependent on rainfed agriculture. Seasonal variability in agriculture strains food and income resources and makes it a challenging time for households to manage a pregnancy or afford a new child. Yet, there are few direct assessments of the role locally varying agricultural quality plays on women's health, especially reproductive health. In this paper we build on and integrate ideas from past studies focused on climate change and growing season quality in low-income countries with those on reproductive health to examine how variation in local seasonal agricultural quality relates to childbearing goals and family planning use in three countries in sub-Saharan Africa: Burkina Faso, Kenya, and Uganda. We use rich, spatially referenced data from the Performance Monitoring for Action (PMA) individual surveys with detailed information on childbearing preferences and family planning decisions. Building on recent advances in remote monitoring of seasonal agriculture, we construct multiple vegetation measures capturing different dimensions of growing season conditions across varying time frames. Results for the Kenya sample indicate that if the recent growing season is better a woman is more likely to want a child in the future. In Uganda, when the growing season conditions are better, women prefer to shorten the time until their next birth and are also more likely to discontinue using family planning. Additional analyses reveal the importance of education and birth spacing in moderating these findings. Overall, our findings suggest that, in some settings, women strategically respond to growing season conditions by adjusting fertility aspirations or family planning use. This study also highlights the importance of operationalizing agriculture in nuanced ways that align with women's lives to better understand how women are impacted by and respond to seasonal climate conditions.
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Affiliation(s)
- Nina Brooks
- School of Public Policy, University of Connecticut, Hartford, CT 06103, United States
| | - Kathryn Grace
- Department of Geography, Environment, and Society, University of Minnesota, Minneapolis, MN 55455, United States
- Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN 55455, United States
| | - Devon Kristiansen
- Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN 55455, United States
| | - Shraddhanand Shukla
- Climate Hazards Center, Department of Geography, University of California Santa Barbara, CA 93106, United States
| | - Molly E. Brown
- Department of Geographical Sciences, University of Maryland, College Park, MD 20742, United States
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Bornstein M, Norris A, Shaba G, Huber-Krum S, Gipson JD. "I know my body and I just can't get pregnant that easily" - Women's use and non-use of the injection to manage fertility. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100071. [PMID: 37021076 PMCID: PMC10069985 DOI: 10.1016/j.ssmqr.2022.100071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately one-third of contraceptive users in Malawi use the Depo-Provera injection, a method that must be re-injected every three-months to prevent pregnancy and may reduce fecundity for a time after discontinuation. Little is known about how women use the injection to achieve their desired family size. In 2018, we conducted 20 in-depth interviews with women who were part of a cohort study in rural Malawi. Interviews focused on contraceptive decision-making. Data were indexed (summarized) and coded using narrative, process, and thematic codes. Women described the importance of knowing about their "natural" fertility by having children prior to ever using contraception because women considered contraception to have a potential negative effect on fertility. Women then applied what they learned about their fertility (i.e., how easy/difficult it was to become pregnant) to manage their fertility over their reproductive life-course. As part of fertility management, women frequently described using the injection less frequently than clinically recommended, using signs from their body (e.g., menstruation) to determine when to reinject. Managing fertility through subclinical injection use was viewed as a way to optimize women's' chances of preventing unintended pregnancy while maintaining their ability to become pregnant when they wanted to. Women wanted to play an active role in managing their fertility and were not passive consumers of contraception. It is therefore critical that family planning programs provide contraceptive counseling to women that engages their desire to manage their fertility, acknowledges their concerns about fertility, and helps them choose a method that best fits their needs.
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Affiliation(s)
- Marta Bornstein
- The Ohio State University College of Public Health, Division of Epidemiology, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43201, USA
- University of California Los Angeles Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive S, Los Angeles, CA, 90015, USA
| | - Alison Norris
- The Ohio State University College of Public Health, Division of Epidemiology, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43201, USA
| | | | - Sarah Huber-Krum
- Harvard T.H. Chan School of Public Health, Cambridge, MA, 02115, USA
| | - Jessica D. Gipson
- University of California Los Angeles Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive S, Los Angeles, CA, 90015, USA
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Fletcher-Hildebrand S, Lawson K, Downe P, Bayly M. The role of motherhood schemas and life transitions in reproductive intention formation. J Reprod Infant Psychol 2022; 40:479-488. [PMID: 33843372 DOI: 10.1080/02646838.2021.1892044] [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: 12/16/2022]
Abstract
OBJECTIVE This study provides a theory-based snapshot of the processes involved in women's fertility intention formation and decisions regarding the timing of motherhood. BACKGROUND The trend to defer childbearing is linked with both empowering and challenging outcomes for women. The cognitive-social (C-S) model suggests that deliberative thinking regarding reproduction occurs following fertility-relevant life transitions, which results in fluctuations in motherhood schemas and fertility intentions. This framework was applied to explore fertility intention formation. METHODS Semi-structured interviews were conducted with twelve women who either had children or desired children. RESULTS Two overarching themes central to the C-S model are discussed: (a) passive expectations and (b) deliberative intentions. Women's motherhood schemas were often underpinned by schematic structures (e.g. group norms and scripts) and material structures (e.g. observational influences). Life transitions and personal experiences tended to prompt deliberative thinking about motherhood plans. CONCLUSION The results were generally consistent with the C-S model, but highlight complexities to consider when investigating fertility expectations and intentions.
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Affiliation(s)
| | - Karen Lawson
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
| | - Pamela Downe
- Department of Archaeology and Anthropology, University of Saskatchewan, Saskatoon, Canada
| | - Mel Bayly
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
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Müller MW, Hamory J, Johnson-Hanks J, Miguel E. The illusion of stable fertility preferences. POPULATION STUDIES 2022; 76:169-189. [PMID: 35576966 PMCID: PMC9256780 DOI: 10.1080/00324728.2022.2057577] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/04/2022] [Indexed: 10/18/2022]
Abstract
Fertility preferences have long played a key role in models of fertility differentials and change. We examine the stability of preferences over time using rich panel data on Kenyan women's fertility desires, expectations, actual fertility, and recall of desires in three waves over a nine-year period, when respondents were in their 20s. We find that although desired fertility is quite unstable, most women perceive their desires to be stable. Under hypothetical future scenarios, few expect their desired fertility to increase over time but, in fact, such increases in fertility desires are common. Moreover, when asked to recall past desires, most respondents report previously wanting exactly as many children as they desire today. These patterns of bias are consistent with the emerging view that fertility desires are contextual, emotionally laden, and structured by identity.
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Sarnak DO, Tsui A, Makumbi F, Kibira SPS, Ahmed S. A Panel Study of Fertility Preferences and Contraceptive Dynamics in the Presence of Competing Pregnancy Risks in Uganda. Demography 2021; 58:295-320. [PMID: 33834246 DOI: 10.1215/00703370-8937285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although many studies have examined the influence of women's fertility preferences on subsequent fertility behavior and the role of contraceptive use intentions on unmet need, very few have explored their concurrent effects on contraceptive use dynamics. This study examines the independent concurrent effects of women's fertility preferences and contraceptive intentions on subsequent adoption and discontinuation, treating pregnancy as a competing risk factor that may alter contraceptive need. The data are derived from a 2018 follow-up survey of a 2014 national sample of 3,800 Ugandan female respondents of childbearing age. The survey included a contraceptive calendar that recorded pregnancy, birth, and contraceptive event episodes, including reasons for discontinuation. We use competing risk regression to estimate the effect of fertility preferences and contraceptive intentions on the cumulative incidence function of contraceptive behaviors, accounting for intervening pregnancy, female background covariates, loss to follow-up, and complex survey design. We find that women's contraceptive intentions significantly increase the rate of contraceptive adoption. After having adopted, women's contraceptive intentions have been realized and do not prolong use. The risk of discontinuation among women who adopted after baseline was significantly higher than for those using at baseline, irrespective of their initial intentions. The effectiveness of the type of contraceptive method chosen significantly lowered discontinuation risk. Fertility preferences were not significantly associated with either time to adoption or discontinuation. The pace of the fertility transition in this sub-Saharan African setting is likely being shaped by reproductive regulation through the intentional use of contraception that enables spacing births.
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Affiliation(s)
- Dana O Sarnak
- Population, Family and Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Tsui
- Population, Family and Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fredrick Makumbi
- Epidemiology and Biostatistics Department, School of Public Health, Makerere University, Kampala, Uganda
| | - Simon Peter Sebina Kibira
- Community Health and Behavioral Sciences Department, School of Public Health, Makerere University, Kampala, Uganda
| | - Saifuddin Ahmed
- Population, Family and Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Timæus IM, Moultrie TA. Pathways to Low Fertility: 50 Years of Limitation, Curtailment, and Postponement of Childbearing. Demography 2020; 57:267-296. [PMID: 31970647 PMCID: PMC7051933 DOI: 10.1007/s13524-019-00848-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study applies survival analysis to the birth histories from 317 national surveys to model pathways to low fertility in 83 less-developed countries between 1965 and 2014. It presents period measures of parity progression, the length of birth intervals and total fertility that have been standardized fully for age, parity, and interval duration. It also examines parity-specific trends in the proportion of women who want no more children. Outside sub-Saharan Africa, fertility transition was dominated by parity-specific family size limitation. As the transition progressed, women also began to postpone their next birth for lengthy periods in many countries. During the first half of the fertility transition in much of sub-Saharan Africa and in some other countries, however, women stopped childbearing without targeting particular family sizes. Moreover, birth intervals in sub-Saharan Africa have been lengthening since the onset of the transition. Birth control is not restricted to a dichotomy between limitation and spacing. Other reasons for curtailing childbearing and postponing having another birth also shape countries’ pathways through fertility transition.
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Affiliation(s)
- Ian M Timæus
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK. .,Centre for Actuarial Research, University of Cape Town, Cape Town, South Africa.
| | - Tom A Moultrie
- Centre for Actuarial Research, University of Cape Town, Cape Town, South Africa
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Cleland J, Machiyama K, Casterline JB. Fertility preferences and subsequent childbearing in Africa and Asia: A synthesis of evidence from longitudinal studies in 28 populations. Population Studies 2019; 74:1-21. [DOI: 10.1080/00324728.2019.1672880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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Abstract
Childbearing intentions among women in high-fertility contexts are usually classified into those wanting to have a baby, those wanting to 'space' a birth and those wanting to 'limit' their family size. However, evidence from Africa increasingly suggests that women's intentions are more complex than this classification suggests, and that there is fluidity in these intentions. This research explores women's accounts of their childbearing intentions and decisions in order to examine how this fluidity plays out in a low-fertility context in urban Africa. Six focus group discussions were conducted in April and May 2012 with women of reproductive age in Nairobi, Kenya. Participants were recruited using random and purposive sampling techniques. The focus group discussions had an average of seven participants each. Data were coded thematically and analysed using Nvivo software. The analysis explored the factors that women consider to be influential for childbearing and found that the health of the mother and child, costs of raising a child and relationships were commonly reported to be important. Evidence of intentions to space births and limit family size was found. However, the data also showed that there is fluidity in women's family planning intentions, driven by changes in relationships or household finances, which often result in a desire to avoid pregnancy in the present moment. The fluidity observed in women's childbearing intentions cannot be accounted for by the concepts of either 'spacing' or 'limitation' but is best explained by the concept of 'postponement'. The research reveals the need for family planning clinics to provide a full method mix, as well as high-quality counselling, to enable women to choose a method that best suits their needs.
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10
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Abstract
A growing body of research has argued that the traditional categories of stopping and spacing are insufficient to understand why individuals want to control fertility. In a series of articles, Timæus, Moultrie, and colleagues defined a third type of fertility motivation-postponement-that reflects a desire to avoid childbearing in the short term without clear goals for long-term fertility. Although postponement is fundamentally a description of fertility desires, existing quantitative research has primarily studied fertility behavior in an effort to find evidence for the model. In this study, we use longitudinal survey data to consider whether postponement can be identified in standard measures of fertility desires among reproductive-age women in rural Mozambique. Findings show strong evidence for a postponement mindset in this population, but postponement coexists with stopping and spacing goals. We reflect on the difference between birth spacing and postponement and consider whether and how postponement is a distinctive sub-Saharan phenomenon.
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Affiliation(s)
- Sarah R Hayford
- Department of Sociology, Ohio State University, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210-1404, USA.
| | - Victor Agadjanian
- Department of Sociology, University of California-Los Angeles, Los Angeles, CA, 90095-1551, USA
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Sennott C, Yeatman S. Conceptualizing Childbearing Ambivalence: A Social and Dynamic Perspective. JOURNAL OF MARRIAGE AND THE FAMILY 2018; 80:888-901. [PMID: 30270937 PMCID: PMC6157927 DOI: 10.1111/jomf.12489] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 03/11/2018] [Indexed: 05/26/2023]
Abstract
Childbearing ambivalence is often conceptualized as a state of conflicting desires about having a child that is characteristic of particular individuals and/or life stages. This study proposes that childbearing ambivalence is dynamic and situational, resulting from the multiple socio-cultural frames surrounding childbearing. Using eight waves of prospective data from a population-based sample of young adults in Malawi, results show that 41% of women and 48% of men are ambivalent about childbearing at some point in the 2.5-year study. There is limited evidence that ambivalence is related to individual sociodemographic or psychosocial characteristics aside from gender; rather, ambivalence is tied to life course markers such as school enrollment and age. Additionally, life course transitions and changes in relationships, health, and economic factors are associated with the onset of ambivalence, supporting the theory that ambivalence is a dynamic state that men and women frequently pass through as their lives and circumstances change.
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Affiliation(s)
- Christie Sennott
- Purdue University, Department of Sociology, 700 W. State St., West Lafayette, IN 47906 ; ;
| | - Sara Yeatman
- University of Colorado Denver, Department of Health and Behavioral Sciences, Campus Box 188, PO Box 173364, Denver, CO 80217-3364, ;
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