Mapping the Timing, Pace, and Scale of the Fertility Transition in Brazil

Estimation and probabilistic projection of age- and sex-specific mortality rates across Brazilian municipalities between 2010 and 2030

BACKGROUND

Mortality rate estimation in small areas can be difficult due the low number of events/exposure (i.e. stochastic error). If the death records are not completed, it adds a systematic uncertainty on the mortality estimates. Previous studies in Brazil have combined demographic and statistical methods to partially overcome these issues. We estimated age- and sex-specific mortality rates for all 5,565 Brazilian municipalities in 2010 and forecasted probabilistic mortality rates and life expectancy between 2010 and 2030.

METHODS

We used a combination of the Tool for Projecting Age-Specific Rates Using Linear Splines (TOPALS), Bayesian Model, Spatial Smoothing Model and an ad-hoc procedure to estimate age- and sex-specific mortality rates for all Brazilian municipalities for 2010. Then we adapted the Lee-Carter model to forecast mortality rates by age and sex in all municipalities between 2010 and 2030.

RESULTS

The adjusted sex- and age-specific mortality rates for all Brazilian municipalities in 2010 reveal a distinct regional pattern, showcasing a decrease in life expectancy in less socioeconomically developed municipalities when compared to estimates without adjustments. The forecasted mortality rates indicate varying regional improvements, leading to a convergence in life expectancy at birth among small areas in Brazil. Consequently, a reduction in the variability of age at death across Brazil's municipalities was observed, with a persistent sex differential.

CONCLUSION

Mortality rates at a small-area level were successfully estimated and forecasted, with associated uncertainty estimates also generated for future life tables. Our approach could be applied across countries with data quality issues to improve public policy planning.

Spatial Statistical Models: An Overview under the Bayesian Approach

Spatial documentation is exponentially increasing given the availability of Big Data in the Internet of Things, enabled by device miniaturization and data storage capacity. Bayesian spatial statistics is a useful statistical tool to determine the dependence structure and hidden patterns in space through prior knowledge and data likelihood. However, this class of modeling is not yet well explored when compared to adopting classification and regression in machine-learning models, in which the assumption of the spatiotemporal independence of the data is often made, that is an inexistent or very weak dependence. Thus, this systematic review aims to address the main models presented in the literature over the past 20 years, identifying the gaps and research opportunities. Elements such as random fields, spatial domains, prior specification, the covariance function, and numerical approximations are discussed. This work explores the two subclasses of spatial smoothing: global and local.

The spatial diffusion of fertility decline in Egypt (1950–2006)

While the Egyptian fertility transition has been widely addressed in the literature, few researches have studied the spatial dimension of fertility. Using population census data, the aim of this study is to describe and measure the evolution of the geography of fertility on a subnational scale (qism/markaz), focusing on the period between 1960 and 2006. We assumed that the decline in fertility had spread spatially through Egypt, the spatial diffusion occurring through two traditional mechanisms: contagion and hierarchical diffusion. Our results confirm our hypotheses and highlight the importance of studying the spatial diffusion of the fertility transition. This study is unique for the Egyptian context given the long period and fine territorial scale considered. Our study constitutes an important addition to the existing group of studies on the spatial diffusion of fertility. Finally, it contributes to gaining further insight into a demographic dynamic which is fundamental for the future of Egypt.

Live Births and Fertility Amid the Zika Epidemic in Brazil

In late 2015, the Brazilian Ministry of Health and the Pan American Health Organization classified the increase in congenital malformations associated with the Zika virus (ZIKV) as a public health emergency. The risk of ZIKV-related congenital syndrome poses a threat to reproductive outcomes that could result in declining numbers of live births and potentially fertility. Using monthly microdata on live births from the Brazilian Information System on Live Births (SINASC), this study examines live births and fertility trends amid the ZIKV epidemic in Brazil. Findings suggest a decline in live births that is stratified across educational and geographic lines, beginning approximately nine months after the link between ZIKV and microcephaly was publicly announced. Although declines in total fertility rates were small, fertility trends estimated by age and maternal education suggest important differences in how Zika might have impacted Brazil's fertility structure. Further findings confirm the significant declines in live births in mid-2016 even when characteristics of the municipality are controlled for; these results highlight important nuances in the timing and magnitude of the decline. Combined, our findings illustrate the value of understanding how the risk of a health threat directed at fetuses has led to declines in live births and fertility.

Understanding sexual and reproductive health needs of young women living in Zika affected regions: a qualitative study in northeastern Brazil

Background

In 2016, the World Health Organization declared a Public Health Emergency of International Concern due to Zika’s association with microcephaly and other neurological disorders. Brazil was the epicenter of this epidemic and the most affected region has the lowest Human Development Index and the highest rates of adolescent pregnancy. Despite the end of the epidemic, Brazil continues to be the epicenter of Zika illness. This study examined the barriers faced by young women who seek sexual and reproductive health (SRH) care services living in affected areas and their attitudes towards SRH needs and the available services.

Methods

Individual semi-structured interviews were conducted with 22 young women, aged 14–24 years in three Zika affected municipalities in the Brazilian Northeast. This qualitative research used thematic analysis for data analysis.

Results

Almost half (n = 10) of the participants had their first pregnancy during adolescence (from 12 to 19), all of which were unintended. Lack of information and barriers to access family planning were found to contribute to the unmet need for contraception. Participants reported knowledge gaps about contraception. Zika was not considered a health concern and participants were unaware of the possibility of Zika’s sexual transmission.

Conclusions

The young women’s knowledge and attitudes towards their SRH needs highlight the barriers to access care. It also implies that comprehensive, biopsychosocial and political, understanding is necessary in order to adequately provide SRH to this population and meet their needs. The government should place women at the center of any public health response to an emergency affecting women of reproductive age and focus on improving access to information and family planning services in a culturally and age appropriate manner.

Profile of Female Sterilization in Brazil

(1) Background: This study analyzes the profile of female sterilization in Brazil by age, parity, type of delivery, place of delivery, color/race, region of residence, years of schooling, marital status, number of unions, and desired number of children reported by women; (2) Methods: The descriptive analysis is based on the most recent Brazilian database on reproductive health: the 2006 Brazilian National Survey on Demography and Health of Women and Children (PNDS). This dataset has information on the history of pregnancies with live births from January 2001 to July 2007; (3) Results: The study suggests that (a) women with high levels of sterilization, high percentages of more than one pregnancy in the period, and larger parity than the desired number of children tend to have high parity, be black, brown, or indigenous, reside in the North or Northeast, have low levels of education, and have two or more unions; and (b) women with high levels of sterilization, low percentages of more than one pregnancy in the period, and lower parity than the desired number of children tend to have cesarean sections, give birth utilizing private health care obtained through a private insurance plan or direct out-of-pocket payment at private hospitals, and be married. (4) Conclusions: The 1997 family planning law could be altered in order to allow female sterilization in conjunction with childbirth, as a way to attend the demand of Brazilian women in public hospitals. Policies are necessary not only to regulate the public sector, but also to aim better services at private institutions. Female sterilization should be discussed in the context of fertility below the replacement level, as one of its associated factors.

A subregional analysis of family change: The spatial diffusion of one-parent families across Italian municipalities, 1991-2011

This paper documents the expansion of new family patterns in Italy by scrutinising the spatial diffusion of one-parent families across Italian municipalities for the period 1991-2011. We apply a hierarchical Bayesian model to the data of the last three Italian Population Censuses, acknowledging that variation cannot be broken down into temporal and spatial effects because space-time interaction is at the very heart of family changes. Our results illustrate substantial subregional and sub-provincial heterogeneities in the spatial organisation of family systems, patterns that might have gone undetected had larger territorial units of analysis been considered. In addition, we show that especially socio-economic factors were associated to the diffusion of new family forms. This paper challenges international scholarship that caricatures Italy as a monolithic, homogeneous family-oriented country.

Completeness of birth registration in Brazil: an overview of methods and data sources

We provide an analysis of the main sources of data used to estimate fertility schedules in developing countries, giving special attention to Brazil. In addition to the brief history of various data sources, we present several indirect demographic methods, commonly used to estimate fertility and assess the quality of data. From the methods used, the Synthetic Relational Gompertz model gives the most robust estimates of fertility, independent of the data source considered. We conclude that different demographic data sources and methods generate differing estimates of fertility and that the country should invest in quality of birth statistics.

SOCIAL DETERMINANTS OF LOW FERTILITY IN BRAZIL

An increasing number of developing countries are experiencing below replacement fertility rates. Although the factors associated with low fertility in developed countries have been widely explored in the literature, studies of low fertility in middle- and low-income countries continue to be rare. To help fill this gap, Brazil was used as a case study to assess whether human development, gender equality and the ability of mothers with young children to work are associated with the likelihood of married or cohabiting women to have a child. For this purpose, multilevel logistic regressions were estimated using the 1991, 2000 and 2010 Brazilian Demographic Censuses. It was found that human development was negatively associated with fertility in the three periods analysed. Gender equality and the ability of mothers with young children to work were positively associated with the odds of having higher order births in Brazil in 2000 and 2010. In 1991, these variables were not associated with higher order births, and gender equality was negatively associated with first births. The positive association found in 2000 and 2010 may constitute a reversal of the relationship that in all likelihood prevailed earlier in the demographic transition when gender equality was most likely negatively correlated with fertility levels.

Family Planning and Deforestation: Evidence from the Ecuadorian Amazon

Despite an abundant body of literature exploring the relationship between population growth and forest cover change, comparatively little research has explored the forest cover impacts of family planning use, which is a key determinant of the rate of population growth in many developing country contexts. Using data from a farm-level panel survey in the Northern Ecuadorian Amazon, this paper addresses whether family planning use impacts forest cover change. Longitudinal model results show that after controlling for household life cycle and land use variables, family planning use did not have an independent effect on deforestation, reforestation, or net forest loss between 1990 and 2008. Forest cover change patterns appear indicative of farm life cycle effects. However, family planning use is associated with reduced subsequent fertility among households, suggesting that the relationship between population growth from births and forest cover change may be limited in this setting.

Parity of indigenous and non-indigenous women in Brazil: does the reported number of children born depend upon who answers national census questions?

Taking parity as the main analytic variable, the objective of this study is to investigate whether the patterns of response to national census questions in Brazil differ when Indigenous and non-Indigenous women are compared, taking into consideration whether the information was provided by the women directly or by a proxy respondent (another household member or a non-resident). We use data on children ever born to Indigenous and non-Indigenous women from two Brazilian regions, the Northeast and the North. Data on the number of household members, total household rooms, interviewee’s color/race, educational attainment, age, parity, and type of respondent were obtained from the 2010 Brazilian census. The relation between color/race and reported parity, as well as the impact of the type of respondent on this association were assessed with the Zero-inflated Negative Binomial regression, stratified by region (North and Northeast) and urban/rural status. Just over half of census interviewees answered directly the census questions (51.2% in the North and 54.4% in the Northeast). Indigenous women in the North region had the highest percentage of interviews carried out with a non-resident (12.7% total; 15.0% and 3.0% in rural and urban areas, respectively). Regardless of color/race, parity means were considerably higher when the question was answered by the woman directly (93.5%-101.4% and 15.6%-21.7% higher, compared co-resident and non-resident based answers, respectively). Parity underreporting was particularly strong in Indigenous women living in the rural North (16.0% less in comparison to White women). Proxy respondents tend to underestimate the count of children, particularly among Indigenous women from the North. The implementation of certain methodological alternatives in the Brazilian national censuses, such as the selection and training of census takers to work specifically in Indigenous territories, might be a productive means to improve data collection.

Diffusion of childbearing within cohabitation

The article analyzes the diffusion of childbearing within cohabitation in Norway, using municipality data over a 24-year period (1988-2011). Research has found substantial spatial heterogeneity in this phenomenon but also substantial spatial correlation, and the prevalence of childbearing within cohabitation has increased significantly over time. We consider several theoretical perspectives and implement a spatial panel model that allows accounting for autocorrelation not only on the dependent variable but also on key explanatory variables, and hence identifies the key determinants of diffusion of childbearing within cohabitation across space and over time. We find only partial support for the second demographic transition as a theory able to explain the diffusion of childbearing within cohabitation. Our results show that at least in the first phase of the diffusion (1988-1997), economic difficulties as measured by increased unemployment among men contributed to the diffusion of childbearing within cohabitation. However, the most important driver for childbearing within cohabitation is expansion in education for women.

The burden of unintended pregnancies in Brazil: a social and public health system cost analysis

Background

Unintended pregnancy (UP) is an unmet medical need with consequences worldwide. We evaluate the costs of UP based on pregnancies in Brazil from for the year 2010.

Methods

The consequences of UP were evaluated using decision analysis based on pregnancy rates and outcomes as miscarriage, induced abortion, and live birth, which were factored into the analysis. The model discriminated between maternal and child outcomes and accounted for costs (in Brazilian currency [Real$, R$]) within the Brazilian public health service attributed to preterm birth, neonatal admission, cerebral palsy, and neonatal and maternal mortality. Event probabilities were obtained from local resources.

Results

We estimate that 1.8 million UPs resulted in 159,151 miscarriages, 48,769 induced abortions, 1.58 million live births, and 312 maternal deaths, including ten (3%) attributed to unsafe abortions. The total estimated costs attributed to UP are R$4.1 billion annually, including R$32 million (0.8%) and R$4.07 billion (99.2%) attributed to miscarriages and births and complications, respectively. Direct birth costs accounted for approximately R$1.22 billion (30.0%), with labor and delivery responsible for most costs (R$988 million; 24.3%) for the year 2010. The remainder of costs were for infant complications (R$2.84 billion; 72.3%) with hospital readmission during the first year accounting for approximately R$2.15 billion (52.9%). Based on the national cost, we estimate the cost per UP to be R$2,293.

Conclusion

Despite weaknesses in precise estimates in annual pregnancies and induced abortions, our estimates reflect the costs of UP for different pregnancy outcomes. The main costs associated with UP are in those carried to parturition. The health cost of abortion represents a small proportion of total costs as these are paid for outside of the public health system. Consequently, reductions in UP will generate not only cost savings, but reductions in woman and child morbidity and mortality.

Integrating the Demographic and Health Surveys, IPUMS-I, and TerraPopulus to Explore Mortality and Health Outcomes at the District Level in Ghana, Malawi, and Tanzania

In this paper, we first show how the Demographic and Health Surveys (DHS) can be integrated with other data sources to expand the types of variables available for analysis of population and health outcomes. Second, we demonstrate one particular example of such integration by modelling the social, physical, and built environment determinants of health outcomes at the district level in Ghana, Malawi, and Tanzania. To do so, we created district-level measures of a number of variables from the DHS, and then merged them with district-level data from the IPUMS, an environmental data set called TerraPopulus, and other sources. We find that it is feasible to combine the DHS with other data sources, and that many health and environment indicators are heterogeneous within countries, justifying further analysis at low levels of geography and suggesting benefits to using such techniques to design fine-grained programmatic interventions.

Bayes plus Brass: estimating total fertility for many small areas from sparse census data

Estimates of fertility in small areas are valuable for analysing demographic change, and important for local planning and population projection. In countries lacking complete vital registration, however, small-area estimates are possible only from sparse survey or census data that are potentially unreliable. In these circumstances estimation requires new methods for old problems: procedures must be automated if thousands of estimates are required; they must deal with extreme sampling variability in many areas; and they should also incorporate corrections for possible data errors. We present a two-step procedure for estimating total fertility in such circumstances and illustrate it by applying the method to data from the 2000 Brazilian Census for over 5,000 municipalities. Our proposed procedure first smoothes local age-specific rates using Empirical Bayes methods and then applies a new variant of Brass's P/F parity correction procedure that is robust to conditions of rapid fertility decline. Supplementary material at the project website ( http://schmert.net/BayesBrass ) will allow readers to replicate all the authors' results in this paper using their data and programs.

Bayesian probabilistic projections of life expectancy for all countries

We propose a Bayesian hierarchical model for producing probabilistic forecasts of male period life expectancy at birth for all the countries of the world to 2100. Such forecasts would be an input to the production of probabilistic population projections for all countries, which is currently being considered by the United Nations. To evaluate the method, we conducted an out-of-sample cross-validation experiment, fitting the model to the data from 1950-1995 and using the estimated model to forecast for the subsequent 10 years. The 10-year predictions had a mean absolute error of about 1 year, about 40 % less than the current UN methodology. The probabilistic forecasts were calibrated in the sense that, for example, the 80 % prediction intervals contained the truth about 80 % of the time. We illustrate our method with results from Madagascar (a typical country with steadily improving life expectancy), Latvia (a country that has had a mortality crisis), and Japan (a leading country). We also show aggregated results for South Asia, a region with eight countries. Free, publicly available R software packages called bayesLife and bayesDem are available to implement the method.

Maternal age at first birth and adolescent education in Brazil

BACKGROUND

Brazil has witnessed dramatic changes in its fertility patterns in recent decades. The decline to below-replacement fertility has been accompanied by increases in the proportion of children born to young mothers. Yet we know little about the well-being of children born to young mothers in Brazil.

OBJECTIVE AND METHODS

Using data from the 2006 Pesquisa Nacional de Demografia e Saúde and a quasi-natural experimental approach, this study examines the implications of maternal age at first birth for the education of Brazilian adolescents.

RESULTS

We find that being born to a young mother is associated with educational disadvantages in adolescence, but that these disadvantages are attenuated once we account for mothers' selection into early childbearing. We also find that, in southern Brazil, adolescents born to young mothers have poorer educational outcomes compared with their peers born to older mothers, but that in northern Brazil no such disparities exist.

CONCLUSIONS

Adolescent educational disadvantages associated with being born to a young mother are not an artifact of selectivity, at least in southern Brazil. Regional variation in the effect of maternal age at first birth on adolescent education suggests the important role of the extended family and the father's presence as mechanisms through which disadvantages operate.

The changing impact of family size on adolescents' schooling: assessing the exogenous variation in fertility using twins in Brazil

Researchers have long been interested in the influence of family size on children's educational outcomes. Simply put, theories have suggested that resources are diluted within families that have more children. Although the empirical literature on developed countries has generally confirmed the theoretical prediction that family size is negatively related to children's education, studies focusing on developing societies have reported heterogeneity in this association. Recent studies addressing the endogeneity between family size and children's education have also cast doubt on the homogeneity of the negative role of family size on children's education. The goal of this study is to examine the causal effect of family size on children's education in Brazil over a 30-year period marked by important social and demographic change, and across extremely different regions within the country. We implement a twin birth instrumental variable approach to the nationally representative 1977-2009 PNAD data. Our results suggest an effect of family size on education that is not uniform throughout a period of significant social, economic, and demographic change. Rather, the causal effect of family size on adolescents' schooling resembles a gradient that ranges from positive to no effect, trending to negative.

Age, education, and earnings in the course of Brazilian development: does composition matter?

BACKGROUND

The impacts of shifts in the age distribution of the working-age population have been studied in relation to the effect of the baby boom generation on the earnings of different cohorts in the U.S. However, this topic has received little attention in the context of the countries of Asia and Latin America, which are now experiencing substantial shifts in their age-education distributions.

OBJECTIVE

In this analysis, we estimate the impact of the changing relative size of the adult male population, classified by age and education groups, on the earnings of employed men living in 502 Brazilian local labor markets during four time periods between 1970 and 2000.

METHODS

Taking advantage of the huge variation across Brazilian local labor markets and demographic census micro-data, we used fixed effects models to demonstrate that age education group size depresses earnings.

RESULTS

These effects are more detrimental among age-education groups with higher education, but they are becoming less negative over time. The decrease in the share of workers with the lowest level of education has not led to gains in the earnings of these workers in recent years.

CONCLUSIONS

These trends might be a consequence of technological shifts and increasing demand for labor with either education or experience. Compositional shifts are influential, which suggests that this approach could prove useful in studying this central problem in economic development.

Long Term Influences of Age-Education Transition on the Brazilian Labour Market

The objective of this study is to estimate the long term mean earnings of the male Brazilian population, taking into account the ageing process of the population and the increase in educational attainment. Using census data, household sample surveys, as well as population and education projections, estimates indicate that an ageing population and an increase in education will have a 2 percent impact on the annual growth of an average income in Brazil by 2050. The challenge for the future is to improve the proportion of the Brazilian population with completed college degrees.

FERTILITY DECLINE UNDER SEEMINGLY UNFAVOURABLE CONDITIONS IN ORISSA, INDIA

Orissa, one of the extremely backward states of India with moderately high infant mortality, extreme poverty, low female literacy and very low level of industrialization and urbanization, has shown an impressive fertility decline in the last two decades. This anomaly calls for an indepth understanding of the fertility transition of the state. An analysis of the period parity progression ratios computed from the fertility histories obtained in the National Family Health Survey III shows a high progression up to the second birth, but a gradual decline after that. Thus, the transition at low level of socioeconomic development suggests a fall in the thresholds for fertility decline from levels presumed to be required in the past.