Potential effects on fertility and child health and survival of birth-spacing preferences in sub-Saharan Africa

Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys

Background

Information on repeat adolescent birth remains scarce in sub-Sahara Africa. We investigated the prevalence and time trends in repeat adolescent birth in Uganda, and associated factors.

Methods

We analyzed Uganda Demographic and Health Survey data of women age 20–24 years collected on 6 surveys (1988/89-2016) to estimate repeat adolescent birth (first live birth <18 years of age followed by another live birth(s) <20 years). Further, we estimated the wantedness of the second order birth and the prevalence of short birth intervals birth (<13 months) between the first and second such birth. On the 2016 survey, we examined factors associated with repeat adolescent birth using bivariate and multivariate modified Poisson regression.

Results

At the 1988/89 survey, 58.9% of women with first birth <18 years reported a repeat adolescent birth. This percentage increased to 66.8% in 2006 (+7.9 percentage points [pp], p = 0.010) and thereafter declined to 55.6% by 2016 (-11.2 pp, p<0.001), nevertheless, no change occurred between 1988/89 and 2016 (-3.3pp, p = 0.251). Among women with repeat adolescent births, the mean number of live births by exact age 20 years (2.2 births) and prevalence of short birth intervals (3.5% in 1988/89, 5.4% in 2016) (+1.9pp, p = 0.245) did not change. Increasingly more women with repeat adolescent births preferred to have had the second child later, 22.5% in 1995 and 43.1% in 2016 (+20.6pp, p = <0.001). On the 2016 survey, women from poorer households and those of younger age at first birth were significantly more likely to report repeat adolescent birth.

Conclusion

Following a first birth <18 years, more than half of the women report a repeat adolescent birth (<20 years), with no decline observed in 30 years. Increasingly more women wanted the second adolescent pregnancy later, highlighting the need to support adolescents with improved family planning services at each contact.

Misconceptions and current use of contraception among women of reproductive age in six major cities in Nigeria

OBJECTIVES

The aims of this study were to assess the determinants of family planning misconceptions and modern contraceptive use, and the influence of misconceptions on the use of modern contraceptive methods.

METHODS

We reviewed and analysed data collected between October 2010 and March 2011 among a representative household sample of 13,575 women of reproductive age (15-49 years) in six urban cities in Nigeria. Multiple linear and logistic regression models were used to examine the predictors of misconceptions and current use of contraception and the association between misconceptions and modern contraceptive use.

RESULTS

Catholic women were significantly more likely to have misconceptions compared with Muslim women (β = 1.09; 95% confidence interval [CI] 0.58, 1.60; p < .001); women with higher education were significantly less likely to have misconceptions about contraception compared with women with no formal education (β= -0.06; 95% CI -0.96, -0.29; p < .001). Unmarried women living with a partner were not significantly different from those who were not cohabiting (single, separated or widowed) in their current contraceptive use (adjusted odds ratio [OR] 0.91; 95% CI 0.79, 1.04; p > .05). Women with lower misconception scores were significantly more likely to adopt and use modern contraception compared with those with high misconception scores (adjusted OR 0.93; 95% CI 0.92, 0.94; p < .001).

CONCLUSION

These findings suggest that programmatic efforts should be geared towards dispelling misconceptions by providing simple factual information related to the benefits of contraception and family planning.

Unconditional Government Social Cash Transfer in Africa Does not Increase Fertility

Among policymakers, a common perception surrounding the effects of cash transfer programmes, particularly unconditional programmes targeted to households with children, is that they induce increased fertility. We evaluate the Zambian Child Grant Programme, a government unconditional cash transfer targeted to households with a child under the age of five and examine impacts on fertility and household composition. The evaluation was a cluster randomized control trial, with data collected over four years from 2010 to 2014. Our results indicate there are no programme impacts on overall fertility. Our results contribute to a small evidence base demonstrating that there are no unintended incentives related to fertility due to cash transfers.

Stability and change in fertility preferences among young women in Malawi

CONTEXT

Although studies have demonstrated change in fertility preferences over time, there is a lack of definitive knowledge about the level and direction of change among individuals, especially young and unmarried women. Furthermore, little is known about the factors associated with changes in fertility preferences over time.

METHOD

The analysis uses the first five waves of data from a longitudinal study of a random sample of women aged 15-25 in southern Malawi. The data were collected four months apart over an 18-month period, between June 2009 and December 2010. Multinomial logit regression models were used to calculate relative risk ratios and identify associations between four categories of life events-reproductive, relationship, health and economic-and shifts in fertility timing preferences.

RESULTS

In each four-month period, more than half of the women reported changes in the desired timing of their next birth, and delays and accelerations in timing desires were common. Several life events, including having a child, entering a serious relationship and changes in household finances were associated with changes in the level and direction of fertility preference.

CONCLUSION

Shifts in fertility timing preferences often occur in response to changes in life circumstances. Understanding the reasons for these shifts may aid family planning providers in meeting women's contraceptive needs.

Concordance between partners in desired waiting time to birth for newlyweds in India

Examining waiting time to birth among newlywed couples is likely to provide insights into the desire for spacing births among newlywed husbands and wives. Data from the Indian National Family Health Survey of 2005-06 are used to examine the desired waiting time (DWT) to birth among newlywed couples. The dependent variable is spousal concordance on desired waiting times. Overall 65% of couples have concordant desired waiting times. Among discordant couples, wives were more likely to want to wait longer than their husbands. Couples from richer wealth quintiles were more likely than couples from the poorest quintile to have concordant desired waiting times. Muslims were less likely than Hindus to have concordant desires. There is a need for spacing contraceptive methods among newlyweds in India. This may have implications for the Indian Family Planning Programme, which to date has largely focused on sterilization. Programmes need to include newlywed husbands to promote use of spacing methods.

Menstrual pattern, sexual behaviors, and contraceptive use among postpartum women in Nairobi urban slums

Postpartum months provide a challenging period for poor women. This study examined patterns of menstrual resumption, sexual behaviors and contraceptive use among urban poor postpartum women. Women were eligible for this study if they had a birth after the period September 2006 and were residents of two Nairobi slums of Korogocho and Viwandani. The two communities are under continuous demographic surveillance. A monthly calendar type questionnaire was administered retrospectively to cover the period since birth to the interview date and data on sexual behavior, menstrual resumption, breastfeeding patterns, and contraception were collected. The results show that sexual resumption occurs earlier than menses and postpartum contraceptive use. Out of all postpartum months where women were exposed to the risk of another pregnancy, about 28% were months where no contraceptive method was used. Menstrual resumption acts as a trigger for initiating contraceptive use with a peak of contraceptive initiation occurring shortly after the first month when menses are reported. There was no variation in contraceptive method choice between women who initiate use before and after menstrual resumption. Overall, poor postpartum women in marginalized areas such as slums experience an appreciable risk of unintended pregnancy. Postnatal visits and other subsequent health system contacts provide opportunities for reaching postpartum women with a need for family planning services.

Cultural background and infant survival in Ghana

This study is premised on the hypothesis that ethnic specific socio-cultural practices such as dietary taboos and food avoidances on mothers and infants, as well as perceptions of disease aetiology and treatment patterns may be salient to understanding infant mortality differentials in Ghana. To inform policy, the paper explores if there are significant ethnic differences in infant survival, and whether such differences reflect socio-economic disparities or intrinsic factors. Using data from the 1998 Ghana Demographic and Health Survey, there was evidence of significant ethnic differences in infant survival at the bivariate level. Using Asante mothers as reference, the risk of death was significantly higher among children whose mothers were Mole-Dagbani, Grussi, Gruma, Dagarti, Fanti and Other Akan. In the multivariate models, however, the higher mortality risks associated with these children significantly attenuated after controlling for the socio-economic and bio-demographic factors except for the Fanti. The findings are discussed with reference to the characteristics and cultural theoretical paradigms.

New evidence on birth spacing: promising findings for improving newborn, infant, child, and maternal health

This editorial summarizes new evidence, some of which is published in this supplement, on birth spacing and newborn, infant, child and maternal health, as well as the demand for birth spacing services in the developing world. The article points to the high number of annual infant, child and maternal deaths, low birth weight infants and malnourished infants and children in developing countries. It highlights several new findings on birth spacing relevant to these conditions: It argues that, in light of the new evidence, birth spacing is an important, feasible and practical intervention to address these conditions and should be included in developing country health programs.