Childbearing desires and behaviour: a prospective assessment in Nairobi slums

Childbearing plans' predictive value for birth outcomes: A systematic review to inform mode of delivery decisions

OBJECTIVE

Rising cesarean delivery (CD) rates significantly impact maternal health, underscoring the need for comprehensive counseling. This review examines the consistency of childbearing plans over time and their predictive value for childbirth events.

DATA SOURCES

PubMed, EMBASE, Web of Science, and PsycINFO databases up to October 2023.

STUDY ELIGIBILITY CRITERIA

Studies assessing women's childbearing plans at baseline (T1) and following up with subsequent plans and/or outcomes (T2).

STUDY APPRAISAL AND SYNTHESIS METHODS

Meta-analyses calculated risk ratios and standardized mean differences using random-effects models. Bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

Forty-four studies (n = 132,846 women) were included. Average desired family size at T1 was 2.63 (95 %CI: 2.03-3.23), remaining stable at follow-up (p = 0.135). While no significant change in plans was observed for women who initially wanted children, negative plans showed significant instability (pooled effect size: 0.18, 95 %CI: 0.03-0.33; p = 0.0162). Estimated rates of stable, decreasing, and increasing childbearing plans were 74 %, 12 %, 11 %, respectively. Positive plans strongly predicted childbirth (RR = 3.95, 95 % CI: 2.46, 6.35; p < 0.0001; I2 = 98 %). Follow-up childbirth rates for initially negative plans were 5 % (95 % CI: 0-44 %) for nulliparae, 13 % (95 % CI: 2-57 %) for primiparae, and 64 % (95 % CI: 61-68 %) formultiparae.

CONCLUSIONS

On average, women desire 2.63 children (95 % CI: 2.03-3.23). Childbearing plans are largely stable, but around 10 % of women with negative or uncertain plans later desired children. Positive plans nearly quadrupled childbirth likelihood. Negative plans were less predictive, particularly in multiparous women. Future research should explore age, socioeconomics, and cultural contexts, particularly for nulliparous women over 35 considering elective CD.

Predictors of desire to limit childbearing among reproductive age women in high fertility regions in Ethiopia. A multilevel mixed effect analysis

BACKGROUND

A high fertility rate can have a number of expensive consequences for developing nations, such as limiting economic growth, adversely impacting women and their children's health, and reducing access to quality education, nutrition, and employment. The problem is more obvious in Ethipia's high fertility regions. Therefore, this study aimed to assess predictors of desire to limit childbearing among reproductive age women in high fertility regions in Ethiopia.

METHODS

The analysis was based on secondary data using the 2016 Ethiopian Demographic and Health Survey. Stata version 14 software was used for analysis. A multi-level mixed-effect logistic regression analysis was fitted. Adjusted Odds Ratio at 95% confidence interval was used to show the strength and direction of the association. Statistical significance was declared at a P- value less than 0.05.

RESULTS

The overall desire to limit childbearing in high fertility regions in Ethiopia was 37.7% (95% CI: 36.28, 39.17). Age; 25-34 (AOR = 3.74; 95% CI: 2.97, 4.73), 35-49 years (AOR = 14; 95% CI: 10.85, 18.06), women education; Primary education (AOR = 0.73; 95% CI: 0.61, 0.88), secondary and higher (AOR = 0.29; 95% CI: 0.19, 0.43), from the community level variables Oromia National Regional state (AOR = 5.86; 95% CI: 2.82, 12.23), high proportion of community level poverity (AOR = 0.67; 95% CI: 0.45, 0.98), and high proportion of community level media exposure (AOR = 1.53; 95% CI: 1.07, 2.19) were statistically significant factors for desire to limit childbearing in high fertility regions of Ethiopia.

CONCLUSION

Nearly four in ten women had the desire to limit childbearing in high fertility regions in Ethiopia. Thus, to fulfill the women's desire to limit childbearing, Ministry of Health and health facilities are needed to increase financial support strategies and Family planning programs that enable pregnant women from poor households to use health services. In addition, increasing community level media exposure are important interventions.

The association between childbirth-related fear, childbirth readiness, and fertility intentions, and childbirth readiness as the mediator

BACKGROUND

Fertility intentions have been proved to be a reliable predictor of actual fertility behaviour. Also, childbirth-related fear (CBRF) has been proven to be negatively associated with childbirth readiness and fertility intentions among women, while childbirth readiness was positively related to fertility intentions. However, the associations and potential mechanisms between CBRF, childbirth readiness, and fertility intentions remain unknown. This study aimed to investigate the unique association between CBRF, childbirth readiness, and fertility intentions and whether childbirth readiness would mediate the relationship between CBRF and fertility intentions.

METHOD

A cross-sectional study of women (N = 1119, aged 16-53 years) who gave birth within 72 h was conducted. Using a convenience sampling, women were recruited from obstetric wards-10 comprehensive hospitals and 3 specialized hospitals in 7 provinces in mainland China. Pearson correlation was used to examine the relationship between CBRF, childbirth readiness, fertility intentions, and social support. Multivariate linear regression was further used to analyze the association between demographic and personal characteristics, CBRF, childbirth readiness, and fertility intentions. Mediation analysis was used to examine whether childbirth readiness mediates the relationship between CBRF and fertility intentions.

RESULTS

Women with high childbirth readiness (β = 0.09, P = 0.002) had higher fertility intentions. However, women with high CBRF (β = - 0.17, P < 0.001) were more likely to have lower fertility intentions. CBRF had both direct and indirect effects on the level of fertility intentions. As predicted, childbirth readiness mediated the relationship between CBRF and the level of fertility intentions (estimate = - 0.012, 95% bootstrap CI: - 0.021 to - 0.005). Higher CBRF was associated with lower scores of childbirth readiness, which was associated with lower levels of fertility intentions.

CONCLUSIONS

This study established the evidence that CBRF had both direct and indirect effects on the level of fertility intentions and childbirth readiness mediated the relationship between CBRF and the level of fertility intentions. Specifically, higher CBRF was associated with lower scores of childbirth readiness, which was associated with lower levels of fertility intentions. This finding suggested that it is important for health policymakers and health providers to pay more attention to improving women's childbirth readiness, which might reduce the negative influence of CBRF on fertility intentions, thus strengthening their fertility intentions.

Spatial variations in family planning demand to limit childbearing and the demand satisfied with modern methods in sub-Saharan Africa

Background

There is an increasing demand for family planning to limit childbearing in sub-Saharan Africa (SSA). However, limited studies have quantified the spatial variations. This study examined: (i) the spatial patterns in the demand for family planning to limit childbearing and satisfied with modern methods, and (ii) the correlates of the demand for family planning to limit childbearing satisfied with modern methods in SSA.

Methods

This study analyzed secondary data on 306,080 married/in-union women obtained from Demographic Health Surveys conducted between 2010 and 2019 in 33 sub-Saharan African countries. We conducted exploratory spatial data analysis, with countries as the unit of analysis. We also performed regression analysis to determine the factors associated with demand for family planning to limit childbearing satisfied with modern methods in SSA.

Results

The mean percentage of women who demanded for family planning to limit childbearing by country was 20.5% while the mean prevalence of demand for family planning to limit childbearing satisfied with modern methods by country was 46.5%. There was a significant positive global spatial autocorrelation in the demand for family planning to limit childbearing (global Moran’s I = 0.3, p = 0.001). The cluster map showed the concentration of cold spots (low–low clusters) in western and central Africa (WCA), while hot spots (high–high clusters) were concentrated in eastern and southern Africa (ESA). Also, the demand for family planning to limit childbearing satisfied with modern methods showed significant positive global spatial autocorrelation (global Moran’s I = 0.2, p = 0.004) and concentration of cold spots in WCA. In the final multivariable regression model the joint family planning decision making (β = 0.34, p < 0.001), and antenatal care (β = 13.98, p < 0.001) were the significant factors associated with the demand for family planning to limit childbearing satisfied by modern methods.

Conclusions

There are significant spatial variations in the demand for family planning to limit childbearing and the demand satisfied by modern methods, with cold spots concentrated in WCA. Promoting joint decision making by partners and increasing uptake of antenatal care may improve the demand for family planning to limit childbearing satisfied with modern methods.

In sub-Saharan Africa (SSA), studies have shown that the proportion of married women who want to stop having children has been increasing as well as the proportion using modern contraceptive methods among them. These studies also indicated that this proportion of women are higher in certain regions of Africa than the others. To extend these previous findings, we performed geographical analysis to assess how the proportion of married/in-union women who want to stop having children and the ones using modern methods among them differ geographically. Our findings indicated that neighboring countries where the proportion of married/in-union women who want to stop having children was higher than the overall average were concentrated in eastern and southern Africa (ESA), while neighboring countries in which the proportion of married/in-union women who want to stop having children was lower than the overall average were concentrated in western and central Africa (WCA). Similarly, the results also showed that neighboring countries where the proportion of married/in-union women using modern contraceptive methods among those who want to stop having children was lower than the overall average were concentrated in WCA. Our findings suggest that increasing joint decision making on family planning and uptake of antenatal care in SSA may improve the use of modern contraceptive methods among married/in-union women who want to stop childbearing.

Fertility Intention Among Chinese Reproductive Couples During the COVID-19 Outbreak: A Cross-Sectional Study

A decline in the fertility rate has been observed worldwide, which hampers social development severely. Given the impacts of COVID-19 on individuals and society, it is of great significance to investigate the fertility intention of reproductive couples under COVID-19. The convenience sampling method was used to obtain our study sample. The self-administered questionnaire included the following components: sociodemographic characteristics (age, residence, education, occupation, characteristics of the couples, and annual household income), reproductive history (parity, number of children, child gender, and duration of preparing pregnancy), and attitudes toward COVID-19, was distributed online via an applet of WeChat. The results showed that among 4,133 valid questionnaires, 1,091 had fertility intention before COVID-19, whereas 3,042 did not, indicating a fertility intention rate of 26.4% among participating couples. Of the 1,091 couples who had fertility intention before COVID-19, 520 (47.7%) were affected by the outbreak, whereas 571 (52.3%) were not. By multivariable logistic regression analysis, we further found that couples living in Hubei Province, the epicenter in China (OR 2.20, 95% CI 1.35–3.60), and couples who prepared for pregnancy longer before COVID-19 (OR 1.19, 95% CI 1.06–1.33) were more likely to change their fertility intention under the pandemic. In addition, most of the participants reported their fertility intention was affected by the inconvenience of seeking medical service under COVID-19. Therefore, more forms of medical services to provide convenience for patients might be effective ways to reverse the declined fertility intention rate in facing COVID-19.

Third birth intention of the childbearing-age population in mainland China and sociodemographic differences: a cross-sectional survey

BACKGROUND

Global fertility declines have become an inevitable trend, and many countries are adopting policies to drive fertility increases. Fertility intention plays an important role in predicting fertility behavior. The Chinese government has recently issued the 'three-child' policy, and there is still little research on the third birth intention of the childbearing-age population. Therefore, the aim of this study is to investigate the prevalence and related reasons of third birth intention in the childbearing-age population in mainland China, and analyze the sociodemographic differences.

METHOD

A cross-sectional survey was conducted in mainland China from June to July 2021. A total of 15,332 childbearing-age participants responded and completed the Fertility Intention Questionnaire online through the Wenjuanxing Platform. Data were explored and analyzed by SPSS (version 22.0) software. Descriptive statistics were used to describe the current situation and reasons of third birth intention. Binary logistic regression analysis was applied to assess the influencing factors in the sociodemographic level.

RESULTS

The mean age of the participants was 32.9 ± 5.94 years. Only 12.2% of participants reported having third birth intention. The subjective norm of having both son and daughter (22.0%) and busy at work (29.2%) accounted for the largest proportion in the reasons of acceptance and rejection, respectively. Age has negative impact on third birth intention (OR = 0.960). Men were 2.209 times more likely to have three children than women (P < 0.001). With the improvement of education and family monthly income, the birth intention shows a downward trend. Compared with Han nationalities, first marriage and city residents, the ethnic minorities, remarriage and rural residents have stronger birth intention (all P < 0.05). And individuals with two existing children are inclined to have the third child (OR = 1.839).

CONCLUSION

The third birth intention in the childbearing-age population in China is still low after the announcement of the three-child policy. It is necessary to create a favorable fertility context for childbearing-age group with high level of third birth intention, like younger, male, minority, remarriage, with lower education and family monthly income, living in rural and two existing children. Furthermore, removing barriers for those unintended is also prominent to ensure the impetus of policy.

Urban Family Planning in Low- and Middle-Income Countries: A Critical Scoping Review

Health agendas for low- and middle-income countries (LMICs) should embrace and afford greater priority to urban family planning to help achieve a number of the global Sustainable Development Goals. The urgency of doing so is heightened by emerging evidence of urban fertility stalls and reversals in some sub-Saharan African contexts as well as the significance of natural increase over migration in driving rapid urban growth. Moreover, there is new evidence from evaluations of large programmatic interventions focused on urban family planning that suggest ways to inform future programmes and policies that are adapted to local contexts. We present the key dimensions and challenges of urban growth in LMICs, offer a critical scoping review of recent research findings on urban family planning and fertility dynamics, and highlight priorities for future research.

Current fertility desire and its associated factors among currently married eligible couples in urban and rural area of Puducherry, south India

Background

There are paucity of studies on current fertility desire at community level.

Objective

To assess current fertility desire and its associated factors among eligible couples of reproductive age group in Puducherry, India.

Methods

A community-based cross-sectional study from 2016 to 2017 among 2228 currently married eligible couples assessed socio-demographic and fertility-related factors associated with fertility desire. Data were collected based on the National Family Health Survey questionnaire. Association of fertility desire was assessed by univariate and generalised linear regression analysis.

Results

Out of 1979 respondents, current fertility desire within two years was 13.7% (95% CI, 12.3%–15.3%). Mean number of children (SD) currently living and preferred was 1.77(0.851) and 2.11 (0.528) respectively. After adjusting for confounders, the significant factors positively associated with fertility desire include woman's age of 18–24 (APR = 2.91), 25–29 years (APR=2.48), 30–34 (APR=2.47), 35–39(APR=2.06), high socioeconomic status (APR=2.02), those without child (APR=52.35) and those with one child (APR=35.60).

Conclusion

The fertility desire is comparatively lesser than other areas. Those without or with a single child and high socioeconomic status group had comparatively more fertility desire.

Intention to have a second child, family support and actual fertility behavior in current China: An evolutionary perspective

OBJECTIVES

This study provides an evolutionary perspective to a classic topic in demography, that is, the discrepancy between reproductive intention and subsequent behavior, in the context of China's two-child policy.

METHODS

We conduct an event history analysis of longitudinal data from the 2015 and 2018 waves of the Xi'an Fertility Survey (sample size = 321 followed one-child mothers) to test the hypotheses of how within-family support/conflict affects women's fertility behavior.

RESULTS

Only 50% of positive intentions (i.e., intending to have a second child) led to another (live) birth within the 3-year interval; meanwhile, 15% of uncertain intentions and 5% of negative intentions resulted in a birth. Husband's and the firstborn's emotional support raised the hazard of second childbirth along maternal life course, which cannot be fully mediated by mother's fertility intention and thus, contributed to an intention-behavior gap. Husband's sibship size had dual effects on female childbearing behavior: A positive indirect effect mediated by fertility intention, but a negative direct effect presumably due to sibling competition for intergenerational support. Finally, after controlling for fertility intention, having a firstborn son was still associated significantly with a lower second-childbirth hazard, presumably due to son preference as well as concern over parental investment.

CONCLUSIONS

Our study identifies a discrepancy between maternal fertility intention and realized childbearing, which was partly explained by (lack of) support from other (multiple) stakeholders in family reproduction.

Beyond growth and density: Recentring the demographic drivers of urban health and risk in the global south

Debates within urban studies concerning the relationship between urbanisation and infectious disease focus on issues of urban population growth, density, migration and connectivity. However, an effective long-term risk and wellbeing agenda, without which the threat of future pandemics cannot be mitigated, must also take account of demographic forces and changes as critical drivers of transmission and mortality risk within and beyond cities. A better understanding of the dynamics of fertility, mortality and changing age structures – key determinants of urban decline/growth in addition to migration – provides the foundation upon which healthier cities and a healthy global urban system can be developed. The study of how basic demographic attributes and trends are distributed in space and how they interact with risks, including those of infectious disease, must be incorporated as a priority into a post-COVID-19 urban public health agenda. This perspective concurs with recent debates in urban studies emphasising the demographic drivers of urban change. Moreover, it raises critical questions about the microbial and environmental emphasis of much research on the interface of urban health and governance.

The Enduring Case for Fertility Desires

Persistently high levels of unintended fertility, combined with evidence that over- and underachieved fertility are typical and not exceptional, have prompted researchers to question the utility of fertility desires writ large. In this study, we elaborate this paradox: widespread unintendedness and meaningful, highly predictive fertility desires can and do coexist. Using data from Malawi, we demonstrate the predictive validity of numeric fertility timing desires over both four-month and one-year periods. We find that fertility timing desires are highly predictive of pregnancy and that they follow a gradient wherein the likelihood of pregnancy decreases in correspondence with desired time to next birth. This finding holds despite the simultaneous observation of high levels of unintended pregnancy in our sample. Discordance between desires and behaviors reflects constraints to achieving one's fertility and the fluidity of desires but not their irrelevance. Fertility desires remain an essential-if sometimes blunt-tool in the demographers' toolkit.

Son Preference and the Reproductive Behavior of Rural-Urban Migrant Women of Childbearing Age in China: Empirical Evidence from a Cross-Sectional Data

Son preference has been shown to influence the childbearing behavior of women, especially in China. Existing research has largely focused on this issue using cross-sectional data of urban or rural populations in China, while evidence from the rural-urban migrant women is relatively limited. Based on the data of China Migrants Dynamic Survey in 2015, we used logistic regression models to explore the relationship of son preference and reproductive behavior of rural-urban migrant women in China. The results show that the son preference of migrant women is still strong, which leads women with only daughters to have significantly higher possibility of having another child and results in a higher imbalance in the sex ratio with higher parity. Migrant women giving birth to a son is a protective factor against having a second child compared to women whose first child was a girl. Similarly, the effects of the gender of the previous child on women’s progression from having two to three children showed the same result that is consistent with a preference for sons. These findings have implications for future public strategies to mitigate the son preference among migrant women and the imbalance in the sex ratio at birth.