Factors influencing first childbearing timing decisions among men: Path analysis

Determinants of childbearing intentions among pregnant women with a suspected fetal congenital heart disease

BACKGROUND

The Saudi population is characterized by a high fertility rate, a conservative sociocultural context, and an ongoing societal and lifestyle transition. Yet, data regarding childbearing intentions and the associated factors is scarce. Furthermore, childbearing intention may be impacted by abnormal pregnancy events, such as the clinical suspicion or diagnosis of a fetal congenital disease and the negative experience that may result from it.

OBJECTIVES

The present study explored childbearing intention and determined the sociodemographic and health-related factors discouraging from future pregnancies among women visiting the cardiology clinic for antenatal screening of congenital heart diseases (CHD).

METHODS

A one-year cross-sectional study involved 150 consecutive pregnant women aged between 18 and 47 years old, who presented for antenatal screening of CHD at the fetal echocardiography clinic for, of a teaching hospital in Jeddah, Saudi Arabia. An interview-based questionnaire was administered before the clinic visit and collected sociodemographic data, obstetrical history, risk factors of congenital diseases, mothers' knowledge about fetal echocardiography and CHDs, and childbearing intention (the primary outcome).

RESULTS

Fetal echocardiography and CHD were correctly described by 60 % and 31.3 % of the participants respectively, while 40.7 % and 12 % recognized the association of congenital diseases with consanguinity and advanced maternal age respectively. Childbearing intentions showed 68.0 % of the participants declared desiring a future baby while the remaining 32.0 % declared having no further pregnancy expectations. Attitudes towards a hypothetical baby with CHD were positive in 97.3 % of the participants, and only 30 % declared that the fetal echocardiography results will impact their future childbearing decision. However, childbearing intention showed no significant association with knowledge or attitudes towards CHD. On the other hand, childbearing intention was independently associated with the number of children (OR=0.34; p<0.001), consanguinity with husband (OR=3.64; p = 0.010), and history of gestational diabetes (OR=0.28; p = 0.040).

CONCLUSION

Fertility expectations among Saudi mothers are more likely to be impacted by the personal experience and judgment of own pregnancy fitness, while no significant impact of fetal risks and events. This demonstrates a certain level of autonomy balanced with deeply rooted religious ethics yet combined with a lack of awareness about fetal and maternal risks associated with advanced maternal age and consanguinity. We emphasize the unmet need of education and family planning.

Child marriage among boys in high-prevalence countries: an analysis of sexual and reproductive health outcomes

BACKGROUND

While the determinants and impacts of child marriage among girls have been well documented, little research exists on the practice among boys. This paper explores the sociodemographic profile of men who married by age 18 and assesses whether they are more or less advantaged than their peers in terms of their sexual and reproductive health outcomes.

METHODS

This analysis used the most recent data from nationally representative household surveys for the 15 countries with the highest prevalence of marriage by age 18 among men aged 20-24 at the time of the survey. The prevalence of child marriage was then explored for the full cohort of men aged 20-49 through descriptive statistics and bivariate analysis. Available reproductive health indicators were explored, comparing men who married during childhood and men who married in adulthood. For the youngest and oldest cohorts, the total number of children fathered and the total ideal number of children were compared based on whether men married by age 18.

RESULTS

For this subset of countries, the prevalence of child marriage among men aged 20-24 ranges from 8.4 to 27.9%. The practice appears most common among respondents living in the poorest households and in rural areas, and with no education or only primary schooling. Men who married as children appear less likely to have comprehensive knowledge of HIV than their peers who married in adulthood. Little difference among men who married by age 18 and those who married in adulthood was observed regarding knowledge or use of modern methods of contraception. In almost all countries with data, the odds of having fathered three or more children among men aged 20-29 are higher for those who married as children compared to their peers. In four countries, the odds of exceeding one's ideal family size among men aged 40-49 also appear higher among those who married during childhood compared to men who married at older ages.

CONCLUSION

These results highlight the need for further research to identify drivers of the practice and short- and long-term outcomes for men who married during childhood, specifically concerning fatherhood, fertility preferences, and completed family size.