Mother's health-seeking behaviour and childhood mortality in Pakistan

"The paper examines the mother's health-seeking behaviour and childhood mortality in Pakistan. This is based on the 1990-91 Pakistan Demographic and Health Survey (PDHS).... It was found that neonatal, infant, and child mortality rate is the highest among children of mothers aged less than 20 years. Infant and child mortality rate is likewise higher among first and higher order births than among births of second or third order. It was further found that mortality declines as the length of the birth interval increases. The results reveal that the education of mother has significant effect on the neonatal, infant and child survival.... Health care factors such as antenatal care, place of delivery, assistance at delivery and immunisation also influenced neonatal, infant and child mortality."

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Dans un article important publié en 1969, Dupâquier et Lachiver ont proposé une nouvelle technique visant à mesurer la diffusion du contrôle des naissances dans les populations anciennes en utilisant des données de reconstitution des familles. On a parfois considéré leur approche comme un substitut ou un complément à la technique classique — mise au point par L. Henry — qui consistait à détecter la restriction volontaire des naissances en examinant l'âge de la mère à la naissance de son dernier enfant et la forme de la courbe de fécondité légitime.

The effect of birth interval on malnutrition in Bangladeshi infants and young children

This study was undertaken to investigate the independent effect of the length of birth interval on malnutrition in infants, and children aged 6-39 months. Data for this study were drawn from a post-flood survey conducted during October-December 1988 at Sirajganj of the Sirajgani district and at Gopalpur of the Tangail district in Bangladesh. The survey recorded the individual weights of 1887 children. Cross-tabulations and logistic regression procedures were applied to analyse the data. The proportion of children whose weight-for-age was below 70% (moderate-to-severely malnourished) and 60% (severely malnourished) of the NCHS median was tabulated against various durations of previous and subsequent birth intervals. The odds of being moderately or severely malnourished were computed for various birth intervals, controlling for: the number of older surviving siblings; maternal education and age; housing area (a proxy for wealth); age and sex of the index child; and the prevalence of diarrhoea in the previous 2 weeks for the index child. About one-third of infants and young children were moderately malnourished and 15% were severely malnourished. The proportion of children who were under 60% weight-for-age decreased with the increase in the length of the subsequent birth interval, maternal education and housing area. The proportion of malnourished children increased with the number of older surviving children. Children were at higher risk of malnutrition if they were female, their mothers were less educated, they had several siblings, and either previous or subsequent siblings were born within 24 months. This study indicates the potential importance of longer birth intervals in reducing malnutrition in children.

Social-demographic influence on first birth interval in China, 1980-1992

This study examines the delay between first marriage and first live birth in China among a sample of women who married between 1980 and 1992. Most couples in China only use contraception after the first child is born. Most sample women had their first child within 2 years of marriage. However, there are significant rural-urban differences in the first birth interval, indicating that there was most probably deliberate fertility regulation after marriage among many urban couples. Survival analysis shows that place of residence, level of education, age at first marriage and marriage cohort affect the first birth interval.

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

Using Demographic and Health Survey data from 20 sub-Saharan African countries, this article compares the actual lengths of birth intervals to women's reported preferred lengths, and assesses the implications of the difference between the two for selected demographic and health indicators. The results show a clear pattern. In Comoros, Ghana, Kenya, Rwanda, and Zimbabwe, women prefer much longer birth intervals than those they actually have, compared with women in the other 15 countries studied. As a consequence, the potential effects of spacing preferences on the level of fertility and on the prevalences of short (less than 24 months) birth intervals and child malnutrition are greatest in the same five countries. The covariates of preferred birth-interval lengths are also examined. An explanation is offered for this pattern, based on the observed sharp decline in fertility recently experienced by these five "forerunners." In general, women who know, approve of, discuss, and use family planning prefer longer intervals than do their counterparts. The policy and program relevance of these results is discussed.

Why do cohabiting couples marry? An example of a causal event history approach to interdependent systems

The purpose of this paper is to demonstrate a causal approach to interdependent systems based on two empirical investigations. These examples demonstrate 1) the study of two highly interdependent processes: entry into first marriage as the dependent process and the process of first birth/first pregnancy as the explaining one; 2) an interdependence occurring mainly in a very specific phase of individuals' lives (i.e., during the period of first family formation); 3) the involvement of time lags between cause and its effect (e.g., time until detection of conception); and 4) the highly dynamic character of an unfolding effect over time (i.e., the effect of first pregnancy/first birth on first marriage strongly depends on the progress of pregnancy and the time since the birth has taken place).

Effect of the interval between pregnancies on perinatal outcomes

BACKGROUND

A short interval between pregnancies has been associated with adverse perinatal outcomes. Whether that association is due to confounding by other risk factors, such as maternal age, socioeconomic status, and reproductive history, is unknown.

METHODS

We evaluated the interpregnancy interval in relation to low birth weight, preterm birth, and small size for gestational age by analyzing data from the birth certificates of 173,205 singleton infants born alive to multiparous mothers in Utah from 1989 to 1996.

RESULTS

Infants conceived 18 to 23 months after a previous live birth had the lowest risks of adverse perinatal outcomes; shorter and longer interpregnancy intervals were associated with higher risks. These associations persisted when the data were stratified according to and controlled for 16 biologic, sociodemographic, and behavioral risk factors. As compared with infants conceived 18 to 23 months after a live birth, infants conceived less than 6 months after a live birth had odds ratios of 1.4 (95 percent confidence interval, 1.3 to 1.6) for low birth weight, 1.4 (95 percent confidence interval, 1.3 to 1.5) for preterm birth, and 1.3 (95 percent confidence interval, 1.2 to 1.4) for small size for gestational age; infants conceived 120 months or more after a live birth had odds ratios of 2.0 (95 percent confidence interval, 1.7 to 2.4);1.5 (95 percent confidence interval, 1.3 to 1.7), and 1.8 (95 percent confidence interval, 1.6 to 2.0) for these three adverse outcomes, respectively, when we controlled for all 16 risk factors with logistic regression.

CONCLUSIONS

The optimal interpregnancy interval for preventing adverse perinatal outcomes is 18 to 23 months.

Effects of the status of women on the first-birth interval in Indian urban society

The status of women, which is relative and multidimensional, has an important bearing on any long-term reduction in fertility. In Indian society, where cohabitation and childbearing are socially sanctioned only after marriage, the length of the first-birth interval affects the completed family size by influencing the spacing and childbearing pattern of a family. This study examines the influence of certain aspects of the status of married women--education, employment, role in family decision making, and age at marriage--along with three socioeconomic variables--per capita income of the family, social position of the household, and the caste system--on the duration of the first-birth interval in an urban Hindu society of the north-east Indian state of Assam. The data were analysed by applying life table and hazard regression techniques. The results indicate that a female's age at marriage, education, current age, role in decision making, and the per capita income of the household are the main covariates that strongly influence the length of the first-birth interval of Hindu females of urban Assam. Of all the covariates studied, a female's education appears to be a key mediating factor, through its influence on her probability of employment outside the home and thereby an earned income and on her role in family decision making. Unlike other Indian communities, the effect of the caste system does not have a significant effect on first-birth timing in this urban Hindu society.

Perinatal mortality in Taiwan

Information on perinatal deaths was obtained from 310 women by collecting detailed obstetric histories dating from marriage to the start of the survey. These histories were compared to those of 688 age matched controls. Potential risk factors, levels and time trends of perinatal mortality in Taiwan were examined and factors underlying stillbirths and early neonatal deaths were also compared using conditional logistic regression analyses. A nearly 56% decline of the perinatal mortality rate during the 35 y, approximately, prior to the survey was observed. Risk of stillbirths was increased among those who had abused illegal drugs during pregnancy, those who reported that the pregnancy was unwanted and those with Thalassemia trait. Body mass index was log-linearly related with stillbirths, with higher body mass associated with higher risk. For early neonatal deaths, those mothers aged 19 y or less, those giving birth to either their first children or to their fifth or later child, those who had their first prenatal care visit after the first three months of pregnancy were associated with increased risk in the logistic model. Those with a birth interval of less than two years and those with less education were associated with increased risk in both perinatal death groups. While some of these factors have already been associated with perinatal deaths, others have not; the new associations provide clues to mechanisms by which the risk of death increases before or after delivery.

Short interpregnancy intervals and the risk of adverse birth outcomes among five racial/ethnic groups in the United States

The authors studied the effects and population-level impact of short (< or = 12 months) interpregnancy intervals on the risks for low (<2.5 kg) birth weight and preterm (<37 weeks) delivery of liveborn singleton infants to US African American, Mexican, Native American, non-Hispanic white, and Puerto Rican mothers (n = 4,841,418) from 1989 to 1991. Statistical analyses were done by using the Mantel-Haenszel correlation statistic chi-square test and logistic regression. The proportion of livebirths associated with < or =12-month interpregnancy intervals was the lowest among non-Hispanic whites (18.5%, 95% confidence interval 18.5-18.5) and the highest among Native Americans (29.7%, 95% confidence interval 29.2-30.2). As compared with mothers with >12-month intervals, mothers with <6-month intervals had an approximately 50% to 80% increased risk of very low (<1.5 kg) birth weight delivery and a 30% to 90% increased risk of very preterm (<32 weeks) delivery. Logistic regression analyses showed that the adverse effects of short intervals were reduced by about 10% but remained for the most part significant after controlling for potential confounding by maternal age, education, parity, marital status, prenatal care, smoking, and previous preterm delivery.

Is the reduction of birth intervals an efficient reproductive strategy in traditional Morocco?

Birth interval lengths are analysed from reproductive life histories of 517 Berber peasant women of the region of Marrakesh (Southern Morocco), whose fertility developed in a full traditional context. The high mortality rates associated with short birth intervals indicate that a rapid succession of births is detrimental to the progeny. The reproductive efficiency of the traditional propensity to a large family size is therefore examined by means of two different evaluations of reproductive success: the 'absolute' reproductive success (the absolute number of offspring surviving to maturity) and the 'relative' reproductive success (the proportion of live born surviving to maturity). The first shows that close pregnancies increase the fertility rate to such an extent that the associate higher number of deaths is more than compensated for, so that the women practising short birth intervals produce more surviving offspring than the others by the end of their reproductive life. The second shows that the probability of survival is directly associated with birth interval length, the efficiency of the reproductive process being therefore greater as birth intervals grow. It is suggested that these two behaviours are not contradictory, and that they represent two successive steps of the same reproductive adjustment to evolving environmental conditions.

Short birth intervals don't kill women: evidence from Matlab, Bangladesh

No previously published study has provided evidence to support the frequently made assertion that closely spaced births increase the risk of maternal death. This study reviews the literature for evidence supporting an association between short birth intervals and maternal mortality and presents empirical evidence to address the question of whether short birth-to-conception intervals alter the risk of maternal death. In this nested case-controls study selected from a cohort of women under demographic surveillance in Matlab, Bangladesh, the length of the preceding birth-to-conception interval is found not to affect the risk of maternal mortality. These results do not support the claim that births that are too close increase the risk of maternal death.

Natural growth of the population of Plovdiv, Bulgaria for the period 1895-1995

A study of the natural growth rate of the population using female cohorts by birth year has been carried out for the first time in our country. The study comprises 14 cohorts. The following characteristics are recorded: birth year, social group, educational level, number of live births, age of marriage, infant mortality rate, proto- and intergenetic intervals. Our report presents the key indicators of natural growth of population in the studied cohorts. A consistent trend of decreasing the number of livebirths is established. In the first studied cohort (1895-1899) the average number of offspring per woman is 3.94, reaching a level of 1.77 in the 1960-1964 cohort. The indicators for natural growth of population exhibit a similar trend. The summary fertility rate in the reference period decreases with more than 2 points--from 4.47 in 1895-1899 to 1.73 in 1960-1964. Likewise, the total reproduction rate goes down from 2.54 to 0.78 for the same period. Considerable changes have occurred in the indicators total period fertility rate and marriage fertility rate of women. For a period of 110 years the former has decreased 3.5 times, the latter--8 times. The drastic drop of the indicators of natural growth of the population is accounted for by an intricate complex of social, economic, psychological and biological factors. The marked aging of the population and the decrease of the percentage of women in active fertility age play a certain role in this process. The ascertained changes in the reproductive behavior and age structure of the female population are factors intensifying the unfavorable trends in the natural growth rate of the population in our country.

The determinants of child mortality in the Philippines: estimation of a structural model

"This paper employs a longitudinal data set from the Philippines to estimate a structural model of the determinants of infant mortality. To control for the endogeneity of some explanatory variables, a set of reduced form equations for these outcomes is estimated simultaneously with the mortality hazard. A non-parametric discrete factor method is used to control for common unobservable factors in the error terms. Birth interval and parity lose explanatory power once biological measures are considered in the model. The results indicate significant correlations across the equations' error terms. The significant effects of breastfeeding and growth on mortality are quantified in simulation experiments." The data are from a longitudinal survey conducted in metropolitan Cebu between 1983 and 1986.

Assessing and interpreting birth spacing goals in Costa Rica

A procedure for assessing birth spacing goals, an important component of fertility preferences, is proposed and applied to 1993 Costa Rican data. Based on a reverse or backward survival analysis, preferred birth intervals are estimated to range between 3.5 and 4.5 years (1.5 years for the interval union to first birth). These intervals are 2 or 3 years shorter than crude estimates from data on open or last closed intervals, which are upwardly biased by selection and left censoring effects. To achieve these spacing preferences, a cohort must spend about two-thirds of the time using contraception (one-third in the interval union to first birth). An inverse association between desired family size and desired birth interval is evident only in parity-specific analyses.

Infant and child mortality determinants in Bangladesh: are they changing?

From the data of the 1989 Bangladesh Fertility Survey, aggregate deaths reported at ages 0-12 and 13-60 months are used to estimate infant and child mortality. Multivariate analysis shows that preceding birth interval length, followed by survival status of the immediately preceding child, are the most important factors associated with differential infant and child mortality risks; sex of the index child and mother's and father's education are also significant. Demographic factors are influential during infancy as well as childhood, but social factors, particularly mother's and father's education, now emerge as significant predictors of infant mortality risks. This indicates a change in the role of socioeconomic factors, since the earlier Bangladesh Fertility Survey in 1975.

International migration and biodemographical behaviour: a study of Italians in Belgium

This paper describes the matrimonial and reproductive behaviour of Italians who migrated to Belgium after the Second World War. Migrants were either already married, or later became married, to other Italians. Among the children of migrants, men equally chose Italian or Belgian wives but women tended to prefer Italian partners. Italian-Belgian marriages were more frequent among the better educated groups. Family size is smaller among migrants marrying after migration and in heterogamous marriages. Significant differences in birth intervals are found when marriage occurred before or after migration, between generations, and between homogamous and heterogamous marriages.

The relation of closed birth intervals to the sex of the preceding child and the sexual orientation of the succeeding child

The study investigated whether homosexual men are, on average, born a shorter time after their next-older siblings than are heterosexual men. Because of mixed evidence that birth intervals are longer after a male child, the sex of the next-older sibling was included as a control variable. The probands were 220 heterosexual and 183 homosexual men with at least one older sibling examined in Southern Ontario in 1994-95. These completed a self-administered, anonymous questionnaire concerning their family background and other biodemographic information. The results showed that birth interval was negatively correlated with sibship size, positively correlated with maternal age, and uncorrelated with paternal age. They also confirmed that birth intervals are longer after a male than after a female child. The mean birth intervals preceding heterosexual and homosexual males, however, were virtually identical, indicating that the association of short birth intervals with decreased sex hormone levels in cord blood is unrelated to the development of sexual orientation.

Unmet need for contraception in Vietnam: who needs what and when

The Vietnam 1988 survey established the first national estimates for reproductive preferences and behavior. It created a unique baseline for levels and differentials, both for the marked differences between North and South, and for various social and demographic categories. It also provided the first national data for program guidance, including information on unmet need. Unmet need for contraception has been extensively documented for much of the developing world, but its structure is not yet well understood. This study differentiates unmet-need couples by several demographic characteristics, by time since the last birth, and by features identified through a computer search program. Past investigations have emphasized the per cent with unmet need within various population subgroups, but some of those subgroups are small, whereas the national family planning program must be oriented to subgroups with large absolute numbers of unmet need couples. Unmet-need couples are selective, whether by reference to the married population or by reference to other couples who also wish to avoid pregnancy but are using a method. Most unmet-need couples are younger than users, have fewer children and, especially, are closer to their last birth. Surprisingly, most have never used a contraceptive method before, even though Vietnam has had a vigorous family planning program and 49 per cent of all couples in the survey reported some experience with a modern contraceptive method. In terms of sheer numbers, those in need are distributed very widely throughout the country. The most disadvantaged segments of the population have both high percentages and large numbers in need, but the concentration of the national program upon a single contraceptive method restricts their options.

Repeat fertility and contraceptive implant use among Medicaid recipients in Colorado

Late in 1991, Colorado's Medicaid program approved coverage for the hormonal contraceptive implant among Medicaid recipients. Subsequently, the Colorado Department of Public Health and Environment undertook an analysis of data supplied by the state's Medicaid program of the probability of repeat births among Medicaid recipients. According to life-table analysis of two cohorts of women in the database who had their first Medicaid-eligible birth in 1991 and 1992, the rate of repeat delivery within 24 months of the preceding birth fell from 14.1% among 11,554 women who first delivered in 1991 to 10.6% among 13,624 women who first delivered in 1992. The 25% decline in the rate of repeat births between the two cohorts was statistically significant. These rates were higher among Medicaid-eligible mothers who first gave birth as teenagers-22.3% in the 1991 cohort and 15.9% in the 1992 cohort. Among the 2,739 Medicaid-eligible women who delivered in 1992 and chose to use the implant within six months of delivery, the repeat delivery rate was just 2.5% within 24 months; this proportion was virtually the same among implant users in the 1992 cohort who first gave birth as teenagers (2.3%).

Birth interval and pregnancy outcome

A cross-sectional study was conducted from September to March 1993 at maternity ward of Jimma Hospital to asses the pattern and determinants of birth interval and the role of contraceptive in influencing the length of birth interval. The information was collected by use of pre-tested questionnaire from 415 mothers by three midwives trained for this purpose. The variables examined were: information on parity, use of contraceptive methods during the preceding birth intervals, breast feeding and some demographic variables such as age, martial status, education. Pregnancy outcome variables such as, live births, stillbirths, abortion and infant deaths. Slightly over seventy five per cent of the study subjects were aged 20-29 years, 59% and 27% were para 2-3 and 4-5 respectively. In more than 81% of the subjects, the birth interval was less than three years with a mean birth interval of 22.1 months. Approximately two per cent used contraceptive when the birth interval was 12 months and less. Stillbirth and early neonatal deaths accounted for 3.2% and 6.9% respectively. Based on the findings, we underscore the importance of birth spacing using the available family planning methods to promote safe motherhood and achieve better child survival.

On a probability model of open birth interval

"Many authors [have] pointed out that analysis of open birth interval (the period elapsed from the last live birth till the date of the survey) could be of great interest to study the process of human reproduction, because it directly exhibits changes in fertility due to recent use of contraception or incidence of secondary sterility. Moreover, open birth intervals may be chosen to study the linkage between fertility and migration. A probability model for describing variations in the length of open birth intervals has been applied separately to couples with both spouses present at home, and to couples with one spouse having migrated away. The model has then been applied to [survey data for India] to get an estimate of the risk of conception and of secondary sterility." (SUMMARY IN ITA AND FRE)

Population policies and reproductive patterns in Vietnam

BACKGROUND

Vietnam's population policy since the 1980s had stipulated a limit on family size to two children, born 3-5 years apart, and recommends a minimum age of 19 for the mother of a first child. We analysed trends in the timing of marriages and births, and in fertility and abortion rates, among women born between 1945 and 1970, to assess the impact of these policies on reproductive patterns.

METHODS

Reproductive histories were recorded in a random sample of 1432 married women aged 15-49 in a rural province in northern Vietnam. Mean age at marriage and at birth of the first child, birth intervals, fertility, and abortion rates were examined in relation to the woman's year of birth.

FINDINGS

Later-born women married and had their first child at a younger age than women born earlier. Birth intervals had increased among later-born women but 25% still had only a 1-year interval between first and second child. Fertility had gradually decreased while abortion ratios had increased rapidly. Childbearing patterns had become "earlier, longer, and fewer" rather than "later, longer, and fewer" as stipulated by the policies. The results also show that women with more schooling married and had their first child later. Women involved in farming had shorter spacing between children.

INTERPRETATION

There are signs that Vietnam's population policy has focused too strongly on contraception and abortion while ignoring the connection between fertility and women's opportunities for education and employment. In these respects, rural women are at particular risk.

[The effects of fertility compression on birth sequence and age composition in Taiwan: a simulation]

"Based on the cohort component projection, this paper simulates the effects of fertility compression on birth sequence and age composition in Taiwan, and explores the implications for social welfare. As a first step, we fix the fertility schedule on the age pattern of 1956 while leaving the TFR to shift as it was, [and] simulate the single year of age population groups from 1956 to 1992.... We subsequently assumed a fixed age pattern of fertility, a compressed pattern and an expanded pattern in a projection of five year...age groups from 1997 to 2097." (SUMMARY IN ENG)

Childlessness, subfertility, and infertility in Tanzania

This study examines the trends and variations in childlessness, subfertility, and infertility in Tanzania according to data from the 1973 National Demographic Survey and the 1991-92 Demographic and Health Survey. Between the surveys, the proportion of women older than 30 who were childless was found to have declined more than 60 percent, and the proportion with an open birth interval extending for longer than five years was reduced by 40 to 50 percent in each standard five-year age group from 20 to 39. Within Tanzania, both childlessness and infertility are higher among urban than rural residents, and a substantial range prevails across eight rural zones. Finally, evidence suggests that the decline in impaired fertility has been followed by an increase in the total fertility rate. The difficulties of implementing population policies that aim simultaneously to control population growth and to improve women's health are discussed.

The determinants of infant and child mortality in Tanzania

This paper investigates the determinants of infant and child mortality in Tanzania using the 1991/92 Tanzania Demographic and Health Survey. A hazards model is used to assess the relative effect of the variables hypothesized to influence under-five mortality. Short birth intervals, teenage pregnancies and previous child deaths are associated with increased risk of death. The Government of the United Republic of Tanzania should therefore maintain its commitment to encouraging women to space their births at least two years apart and delay childbearing beyond the teenage years. Further, this study shows that there is a remarkable lack of infant and child mortality differentials by socioeconomic subgroups of the population, which may reflect post-independence health policy and development strategies. Whilst lack of socioeconomic differentials can be considered an achievement of government policies, mortality remains high so there is still a long way to go before Tanzania achieves its stated goal of 'Health for All'.

Son preference in Vietnam

This article assesses the strength of son preference in Vietnam, as reflected in fertility behavior. It formulates and estimates a proportional hazards model applied to birth intervals, and a contraceptive prevalence model, using household survey data from 2,636 ever-married women aged 15-49 with at least one living child who were interviewed for the Vietnam Living Standards Survey 1992-1993. Son preference is found to be strong by world standards, but nevertheless, it has a minor effect on fertility; in its absence, the total fertility rate would fall by roughly 10 percent from the current level of about 3.2 children per woman of reproductive age.