Development and psychometric evaluation of the questionnaire on the contributing factors of tendency towards voluntary single-childedness and childlessness: a mixed method study

Couples' tendency towards voluntary single-childedness and childlessness (VSCC) has turned into a major challenge in all societies and led to different problems such as population aging. A key step to VSCC management is to determine its contributing factors through valid and reliable instruments. This exploratory sequential mixed method study (qualitative-quantitative) was conducted in 2020-2021. Phases of qualitative consists of all couples aged 15-49 in Babol, Iran, who were single or childless. Sampling is based on the purpose, and the number of samples is 20 couples. To collect data, face-to-face and semi-structured interviews were conducted with the participants. Sampling continued until data saturation. The data were analyzed by the conventional content analysis method and quantitative phase. Initially, a qualitative study was conducted on twenty couples, and were analyzed through conventional content analysis. Findings were used to develop QFT-VSCC and then, the face, content, and construct validity as well as reliability were assessed. Construct validity was assessed through exploratory and confirmatory factor analyses and reliability was assessed through internal consistency and stability assessments. The results of the qualitative part analysis consist of 140 codes, 30 primary categories, and nine main categories and two themes (individual limitations and social limitations). The primary QFT-VSCC had 78 items. Fifty-eight items were omitted during validity assessment and the remaining twenty-two items were loaded on five factors during factor analysis. These factors were threatened priorities, inappropriate familial context for childbearing, sense of occupational and social insecurity for the child, social modeling of childlessness, and tendency towards change or stability in marital life. The five factors explained 52.56% of the total variance. All model fit indices in confirmatory factor analysis were acceptable and the Cronbach's alpha values of QFT-VSCC and all its factors were more than 0.70. The results of convergent validity analysis revealed that all factors had an AVE value greater than 0.5, and the HTMT index for all factors was less than 0.85. This indicated that discriminant validity had been achieved. QFT-VSCC is a simple valid and reliable instrument for VSCC assessment among both men and women.

[The choice of a life without children under the influence of societal concerns]

THE CHOICE OF A LIFE WITHOUT CHILDREN UNDER THE INFLUENCE OF SOCIETAL CONCERNS. Previously unpublished data from 2021 provide an update on the motivations of people who choose not to have children, considering a context of strong social pressure to conceive and a declining birth rate in France. Moreover, childlessness is still a minority phenomenon, and still subject to a certain amount of stigmatization It is part of a social context with a growing concern for ecological issues and the difficulties to achieve gender equality. Taking all of this into consideration, people who choose not to have children are in many ways well anchored in current issues.

[The social hygienic aspects of reproductive behavior of women aged 40-45 years]

In the context of forecasted decreasing of natality, actuality of studying its causes for organizational decision-making increases. The purpose of the study was to determine factors affecting reproductive behavior of women aged 40-45 years residing in areas with different natality levels in 2020-2021. The cohort, analytical, sociological methods were applied. The results of study demonstrated that in areas with high natality level most of urban women with higher education and high income resides in conditions of dormitory or mortgage flat and working in profile of their specialty. They are characterized by belated marriage that results in postponed child-bearing. The areas with low natality are characterized by dwelling of rural women with secondary or secondary specialized education. They reside in their own homes and work in other occupations than their specialty. The analysis of social status of women of different age groups will permit more selective approach in developing measures of increasing natality in modern conditions.

Determinants of high-risk fertility behavior among women of reproductive age in Kenya: a multilevel analysis based on 2022 Kenyan demographic and health survey

BACKGROUND

Women's high-risk fertility behavior (HRFB), which is characterized by narrow birth intervals, high birth order, and younger maternal age at birth, have been scientifically reported to have detrimental effects on the mother and child's health. To date, there has been limited research into the underlying factors contributing to high-risk fertility behavior in Kenya. Thus, the aim of this study is to identify the factors associated with high-risk fertility behavior among women of reproductive age in Kenya.

METHOD

The 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 15,483 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data.

RESULTS

The overall prevalence of HRFB among Kenyan women were 70.86% (95%CI = 69.96, 71.40). Women with primary, secondary, and higher educational levels, Protestant and Muslim religion followers, women whose husbands/partners had secondary and higher educational levels, a high household wealth index, ever had a terminated pregnancy, and rural residence, all of these factors were found to be strongly associated with high-risk fertility behavior.

CONCLUSION

As per the findings of our study, in Kenya a significant proportion of women has experienced HRFB. This is a matter of concern as it poses a significant challenge to the healthcare system. The high prevalence of HRFB indicates that there is an urgent need to take appropriate measures in order to mitigate its impact. The situation calls for a comprehensive and coordinated approach involving all stakeholders to address this issue effectively. It would benefit policymakers to create programs that consider factors like education, wealth, and residence that make women more susceptible to HRFB. Targeting women living in high HRFB-prevalence areas could help address the root causes of the issue. This approach can alleviate negative impacts and ensure effective and sustainable solutions.

Patients' and providers' perspectives on the decision to undergo non-urgent egg freezing: a needs assessment

BACKGROUND

Previous research has demonstrated that patients have difficulty with the decision to undergo non-urgent egg freezing (EF). This study aimed to investigate the decisional difficulties and possible decisional support mechanisms for patients considering EF, and for their providers.

METHODS

This qualitative study involved a needs assessment via individual interviews. Participants included patients considering EF at one academic fertility clinic and providers from across Canada who counsel patients considering EF. 25 participants were included (13 providers and 12 patients). The interview guide was developed according to the Ottawa Decision Support Framework. Interviews were transcribed, and transcripts analyzed for themes and concepts using NVIVO 12.

FINDINGS

Multiple factors contributing to decisional difficulty were identified, including: (1) multiple reproductive options available with differing views from patients/providers regarding their importance; (2) a decision typically made under the pressure of reproductive aging; (3) uncertainty surrounding the technology/inadequate outcome data; (4) the financial burden of EF; (5) inherent uncertainty relating to potential decision regret; and (6) differing perceptions between patients/providers regarding the role providers should play in the decision. Additionally, potential sources of decisional support were identified, including provision of basic information before and/or during initial consultation, followed by an opportunity during or after initial consultation for clarifying information and helping with value judgements. Individualized counselling based on patient values, adequate follow-up, psychosocial counselling, and peer support were also emphasized.

CONCLUSIONS

More decisional support for women considering EF is needed. Suggestions include a patient decision aid in conjunction with modified healthcare provider counselling, support and follow up.

Reproductive behavior of Atlantic halibut (Hippoglossus hippoglossus) interpreted from electronic tags

Reproductive timing, location, and behavior are important characteristics that determine marine population dynamics, structure, and resilience to threats, including fishing and climate change. It is challenging to evaluate factors driving variability in these reproductive traits in wild fishes because of the difficulty observing individuals in their natural environments. In the present study, we used high-resolution depth, temperature, and acceleration time series recorded by pop-up satellite archival tags to (1) identify and characterize patterns in depth and acceleration that may be indicative of spawning events in large Atlantic halibut (Hippoglossus hippoglossus), and (2) estimate the effects of individual traits (body size and sex) and environmental factors (location and temperature) on spawning time and frequency. Unique rapid rises observed in the winter depth profiles were interpreted as spawning events. The initiation of the first presumed spawning rise was negatively correlated to water temperature experienced during the prespawning season, suggesting that currently increasing water temperature in the Gulf of St. Lawrence may induce phenological change in halibut spawning time. The number of rises of batch-spawning females was unrelated to female body size. The present study demonstrates how electronic tagging can be used for in-depth characterization of timing, location, and behaviors associated with spawning in a large flatfish species. Such information can inform spatiotemporal management and conservation measures aiming to protect species from directed fishing and by-catch during spawning.

Monogenoidea Communities Differ Between Male Morphotypes of Bluegill Sunfish (Lepomis macrochirus)

PURPOSE

Bluegill sunfish (Lepomis macrochirus) are a North American sport fish that exhibit two different male morphotypes. Alpha-males are large, colorful, territorial, and have significant parental investment, while β-males are small, drab, and have two reproductive phenotypes, neither of which involves parental investment. Due to the two different reproductive strategies, the level of interaction between congenerics varies, which may impact parasites that are spread via close contact, such as Monogenoidea that infect the gills. Monogeneans are ectoparasites on the gills and skin of fish hosts that may cause significant pathology in high numbers and be an indicator of host behavior and interaction between hosts.

METHODS

In this study, 328 L. macrochirus (106 α-males, 92 β-males, and 130 females) were necropsied from 8 lakes and ponds in northwestern Virginia to identify and enumerate monogenean parasites from the gills.

RESULTS

Alpha-males had a significantly greater parasite abundance and species richness compared to β-males. This may be due to the increased size and surface area of gills in α-males, increased interaction with females during mating, and stationary behavior when guarding nests, which enhanced the chances of α-males contracting the parasites. This also led to significant differences in the monogenean communities infecting the two morphotypes, which were also significantly influenced by the size of the hosts.

CONCLUSIONS

It is important in future studies regarding parasitism that behavioral morphotypes within a sex, such as α-male and β-male L. macrochirus in this study, be treated separately as behavioral and morphometric differences between them can potentially lead to differences in parasitism.

Family orientation, working years and childbearing age: evidence from the China Family Panel Study 2014

This article reports the results of a study investigating the impact of family orientation, the number of years spent working, and their interaction on childbearing age among women who have recently completed their childbearing.We find that a traditional family orientation and a higher number of working years contribute to delaying the childbearing age. People with a traditional family orientation can delay childbearing because they want to make elaborate material preparations for raising their children. Women who have worked many years are more aware of gender inequality in the domestic sphere (having been exposed to gender equality in the workplace). This is especially the case for women with a modern family orientation. However, this does not necessarily lead people with a modern family orientation to delay childbearing. They may advance their childbearing in an effort to escape an oppressive domestic environment in their families of origin.

Construction and validation of a reproductive behavior questionnaire for female patients with rheumatic diseases

INTRODUCTION/OBJECTIVES

Active autoimmune rheumatic diseases (ARDs) before conception increase the risk of flares and adverse pregnancy outcomes. We aimed to construct and validate a reproductive behavior questionnaire in Spanish for patients with ARDs to assess their knowledge and their reproductive behavior.

METHOD

We constructed and validated a reproductive behavior questionnaire in two phases: (1) a literature review followed by interviews of reproductive-age female patients, and (2) a cross-sectional study to complete validation. Convenience sampling was carried out with 165 female patients: 65 participated in the cross-cultural adaptation phase and 100 in the validation phase. The internal consistency was evaluated by estimating Cronbach's alpha and tetrachoric correlation coefficients. Values ≥ 0.40 were considered acceptable (p < 0.05).

RESULTS

The initial instrument included 38 questions. Thematic analysis identified 8 important dimensions or topics, which were combined to create the Rheuma Reproductive Behavior interview questionnaire. A final total of 41 items across 10 dimensions were obtained. The test-retest analysis showed perfect correlations in 34 of the 41 items, moderate in 6 items, and negative in one of the items. The mean age of the patients was 35.65 years (SD 9.02), and the mean time to answer the survey was 13.66 min (SD 7.1).

CONCLUSIONS

The Rheuma Reproductive Behavior questionnaire showed good reliability and consistency capturing patients' reproductive health knowledge and reproductive behavior. Key Points • We designed and validated a questionnaire to assess reproductive health knowledge and reproductive behavior among female patients with ARDs. • The questionnaire was comprehensible for participants, and showed good reliability and consistency capturing reproductive knowledge and behavior. • This tool may aid in the design of strategies to improve reproductive decision-making for female patients with ARDs.

Differences by age group in gender-related attitudes in Oromia, Ethiopia: Findings from a cross-sectional study of women of reproductive age

Attitudes on gender roles affect decision-making dynamics, resource distribution, and income-generating opportunities. However, little is known about how attitudes on gender roles differ by age group. Cross-sectional data collected from 1,113 households in Oromia, Ethiopia were used to assess differences in gender-related attitudes across female "youth" (ages 15-24), "young adults" (ages 25-34), and "older adults" (ages 35-49). Fifteen survey questions using a Likert scale measured attitudes on sexual and reproductive behaviors, expectations around livelihood activities, and perceived influence in household decision making. Associations between attitudes and age group were assessed using the Chi-squared test. Measures of perceived influence in decision making differed significantly by age group for household decisions about participation in wage employment, and use of revenue generated from wage employment, and crop and livestock production. Response patterns were consistent, with youth least likely to feel they have influence in decision making. The results suggest that policies and programs should continue to support the agency of female youth.

organizational effects of sex steroids and their role in the evolution of reproductive behavior: Looking to foot-flagging frogs and beyond

Sex steroids play an important role in regulation of the vertebrate reproductive phenotype. This is because sex steroids not only activate sexual behaviors that mediate copulation, courtship, and aggression, but they also help guide the development of neural and muscular systems that underlie these traits. Many biologists have therefore described the effects of sex steroid action on reproductive behavior as both "activational" and "organizational," respectively. Here, we focus on these phenomena from an evolutionary standpoint, highlighting that we know relatively little about the way that organizational effects evolve in the natural world to support the adaptation and diversification of reproductive behavior. We first review the evidence that such effects do in fact evolve to mediate the evolution of sexual behavior. We then introduce an emerging animal model - the foot-flagging frog, Staurois parvus - that will be useful to study how sex hormones shape neuromotor development necessary for sexual displays. The foot flag is nothing more than a waving display that males use to compete for access to female mates, and thus the neural circuits that control its production are likely laid down when limb control systems arise during the developmental transition from tadpole to frog. We provide data that highlights how sex steroids might organize foot-flagging behavior through its putative underlying mechanisms. Overall, we anticipate that future studies of foot-flagging frogs will open a powerful window from which to see how sex steroids influence the neuromotor systems to help germinate circuits that drive signaling behavior. In this way, our aim is to bring attention to the important frontier of endocrinological regulation of evolutionary developmental biology (endo-evo-devo) and its relationship to behavior.

Exposure to difenoconazole induces reproductive toxicity in zebrafish by interfering with gamete maturation and reproductive behavior

Difenoconazole (DCZ) is a triazole fungicide that negatively affects aquatic organisms and humans. However, data regarding the reproductive toxicity of DCZ are insufficient. In this study, we used zebrafish (from 2 h post-fertilization [hpf] to adulthood) as a model to evaluate whether DCZ at environmentally relevant concentrations (0.1, 1.0, and 10.0 μg/L) induces reproductive toxicity. After exposure to DCZ, egg production and fertilization rates were reduced by 1.0 and 10.0 μg/L. A significant decrease in gamete frequency (late vitellogenic oocytes and spermatozoa) was observed at 10.0 μg/L. The concentrations of 17β-estradiol (E2), testosterone (T), and vitellogenin (VTG) were disrupted in females and males by 1.0 and 10.0 μg/L. Exposure to 10.0 μg/L DCZ significantly inhibited the contact time between female and male fish, which was mainly achieved by affecting male fish. The transcription of genes involved in the hypothalamus-pituitary-gonad (HPG) axis was significantly changed after treatment with DCZ. Overall, these data show that the endocrine-disrupting effect of DCZ on the zebrafish HPG axis inhibited gamete maturation and disrupted reproductive behavior, reducing fertility.

Reproductive behaviour before and after oestrus and oviposition in the captive short-beaked echidna (Tachyglossus aculeatus)

CONTEXT

Most of our current knowledge regarding echidna reproductive behaviour is based on qualitative measurements; therefore, it is unclear if specific behavioural cues could be utilised in their captive reproductive management.

AIMS

This study aimed to identify quantitative changes in general and reproductive behaviour of echidna breeding pairs and pregnant females that might facilitate the detection of oestrus and impending oviposition and provide a summary of reproductive behaviour observed in a captive colony over a three-year observation period.

METHODS

Three echidna breeding pairs and two trios were monitored daily for seven reproductive and eight general behaviours during the 2020 breeding season. After confirmed copulation, females were monitored for four egg-laying and eight general behaviours until egg incubation. General observations of reproductive behaviours during the 2018-2020 breeding seasons were recorded as part of routine husbandry.

KEY RESULTS

For breeding pairs, there was a significant rate of change over time before and after copulation for the behaviours 'urogenital sniffing', 'rolling' and 'copulation attempt'. For pregnant females, time engaged in 'pacing' significantly increased while 'time eating' and the 'quantity of food eaten' significantly decreased on the day of oviposition. We were not able to identify oestrus from specific behaviours, but our observations suggest that the female echidna's period of receptivity is less than 24h.

CONCLUSIONS

The frequency that males express 'urogenital sniffing', 'rolling' and 'copulation attempt' toward the female can be used to alert zookeepers that copulation has likely occurred. Increased pacing, reduced feeding time and quantity of food eaten can aid zookeepers to identify impending oviposition.

IMPLICATIONS

This study demonstrates that there are quantifiable changes in specific echidna behaviours that can be incorporated into zoo husbandry practices to improve the reproductive management of this species.

Low doses and lifecycle exposure of waterborne antidepressants in zebrafish model: A survey on sperm traits, reproductive behaviours, and transcriptome responses

Venlafaxine and citalopram have been commonly found in surface water and may disrupt fish reproduction, yet the long-term impact and the underlying mechanism are largely unknown. Here, zebrafish were exposed to 0.1-100 μg/L venlafaxine and citalopram for their entire life cycle from embryo to adult, respectively. After exposure for 180 days, the lowest observable effective concentration (LOEC) of venlafaxine and citalopram to significantly reduce the mean number of egg production in adults were 10 and 1 μg/L, respectively, whereas the fertilization rate displayed no significant changes. Further, we investigated the impacts of venlafaxine and citalopram in a reproductive context, including sperm quality and reproductive behaviour. In contrast, venlafaxine and citalopram exposure did not affect sperm quality but caused a reduction of reproductive behaviour (e.g., mating duration and mating interval) of adults exposed to 1-10 μg/L of the antidepressant. Transcriptomic profiling of the whole ovary revealed that lifecycle venlafaxine and citalopram exposure significantly affected the Na⁺/Cl^- dependent neurotransmitter transporters signaling. Moreover, immune system-mediated ovarian regeneration and creatine metabolism regulated energy metabolism were proposed as the novel mechanism in the observed effects. Taken together, our results highlight the risk of lifecycle venlafaxine and citalopram exposure to fish reproduction and provide novel perspectives for unveiling the mechanism of female reproductive dysfunction.

Childlessness: Concept Analysis

The purpose of this concept analysis is to explore childlessness and provide understanding to professionals involved in the field of infertility. Walker and Avant's method was used to identify descriptions, antecedents, consequences, and empirical referents of the concept. A model with related and contrary cases was developed. The analysis was based on the definition of the term in major dictionaries in the Greek, Lithuanian, Finnish, Maltese, and Turkish languages, while further literature searches utilized the Web of Science, PubMed, PsychInfo, Medline, Google Scholar, and National Thesis Databases. The literature search was limited to papers/books published in the authors' national languages and English. As a result, childlessness is defined as the absence of children in the life of an individual, and this can be voluntary or involuntary. However, the deeper analysis of the concept may be preceded and amplified through cultural, psychological, biological, philosophical, theological, sociological, anthropological, and linguistic aspects throughout history. These elements presented challenges for childless individuals, ultimately influencing their choices to resort to alternative ways of becoming parents, such as in vitro fertilization (IVF), surrogacy, adoption, or other forms of childbearing. Historically, childlessness has been viewed with negative connotations due to its potential impact on the survival of the human species. This negativity can be directed even to individuals who may decide to opt to voluntarily remain childfree. The long-term impact of the experience, both on an individual and collective level, continues to cause pain to those who are involuntarily childless. In conclusion, health professionals and other stakeholders who have a deep understanding of childlessness, including the antecedents and attributes, can minimize the potential negative consequences of those factors contributing to childlessness, whether voluntary or involuntary. In fact, they can capitalize on a powerful impact of change adaptation by providing support to those in their practice to recover the lost homeostasis.

Ethnic Culture as Related to Sexual and Reproductive Behavior in the Republic of Suriname: The Pervasiveness of Culture

We examined the effects of culture and ethnicity on life history strategies in terms of sexual and reproductive behaviors. The sample included 500 adults, aged 25-50 years, from the five major ethnic groups in Suriname, i.e., the Maroons, Creoles, Hindustani, Javanese, and Mixed. First, there were strong gender differences: men reported to have had more sex partners and to have had their first sexual experience earlier than women, whereas women had their first child earlier and had more children than men. Second, in general, ethnicity affected life history substantially. The Maroons stood out by a relatively fast life history: they reported to have had more sexual partners, to have had their first sex and first child at an earlier age, and to have more children than all other groups. The Creoles were in general similar to the Maroons, whereas the Hindustani and the Javanese were characterized by a relatively slow life history: they reported to have had the lowest number of sexual partners, to have had their first sex and first child at the latest age, and to have had the lowest number of children. The differences between the ethnic groups were upheld when controlling for income, educational level, and father absence during childhood. A lower education was associated with reporting to have had one's first sex as well as one's first child at a younger age and children who grew up without a father reported to have had their first sex at a younger age.

Male childlessness across the adult life course: A case study addressing a potentially 'vulnerable' population

BACKGROUND

Like other Latin American countries, over the past half-century, Colombia has experienced rapid urbanization, dramatic fertility decline, and massive educational expansion. These socio-demographic changes have transformed gender roles and, with them, the landscape surrounding reproductive decisions, family life, and opportunities in other life 'domains.' I draw on the 'life course cube' (LCC) approach, which frames individual actions within a multidimensional behavioral process shaped by interdependencies between time, life domains, and levels to explore Colombian male childlessness.

OBJECTIVE

I seek to answer two questions: How does Colombian non-fatherhood vary across the life course (with respect to overall prevalence and associated factors)? and How do men frame their non-fatherhood, and, especially, how do they envision a future without children?

METHODOLOGY

To address the first question, I used the 2015 Colombian Demographic and Health Survey's men's dataset (N > 30,000) to explore the overall level of male childlessness across age/generational groups and separate voluntary/involuntary childlessness. Then, using generalized linear models, I analyzed the relationships between different life domains (e.g. education, employment) and non-fatherhood at time points representing early-, mid-, and later-life childlessness (among men in their thirties, forties, and fifties). To address the second question, I used qualitative data from in-depth life history interviews I conducted with male (N = 7) and female (N = 28) parents/non-parents in Bogotá, analyzing connections between different 'levels' of men's experiences: their inner feelings, past and (envisioned) future actions, and societal factors framing childlessness.

RESULTS AND DISCUSSION

The quantitative findings indicate that male childlessness across the adult life course is strongly associated with later start of first union/never entering a union, and with small ideal family size. Later-life, definitive childlessness is also strongly associated with relative economic disadvantage and lower-prestige occupations, though early-life fatherhood postponement is not. Qualitatively, interviewed men expressed more worry and less preparation for the future than childless women. Understanding 'vulnerability' as 'the dynamics of stress and resources across the life course', I discuss these findings, paying attention to older non-fathers' potential psycho-social, relational, and socioeconomic vulnerability. Therefore, this work seeks to contribute to the literature on the determinants and experiences of male childlessness, focusing on a Latin American perspective.

Transcriptome-wide changes associated with the reproductive behaviour of male guppies exposed to 17α-ethinyl estradiol

Although many pharmaceutical compounds (and their metabolites) can induce harmful impacts at the molecular, physiological and behavioural levels, their underlying mechanistic associations have remained largely unexplored. Here, we utilized RNA-Seq to build a whole brain transcriptome profile to examine the impact of a common endocrine disrupting pharmaceutical (17α-ethinyl estradiol, EE2) on reproductive behaviour in wild guppies (Poecilia reticulata). Specifically, we annotated 16,791 coding transcripts in whole brain tissue in relation to the courtship behaviour (i.e. sigmoid display) of EE2 exposed (at environmentally relevant concentration of 8 ng/L for 28-days) and unexposed guppies. Further, we obtained 10,960 assembled transcripts matching in the non-coding orthologous genomes. Behavioural responses were assessed using a standard mate choice experiment, which allowed us to disentangle chemical cues from visual cues. We found that a high proportion of the RNAseq reads aligned back to our de novo assembled transcriptome with 80.59% mapping rate. Behavioural experiments showed that when males were presented only with female visual cues, there was a significant interaction between male treatment and female treatment in the time spent in the preference zone. This is one of the first studies to show that transcriptome-wide changes are associated with the reproductive behaviour of fish: EE2 exposed male guppies that performed high levels of courtship had a gene profile that deviated the most from the other treatment groups, while both non-courting EE2 and control males had similar gene signatures. Using Gene Ontology pathway analysis, our study shows that EE2-exposed males had gene transcripts enriched for pathways associated with altered immunity, starvation, altered metabolism and spermatogenesis. Our study demonstrates that multiple gene networks orchestrate courting behaviour, emphasizing the importance of investigating impacts of pharmaceuticals on gene networks instead of single genes.

Exogenous leptin promotes reproductive behavior during aphagia in red-sided garter snakes (Thamnophis sirtalis parietalis)

Despite the established dichotomy between investment in either reproduction or self-maintenance, a hormonal mechanism that influences an organism's decision to prioritize these behaviors remains elusive. The protein hormone leptin is a likely candidate because it is secreted from adipocytes in proportion to the amount of stored fat in numerous species. Although the majority of studies suggest that leptin stimulates reproduction, the actions of leptin can be context-dependent. Leptin increases sexual behavior in fed individuals, but inhibits sexual behavior in food-restricted individuals. We investigated if exogenous leptin influences sexual behavior in red-sided garter snakes (Thamnophis sirtalis parietalis) experiencing a predictable bout of aphagia during the mating season. We tested two doses of recombinant murine leptin injected for three days. Males were subjected to three mating trials, one on each day of injections, while females were subjected to one mating trial on the last day of injections. Leptin affects male and female snakes similarly by increasing both appetitive (i.e., mating behavior score) and consummatory (i.e., number of copulations, proportion of individuals copulated) sex behavior. We found no evidence to suggest that leptin influenced latency to copulate or duration of copulation. Because leptin promotes reproductive behavior in non-feeding garter snakes, these findings do not align with research on food-restricted mammals. Further investigations into how leptin affects sexual behavior in snakes exposed to food-restriction manipulations would clarify if the role of leptin is evolutionarily divergent.

Modeling Variation in the Reproductive Lifespan of Female Adolescent and Young Adult Cancer Survivors Using AMH

CONTEXT

Many female survivors of adolescent and young adult cancers (AYA survivors) have shortened reproductive lifespans. However, the timing and duration of ovarian function after cancer treatment are largely unknown.

OBJECTIVE

To model the trajectory of ovarian function over two decades following cancer treatment and evaluate how trajectories vary by treatment gonadotoxicity and age.

DESIGN

In a prospective cohort, AYA survivors aged 18-39 at variable times since cancer treatment completion provided dried blood spots (DBS) every 6 months for up to 18 months. Anti-Müllerian hormone (AMH) levels were measured using the Ansh DBS AMH enzyme-linked immunosorbent assay. The mean AMH trajectory was modeled for the entire cohort and separately by treatment gonadotoxicity and age using functional principal components analysis.

RESULTS

763 participants, mean (standard deviation) enrollment age 33.3 (4.7) and age at cancer diagnosis 25.9 (5.7) years, contributed 1905 DBS samples. The most common cancers were breast (26.9%), lymphoma (24.8%), and thyroid (18.0%). AMH trajectories differed among survivors by treatment gonadotoxicity (low, moderate, or high) (P < 0.001). Following low or moderately gonadotoxic treatments, AMH levels increased over 2-3 years and plateaued over 10-15 years before declining. In contrast, following highly gonadotoxic treatment, AMH levels were lower overall and declined shortly after peak at 2-3 years. Younger age at treatment was associated with higher trajectories, but a protective effect of younger age was not observed in survivors exposed to highly gonadotoxic treatments (Pinteraction < 0.001).

CONCLUSIONS

In this large AYA survivor cohort, timing and duration of ovarian function strongly depended on treatment gonadotoxicity and age at treatment. The findings provide novel, more precise information to guide reproductive decision-making.

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.

Knowledge about the impact of age on fertility: a brief review

Delayed childbearing is currently a major challenge in reproductive medicine as increased age has an important impact on successful conception, both in natural and in assisted reproduction. There is a lack of knowledge about the impact of age on fertility, even in highly educated populations. A number of initiatives have been taken to increase fertility awareness. Health care providers have been encouraged to talk with patients about their reproductive life plan (RLP) for almost a decade based on recommendations from the Centres for Disease Control and Prevention. This concept has been explored successfully in Swedish contraception counselling. A growing number of online interventions aim to raise fertility awareness. These websites or interactive tools provide relevant information for individuals and couples as they consider whether they want children, when they should have them, and how many they may wish to have. These interventions are important, because research depicts that knowledge helps people in their decision-making process. With new fertility preservations such as egg freezing now available, additional education is needed to be sure that women and couples are well informed about the cost and low success rates of this intervention.

Pymetrozine inhibits reproductive behavior of brown planthopper Nilaparvata lugens and fruit fly Drosophila melanogaster

Pymetrozine is a promising chemical used to control brown planthopper, which developed resistance to imidacloprid and buprofezin in the past decade. Field efficacy indicates that pymetrozine can reduce the number of offsprings of brown planthopper, but the specific physiological mechanism is unknown. In this study, we systematically described the mating process of brown planthopper including 8 steps (abdominal vibration, following, positioning, wing extension, attempted copulation, copulation, terminated copulation and leaving) and explored the optimal mating time after adult eclosion (3-5 days) and observation time (30 mins). Also, behavioral data showed that pymetrozine can affect the mating behavior and female fecundity of brown planthopper and fruit fly. As one of the target genes for pymetrozine, Nanchung (Nan), the nan^36a mutant male courtship index, female receptivity and the number of offsprings were significantly decreased. Behavioral defects in nan^36a mutant flies can be rescued by expressed NlNan. Our results indicated that Nan plays essential roles in the mating behavior and female fecundity. These findings provide useful information for demonstrating that pymetrozine effectively reduce the reproduction of brown planthopper and contribute to our understanding of reproductive strategies controlled by pymetrozine in insects.

Social dimensions of fertility behavior and consumption patterns in the Anthropocene

We consider two aspects of the human enterprise that profoundly affect the global environment: population and consumption. We show that fertility and consumption behavior harbor a class of externalities that have not been much noted in the literature. Both are driven in part by attitudes and preferences that are not egoistic but socially embedded; that is, each household's decisions are influenced by the decisions made by others. In a famous paper, Garrett Hardin [G. Hardin, Science 162, 1243-1248 (1968)] drew attention to overpopulation and concluded that the solution lay in people "abandoning the freedom to breed." That human attitudes and practices are socially embedded suggests that it is possible for people to reduce their fertility rates and consumption demands without experiencing a loss in wellbeing. We focus on fertility in sub-Saharan Africa and consumption in the rich world and argue that bottom-up social mechanisms rather than top-down government interventions are better placed to bring about those ecologically desirable changes.

A qualitative assessment of perspectives on getting pregnant: the Social Position and Family Formation study

BACKGROUND

Intentions-oriented approaches to measuring pregnancy do not necessarily align with how people view and approach pregnancy. Our objective was to obtain an in-depth understanding of the notions women and men hold regarding pregnancy.

METHODS

We conducted semi-structured in-depth interviews with 176 heterosexual women and men ages 18-35, in the United States. Data were analyzed using grounded theory methodology.

RESULTS

Participants described notions of getting pregnant in one of three ways. One group of participants used language that solely described pregnancy as a deliberate process, either premeditated or actively avoided. Another described pregnancy as a predetermined phenomenon, due to fate or something that 'just happens.' The third group represented a blending of both notions.

CONCLUSIONS

Our findings underscore the need to shift the current paradigm of deliberate intentions to one that recognizes that pregnancy can also be viewed as predetermined. These findings can be used to improve measurement, health services, and better direct public health resources.

Knowledge and correlates of use of safer conception methods among HIV-infected women attending HIV care in Uganda

BACKGROUND

Many people living with HIV would like to have children but family planning (FP) services often focus on only contraception. Availability of safer conception services is still very low in most low income countries. In this study we assessed the knowledge and use of safer conception methods (SCM) among HIV infected women in HIV care in Uganda to inform integration of safer conception in existing FP services.

METHODS

Data were accrued from a nationally representative cross-sectional survey of 5198 HIV+ women aged 15-49 years from 245 HIV clinics in Uganda. Knowledge and use of safer conception methods and associated factors were determined. The measure of association was prevalence ratio (PR) with corresponding 95% confidence intervals, obtained using a modified Poisson regression via generalized linear models. All the analyses were conducted using STATA version 12.0.

RESULTS

Overall knowledge of any safer conception method was 74.1% (3852/5198). However only 13.2% knew 3 to 4 methods, 18.9% knew only 2 methods and 42% knew only one method. Knowledge of specific SCM was highest for timed unprotected intercourse (TUI) at 39% (n = 2027) followed by manual self-insemination (MSI) at 34.8% (n = 1809), and pre-exposure prophylaxis (PrEP) at 24.8% (n = 1289). Knowledge of SCM was higher in the Eastern region (84.8%, P < 0.001), among women in HIV-discordant relationships (76.7%, p < 0.017), and those on ART (74.5%, p < 0.034). Overall, 1796 (34.6%) women were pregnant or reported a birth in the past 2 years-overall use of SCM in this group was 11.6% (209/1796). The odds of use of SCM were significantly lower in Kampala [adj. PR = 0.489(0.314, 0.764)] or Eastern region [adj.PR = 0.244; (0.147, 0.405)] compared to Northern region. Higher odds of SCM use were associated with HIV status disclosure to partner [adj.PR = 2.613(1.308, 5.221)] and sero-discordant compared to HIV+ concordant relationship [adj.PR = 1.637(1.236, 2.168)]. Pre-existing knowledge of any one SCM did not influence SCM use.

CONCLUSIONS

Knowledge and use of SCM among HIV+ women in care is low. Efforts to improve HIV status disclosure, integration of safer conception into FP and HIV services and regional efforts to promote sensitization and access to safer conception can help to increase uptake of safer conception methods.

Knowledge and intake of folic acid among teachers of childbearing age in the State of Qatar: a cross-sectional study

OBJECTIVES

To assess the knowledge and intake of folic acid among teachers of childbearing age and to identify barriers to folic acid intake.

SETTING

Governmental schools, which included 14 primary models, 29 primary, 14 preparatory and 16 secondary schools. The proportion of teachers in each stratum was then determined, and a stratified random sampling design had been used with proportional allocation.

STUDY DESIGN

Cross-sectional study PARTICIPANTS: A total of 406 non-pregnant teachers of childbearing age enrolled in the study. A validated questionnaire in the Arabic language was used.

RESULTS

The overall response rate was 98%. About 34.6% reported the optimal period in which they should take folic acid, 28.3% reported the correct intake duration and only 29.5% could name food rich in folic acid. Friends and healthcare providers were the main sources of information for the participants; however, 44% said that they did not receive enough information from their healthcare providers.

CONCLUSION

There is a lack of knowledge and poor intake of folic acid among the participants. In particular, they lacked information about the appropriate time to start folic acid supplementations, the duration of intake and the folic acid-rich food. The most common reason being the limited advice given by their healthcare providers.Awareness campaigns are recommended to emphasise the role of healthcare providers in counselling women about the proper use of folic acid before pregnancy.

Professional identity formation of female doctors in Japan - gap between the married and unmarried

BACKGROUND

During professional identity formation (PIF), medical students and young doctors enter the process of socialization in medicine with their preexisting personal identities. Here, the authors focused on how gender influences both the professional and personal identities of doctors. The authors' particular research question was how the professional and personal identities of female doctors are formed in Japan, a patriarchal and highly masculinized country, especially before and after marriage and childbirth.

METHODS

Narrative inquiry was used as the research methodology. The authors purposively sampled 10 unmarried and 15 married Japanese female physicians with varying lengths of full-time work experience and conducted individual semi-structured face-to-face interviews between July 2013 and February 2015. The authors recorded, transcribed and anonymized the narrative data and extracted themes and representative narratives related to the formation of professional and personal identities. Based on these, the authors developed the master narrative for the whole study.

RESULTS

The PIF process by which female physicians integrate personal and professional identities was profoundly affected by gender stereotypes. Further, participant narratives revealed the existence of conflict between married and unmarried female doctors, which created a considerable gap between them.

CONCLUSIONS

Female physicians lived with conflicting emotions in a chain of gender stereotype reinforcement. To overcome these issues, we propose that it is necessary to depart from a culture that determines merit based on a fixed sense of values, and instead develop a cultural system and work environment which allows the cultivation of a professional vision that accepts a wide variety of professional and personal identities, and a similarly wide variety of methods by which the two can be integrated.

Tsogolo la Thanzi: A Longitudinal Study of Young Adults Living in Malawi's HIV Epidemic

Tsogolo la Thanzi (TLT) was designed to study how young adults navigate sexual relationships and childbearing during a generalized HIV epidemic. TLT began in 2009 with a population-representative sample of 1,505 women and 574 men between the ages of 15 and 25 living in Balaka, southern Malawi, where regional adult HIV prevalence then stood at 15 percent. The first phase (2009-11) included a series of eight interviews, spaced four months apart. During this time, women's romantic and sexual partners enrolled in the study on an ongoing basis. A refresher sample of 315 women was added in 2012. Seventy-eight percent of respondents were re-interviewed in the second phase of TLT (2015), which consisted of follow-up interviews approximately 3.5 years after the previous interview (ages 21-31). At each wave, detailed information about fertility intentions and behaviors, relationships, sexual behavior, health, and a range of sociodemographic and economic traits was gathered by means of face-to-face surveys. Biomarkers for HIV and pregnancy were also collected. Distinguishing features include: a population-representative sample, closely spaced data collection, dyadic data on couples over time, and an experimental approach to HIV testing and counseling. Data are available through restricted data-user agreements managed by Data Sharing for Demographic Research (DSDR) at the University of Michigan.

A prospective measure of unintended pregnancy in the United States

OBJECTIVE

To describe a new measure, the unintended pregnancy risk index (UPRI), which is based primarily on attitudinal and behavioral measures of women's prospective pregnancy desire, and compare it to the unintended pregnancy rate, typically calculated retrospectively.

STUDY DESIGN

We used three rounds of the National Survey of Family Growth to calculate trends in the UPRI and compare it to the retrospective rate. The UPRI estimates the annual risk of becoming unintentionally pregnant on a scale from 0 to 100. It is based on women's prospective pregnancy desire as well as fecundity, sexual activity and contraceptive use patterns.

RESULTS

Among all women aged 15-34, the UPRI ranged from 7.4 in 2002 to 5.7 in 2013. The retrospective unintended pregnancy rate had similar levels and declines for the same overall period, although the UPRI declined earlier than the retrospective rate.

CONCLUSIONS

Changes in the use of any contraceptive method, the methods used and the effectiveness of the methods used all contributed to the decline in the UPRI.

IMPLICATIONS

The sufficiency of retrospective measures of pregnancy intention has been challenged, and data availability has constrained needed surveillance of the unintended pregnancy rate. The UPRI offers a new measure that can be calculated with existing national surveillance data or for any population for which data on prospective pregnancy desire, pregnancy risk and contraceptive use are available.

Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

The effectiveness of antiretroviral treatment has reduced sexual HIV transmission and mother-to-child-transmission. To optimally support women living with HIV, health care providers need deepened knowledge about HIV, sexuality and childbearing. The aim of this study was to describe the phenomenon sexuality and childbearing as experienced by women living with HIV in Sweden. Data were collected by phenomenon-oriented interviews with 18 HIV-positive women. A reflective lifeworld analysis based on phenomenological philosophy was conducted, describing the meaning structure of the phenomenon. The essence of the phenomenon is that perceptions about HIV and its contagiousness profoundly influence sexual habits and considerations in relation to pregnancy and childbearing. These perceptions are formed in combination with knowledge and interpretations about HIV by the women themselves and by their environments. The essence is further described by its constituents: Risk of transmission imposes demands on responsibility; The contagiousness of HIV limits sexuality and childbearing; Knowledge about HIV transmission provides confident choices and decisions; and To re-create sexuality and childbearing. Although HIV has a low risk of transmission if being well treated, our study shows that HIV-positive women feel more or less contagious, which influences sexuality and decision-making in relation to become pregnant and give birth.

Exploring women's decisions about childbearing after the lifting of the one-child policy

In 2016, China officially ended the 'one-child' policy permitting all couples to have two children for the first time since 1979. While the policy was relaxed due to demographic concerns, it simultaneously provided many women with a new reproductive opportunity. The goal of this study was to qualitatively understand the childbearing decision process in the new era of the two-child policy. We conducted in-depth, semi-structured interviews with 45 postpartum women at two hospitals in Zhejiang Province, China. The interviews explored women's views on the two-child policy and reproductive decisions and how they decided to have their first or second child. Most women approved of the lifting of the one-child policy; however, many were hesitant or uncertain about their own decisions to have second children. Many felt pressured to have two children for the good of, or as an obligation to, the family. However, they also felt that caring for two children was burdensome, and that they would have to sacrifice a lot in terms of freedom, energy and money. Their responses to the new reproductive opportunity highlight the complexity of childbearing decision-making in modern Chinese society, against a background of persisting traditional values.

Health facility or home delivery? Factors influencing the choice of delivery place among mothers living in rural communities of Eritrea

BACKGROUND

In Eritrea, despite high antenatal care (ANC) use, utilization of health facilities for child birth is still low and with marked variations between urban and rural areas. Understanding the reasons behind the poor use of these services in a rural setting is important to design targeted strategies and address the challenge contextually. This study aimed to determine factors that influence women's choice of delivery place in selected rural communities in Eritrea.

METHODS

A cross-sectional survey of 309 women aged 15-49 years with a delivery in the last 1-2 years prior to the survey was conducted in a randomly selected villages of Hadish Adi, Serea, Genseba, Kelay Bealtat, Dirko, Mai Leham, Kudo Abour, Adi Koho, and Leayten. Data were collected using an interviewer administered questionnaire. Chi-square tests were used to explore association between variables. Using odds ratios with 95% confidence intervals with p < 0.05 taken as statically significant association, bivariate and multivariate logistic regression analysis were used to identify factors that affect the choice of delivery place.

RESULTS

Overall, 75.4% of the respondents delivered their last child at home while 24.6% delivered in health facility. Women whose husband's had no formal education were less likely [AOR = 0.02; 95% CI 0.01-0.54] to deliver in health facility. Women who had joint decision-making with husbands on delivery place [AOR = 5.42; 95% CI 1.78-16.49] and women whose husbands choose health facility delivery [AOR = 2.32; 95% CI 1.24-5.11] were more likely to have health facility delivery. Respondents who had medium wealth status [AOR = 3.78; 95% CI 1.38-10.37] have access to health facility within 2 km distance [AOR = 14.67; 95% CI 2.30-93.45] and women with traditional means of transport [AOR = 9.78; 95% CI 1.23-77.26] were also more likely to deliver in health facility. Women who read newspaper daily or infrequently had three [AOR = 3.77; 95% CI 1.12-4.04] and almost three times [AOR = 2.95; 95% CI 1.01-8.59] higher odds of delivering in health facility. Similarly, women who have knowledge about complications during delivery [AOR = 4.39; 95% CI 1.63-11.83], good perception on the quality of care they received [AOR = 9.52; 95% CI 1.91-47.50], had previous facility delivery [AOR = 2.69; 95% CI 0.94-7.68], have negative experiences of delivery outcomes in her community [AOR = 1.31; 95% CI 1.00-4.96], and women who perceive home delivery as life threatening [AOR = 1.84; 95% CI 1.46-3.38] were more likely to deliver in health facility.

CONCLUSION

To increase health facility delivery, raising women's awareness on the benefits of delivering in health facility, male involvement in the use of maternal health services, increasing women decision-making power, addressing common barriers of lack of transport, and compensations for transport expenses to alleviate the cost of transport are recommended. Efforts to shorten distance to reach health facility and health education focusing on the potential threats of delivering at home at the individual and community level can have substantial contribution to increase health facility delivery in rural communities of Eritrea.

Generosity pays: Selfish people have fewer children and earn less money

Does selfishness pay in the long term? Previous research has indicated that being prosocial (or otherish) rather than selfish has positive consequences for psychological well-being, physical health, and relationships. Here we instead examine the consequences for individuals' incomes and number of children, as these are the currencies that matter most in theories that emphasize the power of self-interest, namely economics and evolutionary thinking. Drawing on both cross-sectional (Studies 1 and 2) and panel data (Studies 3 and 4), we find that prosocial individuals tend to have more children and higher income than selfish individuals. An additional survey (Study 5) of lay beliefs about how self-interest impacts income and fertility suggests one reason selfish people may persist in their behavior even though it leads to poorer outcomes: people generally expect selfish individuals to have higher incomes. Our findings have implications for lay decisions about the allocation of scarce resources, as well as for economic and evolutionary theories of human behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Association between Anaemia in Children 6 to 23 Months Old and Child, Mother, Household and Feeding Indicators

In Low and Lower-Middle-Income countries, the prevalence of anaemia in infancy remains high. In early childhood anaemia cause irreversible cognitive deficits and represents a higher risk of child mortality. The consequences of anaemia in infancy are a major barrier to overcome poverty traps. The aim of this study was to analyse, based on a multi-level approach, different factors associated with anaemia in children 6⁻23 months old based on recent available Standard Demographic Health Surveys (S-DHS). We identified 52 S-DHS that had complete information in all covariates of interest in our analysis between 2005 and 2015. We performed traditional logistic regressions and multilevel logistic regression analyses to study the association between haemoglobin concentrations and household, child, maternal, socio-demographic variables. In our sample, 70% of the 6⁻23 months-old children were anaemic. Child anaemia was strongly associated with maternal anaemia, household wealth, maternal education and low birth weight. Children fed with fortified foods, potatoes and other tubers had significantly lower rates of anaemia. Improving overall household living conditions, increasing maternal education, delaying childbearing and introducing iron rich foods at six months of age may reduce the likelihood of anaemia in toddlerhood.

Zika virus incidence, preventive and reproductive behaviors: Correlates from new survey data

During the outbreak of the Zika virus, Brazilian health authorities recommended that pregnant women take meticulous precaution to avoid mosquito bites and that women in general use contraceptive methods to postpone/delay pregnancies. In this article, we present new estimates on the Zika virus incidence, its correlates and preventive behaviors in the Northeast of Brazil, where the outbreak initiated, using survey data collected between March 30^th and June 3^rd of 2016. The target population were women aged 15-49 in the capital cities of the nine states of the Northeast region of Brazil. We find that more educated women were less likely to report suffering from Zika (or its symptoms) and more likely to report having taken precaution against Zika, such as having used long and light-colored clothes, having used mosquito repellent or insecticides, having used mosquito protective screens or kept windows closed, and having dumped standing water where mosquitoes can breed. In addition, more educated women were more likely to report being informed about the association between Zika and microcephaly and to avoid pregnancy in the last 12 months. Finally, we also find that women who reported experiencing sexual domestic violence in the last 12 months were more likely to report suffering from Zika.

Changes in Providers' Self-Efficacy and Intentions to Provide Safer Conception Counseling Over 24 Months

High rates of fertility desires, childbearing and serodiscordant partnerships among people living with HIV (PLHIV) in Uganda underscore the need to promote use of safer conception methods (SCM). Effective SCM exist but few PLHIV benefit from provider-led safer conception counseling (SCC) and comprehensive national SCC guidelines are still lacking. Providers' self-efficacy, intentions and attitudes for SCC impact provision and should inform development of services, but there are no longitudinal studies that assess these important constructs. This study reports on changes in providers' knowledge, attitudes, motivation and confidence to provide SCC among a 24-month observational cohort of Ugandan HIV providers. Compared to baseline, providers evidenced increased awareness of SCM, perceived greater value in providing SCC, saw all SCM but sperm washing as likely to be acceptable to clients, reported consistently high interest in and peer support for providing SCC, and perceived fewer barriers at the 24-month follow-up. Providers' intentions for providing SCC stayed consistently high for all SCM except manual self-insemination which decreased at 24 months. Self-efficacy for providing SCC increased from baseline with the greatest improvement in providers' confidence in advising serodiscordant couples where the man is HIV-infected. Providers consistently cite the lack of established guidelines, training, and their own reluctance to broach the issue with clients as significant barriers to providing SCC. Despite providers being more interested and open to providing SCC than ever, integration of SCC into standard HIV services has not happened. Concerted efforts are needed to address remaining barriers by establishing national SCC guidelines and implementing quality provider training.

Realizing Women Living with HIV's Reproductive Rights in the Era of ART: The Negative Impact of Non-consensual HIV Disclosure on Pregnancy Decisions Amongst Women Living with HIV in a Canadian Setting

To better understand the structural drivers of women living with HIV's (WLWH's) reproductive rights and choices, this study examined the structural correlates, including non-consensual HIV disclosure, on WLWH's pregnancy decisions and describes access to preconception care. Analyses drew on data (2014-present) from SHAWNA, a longitudinal community-based cohort with WLWH across Metro-Vancouver, Canada. Multivariable logistic regression was used to model the effect of non-consensual HIV disclosure on WLWH's pregnancy decisions. Of the 218 WLWH included in our analysis, 24.8% had ever felt discouraged from becoming pregnant and 11.5% reported accessing preconception counseling. In multivariable analyses, non-consensual HIV disclosure was positively associated with feeling discouraged from wanting to become pregnant (AOR 3.76; 95% CI 1.82-7.80). Non-consensual HIV disclosure adversely affects WLWH's pregnancy decisions. Supporting the reproductive rights of WLWH will require further training among general practitioners on the reproductive health of WLWH and improved access to women-centred, trauma-informed care, including non-judgmental preconception counseling.

Freezing for love: enacting 'responsible' reproductive citizenship through egg freezing

The promise of egg freezing for women's fertility preservation entered feminist debate in connection with medical and commercial control over, and emancipation from, biological reproduction restrictions. In this paper we explore how women negotiate and make sense of the decision to freeze their eggs. Our analysis draws on semi-structured interviews with 16 women from the Midwest and East Coast regions of the USA who froze their eggs. Rather than freezing to balance career choices and 'have it all', the women in this cohort were largely 'freezing for love' and in the hope of having their 'own healthy baby'. This finding extends existing feminist scholarship and challenges bioethical concerns about egg freezing by drawing on the voices of women who freeze their eggs. By viewing egg freezing as neither exclusively liberation nor oppression or financial exploitation, this study casts egg freezing as an enactment of 'responsible' reproductive citizenship that 'anticipates coupledom' and reinforces the genetic relatedness of offspring.

Consensus statement: Supporting Safer Conception and Pregnancy For Men And Women Living with and Affected by HIV

Safer conception interventions reduce HIV incidence while supporting the reproductive goals of people living with or affected by HIV. We developed a consensus statement to address demand, summarize science, identify information gaps, outline research and policy priorities, and advocate for safer conception services. This statement emerged from a process incorporating consultation from meetings, literature, and key stakeholders. Three co-authors developed an outline which was discussed and modified with co-authors, working group members, and additional clinical, policy, and community experts in safer conception, HIV, and fertility. Co-authors and working group members developed and approved the final manuscript. Consensus across themes of demand, safer conception strategies, and implementation were identified. There is demand for safer conception services. Access is limited by stigma towards PLWH having children and limits to provider knowledge. Efficacy, effectiveness, safety, and acceptability data support a range of safer conception strategies including ART, PrEP, limiting condomless sex to peak fertility, home insemination, male circumcision, STI treatment, couples-based HIV testing, semen processing, and fertility care. Lack of guidelines and training limit implementation. Key outstanding questions within each theme are identified. Consumer demand, scientific data, and global goals to reduce HIV incidence support safer conception service implementation. We recommend that providers offer services to HIV-affected men and women, and program administrators integrate safer conception care into HIV and reproductive health programs. Answers to outstanding questions will refine services but should not hinder steps to empower people to adopt safer conception strategies to meet reproductive goals.

Evolutionary demography of age at last birth: integrating approaches from human behavioural ecology and cultural evolution

Cultural evolutionary theory and human behavioural ecology offer different, but compatible approaches to understanding human demographic behaviour. For much of their 30 history, these approaches have been deployed in parallel, with few explicit attempts to integrate them empirically. In this paper, we test hypotheses drawn from both approaches to explore how reproductive behaviour responds to cultural changes among Mosuo agriculturalists of China. Specifically, we focus on how age at last birth (ALB) varies in association with temporal shifts in fertility policies, spatial variation and kinship ecologies. We interpret temporal declines in ALB as plausibly consistent with demographic front-loading of reproduction in light of fertility constraints and later ages at last birth in matrilineal populations relative to patrilineal ones as consistent with greater household cooperation for reproductive purposes in the former. We find little evidence suggesting specific transmission pathways for the spread of norms regulating ALB, but emphasize that the rapid pace of change strongly suggests that learning processes were involved in the general decline in ALB over time. The different predictions of models we employ belie their considerable overlap and the potential for a synthetic approach to generate more refined tests of evolutionary hypotheses of demographic behaviour.This article is part of the theme issue 'Bridging cultural gaps: interdisciplinary studies in human cultural evolution'.

Reproductive ageing-turning back the clock?

BACKGROUND

Unintended childlessness is a distressing, and often unintended, consequence of delayed childbearing and reproductive ageing. The average maternal age at first birth has risen steadily in many industrialised countries since the 1980s. There are many societal factors involved in the decision to postpone motherhood. As a result, many women are postponing having children until it is too late. In this review, we aim to summarise the reasons behind delayed childbearing, the impact of delayed childbearing and the scientific advances that seek to reverse reproductive ageing and ensure reproductive autonomy for women.

METHODS

An extensive literature search of PubMed was conducted to include all published articles on delayed childbearing and the consequences of reproductive ageing. Secondary articles were identified from key paper reference listings.

CONCLUSION

If the current reproductive trends continue, many women will find themselves in the harrowing position of being unintentionally childless. In addition, many will inevitably turn to assisted reproductive technologies in an effort to protect and preserve their reproductive autonomy. However, it is not always possible to reverse the effects of reproductive ageing.

When the mother-in-law is just as good-Differential mortality of reproductive females by family network composition

Motivated by the cooperative breeding hypothesis, we investigate the effect of having kin on the mortality of reproductive women based on family reconstitutions for the Krummhörn region (East Frisia, Germany, 1720-1874). We rely on a combination of Cox clustered hazard models and hazard models stratified at the family level. In order to study behavior-related effects, we run a series of models in which only kin who lived in the same parish are considered. To investigate structural, non-behavior-related effects, we run a different model series that include all living kin, regardless their spatial proximity. We find that women of reproductive age who had a living mother had a reduced mortality risk. It appears that having living sisters had an ambivalent impact on women's mortality: i.e., depending on the socioeconomic status of the family, the effect of having living sisters ranged between representing a source of competition and representing a source of support. Models which are clustered at the family level suggest that the presence of a living mother-in-law was associated with reduced mortality among her daughters-in-law especially among larger-scale farm families. We interpret this finding as a consequence of augmented consanguineous marriages among individuals of higher social strata. For instance, in first cousin marriages, the mother-in-law could also be a biological aunt. Thus, it appears that among the wealthy elite, the genetic in-law conflict was neutralized to some extent by family solidarity. This result further suggests that the tipping point of the female trade-off between staying with the natal family and leaving the natal family to join an economically well-established in-law family might have been reached very quickly among women living under the socioeconomic conditions of the Krummhörn region.

Turkish University seniors' knowledge of and opinions on fertility and expectations of having children

Background

In recent years the trend of postponement of child bearing has been increasing.

Aim

To assess knowledge on fertility and expectations of having children in seniors at a Turkish University.

Methods

The cross-sectional study sample (n=485) comprised senior students of the University in the branches of medicine, social sciences, and life sciences. Data were collected via a self-administered questionnaire in 2015.

Results

The mean age of the students was 23.03±1.93 and 98.1% were unmarried. 88.45% of these students wanted to have children in the future. A higher percentage of females planned parenthood in the future than males. Males desired more children than females. Most students wanted to have their first child at age 25–29. Males wanted to have their first and last child later than did females. In case of infertility, 74.4% of females and 54.2% of males stated that they can benefit from assisted reproduction techniques. Students overestimated the success rate of assisted reproduction techniques. The percentage of students who were aware of the age at which fertility begins to decline was low.

Conclusion

The expectations of seniors at a Turkish university to have children in the future are high, with insufficient knowledge on fertility.

Influences on medical career choice and future medical practice plans among women: Perspective from final year students and house officers

There is a growing perception in Pakistan that comparatively more women are gaining admissions and graduating from medical colleges; however these graduates are not practicing medicine. This pilot study provides perspectives on the influences on medical career choice and plans regarding future medical practice among female final-year students and house-officers in Karachi. Using convenience sampling, a study was conducted in August and September 2016, wherein out of 141 women, 95 (67.4%) were final-year medical students and 46 (32.6%) were house-officers. Most of the women (n=101; 71.6%) made their own choice to become doctors, while only 18 (12.8%) were compelled by their parents. An overwhelming majority (n=131; 92.9%) planned to do house job upon graduation or complete their ongoing one. Regarding post-graduation, 124 (87.9%) participants intended to acquire post-graduate qualification. Results indicate the need for representative studies to quantify the determinants and correlates of women's choice to study and practice medicine.

Women's experiences with unplanned pregnancy and abortion in Kenya: A qualitative study

BACKGROUND

Safe and legal abortions are rarely practiced in the public health sector in Kenya, and rates of maternal mortality and morbidity from unsafe abortion is high. Little is known about women's experiences seeking and accessing abortion in informal settlements in Nairobi, Kenya.

METHODS

Seven focus group discussions were conducted with a total of 71 women and girls recruited from an informal settlement in Nairobi. The interview guide explored participants' perceptions of unplanned pregnancy, abortion, and access to sexual and reproductive health information in their community. Thematic analysis of the focus group transcripts was conducted using MAX QDA Release 12.

RESULTS

Participants described a variety of factors that influence women's experiences with abortion in their communities. According to participants, limited knowledge of sexual and reproductive health information and lack of access to contraception led to unplanned pregnancy among women in their community. Participants cited stigma and loss of opportunities that women with unplanned pregnancies face as the primary reasons why women seek abortions. Participants articulated stigma as the predominant barrier women in their communities face to safe abortion. Other barriers, which were often interrelated to stigma, included lack of education about safe methods of abortion, perceived illegality of abortion, as well as limited access to services, fear of mistreatment, and mistrust of health providers and facilities.

CONCLUSIONS

Women in informal settlements in Nairobi, Kenya face substantial barriers to regulating their fertility and lack access to safe abortion. Policy makers and reproductive health advocates should support programs that employ harm reduction strategies and increase women's knowledge of and access to medication abortion outside the formal healthcare system.

Measurement of Social Norms Affecting Modern Contraceptive Use: A Literature Review

As a critical building block to developing social norms interventions to support healthy family planning and other reproductive health behaviors, we conducted a literature review to identify and evaluate social norm measures related to modern contraceptive use. Of 174 articles reviewed in full, only 17 studies met our criteria for inclusion. Across these articles, no single measure of norms was used in more than one study; failure to specify the boundaries of who was engaging in and influencing the behaviors of interest contributed to the variation. Most of the studies relied on cross-sectional data, only included condom use as their contraceptive use outcome, used individual- or interpersonal-level behavior change theories rather than social-level theories, and assumed a reference group, all of which limit the quality of the norm measures. We make several recommendations to bring greater consistency and comparability to social norm measures.

Reproductive competition and sexual selection

This paper traces the development of our understanding of the development of different approaches to estimating the strength of reproductive competition and sexual selection in the two sexes, based on measures of the operational sex ratio, the opportunity for sexual selection and contrasts in selection gradients between the sexes. It argues that different approaches provide complementary insights into the causes of sex differences in reproductive competition, the operation of sexual selection and the evolution of secondary sexual characters and that improvements in our understanding of the evolution of secondary sexual characters will require a more comprehensive understanding of the ways in which social and ecological conditions modify reproductive competition and development in females and males.This article is part of the themed issue 'Adult sex ratios and reproductive decisions: a critical re-examination of sex differences in human and animal societies'.

Sexual Orientation Disparities in Mistimed and Unwanted Pregnancy Among Adult Women

CONTEXT

Many sexual minority women, regardless of sexual identity, engage in heterosexual behavior across the life course, which provides them opportunities to experience an unintended pregnancy. In addition, sexual minority women are more likely than others to report characteristics that may make them vulnerable to unintended pregnancy. Little research, however, has examined whether the risk of unintended pregnancy is elevated among these women.

METHODS

Using data from the 2006-2010 National Survey of Family Growth, logistic regression models were fitted to examine sexual orientation disparities in mistimed and unwanted pregnancies among 9,807 women aged 20-45; mixed-effects hazard models assessed disparities in the intention status of 5,238 pregnancies among these women by maternal sexual orientation.

RESULTS

Compared with heterosexual women reporting only male partners, heterosexual women who have sex with women had higher odds of reporting a mistimed pregnancy (odds ratio, 1.4), and bisexual women had higher odds of reporting an unwanted pregnancy (1.8). When compared with pregnancies reported by heterosexual women with only male partners, those reported by heterosexual women who have sex with women were more likely to be mistimed (hazard ratio, 1.7), and those reported by bisexual and lesbian women were more likely to be unwanted (1.7-4.4).

CONCLUSIONS

Compared with heterosexuals who have sex with men only, adult sexual minority women are at equal or greater risk of reporting an unintended pregnancy. More research addressing the reproductive health care needs of sexual minority women is needed to develop strategies to improve family planning for this population.

Contraceptive Sterilization: Introducing A Couple Perspective to Examine Sociodemographic Differences in Use

CONTEXT

Most studies of contraceptive use have relied solely on the woman's perspective, but because men's attitudes and preferences are also important, analytic approaches based on couples should also be explored.

METHODS

Data from the 2006-2010 and 2011-2013 rounds of the National Survey of Family Growth yielded a sample of 4,591 men and women who were married or cohabiting with an opposite-sex partner and who had completed their intended childbearing. Respondents' reports of both their own and their partners' characteristics and behaviors were employed in two sets of analyses examining educational and racial and ethnic differences in contraceptive use: an individualistic approach (using multinomial logistic regression) and a couple approach (using multinomial logistic diagonal reference models).

RESULTS

In the full model using the individualistic approach, respondents with less than a high school education were less likely than those with at least a college degree to rely on male sterilization (odds ratios, 0.1-0.2) or a reversible method (0.4-0.5), as opposed to female sterilization. Parallel analyses limited to couples in which partners had the same educational levels (i.e., educationally homogamous couples) showed an even greater difference between those with the least and those with the most schooling (0.03 for male sterilization and 0.2 for a reversible method). When race and ethnicity, which had a much higher level of homogamy, were examined, the approaches yielded more similar results.

CONCLUSIONS

Research on contraceptive use can benefit from a couple approach, particularly when focusing on partners' characteristics for which homogamy is relatively low.