Yearning, learning, and conceding: reasons men and women change their childbearing intentions

People's childbearing intentions change over the course of their reproductive lives. These changes have been conceptualized as occurring in response to the realization that an individual is unlikely to achieve his or her intended fertility, because of constraints such as the "biological clock" or lack of a partner. In this article, we find that changes to child-bearing plans are influenced by a much wider range of factors than this. People change their plans in response to the wishes of their partners, in response to social norms, as the result of repartnering, and as the result of learning about the costs and benefits of parenthood; there are also differences between the factors that influence men's and women's decision-making. In a departure from existing studies in this area, we use a flexible analytical framework that enables us to analyze increases in planned fertility separately from decreases. This allows us to uncover several complexities of the decision-making process that would otherwise be hidden, and leads us to conclude that the determinants of increases in planned fertility are not simply equal and opposite to the determinants of decreases.

Intimate partner violence and reproductive coercion: global barriers to women's reproductive control

Jay Silverman and Anita Raj discuss the policies and interventions required to address the range of poor reproductive outcomes for women and adolescents, including loss of reproductive control, associated with intimate partner violence.

Please see later in the article for the Editors' Summary

East Asian childbearing patterns and policy developments

Childbearing behavior in East Asian countries has changed rapidly during the past half century from an average of five to seven children per family, to replacement-level fertility, and subsequently to unprecedentedly low levels, the lowest in the world. This article analyzes fertility trends in Hong Kong, Japan, singapore, south Korea, and Taiwan using cohort fertility data and methods, then examines social and economic causes of the childbearing trends, and surveys policies pursued to reverse the fertility trends. Postponement of childbearing started in the 1970s with continuously fewer delayed births being "recuperated," which resulted in ultra-low fertility. A rapid expansion of education and employment among women in a patriarchal environment has generated a stark dilemma for women who would like to combine childbearing with a career. Policy responses have been slow, with a more serious attempt to address issues in recent years. Thus far public and private institutions are not devoting sufficient attention to generating broad social change supportive of parenting.

Childlessness, psychological well-being, and life satisfaction among the elderly in China

This paper examines the effects of childlessness on the well-being of persons aged 65 and above in China. It is based on an application of ordered-logit regression in the analysis of the data from the 2002 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 22 provinces of China (N = 13,447). It compares parents with the childless elderly, focusing on three dimensions of psychological well-being, namely feelings of anxiety, loneliness, and uselessness, and on life satisfaction. The findings include the following. First, with control of social demographic variables of age, gender and education, childlessness is significantly associated with life satisfaction, feeling of anxiety and loneliness, but not feeling of uselessness. The childless elderly are less satisfied with their lives and feel more anxious and lonely than do parents, but they do not necessarily feel significantly more useless. Second, when controlled with social-demographic variables and additional socioeconomic variables of residence, living arrangement, availability of pension and medical services, childlessness is no longer significantly related to anxiety and loneliness, and it is related at only a marginally-significant level to life satisfaction. Third, individual education, place of residence, living arrangements, economic security and access to medical services are consistently related to life satisfaction and psychological well-being among the elderly. We conclude that providing social investments in education in early life and economic security and medical insurance in later life for both the childless and parents are crucial for improving individual psychological well-being and life satisfaction for the elderly.

Fertility awareness and attitudes towards parenthood among Danish university college students

BACKGROUND

Postponing parenthood has steadily increased during the past decades in Western countries. This trend has affected the size of families in the direction of fewer children born per couple. In addition, higher maternal age is associated with an increased risk of pregnancy-related complications such as prematurity and foetal death, while higher paternal age increases the risk of miscarriage and affects time-to-pregnancy. Hence, understanding the circumstances and reflections that influence the decision is greatly needed and little is known about potential gender difference influencing the choice. The aim was to investigate attitudes towards parenthood, intentions for childbirth and knowledge about fertility issues among men and women.

METHODS

We conducted a cross-sectional study based on a validated 49-item questionnaire among students, who attended selected mandatory lectures at a Danish university college in February to April 2016. The participation rate was 99%, and 517 completed the questionnaire.

RESULTS

Though the majority of all participants wished to have children in the future (>86%), there was significant difference between the genders (p = 0.002). Women rated having children to be more important than men did (p < 0.001), while men rated higher the likelihood of abstaining from having children if faced with infertility (p = 0.003). Knowledge about fertility issues was similar between genders including poor knowledge about the age-related decline in female fertility. While women found it more important to have children before being 'too old' (p = 0.04), still more than 40% of all respondents intended to have their last child after the age of 35 years. For both genders the most important prerequisite for parenthood was having a partner to share responsibility with. Perceived or experienced life changes related to parenthood were generally positive such as personal development.

CONCLUSION

The majority of respondents wished to have children, but many desired to have these after the biological decline in female fertility. The moderate knowledge level among both genders uncovered in this study is of concern. Future research should address the potential link between fertility knowledge and planning of parenthood. We may benefit from intervention studies examining the effect of routine preconception care.

Pervasive Muslim-Hindu fertility differences in India

Using the 1993 Indian Family and Health Survey, we examined Muslim-Hindu differences in (1) the parity-specific intent to have another child and (2) given a stated intent for no more children, reports of the current use of contraceptives. We found that Muslims are much more likely than Hindus to intend to have additional children and, among those who do not want more children, Muslims are much less likely than Hindus to use contraceptives. These findings are robust to model specification and pervasive across the states of India. This national study provides the context within which local studies should be enmeshed and begs for general (as opposed to place-specific) explanations for these pervasive differences.

Improving adolescent sexual and reproductive health in Latin America: reflections from an International Congress

In February 2014, an international congress on Promoting Adolescent Sexual and Reproductive Health (ASRH) took place in Cuenca, Ecuador. Its objective was to share evidence on effective ASRH intervention projects and programs in Latin America, and to link this evidence to ASRH policy and program development. Over 800 people participated in the three-day event and sixty-six presentations were presented.This paper summarizes the key points of the Congress and of the Community Embedded Reproductive Health Care for Adolescents (CERCA) project. It aims at guiding future ASRH research and policy in Latin America. 1. Context matters. Individual behaviors are strongly influenced by the social context in which they occur, through determinants at the individual, relational, family, community and societal levels. Gender norms/attitudes and ease of communication are two key determinants. 2. Innovative action. There is limited and patchy evidence of effective approaches to reach adolescents with the health interventions they need at scale. Yet, there exist several promising and innovative examples of providing comprehensive sexuality education through conventional approaches and using new media, improving access to health services, and reaching adolescents as well as families and community members using community-based interventions were presented at the Congress. 3. Better measurement. Evaluation designs and indicators chosen to measure the effect and impact of interventions are not always sensitive to subtle and incremental changes. This can create a gap between measured effectiveness and the impact perceived by the targeted populations. Thus, one conclusion is that we need more evidence to better determine the factors impeding progress in ASRH in Latin American, to innovate and respond flexibly to changing social dynamics and cultural practices, and to better measure the impact of existing intervention strategies. Yet, this Congress offered a starting point from which to build a multi-agency and multi-country effort to generate specific evidence on ASRH with the aim of guiding policy and program decision-making. In a region that contains substantial barriers of access to ASRH education and services, and some of the highest adolescent pregnancy rates in the world, the participants agreed that there is no time to lose.

Racial disparities in perinatal outcomes and pregnancy spacing among women delaying initiation of childbearing

INTRODUCTION

Reducing racial/ethnic disparities is a key objective of the Healthy People 2010 initiative. Unfortunately, racial disparities among women delaying initiation of childbearing have received limited attention. As more women in the US are delaying initiation of childbearing, it is important to examine racial disparities in reproductive health outcomes for this subgroup of women.

OBJECTIVE

To examine racial disparities in perinatal outcomes, interpregnancy interval, and to assess the risk for adverse outcomes in subsequent pregnancy for women delaying initiation of childbearing until age 30 or older compared to those initiating childbearing at age 20-29.

METHODS

We conducted a retrospective cohort study using the Missouri maternally linked cohort files 1978-1997. Final study sample included 239,930 singleton sibling pairs (Whites and African Americans). Outcome variables included first and second pregnancy outcomes (fetal death, low birth weight, preterm delivery and small-for-gestational age) and interpregnancy interval between first and second pregnancy. Independent variables included maternal age at first pregnancy and race. Analysis strategies used involved stratified analyses and multivariable unconditional logistic regression; interactions between maternal race, age and interpregnancy interval were examined in the regression models.

RESULTS

Compared to Whites, African American mothers initiating childbearing at age 30 or older had significantly higher rates of adverse outcomes in the first and second pregnancy (P < 0.0001). Generally, African Americans had significantly higher rates of second pregnancy following intervals <6 months compared to Whites; however, no significant racial differences were noted in interpregnancy interval distribution pattern after controlling for maternal age at first pregnancy. African Americans delaying initiation of childbearing had significantly higher risk for adverse perinatal outcomes in the second pregnancy compared to Whites after controlling for potential confounders, however there were no significant interactions between maternal age at first pregnancy, race and short interpregnancy interval.

CONCLUSION

Although African Americans were less likely to delay initiation of childbearing than were White women, their risk for adverse perinatal outcomes was much greater. As health care providers strive to address racial disparities in birth outcomes, there is need to pay attention to this unique group of women as their population continues to increase.

Immigration measures and reproductive health among Hispanic youth: findings from the national longitudinal survey of youth, 1997-2003

PURPOSE

To explore relationships between immigration measures and risk of reproductive and sexual events among U.S. Hispanic adolescents.

METHODS

We examined generation status, language in the home and country of origin in relation to sexual activity, contraception, and childbearing among 1614 Hispanic adolescents, using nationally representative 1997-2003 longitudinal data. Multivariable analyses controlled for potentially confounding variables. Tests for effect modification by gender and Mexican origin were conducted.

RESULTS

Fewer first generation adolescents transitioned to sexual intercourse before age 18 (odds ratio [OR]=.80, 95% confidence interval [CI]=.66-.98) and fewer first and second generation sexually active teens used contraceptives consistently at age 17 (OR=.32, 95% CI=.17-.60 and OR=.50, 95% CI=.31-.80, respectively) than third-generation teens. Language was similarly associated with the transition to sexual intercourse and contraceptive practices. Versus teens of Mexican origin, teens of Puerto Rican origin and origins other than Cuba and Central/South America had greater odds of becoming sexually active; youth of all origins except Central/South America had fewer multiple live births (OR=.14-.31). Gender modified the effects of generation on consistent use of contraceptives and condoms at age 17. Gender also modified the effect of country of origin on transitioning to sexual intercourse before age 18 years.

CONCLUSIONS

Results expand on previous observations that generation, language, and country of origin are predictors of reproductive and sexual risks for Hispanic adolescents. These immigration measures may therefore be useful in targeting community and clinical preventive services.

Holding the line: family responses to pregnancy and the desire for a child in the context of HIV in Vietnam

Health services around the world offer many guidelines for HIV-positive women who are pregnant or who want to become pregnant, and for women with HIV infected partners. These guidelines are addressed to women and, increasingly, also to men, but pay little or no attention to the role of other members of the family in fertility decisions. This study looked at factors influencing decisions about fertility in families with an HIV-positive member. In Vietnam, the whole family takes a crucial role in deciding whether a woman should become pregnant and whether she will keep her child. This decision is taken in the context not only of the close family but also under the influence of ancestors and the weight given to them within the culture. Key in this regard is the need for parents and grandparents to have male offspring. Health workers share these ideas about preferred family composition and support men and women in the quest for male offspring. Policies and guidelines should take into account these additional family factors and goals as a basis for the design of appropriate programmes to reduce HIV transmission.

Measurement of unmet need for family planning: longitudinal analysis of the impact of fertility desires on subsequent childbearing behaviors among urban women from Uttar Pradesh, India

BACKGROUND

The measure of unmet need relies on women's reported fertility desires; previous research has demonstrated that fertility desires may be fluid and not firm.

STUDY DESIGN

Our study uses recently collected longitudinal data from four cities in Uttar Pradesh, India, to examine whether women's fertility desires and family planning (FP) use at baseline predict pregnancy/birth experience in the 2-year follow-up period.

RESULTS

Multivariate models demonstrate that women who were using any method of FP and reported an intention to stop childbearing were the least likely to experience a pregnancy/birth in the 2-year follow-up period. The stated desire to delay childbearing, whether or not the woman was using FP, did not distinguish pregnancy/birth experience. Ninety-two percent of pregnancies/births over the follow-up period were considered "wanted then" suggesting post-hoc rationalization of the pregnancy/birth even among those women who reported a desire to stop childbearing 2 years earlier.

CONCLUSIONS

More nuanced assessments of fertility intentions may be needed to adequately gauge latent FP needs. Non-users of FP may be ambivalent about future childbearing and the timing of future births; these women may not have an unmet need for FP as typically defined.

Comparative reproductive output of androphilic and gynephilic males in samoa

Debate exists in the behavioral sciences regarding the extent to which androphilic males reproduce compared to their gynephilic counterparts. Quantitative data that might speak to this debate are surprisingly rare. Here, we compared the reproductive output of 235 transgendered, exclusively androphilic Samoan males (known locally as fa'afafine) to that of 447 exclusively gynephilic Samoan males. Samoan gynephilic male participants fathered significantly more children than fa'afafine participants. In fact, none of the fa'afafine in our sample produced offspring. On the basis of this evidence and anecdotal accounts in the anthropological literature, we contend that absence of reproductive output is a near absolute cross-cultural universal characterizing non-Western, transgendered androphilic ("third-gender") males. Models for the evolution of male androphilia must account for how genes associated with this sexual orientation originated in the past and persisted in populations over time despite the fact that the vast majority of androphilic males have no direct reproductive success.

Reproductive Strategies and Islamic Discourse

Approximately 37 thousand Malians currently reside in France as part of the West African diaspora. Primarily Muslim, both women and men confront challenges to their understandings of Islamic prohibitions and expectations, especially those addressing conjugal relations and reproduction. Biomedical policies generate marital conflicts and pose health dilemmas for women who face family and community pressures to reproduce but biomedical encouragement to limit childbearing. For many women, contraception represents a reprieve from repeated pregnancies and fatigue in spite of resistance from those who contest women's reproductive decisions as antithetical to Islam. French social workers play a particularly controversial role by introducing women to a discourse of women's rights that questions the authority of husbands and of religious doctrine. Women and men frame decisions and debate in diverse interpretations of Islam as they seek to manage the contradictions of everyday life and assert individual agency in the context of immigration and health politics.

Childbearing postponement and child well-being: a complex and varied relationship?

Over the past several decades, U.S. fertility has followed a trend toward the postponement of motherhood. The socioeconomic causes and consequences of this trend have been the focus of attention in the demographic literature. Given the socioeconomic advantages of those who postpone having children, some authors have argued that the disadvantage experienced by certain groups would be reduced if they postponed their births. The weathering hypothesis literature, by integrating a biosocial perspective, complicates this argument and posits that the costs and benefits of postponement may vary systematically across population subgroups. In particular, the literature on the weathering hypothesis argues that, as a consequence of their unique experiences of racism and disadvantage, African American women may experience a more rapid deterioration of their health which could offset or eventually reverse any socioeconomic benefit of postponement. But because very few African American women postpone motherhood, efforts to find compelling evidence to support the arguments of this perspective rely on a strategy of comparison that is problematic because a potentially selected group of older black mothers are used to represent the costs of postponement. This might explain why the weathering hypothesis has played a rather limited role in the way demographers conceptualize postponement and its consequences for well-being. In order to explore the potential utility of this perspective, we turn our attention to the UK context. Because first-birth fertility schedules are similar for black and white women, we can observe (rather than assume) whether the meaning and consequences of postponement vary across these population subgroups. The results, obtained using linked UK census and birth record data, reveal evidence consistent with the weathering hypothesis in the United Kingdom and lend support to the arguments that the demographic literature would benefit from integrating insights from this biosocial perspective.

"Fewer Children, Better Life" or "As Many as God Wants"?

In the West it is often assumed that religion (esp. Islam) and contraception are mutually exclusive. Yet, the Islamic Republic of Iran has one of the most successful family-planning programs in the developing world, and is often looked to as a potential model for other Muslim countries. Although Iran's family-planning program has been extremely successful among Iranians, it has been far less successful among Afghan refugees and other ethnic groups. Afghans and Iranians both seek services in Iran's public health sector for family health care, treatment of infectious disease, and childhood vaccinations. On these occasions, all adult married patients are strongly encouraged to use family planning to reduce the number of offspring. In this article, we explore how Iran's family-planning program is differentially perceived and utilized among low-income Iranian and Afghan refugee families in rural and urban locations. Particular attention is given to how different interpretations of Islam may or may not influence reproductive health-related behaviors and how cultural factors influence reproductive strategies.

On the politics and practice of Muslim fertility: comparative evidence from West Africa

Recent popular works have represented Muslim fertility as dangerously high, both a cause and consequence of religious fundamentalism. This article uses comparative, statistical methods to show that this representation is empirically wrong, at least in West Africa. Although religion strongly inflects reproductive practice, its effects are not constant across different communities. In West African countries with Muslim majorities, Muslim fertility is lower than that of their non-Muslim conationals; in countries where Muslims are in the minority, their apparently higher reproductive rates converge to those of the majority when levels of education and urban residence are taken into account. A similar pattern holds for infant mortality. By contrast, in all seven countries, Muslim women are more likely to report that their most recent child was wanted. The article concludes with a discussion of the relationship between autonomy and fertility desires.

Induced abortion among HIV-positive women in Northern Vietnam: exploring reproductive dilemmas

Across the world, childbearing among HIV-positive women is a socially controversial issue. This paper derives from a larger research project that investigated reproductive decisions among HIV-positive women in Quang Ninh, a northern province of Vietnam. The paper focuses on 13 women who had an abortion after being diagnosed as HIV-positive, exploring their reflections, concerns and dilemmas. The results show that the HIV-positive pregnant women sought to balance their desires for a child with their worries of being unable to fulfill their responsibilities as mothers. Even while strongly desiring to become mothers, women in this study opted to terminate their pregnancies out of fear that they could not care adequately for the child they expected. These results indicate that when providing reproductive health counselling and support for HIV-positive women and their families, it is essential to take into account the socio-cultural factors that shape women's reproductive options.

The association of television and radio with reproductive behavior

This note analyzes the association between media exposure and reproductive behavior in 48 developing countries. A summary of part of a more extensive Demographic and Health Surveys report, it shows strong connections between media exposure and the use of modern contraception, the number of children desired, and recent fertility. Television viewing is particularly important; it is assumed to expose viewers to aspects of modern life that compete with traditional attitudes toward the family and is associated with greater use of modern contraceptive methods, with a desire for fewer children, and with lower fertility. These relationships are particularly noteworthy because the data measure only the frequency of media exposure with no information about its content.

Cultural expectations and reproductive desires: experiences of South African women living with HIV/AIDS (WLHA)

We explored factors influencing sexual and reproductive (SR) decisions related to childbearing for women living with HIV/AIDS (WLHA) in South Africa. We conducted four focus group interviews with 35 women living with HIV/AIDS. Our results show that the SR health care needs of women were not being addressed by many health care workers (HCWs). Additionally, we found that health care decisions were influenced by partners and cultural expectations of motherhood. Given the importance of motherhood, it is necessary for HCWs to address the diverse sexual needs and reproductive desires of WLHA.

Trends in reproductive behavior among young single women in Colombia and Peru: 1985-1999

Using "calendar" data for single women aged 15-24 from successive Demographic and Health Surveys (DHS) conducted in Colombia and Peru during the 1990s, we document trends, year by year, in sexual activity, the use of contraceptives, and subsequent reproductive outcomes. We provide evidence of the important and hitherto largely untapped potential of DHS calendar data to draw complete sexual and reproductive profiles when data from various surveys are integrated. Over the period 1985-1999, young single women in both Colombia and Peru became sexually active at younger ages. The use of contraceptives, especially the use of condoms, increased but did not fully offset the rise in sexual activity, and thus the incidence of premarital conceptions rose among young single women. In both countries, sharp declines occurred in the proportion of premaritally conceived births that were reported as being wanted.

Gender, culture and reproductive decision-making among recent Mexican migrants in California

This study of the experiences of recent Mexican immigrants living in California explores the changing perceptions of sexual and societal norms, including gender roles and resulting reproductive decision-making, that appear to accompany the migration process. These norms are compared to those held by migrants' families of origin in Mexico. We analysed 44 semi-structured interviews conducted with a client-based population in order to identify reproductive perceptions and practices that appear to be influenced by recent migration. Using a grounded theory approach, 26 women and 18 men's narratives were analysed to understand the complexity of changing expectations and resulting reproductive health practises. The social marginalisation and isolation of immigrants' experiences, the challenges of new socio-economic factors and access to health services appear to reshape views on reproductive decisions. While traditional gender roles and large families remain a spoken ideal, in practice these reproductive patterns are changing. Our analysis suggests that the migration process does alter relationships, reproductive decisions and contraceptive use among recent Mexican immigrants. The public health goal should be to provide an array of accessible and affordable services, tailored to the needs of this increasingly larger population of recent Mexican migrants in California and throughout the USA.

Sexual and reproductive health behavior and unmet needs among a sample of adolescents living with HIV in Zambia: a cross-sectional study

BACKGROUND

Adolescents living with HIV face challenges, such as disclosure of HIV status, adherence to antiretroviral therapy, mental health, and sexual and reproductive health (SRH). These challenges affect their future quality of life. However, little evidence is available on their sexual behaviors and SRH needs in Zambia. This study aimed at assessing their sexual behaviors and SRH needs and identifying factors associated with marriage concerns and a desire to have children.

METHODS

This cross-sectional study was conducted at the University Teaching Hospital from April to July 2014. We recruited 200 adolescents aged 15-19 years who were aware of their HIV-positive status. We collected data on their first and recent sexual behavior, concerns about marriage, and desire to have children. We used the Generalized Linear Model to identify factors associated with having concerns about marriage and desire to have children. We performed thematic analysis with open-ended data to determine their perceptions about marriage and having children in the future.

RESULTS

Out of 175 studied adolescents, 20.6% had experienced sexual intercourse, and only 44.4% used condoms during the first intercourse. Forty-eight percent had concerns about marriage, and 87.4% desired to have children. Marriage-related concerns were high among those who desired to have children (adjusted relative risk [ARR] = 2.51, 95% CI = 1.02 to 6.14). Adolescents who had completed secondary school were more likely to desire to have children (ARR = 1.35, 95% CI = 1.07 to 1.71). Adolescents who had lost both parents were less likely to want children (ARR = 0.80, 95% CI = 0.68 to 0.95). Thematic analysis identified that major concerns about future marriage were fear of disclosing HIV status to partners and risk of infecting partners and/or children. The reasons for their willingness to have children were the desire to be a parent, having children as family assets, a human right, and a source of love and happiness.

CONCLUSIONS

Zambian adolescents living with HIV are at risk of engaging in risky sexual relationships and have difficulties in meeting needs of SRH. HIV care service must respond to a wide range of needs.

Dual contraceptive method use and pregnancy intention among people living with HIV receiving HIV care at six hospitals in Thailand

BACKGROUND

Describe dual contraceptive method use and the intention to become pregnant of people living with HIV (PLHIV) and their partners in Thailand.

METHODS

From January 2008-March 2009, we systematically selected a cohort of PLHIV from PLHIV seeking care at five tertiary care hospitals and one community hospital to complete a questionnaire assessing sexual activity, intention to become pregnant, and contraceptive practices at baseline and 12 months after enrollment. Participants received short family planning messages every 2-3 months to promote the use of dual contraceptives and were offered family planning services.

RESULTS

A total of 1,388 PLHIV enrolled, their median age was 37 years (IQR 33-43), 898 (64.7%) had a steady partner, and 737 (53.1%) were male. Among those with a steady partner, 862 (96.0%) did not intend to become pregnant; 709 (82.3%) had sex during the previous 3 months, 683 (96.3%) used at least one contraceptive method, and 202 (29.6%) used dual contraceptive methods. Of the 317 PLHIV who used a single contraceptive method at baseline, 66 (20.8%) reported using dual methods at 12 months. Participants at two tertiary care hospitals where coordinators facilitated PLHIV referral between HIV and OB/GYN clinics were more likely than participants at the other hospitals to change from single method to dual method (p ≤ 0.03).

CONCLUSION

Few PLHIV in this study intended to become pregnant; however, only one-fourth used dual contraceptive methods. Integrating an assessment of the intention to become pregnant and strengthening the PLHIV referral systems in family planning services may contribute to higher rates of dual contraceptive use.

Reproductive attitudes and behaviors in people with sickle cell disease or sickle cell trait: a qualitative interpretive meta-synthesis

Sickle cell disease (SCD) is a serious and life threatening disorder. The literature on informed reproductive decisions among people with SCD is limited, suggesting that there is a lack of awareness about SCD and Sickle cell trait status (SCT) among high-risk populations. The purpose of this qualitative interpretive meta-synthesis (QIMS) is to examine the reproductive attitudes and behaviors in people with SCD or SCT to create effective genetic counseling programs to inform reproductive decision making. Three studies were included in the QIMS for a total sample of 79 participants. The majority of the sample was African American, ages 16 to 63. Other demographic characteristics of the study populations and data collection methods used in these studies varied. Seven themes on reproductive attitudes and behaviors among people with SCD or SCT emerged: lack of awareness or education about SCD and SCT; men who deny having SCT; attitudes toward learning one's SCT status; rationales for learning a partner's SCT status prior to commencing a relationship; valuing relationships over SCD risk; learning one's own and partner's SCT status; and the consequences of not asking about partners' SCT status. Implications for prevention programming involving improved education and awareness about the disease and reproduction are discussed.

Age at first reproduction and economic change in the context of differing kinship ecologies

Kinship systems which tend to be based on ecologies of subsistence also assign differential power, privilege, and control to human connections that present pathways for manipulation of resource access and transfer. They can be used in this way to channel resource concentrations in women and hence their reproductive value. Thus, strategic female life course trade-offs and their timing are likely to be responsive to changing preferences for qualities in women as economic conditions change. Female life histories are studied in two ethnic groups with differing kinship systems in NE India where the competitive market economy is now being felt by most households. Patrilineal Bengali (599 women) practice patrilocal residence with village exogamy and matrilineal Khasi (656 women) follow matrilocal residence with village endogamy, both also normatively preferring three-generation extended households. These households have helpful senior women and significantly greater income. Age at first reproduction (AFR), achieved adult growth (height) and educational level (greater than 6 years or less) are examined in reproductive women, ages 16-50. In both groups, women residing normatively are older at AFR and taller than women residing nonnormatively. More education is also associated with senior women. Thus, normative residence may place a woman in the best reproductive location, and those with higher reproductive and productive potential are often chosen as households face competitive market conditions. In both groups residing in favorable reproductive locations is associated with a faster pace of fertility among women, as well as lower offspring mortality among Khasi, to compensate for a later start.