Women's involvement in decision-making and association with reproductive health behaviors: findings from a cross-sectional survey in Niger

BACKGROUND

Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women's participation in decision-making and its influence on reproductive health behaviors.

METHODS

Cross-sectional survey with married women (15-49 years, N = 2,672) in Maradi and Zinder Niger assessed women's participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women's participation in decision-making.

RESULTS

Only 16% of the respondents were involved-either autonomously or jointly with their spouse-in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06-1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage.

CONCLUSION

Women's engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women's involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women's decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women's voice either before women enter marital partnerships or after (for instance, using health and social programming).

A Questionnaire-Based Study to Evaluate Health-Related Behaviors in 602 Women of Reproductive Age in Poland

BACKGROUND Women's health and undertaking health behaviors during the reproductive period by women, especially during pregnancy, are an important indicator that is reflected both in their own health and in health of their children. This study aimed to use a questionnaire to evaluate the health-related behaviors in women of reproductive age in Poland. MATERIAL AND METHODS The studies were conducted among 602 women of reproductive age by diagnostic poll method with the use of questionnaire technique. The applied tool was an original on-line questionnaire. A link to the questionnaire was sent to women aged 18-49 years using the snowball sampling technique and was posted on thematic pro-health website forums. RESULTS The majority of women participating in the study exhibited health behaviors on the average level (65.3%; M=7.6). Pro-health behaviors were exhibited mainly by women with higher education (M=7.7; SD=2.6), married women (M=8.0; SD=2.6), and women who were pregnant at the time (M=8.8; SD=2.6). However, single women participating in the study consumed alcohol more often (80.6%). The observed relationships were statistically significant (P<0.05). CONCLUSIONS This survey showed that younger women with no children were significantly less likely to be aware of positive health-associated behaviors and lifestyle when compared with older women with children. This small study supports the importance of health education in young women before they have children.

Determinants of maternal high-risk fertility behaviors and its correlation with child stunting and anemia in the East Africa region: A pooled analysis of nine East African countries

Background

In low-income nations, high-risk fertility behavior is a prevalent public health concern that can be ascribed to unmet family planning needs, child marriage, and a weak health system. As a result, this study aimed to determine the factors that influence high-risk fertility behavior and its impact on child stunting and anemia.

Method

This study relied on secondary data sources from recent demography and health surveys of nine east African countries. Relevant data were extracted from Kids Record (KR) files and appended for the final analysis; 31,873 mother-child pairs were included in the final analysis. The mixed-effect logistic regression model (fixed and random effects) was used to describe the determinants of high-risk fertility behavior (HRFB) and its correlation with child stunting and anemia.

Result

According to the pooled study about 57.6% (95% CI: 57.7 to 58.2) of women had at least one high-risk fertility behavior, with major disparities found across countries and women’s residences. Women who lived in rural areas, had healthcare access challenges, had a history of abortion, lived in better socio-economic conditions, and had antenatal care follow-up were more likely to engage in high-risk fertility practices. Consequently, Young maternal age at first birth (<18), narrow birth intervals, and high birth orders were HRFBs associated with an increased occurrences of child stunting and anemia.

Conclusion

This study revealed that the magnitude of high-risk fertility behavior was higher in east Africa region. The finding of this study underscores that interventions focused on health education and behavioral change of women, and improvement of maternal healthcare access would be helpful to avert risky fertility behaviors. In brief, encouraging contraceptive utilization and creating awareness about birth spacing among reproductive-age women would be more helpful. Meanwhile, frequent nutritional screening and early intervention of children born from women who had high-risk fertility characteristics are mandatory to reduce the burden of chronic malnutrition.

Fecundability in reproductive aged women at risk of sexual dysfunction and associated risk factors: a prospective preconception cohort study

BACKGROUND

Female sexual dysfunction (FSD) is a prevalent problem, affecting up to 41% of reproductive aged women worldwide. However, the association between female sexual function (FSF) and fecundability in women attempting to conceive remains unclear. We aimed 1) to examine the association between FSF in reproductive-aged preconception Asian women and fecundability, as measured by time-to-pregnancy in menstrual cycles, and 2) to examine lifestyle and behavioral factors associated with FSF.

METHODS

From the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) prospective cohort, we evaluated FSF using the 6-item Female Sexual Function Index (FSFI-6) and ascertained time-to-pregnancy within a year of baseline assessment. We estimated fecundability ratio (FR) and 95% confidence interval (CI) using the discrete-time proportional hazards model, accounting for left-truncation and right censoring. We used multivariable logistic and linear regression models to identify potential factors related to FSF.

RESULTS

Among 513 participants, 58.9% had low FSF as defined by a total FSFI-6 score at or below the median value of 22. Compared to women with high FSF, those with low FSF had a 27% reduction in fecundability (FR 0.73; 95% CI 0.54, 0.99), with adjustment for age, ethnicity, education, parity and body mass index. Overall, the FRs generally reduced with decreasing FSFI-6 scores. Physical activity, obesity, absence of probable depression and anxiety were independently associated with reduced odds of low FSF and increased FSFI-6 scores, after adjusting for sociodemographic characteristics.

CONCLUSIONS

Low FSF is associated with a longer time-to-pregnancy. Early evaluation and optimization of FSF through increased physical activity and optimal mental health may help to improve female fecundity. The finding of obese women having improved FSF remains uncertain which warrants further investigations on plausibly mechanisms. In general, the current finding highlights the importance of addressing FSF in preconception care service for general women, which is currently lacking as part of the fertility promotion effort in the country.

Early marriage and early childbearing in South Asia: trends, inequalities, and drivers from 2005 to 2018

Early marriage (EM) and early childbearing (ECB) have far-reaching consequences. This study describes the prevalence, trends, inequalities, and drivers of EM and ECB in South Asia using eight rounds of Demographic and Health Survey data across 13 years. We report the percentage of ever-married women aged 20-24 years (n = 105,150) married before 18 years (EM) and with a live birth before 20 years (ECB). Relative trends were examined using average annual rate of reduction (AARR). Inequalities were examined by geography, marital household wealth, residence, and education. Sociodemographic drivers of changes for EM were assessed using regression decomposition analyses. We find that EM/ECB are still common in Bangladesh (69%/69%), Nepal (52%/51%), India (41%/39%), and Pakistan (37%/38%), with large subnational variation in most countries. EM has declined fastest in India (AARR of -3.8%/year), Pakistan (-2.8%/year), and Bangladesh (-1.5%/year), but EM elimination by 2030 will not occur at these rates. Equity analyses show that poor, uneducated women in rural areas are disproportionately burdened. Regression decomposition analysis shows that improvements in wealth and education explained 44% (India) to 96% (Nepal) of the actual EM reduction. Investments across multiple sectors are required to understand and address EM and ECB, which are pervasive social determinants of maternal and child wellbeing.

Childlessness and Health Among Older Adults: Variation Across Five Outcomes and 20 Countries

OBJECTIVES

No previous study to the best of our knowledge has examined the association between childlessness and health using a wide range of countries and health outcomes. This study improves previous literature by examining the relationship between "childlessness" (1 = childless for any reason, 0 = parent of biological, step, or adopted child) and health across 20 countries and five health outcomes.

METHODS

Drawing on cross-sectional harmonized data from the family of Health and Retirement Surveys across the United States (HRS, Wave 11), Europe (SHARE, Waves 4 and 5), Mexico (MHAS, Wave 3), and China (CHARLS, Wave 2), we use logistic regression models to estimate the association between childlessness and poor health (poor self-rated health, 1 or more ADL limitations, 1 or more IADL limitations, 1 or more chronic conditions, and depression) in a sample of adults aged 50 and older across 20 countries (N = 109,648).

RESULTS

Our results point to an absence of associations between childlessness and health, and suggest that childlessness may be associated with better (e.g., Mexico, Hungary) or worse health (e.g., Austria, Estonia, Netherlands, Poland) in certain contexts and for certain measures.

DISCUSSION

We discuss these findings in light of the meaning of childlessness, as well as cross-national economic, social, and cultural contexts to provide suggestions for aging policy and future research.

Using Systematic Anomalous Case Analysis to Examine Sexual and Reproductive Health Outcomes in the Philippines

The Philippines is characterized by sustained economic growth and political stability, yet sexual and reproductive health indicators have stalled or even worsened in recent decades. We employed an innovative, mixed-methods approach-Systematic Anomalous Case Analysis-to gain insights into these worsening trends by examining sexual and reproductive decision-making among a cohort of young adults in Metro Cebu, Philippines. We first analyzed longitudinal data (1998-2009) to predict reproductive outcomes (i.e., age of first sex, number of living children) among participants in the Cebu Longitudinal Health and Nutrition Survey to identify cases (predicted and anomalous) with whom we subsequently conducted qualitative, in-depth interviews in 2013-14 (n = 48). Analysis of the qualitative data revealed unique social and contextual factors that shaped patterns of sexual and contraceptive decision-making across three, distinct reproductive life stages: (1) at first sex, (2) after the birth of first child, and (3) after the birth of several children. However, gendered roles and expectations exerted strong influences on sexual and reproductive outcomes across these life stages. Finally, we identified two constructs from our qualitative analysis-sexual fluidity and sexual agency-that deserve further examination and integration into theoretical and empirical models of sexual and reproductive decision-making.

Fertility intentions and maternal health behaviour during and after pregnancy

This study examines associations between fertility intentions and maternal health behaviours during and after pregnancy among a nationally representative sample of 3,442 women from India. Two waves of data (2005, 2012) from the India Human Development Survey were analyzed to investigate the influence of unwanted births on women's use of antenatal care, timely postnatal care, and the delivery setting using binary and ordered logistic regression, partial proportional odds models, and propensity score weighting. Fifty-eight per cent of sample births were unwanted. Regression results show that, net of maternal and household characteristics, women with unwanted births were less likely to obtain any antenatal care and had fewer antenatal tests performed. Unwantedness was also associated with a lower likelihood of delivering in an institutional setting and of obtaining timely postnatal care. The relationships between unwantedness and antenatal care, postnatal care, and delivery setting were robust to models accounting for propensity weighting.

Spacing, Stopping, or Postponing? Fertility Desires in a Sub-Saharan Setting

A growing body of research has argued that the traditional categories of stopping and spacing are insufficient to understand why individuals want to control fertility. In a series of articles, Timæus, Moultrie, and colleagues defined a third type of fertility motivation-postponement-that reflects a desire to avoid childbearing in the short term without clear goals for long-term fertility. Although postponement is fundamentally a description of fertility desires, existing quantitative research has primarily studied fertility behavior in an effort to find evidence for the model. In this study, we use longitudinal survey data to consider whether postponement can be identified in standard measures of fertility desires among reproductive-age women in rural Mozambique. Findings show strong evidence for a postponement mindset in this population, but postponement coexists with stopping and spacing goals. We reflect on the difference between birth spacing and postponement and consider whether and how postponement is a distinctive sub-Saharan phenomenon.

Predictors of parenting intentions among childless lesbian, gay, and heterosexual adults

Disparities in the intention to parent have been found for lesbian and gay individuals compared with heterosexual individuals, but little is known about what social contexts predict these differences. Qualities of family relationships, friendships, and romantic relationships may all play a role, but these have not been studied as a function of sexual orientation. Using a large national sample of adults in the United States, this study explored intentions for parenthood, ideal family size, and predictors of parenting intentions as a function of gender and sexual orientation. Results showed that fewer lesbian and gay than heterosexual individuals intended to become parents. In addition, among those who intended parenthood, lesbian and gay individuals reported smaller intended family sizes than did their heterosexual peers. Sociocontextual and demographic variables predicted parenting intentions similarly among all participants, regardless of sexual orientation. However, dissimilarities in the levels of these predictors explained some of the disparity in parenting intentions between lesbian/gay and heterosexual participants. Much remains to be learned about the role of sexual orientation in family formation processes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Relationships of Reproductive Coercion and Intimate Partner Violence to Unintended Pregnancy

OBJECTIVE

To examine the prevalence, correlates, and influences of male partner reproductive coercion (RC) and intimate partner violence (IPV) on unintended pregnancy (UIP).

DESIGN

Retrospective cohort study using population-based data.

SETTING

Six participating states contributed data from the Pregnancy Risk Assessment Monitoring System (PRAMS).

PARTICIPANTS

Data were obtained for 20,252 women who gave birth between 2012 and 2015 and completed the PRAMS survey within 9 months of giving birth.

METHODS

Weighted descriptive statistics and multivariate logistic regression models were used to assess the influence of RC and IPV on odds of UIP.

RESULTS

Approximately 2.7% (n = 600) of participants reported physical IPV, and 1.1% (n = 285) reported RC. Participants less than 30 years of age, with low socioeconomic status, who were single and of Black or Hispanic race/ethnicity were at significantly increased risk of IPV. With the exception of Hispanic race/ethnicity, these sociodemographic characteristics were also associated with an increased risk for RC. Participants who experienced IPV had a nearly eightfold increased risk of RC (adjusted odds ratio = 7.98, 95% confidence interval [CI] [4.68, 13.59]) than their nonabused counterparts. In univariate models, RC, IPV, or RC with IPV were significantly associated with increased odds of UIP (odds ratio [OR] = 2.18, 95% CI [1.38, 3.44]; OR = 2.36, 95% CI [1.75, 3.19]; OR = 3.55, 95% CI [1.56, 8.06], respectively); however, results were nonsignificant after adjusting for sociodemographic factors.

CONCLUSION

In this population-based sample, we confirmed that there were links among IPV, RC, and UIP, all factors associated with poor maternal and infant outcomes. Screening for IPV and RC is an important step toward reducing rates of UIP.

Male partner reproductive coercion among women veterans

BACKGROUND

Male partner reproductive coercion is defined as male partners' attempts to promote pregnancy through interference with women's contraceptive behaviors and reproductive decision-making. Male partners may try to promote pregnancy through birth control sabotage such as taking away or destroying their partners' contraceptives, refusing to wear condoms, and/or verbally pressuring their partners to abstain from contraceptive use. Reproductive coercion is associated with an elevated risk for unintended pregnancy. Women who experience intimate partner violence, who are in racial/ethnic minorities, and who are of lower socioeconomic status are more likely to experience reproductive coercion. Women veterans who use Veterans Affairs for health care may be particularly vulnerable to reproductive coercion because they are disproportionally from racial/ethnic minority groups and experience high rates of intimate partner violence.

OBJECTIVES

We sought to examine the prevalence, correlates, and impact of reproductive coercion among women veterans who are served by the Veterans Affairs healthcare system.

STUDY DESIGN

We analyzed data from a national telephone survey of women veterans aged 18-44 years, with no history of sterilization or hysterectomy, who had received care within the Veterans Affairs system in the previous 12 months. Participants who had sex with men in the last year were asked if they experienced male partner reproductive coercion. Adjusted logistic regression was used to examine the relationship between participant characteristics and male partner reproductive coercion and the relationship between reproductive coercion and the outcomes of contraceptive method used at last sex and pregnancy and unintended pregnancy in the last year.

RESULTS

Among the 1241 women veterans in our study cohort, 11% reported experiencing male partner reproductive coercion in the past year. Black women, younger women, and single women were more likely to report reproductive coercion than their white, older, and married counterparts. Women who experienced military sexual trauma were also more likely to report reproductive coercion compared with women who did not report military sexual trauma. In adjusted analyses, compared with women who did not experience reproductive coercion, those who did were less likely at last sex to have used any method of contraception (76% vs 80%; adjusted odds ratio, 0.61; 95% confidence interval, 0.38-0.96), prescription contraception (43% vs 55%; adjusted odds ratio, 0.62; 95% confidence interval, 0.43-0.91), and their ideal method of contraception (35% vs 45%; adjusted odds ratio, 0.63; 95% confidence interval, 0.43-0.93). Those who reported coercion were more likely to have had a pregnancy in the last year (14% vs 10%; adjusted odds ratio, 2.07; 95% confidence interval, 1.17-3.64); there were no significant differences in unintended pregnancy by coercion status (6% vs 4%; adjusted odds ratio, 1.63; 95% confidence interval, 0.71-3.76).

CONCLUSION

Eleven percent of women veterans in our sample experienced male partner reproductive coercion, which may impact their use of contraception and ability to prevent pregnancy.

Pregnancy Ambivalence and Long-Acting Reversible Contraceptive (LARC) Use Among Young Adult Women: A Qualitative Study

CONTEXT

Many young adults are unclear about how much they want to have, or prevent having, a baby. However, pregnancy ambivalence is an underexamined factor in the uptake of long-acting reversible contraceptive (LARC) methods-IUDs and implants-the most effective methods available.

METHODS

In 2014, investigators conducted six focus groups and 12 interviews with 50 women aged 18-29 in Dane County, Wisconsin; participants were either university students or community residents receiving public assistance. A modified grounded theory approach was used to analyze the data.

RESULTS

Four themes emerged. First, participants described a pregnancy desire spectrum: Those strongly motivated to avoid pregnancy were most receptive to LARC methods, while those with less clear or mixed desires worried that these methods would prevent "accidental" pregnancies that might not be unwelcome. Second, women within a few years of wanting children perceived LARC methods as too "permanent," despite awareness of their reversibility. Third, age and life stage were important factors: Younger women and those attending school or beginning careers were more likely than others to consider these methods because they had clearer motivations to avoid pregnancy. Finally, relationship stage influenced receptiveness to LARC methods: Women in newer relationships were more receptive than were those in longer term relationships who imagined having a baby with their partner someday.

CONCLUSION

Effectiveness is not the only factor in women's selection and use of contraceptive methods. Individual preferences will lead some women to choose non-LARC methods even when fully informed of their options.

Sexual orientation and future parenthood in a 2011-2013 nationally representative United States sample

Previous researchers have found evidence for differences in parenting goals between lesbian and gay people and their heterosexual peers. However, no previous research has quantified the parenting goals of bisexual people or evaluated parenting goals as a function of sexual partner gender. In addition, political and social climates for sexual minority people had improved rapidly since the last representative data on lesbian and gay peoples' plans for parenthood were collected. We analyzed data from 3,941 childless lesbian, gay, bisexual, and heterosexual participants from the 2011-2013 National Survey of Family Growth (NSFG; United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2014), a nationally representative sample of United States residents aged 15 to 44 years. We found that statistically significant, within-gender sexual orientation differences in parenting plans persist, despite social and legal changes. Consistent with hypotheses, bisexual men's parenting desires and intentions were similar to those of their heterosexual male peers and different from those of their gay male peers, while bisexual women's reports were more mixed. Also consistent with hypotheses, the gender of the most recent sexual partner was a strong predictor of parenting goals. We discuss implications for mental and reproductive health-care providers, attorneys, social workers, and others who interact with sexual minority adults. (PsycINFO Database Record

The demography of words: The global decline in non-numeric fertility preferences, 1993-2011

This paper examines the decline in non-numeric responses to questions about fertility preferences among women in the developing world. These types of response-such as 'don't know' or 'it's up to God'-have often been interpreted through the lens of fertility transition theory as an indication that reproduction has not yet entered women's 'calculus of conscious choice'. However, this has yet to be investigated cross-nationally and over time. Using 19 years of data from 32 countries, we find that non-numeric fertility preferences decline most substantially in the early stages of a country's fertility transition. Using country-specific and multilevel models, we explore the individual- and contextual-level characteristics associated with women's likelihood of providing a non-numeric response to questions about their fertility preferences. Non-numeric fertility preferences are influenced by a host of social factors, with educational attainment and knowledge of contraception being the most robust and consistent predictors.

[Parental project of general medicine residents from Aix-Marseille university: Theoretical knowledge in reproduction and behavior towards parenting]

OBJECTIVES

Analyze residents' intentions about parenting and knowledge about fertility, as well as their alleged behavior towards a diagnosis of diminished ovarian reserve.

MATERIALS AND METHODS

Prospective study with distribution of self-administered questionnaire to residents of Aix-Marseille university from June to September 2015. The questionnaire was composed of a first descriptive part including generic and personal informations about the residents and their intentions towards parenting. The second part was a 9 questions survey aimed at testing their knowledge about fertility and ovarian reserve and a final question placing them in a situation of a diminished ovarian reserve diagnosis in order to analyze their reactions.

RESULTS

The overall participation rate was 53.2%, including 220 women with an average age of 27 years (SD: 1.8 years) and 116 men with an average age of 27.3 years (SD: 2.2 years). The 11.8% of female residents (n=26) already had one or more children vs.6.9% of male residents (n=8). Among the residents without children, 99% of females (n=192) and 91.7% of males (n=99) said they wanted to have children in the future, planning an average age to have their first child of 29.6 years (SD: 1.9 years) for females and 30.4 years (SD: 2.2 years) for men. Moreover, 58.3% of female residents (n=112) and 53.5% of male residents (n=53) reported that they were postponing their plan to have children after the completion of their medical studies. In a simulation of couples facing a diagnosis of diminished ovarian reserve, 73.6% of females and 61.2% of males would be ready to change their life choices and conceive a baby sooner than originally planned.

CONCLUSION

Almost all the general medicine residents have plannedto have children in the future and more than half of them postpone their parental plan after the end of their residency, although the decline of female fertility in relation to aging is widely known among them.

Elective oocyte cryopreservation for deferred childbearing

PURPOSE OF REVIEW

Elective oocyte cryopreservation for deferred childbearing has gained popularity worldwide, commensurate with increased knowledge regarding age-related fertility decline. The purpose of this review is to summarize recent data regarding trends in delayed childbearing, review recent findings surrounding age-related fertility decline, acknowledge significant gaps in knowledge among patients and providers regarding fertility decline and review outcomes following elective oocyte cryopreservation.

RECENT FINDINGS

Despite an inevitable decline in fertility and increase in miscarriage with increasing female age, there is a growing worldwide trend to delay childbearing. Patients and providers alike demonstrate large gaps in knowledge surrounding age-related fertility decline. Oocyte cryopreservation is clinically approved for medically indicated fertility preservation, but a growing number of women are using oocyte cryopreservation to defer childbearing and maintain reproductive autonomy. Mounting data support the efficacy and safety of oocyte cryopreservation when used to electively defer childbearing, with recent studies demonstrating rates of euploidy, implantation and live birth rates equivalent to in-vitro fertilization (IVF) with fresh oocytes.

SUMMARY

Oocyte cryopreservation provides women with an option to defer childbearing and maintain reproductive autonomy, with IVF success rates on par with fresh IVF. However, it is critical that patients understand the limitations of oocyte cryopreservation. Greater education regarding age-related fertility decline should be geared toward patients and providers to prevent unintended childlessness.

The limited effect of increasing educational attainment on childlessness trends in twentieth-century Europe, women born 1916-65

During the twentieth century, trends in childlessness varied strongly across European countries while educational attainment grew continuously across them. Using census and large-scale survey data from 13 European countries, we investigated the relationship between these two factors among women born between 1916 and 1965. Up to the 1940 birth cohort, the share of women childless at age 40+ decreased universally. Afterwards, the trends diverged across countries. The results suggest that the overall trends were related mainly to changing rates of childlessness within educational groups and only marginally to changes in the educational composition of the population. Over time, childlessness levels of the medium-educated and high-educated became closer to those of the low-educated, but the difference in level between the two better educated groups remained stable in Western and Southern Europe and increased slightly in the East.

Reproductive and Contraceptive Characteristics of Premenopausal Kidney Transplant Recipients

Objective

To obtain information on menstrual patterns before and after transplantation, desire for future pregnancy, and use of contraception among premenopausal kidney transplant recipients.

Study Design

This observational study collected information using self-administered anonymous questionnaires during a routine outpatient clinic visit.

Results

Of the 107 women who completed the questionnaire, 41 identified themselves as being premenopausal. Among the 41 premenopausal women, approximately half of the women reported their current menstrual patterns as normal and 26% were not using any form of contraception. Overall, 10 women (24%) reported a desire to become pregnant and 4 women (10%) had a successful pregnancy after transplantation. Most of the women who desired a future pregnancy (8/10) were receiving an immunosuppressive regimen that included mycophenolate mofetil.

Conclusion

Kidney transplantation in the current era is associated with a return of normal menstrual function in the majority of female transplant recipients. A substantial fraction of women desire pregnancy after transplantation and many are using an immunosuppressive drug with limited safety data on use during pregnancy. More caution should be used with the use of newer immunosuppressive agents in sexually active premenopausal transplant recipients until more safety data are available.

Reproduction and marriage among male survivors of cancer in childhood, adolescence and young adulthood: a national cohort study

BACKGROUND

Increased survival after cancer in young age has made long-term follow-up studies of high external validity important. In this national cohort study, we explored the impact of cancer in young age on reproduction and marital status in male survivors.

METHODS

Hazard ratios (HRs) and relative risks (RRs) of reproductive and marital outcomes were studied for male survivors of cancer in young age (<25 years) and cancer-free male comparisons, born during 1965-1985, by linking compulsory national registries in Norway.

RESULTS

Male cancer survivors (n=2687) had reduced paternity (HR: 0.72, 95% confidence interval (CI): 0.68-0.76). This was most apparent in survivors of testicular cancer, brain tumours, lymphoma, leukemia and bone tumours, and when diagnosed with cancer before 15 years of age. Male cancer survivors were more likely to avail of assisted reproduction (RR: 3.32, 95% CI: 2.68-4.11). There was no increased risk of perinatal death, congenital malformations, being small for gestational age, of low birth weight or preterm birth in their first offspring. Male cancer survivors were less likely to marry (HR: 0.93, 95% CI: 0.86-1.00), in particular brain tumour survivors.

CONCLUSIONS

In this national cohort study, we demonstrated reduced paternity and increased use of assisted reproduction among male cancer survivors, but no adverse outcome for their first offspring at birth.

An Old Mom Keeps You Young: Mother's Age at Last Birth and Offspring Longevity in Nineteenth-Century Utah

This study analyzes the intergenerational effects of late childbearing on offspring's adult longevity in a population in Utah (United States) that does not display evidence of parity-specific birth control-a so-called natural fertility population. Studies have found that for women who experience late menopause and prolonged reproduction, aging is postponed and longevity is increased. This is believed to indicate female "robustness" and the impact of biological or genetic factors. If indeed there is a genetic component involved, one would expect to also find evidence for the intergenerational transmission of longevity benefits. Our study investigates the relationship between prolonged natural fertility of mothers and their offspring's survival rates in adulthood. Gompertz regression models (N = 7,716) revealed that the offspring of mothers who were naturally fertile until a relatively advanced age lived significantly longer. This observed positive effect of late reproduction was not independent of but conditional upon survival of the mother to the end of her fecundity (defined as age 50). Offspring's relative risks at death beyond age 50 were 6-12 percent lower than those of their counterparts born to mothers who had an average age at last birth. Our results, which account for various early, adult, and later-life conditions, as well as shared frailty, suggest that there is a positive relationship between mother's age at last birth and offspring longevity, and strengthen the notion that age at menopause is a good predictor of this relationship.

Reproductive History and Later-Life Comorbidity Trajectories: A Medicare-Linked Cohort Study From the Utah Population Database

Reproductive lives of men and women may provide significant insight into later-life morbidity and mortality. Sociological, biological, and evolutionary theories predict a relationship between reproductive history and later-life health; however, current research is lacking consensus on the direction of the relationship. Parity, early age at first birth and last birth, birth weight of offspring, having a child die as an infant, and having a preterm birth may have long-term effects on health for both men and women. In this study, the relationship between these measures of reproductive history and later-life health is examined using the Utah Population Database (a rich source of longitudinal data), and Medicare claims data from 1992-2009. Later-life health is measured using annual Charlson comorbidity index scores, a construct that summarizes most serious illnesses afflicting older individuals. Group-based trajectory modeling that accounts for nonrandom attrition due to death is used to identify the number and types of morbidity trajectories by sex and age for 52,924 individuals aged 65-84 in 1992. For females, early age at first birth, high parity, and having a preterm or high-birth-weight baby are associated with increased risks of comorbidity; later age at last birth is associated with a decreased risk of comorbidity. For males, early age at first birth and having a child with an abnormal birth weight leads to increased risk of comorbidity. The results suggest that both biological and social factors play important roles in the relationships between fertility and morbidity profiles at older ages.

Relationship between income generating activities of rural women and their reproductive health behavior in Bangladesh

INTRODUCTION

The objective of the study was to find out the effects of income generating activities of rural women and their reproductive health behavior (contraceptive use) in Bangladesh.

METHODS

A cross-sectional study using a multi-stage sampling technique was carried out among 200 married rural women in Cox's Bazar, Bangladesh. Data were collected using a structured questionnaire on socioeconomic factors, income generating activities, women's empowerment in mobility, decision making and reproductive health behavior in terms of contraceptive use, number of children and desire for more children. Logistic regression analysis was used to determine the relationship between income generating activities and contraceptive use.

RESULTS

Almost half (45.5%) of the participants were involved in income generating activities. A great majority (63.9%) worked year-round, two-thirds (75.0%) earned cash for their family and 21.3% were engaged in poultry farms. Women aged 26-35 years, members of any non-governmental organization and from a poor family were more likely to be engaged in income generating activities (≤0.001). Highly educated women worked more than their less educated counterparts and the opposite was true for their husbands (≤0.001). Almost half of the women (45.0%) did not use any contraceptive. Contraceptive use was significantly higher among working women (73.4%) than with non-working women (33.0%). Women engaged in income generating activities were more likely to use contraceptives compared to non-working women (odds ratio 5.6, 95% confidence interval 3.1-7.0, ≤0.001).

RESULTS

Income generating activities seem to empower women, increase their likelihood of using contraception and are one of the key issues for changing the life of rural women in Bangladesh.

Baby budgeting: oocyte cryopreservation in women delaying reproduction can reduce cost per live birth

OBJECTIVE

To determine whether oocyte cryopreservation for deferred reproduction is cost effective per live birth using a model constructed from observed clinical practice.

DESIGN

Decision-tree mathematical model with sensitivity analyses.

SETTING

Not applicable.

PATIENT(S)

A simulated cohort of women wishing to delay childbearing until age 40 years.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

Cost per live birth.

RESULT(S)

Our primary model predicted that oocyte cryopreservation at age 35 years by women planning to defer pregnancy attempts until age 40 years would decrease cost per live birth from $55,060 to $39,946 (and increase the odds of live birth from 42% to 62% by the end of the model), indicating that oocyte cryopreservation is a cost-effective strategy relative to forgoing it. If fresh autologous assisted reproductive technology (ART) was added at age 40 years, before thawing oocytes, 74% obtained a live birth, and cost per live birth increased to $61,887. Separate sensitivity analyses demonstrated that oocyte cryopreservation remained cost effective as long as performed before age 38 years, and more than 49% of those women not obtaining a spontaneously conceived live birth returned to thaw oocytes.

CONCLUSION(S)

In women who plan to delay childbearing until age 40 years, oocyte cryopreservation before 38 years of age reduces the cost to obtain a live birth.

Optimal timing for elective egg freezing

OBJECTIVE

To estimate the optimal age to pursue elective oocyte cryopreservation.

DESIGN

A decision-tree model was constructed to determine the success and cost-effectiveness of oocyte preservation versus no action when considered at ages 25-40 years, assuming an attempt at procreation 3, 5, or 7 years after initial decision.

SETTING

Not applicable.

PATIENT(S)

Hypothetical patients 25-40 years old presenting to discuss elective oocyte cryopreservation.

INTERVENTION(S)

Decision to cryopreserve oocytes from age 25 years to age 40 years versus taking no action.

MAIN OUTCOME AND MEASURE(S)

Probability of live birth after initial decision whether or not to cryopreserve oocytes.

RESULT(S)

Oocyte cryopreservation provided the greatest improvement in probability of live birth compared with no action (51.6% vs. 21.9%) when performed at age 37 years. The highest probability of live birth was seen when oocyte cryopreservation was performed at ages <34 years (>74%), although little benefit over no action was seen at ages 25-30 years (2.6%-7.1% increase). Oocyte cryopreservation was most cost-effective at age 37 years, at $28,759 per each additional live birth in the oocyte cryopreservation group. When the probability of marriage was included, oocyte cryopreservation resulted in little improvement in live birth rates.

CONCLUSION(S)

Oocyte cryopreservation can be of great benefit to specific women and has the highest chance of success when performed at an earlier age. At age 37 years, oocyte cryopreservation has the largest benefit over no action and is most cost-effective.

Desire for children, difficulties achieving a pregnancy, and infertility distress 3 to 7 years after cancer diagnosis

PURPOSE

The aim was to investigate desire for children, difficulties achieving a pregnancy, and infertility distress among survivors 3 to 7 years after cancer treatment in reproductive age.

METHODS

Cancer survivors were identified in national population-based cancer registries. Eligible subjects presented with selected cancer diagnoses between 2003 and 2007 between the ages of 18 to 45. A postal questionnaire including study-specific questions, the Short-Form 36 Health Survey and the Fertility Problem Inventory, was sent to 810 survivors, and 484 participated (60 % response).

RESULTS

Most survivors who had a pretreatment desire for children still wanted children 3-7 years after treatment, and this group was characterized by young age and being childless at diagnosis. In addition, a substantial group of survivors (n = 55, 17 %) that did not have a pretreatment desire for children had changed their mind about wanting children after treatment. About a third of the survivors with a desire to have children had experienced difficulties achieving a pregnancy after the cancer treatment, and an unfulfilled desire to have children was associated with worse mental health. Survivors presently facing difficulties achieving a pregnancy reported moderate levels of infertility distress and expressed low interest in using gamete donation.

CONCLUSIONS

Health professionals in cancer care need to be aware that patients' plans for future children may change, particularly if they are young and childless. All patients of reproductive age should be provided with adequate information about the impact of cancer treatment on future fertility and fertility preservation.

Residential context, migration and fertility in a modern urban society

This study examines fertility variation by residential context in Britain. While there is a large literature on fertility trends and determinants in industrialised countries, to date longitudinal research on spatial fertility variation has been restricted to the Nordic countries. We study fertility variation across regions of different sizes, and within urban regions by distinguishing between central cities and suburbs. We use vital statistics and longitudinal data and apply event history analysis. We investigate the extent to which the socio-economic characteristics of couples and selective migrations explain fertility variation between residential contexts, and the extent to which contextual factors potentially play a role. Our analysis shows that fertility levels decline as the size of an urban area increases; within urban regions suburbs have significantly higher fertility levels than city centres. Differences in fertility by residential context persist when we control for the effect of population composition and selective migrations.

Culture and demography: from reluctant bedfellows to committed partners

Demography and culture have had a long but ambivalent relationship. Cultural influences are widely recognized as important for demographic outcomes but are often "backgrounded" in demographic research. I argue that progress toward a more successful integration is feasible and suggest a network model of culture as a potential tool. The network model bridges both traditional (holistic and institutional) and contemporary (tool kit) models of culture used in the social sciences and offers a simple vocabulary for a diverse set of cultural concepts, such as attitudes, beliefs, and norms, as well as quantitative measures of how culture is organized. The proposed model conceptualizes culture as a nested network of meanings represented by schemas that range in complexity from simple concepts to multifaceted cultural models. I illustrate the potential value of a model using accounts of the cultural changes underpinning the transformation of marriage in the United States and point to developments in the social, cognitive, and computational sciences that could facilitate the application of the model in empirical demographic research.

Predictors of pregnancy and changes in pregnancy incidence among HIV-positive women accessing HIV clinical care

OBJECTIVES

To describe predictors of pregnancy and changes in pregnancy incidence among HIV-positive women accessing HIV clinical care.

METHODS

Data were obtained through the linkage of two separate studies: the UK Collaborative HIV Cohort study (UK CHIC), a cohort of adults attending 13 large HIV clinics; and the National Study of HIV in Pregnancy and Childhood (NSHPC), a national surveillance study of HIV-positive pregnant women. Pregnancy incidence was measured using the proportion of women in UK CHIC with a pregnancy reported to NSHPC. Generalized estimating equations were used to identify predictors of pregnancy and assess changes in pregnancy incidence in 2000-2009.

RESULTS

The number of women accessing care at UK CHIC sites increased as did the number of pregnancies. Older women were less likely to have a pregnancy [adjusted relative rate (aRR) 0.44 per 10 year increment in age, [95% confidence interval (CI) (0.41-0.46)], P < 0.001] as were women with CD4 cell count less than 200 cells/μl compared with CD4 cell count 200-350 cells/μl [aRR 0.65 (0.55-0.77), P < 0.001] and women of white ethnicity compared with women of black African ethnicity [aRR 0.67 (0.57-0.80), P < 0.001]. The likelihood that women had a pregnancy increased over the study period [aRR 1.05 (1.03-1.07), P < 0.001). The rate of change did not significantly differ according to age group, antiretroviral therapy use, CD4 group or ethnicity.

CONCLUSION

The pregnancy rate among women accessing HIV clinical care increased in 2000-2009. HIV-positive women with, or planning, a pregnancy require a high level of care and this is likely to continue and increase as more women of older age have pregnancies.

The reproductive transition in an indigenous population of northern Argentina

Latin America has been registering a fast decrease in fertility rates since the mid-twentieth century. This change can be linked to the modernization process these populations have been undergoing. However, research with Latin American indigenous populations, which are undergoing relatively similar lifestyle changes, shows very different trends in fertility. The aim of this study was to analyze fertility patterns in the indigenous Toba community of Cacique Sombrero Negro, which is experiencing a rapid process of economic and social Westernization. Fertility patterns were analyzed between 1981 and 1999, the period for which the most accurate records were found. Results showed an overall increase in fertility rates and changes in the age of peak fertility across time periods. It is hypothesized that the lifestyle transition this population is experiencing leads to better access to resources that, in the absence of contraception, allow for a higher number of offspring. Nevertheless, this higher resource availability would be differential, affecting mostly the fertility of younger mothers.

Awareness, use and main source of information on preventive health examinations: a survey of childbearing women in Uyo, Nigeria

The study determined awareness, use and the main source of information about preventive health examinations among 387 childbearing women attending three health facilities in Uyo, Nigeria. Respondents were consenting women aged 15-49 years who had a live birth in the two months preceding the survey. Respondents were interviewed using structured questionnaires during child welfare clinic visits at each facility. Awareness about pap smears and breast self examination was 14.2% and 35.3% respectively. Testing rates were highest for blood pressure checks, HIV and blood sugar and lowest for Pap smears and mammograms. Health workers were the main informants on preventive tests. Awareness and secondary education enhanced women's uptake of screening services across levels of health care. Secondary education as a minimum and intensified awareness creation about preventive health examinations through media, school based programs, durbars and public health campaigns are vital to the health and well being of women and children.

Trends and differentials of adolescent motherhood in Ethiopia: evidences from 2005 Demographic and Health Survey

Adolescent childbearing has undesirable consequences. Dropping out of school, high rates of abortion, maternal mortality and morbidity are noted consequences of adolescent pregnancy and childbearing. The objective of this study, which is based on the 2005 Ethiopian Demographic and Health Survey data, is to analyze the levels, trends and differentials of adolescent motherhood in Ethiopia. A multilevel logistic regression was fitted to analyze the determinants of adolescent childbearing. Adolescent motherhood in Ethiopia has shown a generally declining trend over time. The decline was more marked in the periods following the adoption of the national population policy in the country. Further, it was lower in urban areas and among women who have secondary and above level of education, but higher among women not working and those engaged in agricultural activities. Housewives and women working in the agricultural sector should be given attention to reduce the risks and consequences of adolescent motherhood.

Delayed motherhood: understanding the experiences of women older than age 33 who are having abortions but plan to become mothers later

OBJECTIVE

To examine the experiences of women who are delaying motherhood by having abortions.

DESIGN

Mixed-methods study.

SETTING

An abortion clinic in Vancouver, BC.

PARTICIPANTS

Women presenting for abortion at an urban, free-standing abortion clinic. Interviews were only with women older than 35 years of age.

METHODS

A chart review was initially performed, followed by a survey of women presenting to the clinic, as well as in-depth interviews that were audiotaped and transcribed.

MAIN FINDINGS

Of the 1844 charts reviewed, 550 (30%) were for women 33 years of age and older and 117 (21%) of those had no children (6% of the total 1844). Plans for future pregnancies were reported in only 70 of the 117 charts; 37 (53%) of the women said they wanted children in the future and 20 (29%) said they were unsure. There were 1118 questionnaires completed (response rate of 86%). There were 334 (30%) women 33 years of age and older and 87 (26%) of those had no children (8% of the total 1113). Of these women, 47 (54%) planned to have children in the future and 24 (28%) were unsure. The most common reason these older childless women gave for having abortions was that they were "just not ready" (59%). We used logistic regression to examine predictors for delaying motherhood and the stepwise regression retained only 2 factors: high rating of "stable relationship" (P=.003) and a "partner who would be a good parent" (P=.008). The most striking themes in the interviews were women's uncertainty about childbearing and their focus on the quality of their relationships.

CONCLUSION

This study contributes additional insight into the uncertainty older nulliparous women experience about childbearing, and it points to women's primary focus on relationships with partners rather than with children as a possible explanation for this trend.

[The medical social characteristics of women of active reproductive age and their families]

The article presents the comparative medical social characteristics ofreproductive attitudes and reproductive behavior of urban families in present conditions. The risk factors leading to small number of children in families of various types are analyzed. The health characteristics of'women with one, two, three and more children are presented.

The Life Journeys Of Young Women Project: objectives, design, and recruitment results

The Life Journeys of Young Women Project is the first population-based study to examine the role of economic uncertainty throughout early adulthood on age at first childbirth. A retrospective cross-sectional component was added to an existing cohort study that is based on a birth cohort of women born during 1973-1975 in Adelaide, South Australia (n ∼ 1,000). An event history calendar instrument was used to obtain data regarding a range of life domains including partnering, educational attainment, home ownership, higher education debt, employment, and pregnancies over a 20-year period (sometimes as detailed as at monthly intervals). Interviews were conducted between 2007 and 2009. An analysis framework applying time-varying and time-constant survival analysis techniques within a life-course framework was developed that will guide analyses to examine the role of duration and life-course timing of economic uncertainty on age at first childbirth. This paper discusses study objectives and design, fieldwork procedures, planned statistical analyses, and recruitment outcomes, focusing on novel features that would facilitate analogous epidemiologic research.

Motivational intervention to reduce rapid subsequent births to adolescent mothers: a community-based randomized trial

PURPOSE

One-quarter of adolescent mothers bear another child within 2 years, compounding their risk of poorer medical, educational, economic, and parenting outcomes. Most efforts to prevent rapid subsequent birth to teenagers have been unsuccessful but have seldom addressed motivational processes.

METHODS

We conducted a randomized trial to determine the effectiveness of a computer-assisted motivational intervention (CAMI) in preventing rapid subsequent birth to adolescent mothers. Pregnant teenagers (N = 235), aged 18 years and older who were at more than 24 weeks' gestation, were recruited from urban prenatal clinics serving low-income, predominantly African American communities. After completing baseline assessments, they were randomly assigned to 3 groups: (1) those in CAMI plus enhanced home visit (n = 80) received a multi-component home-based intervention (CAMI+); (2) those in CAMI-only (n = 87) received a single component home-based intervention; (3) and those in usual-care control (n = 68) received standard usual care. Teens in both intervention groups received CAMI sessions at quarterly intervals until 2 years' postpartum. Those in the CAMI+ group also received monthly home visits with parenting education and support. CAMI algorithms, based on the transtheoretical model, assessed sexual relationships and contraception-use intentions and behaviors, and readiness to engage in pregnancy prevention. Trained interventionists used CAMI risk summaries to guide motivational interviewing. Repeat birth by 24 months' postpartum was measured with birth certificates.

RESULTS

Intent-to-treat analysis indicated that the CAMI+ group compared with the usual-care control group exhibited a trend toward lower birth rates (13.8% vs 25.0%; P = .08), whereas the CAMI-only group did not (17.2% vs 25.0%; P = .32). Controlling for baseline group differences, the hazard ratio (HR) for repeat birth was significantly lower for the CAMI+ group than it was with the usual-care group (HR = 0.45; 95% CI, 0.21-0.98). We developed complier average causal effects models to produce unbiased estimates of intervention effects accounting for variable participation. Completing 2 or more CAMI sessions significantly reduced the risk of repeat birth in both groups: CAMI+ (HR = 0.40; 95% CI, 0.16-0.98) and CAMI-only (HR = 0.19; 95% CI, 0.05-0.69).

CONCLUSIONS

Receipt of 2 or more CAMI sessions, either alone or within a multicomponent home-based intervention, reduced the risk of rapid subsequent birth to adolescent mothers.

Delayed childbearing: more women are having their first child later in life

Of particular interest to both researchers and the public is the "average" age of women when they have a child, especially their first. Age at first birth influences the total number of births that a woman might have in her life, which impacts the size, composition, and future growth of the population. The age of the mother, both younger and older, plays a strong role in a wide range of birth outcomes (e.g., birthweight, multiple births, and birth defects), so it is critical to track the average age at which women have their first birth.

A comparison of the characteristics of childless women and mother in the ONS longitudinal study

An increase in the number of childless women has been a prominent feature of the post baby boom period of fertility decline. However, childlessness as a stand alone research topic has received less attention within the literature on low fertility. This research uses for the first time the ONS Longitudinal Study (LS) to explore lifelong childlessness as a research topic in its own right. Using a large scale sample of women from the 1956-60 generation who are continuously resident in England and Wales during their childbearing years, this article investigates the degree to which socio-economic characteristics of women and, where present, their partners are related to female lifelong childlessness. The study measures the extent to which women who remained childless throughout their life course are distinctive from those who became mothers, and therefore improves our understanding of childlessness among women in England and Wales.

Long-term medical and social consequences of preterm birth

BACKGROUND

Advances in perinatal care have increased the number of premature babies who survive. There are concerns, however, about the ability of these children to cope with the demands of adulthood.

METHODS

We linked compulsory national registries in Norway to identify children of different gestational-age categories who were born between 1967 and 1983 and to follow them through 2003 in order to document medical disabilities and outcomes reflecting social performance.

RESULTS

The study included 903,402 infants who were born alive and without congenital anomalies (1822 born at 23 to 27 weeks of gestation, 2805 at 28 to 30 weeks, 7424 at 31 to 33 weeks, 32,945 at 34 to 36 weeks, and 858,406 at 37 weeks or later). The proportions of infants who survived and were followed to adult life were 17.8%, 57.3%, 85.7%, 94.6%, and 96.5%, respectively. Among the survivors, the prevalence of having cerebral palsy was 0.1% for those born at term versus 9.1% for those born at 23 to 27 weeks of gestation (relative risk for birth at 23 to 27 weeks of gestation, 78.9; 95% confidence interval [CI], 56.5 to 110.0); the prevalence of having mental retardation, 0.4% versus 4.4% (relative risk, 10.3; 95% CI, 6.2 to 17.2); and the prevalence of receiving a disability pension, 1.7% versus 10.6% (relative risk, 7.5; 95% CI, 5.5 to 10.0). Among those who did not have medical disabilities, the gestational age at birth was associated with the education level attained, income, receipt of Social Security benefits, and the establishment of a family, but not with rates of unemployment or criminal activity.

CONCLUSIONS

In this cohort of people in Norway who were born between 1967 and 1983, the risks of medical and social disabilities in adulthood increased with decreasing gestational age at birth.

Parental influence on reproductive health behaviour of youths in Ibadan, Nigeria

The study was carried out to document parental influence on the reproductive health behaviour of youths in Ibadan, Nigeria. A cross-sectional survey of 274 youths from Idikan community was carried out. Information on the socio-demographic characteristics, parental communication, parental monitoring and sexual practices of respondents were collected using a structured interviewer-administered questionnaire. A total of 274 youths were interviewed, 111 (40.5%) were sexually active. The overall mean age at first sexual exposure was 15.2 +/- 3.0 yrs (males = 15.4 +/- 3.5 yrs, females 14.90 +/- 2.6 yrs). Fifty-two (19.0%) respondents used condom regularly. More out of school youths (42.2%) were more sexually active than those in school (38.7%) (chi2 = 0.32 p = 0.573). Youths (50.8%) with secondary school education used condom regularly than those with primary education 40.4% (p > 0.05). Mothers were more involved in family life education than fathers (40.9% vs. 16.8% p < 0.05) and family life education was found to promote condom use (p < 0.001). Predictors of regular condom use among the youths were comprehensive family life education by mothers (OR = 6.24, C.I = 2.47-15.75, p = 0.001), respondents' level of education (OR = 0.415, C.I = 0.211-0.814 p = 0.011) and occupation (OR = 0.48, C.I = 0.24-0.95 p = 0.034). While comprehensive family life education by mothers (OR = 2.11, C.I = 1.04-4.28, p = 0.038), female sex (OR = 2.2, C.I = 1.28-3.83 p = 0.005) and liberal monitoring pattern by mother (OR = 2.16, C.I = 1.03-4.53 p = 0.04) were predictors of increased sexual activity. Parents particularly mothers can promote safe sexual practices by giving information and education on reproductive health matters.

[The latent determinants of the reproduction of population]

A wide range of factors determining the actual dynamics of the fertility levels and their age-specific distribution is discussed. The unfavorable tendency of shifting the fertility model to the older age is demonstrated. The priority of the spiritual and moral determinants in the individual and public awareness to overcome the demographic crisis is founded.

The effect of nonreproductive groups on persistent sexually transmitted diseases

We describe several population models exposed to a mild life long sexually transmitted disease, i.e. without significant increased mortality among infected individuals and providing no immunity/recovery. We then modify these models to include groups isolated from sexual contact and analyze their potential effect on the dynamics of the population. We are interested in how the isolated class may curb the growth of the infected group while keeping the healthy population at acceptable levels.

Fertility of first-degree relatives of patients with schizophrenia: a three generation perspective

We explored the fertility in three generations; fertility of parents, siblings and offspring to patients with schizophrenia, to test the hypothesis that the decreased reproductive rate in the patients is compensated by an increased rate in their first-degree relatives. A population-based national database was created by linking the Swedish Multi-Generation and Hospital Discharge Registers. To maximize follow-up time for schizophrenia and reproductive history, three birth cohorts were selected: parental generation, born 1918-1927 (n=274464); affected generation, born 1932-1941 (n=108502) and offspring to affected generation, born 1951-1960 (n=103105). Ratios of estimated mean number of offspring were measured (fertility ratios), comparing the study subjects to the general population. The fertility among males with schizophrenia was decreased by over 70% (fertility ratio(patients/population)=0.29, 95% CI 0.25-0.35), whereas female patients had less than half as many offspring as the general female population (fertility ratio(patients/population)=0.48, 95% CI 0.42-0.55). When accounting for selection bias of larger families, no statistically significant difference was found among parents of patients with and without a diagnosis of schizophrenia. Further, the fertility among siblings of schizophrenic patients did not differ from the general population. A reduction in fertility was found among offspring to patients with schizophrenia, male offspring had 12% fewer offspring (fertility ratio(offspring/population)=0.88, 95%CI 0.77-1.01), while female offspring had 6% fewer offspring (fertility ratio(offspring/population)=0.94, 95% CI 0.84-1.05). In conclusion, we found reduced fertility in patients with schizophrenia and among their offspring that was not compensated by higher parental or sibling fertility.