The potential impact of improvements in contraception on fertility and abortion in western countries

Survey information on fertility intentions, patterns of contraceptive use, contraceptive failures and abortions is used to develop estimates of unwanted births and of unplanned pregnancies for seven countries, by method of contraception. Potential improvements in contraception, leading to more use of highly efficient methods are considered, and several scenarios for improved contraceptive use are presented. The impact each would have on fertility levels and on abortion rates is estimated. Although improvements in contraception will have only a limited impact on fertility — which is already very low — their impact on abortion could be considerable Les auteurs utilisent des données d'enquêtes sur les intentions de procréation, le recours à la contraception, les échecs de la contraception et l'avortement pour évaluer les naissances non désirées et les grossesses non planifiées, selon la méthode de contraception utilisée, dans sept pays. Ils envisagent d'éventuels progrès de la contraception conduisant à un élargissement de l'emploi de méthodes très efficaces, et évaluent, dans différents scénarios de progrès du recours à la contraception, son impact sur les niveaux de la fécondité et de l'avortement. Si le progrès de la contraception n'aura qu'un effet limité sur la fécondité — déjà très basse — son impact sur les niveaux de l'avortement pourrait être considérable.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42729/1/10680_2005_Article_BF01797090.pd

Assessing regional differences in contraceptive discontinuation, failure and switching in Brazil

<p>Abstract</p> <p>Background</p> <p>Contraceptive prevalence is relatively high in Brazil (55% among women of reproductive age). However, reversible methods account for less than half of the method mix and widespread differences persist across regions and social groups. This draws attention to the need for monitoring family planning service-related outcomes that might be linked with quality of care. The present study examines the factors associated with method discontinuation, failure and switching among current contraceptive users, with a focus on sub-national assessment.</p> <p>Methods</p> <p>Data for the analysis are drawn from the Brazil Demographic and Health Survey, notably the calendar module of reproductive events. Multilevel discrete-time competing risks hazard models are used to estimate the random- and fixed-effects on the probability of a woman making a specific transition after a given duration of contraceptive use.</p> <p>Results</p> <p>Contraceptive continuation was found to be highest for the contraceptive pill, the most popular reversible method. Probabilities of abandonment while in need of family planning and of switching to another method were highest for injections. Failure, abandonment and switching were each higher among users in the Northeast region compared to the more prosperous Southeast and South.</p> <p>Conclusion</p> <p>Findings point to seemingly important disparities in the availability and quality of family planning and reproductive health care services across regions of the country. Expanding access to a range of contraceptive methods, improving knowledge among health agents of contraceptive technologies and increasing medical supervision of contraceptive practice may be considered key to expanding quality reproductive health care services for all.</p

A comparative analysis of contraceptive use in Africa: evidence from DHS

The aim of this article is to show a comparative analysis of contraceptive use in areas of traditionally high fertility that have gone through profound changes. Data have been taken from the latest Demographic and Health Surveys (DHS). Logistic regression models were adopted for four selected representative countries, namely Egypt, Mali, Namibia and Niger. There were two selection criteria: data should be recent, and selected countries should have high (Egypt 57.4%; Namibia 46.4%) or low (Mali 7.5%; Niger 10.0%) contraceptive use. The probability of using contraception when a woman has had one to four children is 2.4 times higher than when they have had no children. Contraception data are always gathered at a point of time, but crosssectional data are not sufficient to understand all the mechanisms hidden behind contraceptive use. Different contraceptive behaviours need good estimation tools to develop specific family planning programmes.Web of Scienc

Population policies and education: exploring the contradictions of neo-liberal globalisation

The world is increasingly characterised by profound income, health and social inequalities (Appadurai, 2000). In recent decades development initiatives aimed at reducing these inequalities have been situated in a context of increasing globalisation with a dominant neo-liberal economic orthodoxy. This paper argues that neo-liberal globalisation contains inherent contradictions regarding choice and uniformity. This is illustrated in this paper through an exploration of the impact of neo-liberal globalisation on population policies and programmes. The dominant neo-liberal economic ideology that has influenced development over the last few decades has often led to alternative global visions being overlooked. Many current population and development debates are characterised by polarised arguments with strongly opposing aims and views. This raises the challenge of finding alternatives situated in more middle ground that both identify and promote the socially positive elements of neo-liberalism and state intervention, but also to limit their worst excesses within the population field and more broadly. This paper concludes with a discussion outling the positive nature of middle ground and other possible alternatives

Potential Cost-Effectiveness of Universal Access to Modern Contraceptives in Uganda

<div><h3>Background</h3><p>Over two thirds of women who need contraception in Uganda lack access to modern effective methods. This study was conducted to estimate the potential cost-effectiveness of achieving universal access to modern contraceptives in Uganda by implementing a hypothetical new contraceptive program (NCP) from both societal and governmental (Ministry of Health (MoH)) perspectives.</p> <h3>Methodology/Principal Findings</h3><p>A Markov model was developed to compare the NCP to the status quo or current contraceptive program (CCP). The model followed a hypothetical cohort of 15-year old girls over a lifetime horizon. Data were obtained from the Uganda National Demographic and Health Survey and from published and unpublished sources. Costs, life expectancy, disability-adjusted life expectancy, pregnancies, fertility and incremental cost-effectiveness measured as cost per life-year (LY) gained, cost per disability-adjusted life-year (DALY) averted, cost per pregnancy averted and cost per unit of fertility reduction were calculated. Univariate and probabilistic sensitivity analyses were performed to examine the robustness of results. Mean discounted life expectancy and disability-adjusted life expectancy (DALE) were higher under the NCP vs. CCP (28.74 vs. 28.65 years and 27.38 vs. 27.01 respectively). Mean pregnancies and live births per woman were lower under the NCP (9.51 vs. 7.90 and 6.92 vs. 5.79 respectively). Mean lifetime societal costs per woman were lower for the NCP from the societal perspective ($1,949 vs.$1,987) and the MoH perspective ($636 vs.$685). In the incremental analysis, the NCP dominated the CCP, i.e. it was both less costly and more effective. The results were robust to univariate and probabilistic sensitivity analysis.</p> <h3>Conclusion/Significance</h3><p>Universal access to modern contraceptives in Uganda appears to be highly cost-effective. Increasing contraceptive coverage should be considered among Uganda's public health priorities.</p> </div

Uncertainty and Narratives of the Future. A Theoretical Framework for Contemporary Fertility

Explanations for fertility decisions based on structural constraints—such as labor, housing condition, or income—do not account for the contemporary fertility downturn faced by many countries in Europe. In this paper, we posit that the rise of uncertainty is central for understanding contemporary fertility dynamics. We propose a theoretical framework (the Narrative Framework) for the study of fertility decisions under uncertain conditions based on expectations, imaginaries and narratives. Relying on the idea of future–oriented action, we argue that uncertainty needs to be conceptualized and operationalized taking into account that people use works of imagination, producing their own narrative of the future. Narratives of the future are potent driving forces helping people to act according to or despite uncertainty. We present the different elements of the Narrative Framework and address its causal validity. We conclude by highlighting the advantages of taking into account the narratives of the future in fertility research

Risk of breast cancer in young women in relation to body size and weight gain in adolescence and early adulthood

Findings have been inconsistent on effects of adolescent body size and adult weight gain on risk of breast cancer in young women. These relations were examined in a population-based case control study of 1590 women less than 45 years of age newly diagnosed with breast cancer during 1990–1992 in three areas of the US and an age-matched control group of 1390 women. Height and weight were measured at interview and participants asked to recall information about earlier body size. Logistic regression was used to estimate the relative risk of breast cancer adjusted for other risk factors. Women who were either much heavier or lighter than average in adolescence or at age 20 were at reduced risk. Weight gain after age 20 resulted in reduced risk, but the effect was confined to early-stage and, more specifically, lower grade breast cancer. Neither the risk reduction nor the variation by breast cancer stage or grade was explained by the method of cancer detection or by prior mammography history. These findings suggest that relations between breast cancer risk in young women and body weight at different ages is complex and that the risk reduction with adult weight gain is confined to less aggressive cancers. © 1999 Cancer Research Campaig

A Reflection on Economic Uncertainty and Fertility in Europe: The Narrative Framework

none5openVignoli, Daniele; Guetto, Raffaele; Bazzani, Giacomo; Pirani, Elena; Minello, AlessandraVignoli, Daniele; Guetto, Raffaele; Bazzani, Giacomo; Pirani, Elena; Minello, Alessandr

Population policies, programmes and the environment

Human consumption is depleting the Earth's natural resources and impairing the capacity of life-supporting ecosystems. Humans have changed ecosystems more rapidly and extensively over the past 50 years than during any other period, primarily to meet increasing demands for food, fresh water, timber, fibre and fuel. Such consumption, together with world population increasing from 2.6 billion in 1950 to 6.8 billion in 2009, are major contributors to environmental damage. Strengthening family-planning services is crucial to slowing population growth, now 78 million annually, and limiting population size to 9.2 billion by 2050. Otherwise, birth rates could remain unchanged, and world population would grow to 11 billion. Of particular concern are the 80 million annual pregnancies (38% of all pregnancies) that are unintended. More than 200 million women in developing countries prefer to delay their pregnancy, or stop bearing children altogether, but rely on traditional, less-effective methods of contraception or use no method because they lack access or face other barriers to using contraception. Family-planning programmes have a successful track record of reducing unintended pregnancies, thereby slowing population growth. An estimated $15 billion per year is needed for family-planning programmes in developing countries and donors should provide at least$5 billion of the total, however, current donor assistance is less than a quarter of this funding target