Interrelations among child mortality, breastfeeding, and fertility in Egypt, 1975-80

This report examines the relationship between reproductive behavior and child survivalin Egypt. The relationship is of fundamental importance to an understanding of demographic dynamics and for the formulation of population policies. Using Egyptian data from 1975-80, it was found that weaning children in infancy increases ths risk of death for children under five. Early weaning is responsible for up to 29 percent of Egyptian children's deaths. Children whose mothers become pregnant again are more likely to die if the pregnancy begins while the child is still an infant. Ending breastfeeding is responsible for up to 41 percent of pregnancies - 52 percent among women who do not use contraceptives. Breastfeeding lasts an average of 17 to 18 months in Egypt, so policy probably should not encourage all women to breastfeed longer, but women who breastfeed for only short periods should probably be encouraged to breastfeed longer. Parents should be encouraged to be more careful about childcare and children's diet and hygiene after weaning. An important feature of this analysis is that fertility was examined simultaneously with child survival and breastfeeding, as three components of a system. The analysis involved regression models for the hazard, or risk, of three events occurring after a live birth: another pregnancy, weaning, or the death of the child.Health Monitoring&Evaluation,Early Child and Children's Health,Adolescent Health,Gender and Health,Reproductive Health

The Onset of Fertility Transition in Pakistan

In a Comment published in the Autumn 2000 issue of this journal, Mr Ghulam Soomro1 takes issue with our recent article in Population and Development Review.2 Although Mr Soomro is highly critical of our article, we are pleased that he has read the article carefully and made the effort to write an extended comment. We are not prepared, however, to concede the major points in that Comment. Two major points are made by him. First, that marital fertility decline is a small component of the recent fertility decline in Pakistan, which has been mainly due to postponement of entry to first marriage. Second, that the underlying motivation for fertility change in the 1990s has been economic distress, a consequence in part of the structural adjustment programmes instituted in the late 1980s. However, in the first point, Soomro interprets the demographic data from the past three decades incorrectly and, in the second point, he misrepresents our argument

Trends in the timing of first marriage among men and women in the developing world [Arabic]

The timing of first union merits investigation not only because of the close temporal link between marriage and the onset of childbearing, but also because the age when men and women marry has implications for the organization of family life and for gender relations within society. This paper begins by reviewing the contributions of various social science disciplines to an understanding of the timing of marriage. Using current status data from 73 countries provided by the United Nations Population Division and retrospective data from 52 Demographic and Health Surveys conducted between 1990 and 2001, we then examine recent trends in the timing of first marriage or union for men and women in the developing world. With the exception of South America for both sexes and South and Southeast Asia for men, substantial declines have occurred in the proportion of young men and women who are married. Given the differentials in the timing of marriage by educational attainment and residence, we assess whether the decline in the proportion of young people who are married is related to increases in schooling and urbanization. Expansion of schooling for women has had some impact, but a considerable portion of the reduction in early marriage is not explained by changes in levels of education. We consider other factors that might account for the increase in age at marriage. Finally, we review what is known about the consequences of changing age at marriage with a particular focus on risk of HIV infection

The onset of fertility transition in Pakistan

Recent trends in fertility and contraceptive prevalence indicate that the marital fertility transition in Pakistan, which has been anticipated for three decades, has begun in the 1990s. Before that decade, the total fertility rate had exceeded 6 births per woman for at least three decades, and fewer than 10 percent of married women practiced contraception. The most recent survey data, collected in 1996- 97, show a total fertility rate of 5.3 births per woman and a contraceptive prevalence rate of 24 percent. Underlying this development are macroeconomic trends that have led to widespread economic distress at the household level, and social changes that have diluted the influence of extended kin and resulted in greater husband-wife convergence in reproductive decisionmaking. The more-direct causes of declining fertility are a crystallization of existing desires for smaller families along with a decline in family size desires and a reduction in the social, cultural, and psychic costs of contraception. Improvements in family planning services (their density and quality) have contributed little to the onset of fertility decline but could be decisive in sustaining the decline over the next decade. Other obstacles to contraceptive use, including fear of health side effects and perceptions that husbands are opposed, must also be undermined in order for contraceptive practice to become more widespread and the decline in fertility to continue. Over the long term, progression to replacement-level fertility will require a substantial decline in the demand for children

Fertility preferences and subsequent childbearing in Africa and Asia: A synthesis of evidence from longitudinal studies in 28 populations.

Survey data on fertility preferences have played a central but controversial role in fertility research and advocacy for family planning. We summarize evidence from longitudinal studies in 28 Asian and African populations on the relationship between preferences and subsequent childbearing. While we found no consistent association between women's desire to delay childbearing and subsequent fertility, the baseline desire of women to stop childbearing was a powerful predictor of subsequent fertility in all populations and increased in strength as overall contraceptive use in the study populations rose. Partners' desire also exercised some influence but was of modest importance in most populations. However, the correspondence between desire to stop and behaviour was found to be far from perfect. Weak implementation of preferences by contraception is likely to be the major cause of this preference-behaviour discrepancy. Uncertainty and instability in preferences may also contribute to the discrepancy, particularly in sub-Saharan Africa

Social organization and reproductive behavior in southern Ghana

The objective of this research is to examine the association between social organization and reproductive behavior in one setting in sub-Saharan Africa. The particular focus is on the effects of social organization on the diffusion of innovative reproductive ideas and behaviors. Social diffusion is assumed to be strongly affected by patterns of informal social interaction, and these in turn are assumed to be determined in part by the social organization of local communities (gender relations, employment activity, voluntary organizations). The research draws on data collected in six communities in southern Ghana. The analysis reveals a weaker than expected association between the social organization of the communities and key reproductive indicators (fertility preferences, age at first marriage, postpartum practices, use of modern contraception). Closer examination of the six communities suggests that the weak association is explained by the idiosyncratic histories of several of the communities, in particular their histories of health and family planning provision. Explanations for reproductive change that place social organization on center stage must be enlarged to incorporate the potentially powerful influence of community history

Modelling Diffusion Effects in Fertility Transition

Artículo científico-- Instituto de Investigaciones en Salud-- 1993Mathematical models bind theory to precise formulations, and by doing so accentuate logical inconsistences in theories and facilitate their testing. In this article we explore the implications of simple mathematical models of fertility transition that contain social interaction diffusion effects. We put forward the hypothesis that diffusion effects act as a third type of causal agent of fertility transition, above and beyond the traditionally studied demand and supply factors. Substantial historical and contemporary evidence points to the existence of diffusion effects on the timing and pace of fertility transition.' Among the pieces of evidence most commonly cited are the fact that fertility declines have occurred under a wide variety of social and economic circumstances, with the pace of decline frequently outpacing the rate of socio-economic change; the irreversibility and rapid pace of decline; the remarkable spatial and temporal patterning of fertility decline in terms of linguistic, ethnic, and cultural boundaries; and, in contemporary developing societies, the relatively small cross-societal and temporal variation in stated reproductive preferences, as compared to the variation in levels of fertility and contraceptive behaviour in the same populations.Universidad de Costa Rica. Instituto de Investigaciones en SaludUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA

Unmet need for family planning in developing countries and implications for population policy

Unmet need for family planning has been a core concept in international population discourse for several decades. In this paper we reevaluate its utility. We review the history of unmet need and the development of increasingly refined methods of its empirical measurement. We then turn to the main questions that have been raised about unmet need during the past decade, some of which concern the validity of the concept and others its role in the post-ICPD environment. The discussion draws heavily on empirical research conducted during the 1990s, much of it localized, in-depth studies combining quantitative and qualitative methodologies, that has significantly advanced our understanding of the nature and causes of unmet need. Of the causes of unmet need other than those related to access to services, three emerge from the in-depth studies as especially salient: lack of necessary knowledge about contraceptive methods, social opposition to their use, and health concerns about possible side effects. We argue that the concept of unmet need for family planning, by joining together contraceptive behavior and fertility preferences, encourages an integration of family planning and broader development approaches to population policy. In its emphasis on individual aspirations and their fulfillment, unmet need remains a readily defended rationale for the formulation of population policy and a sensible guide to the design of family planning programs

Unmet need for family planning in developing countries and implications for population policy [Arabic]

Unmet need for family planning has been a core concept in international population discourse for several decades. In this paper we reevaluate its utility. We review the history of unmet need and the development of increasingly refined methods of its empirical measurement. We then turn to the main questions that have been raised about unmet need during the past decade, some of which concern the validity of the concept and others its role in the post-ICPD environment. The discussion draws heavily on empirical research conducted during the 1990s, much of it localized, in-depth studies combining quantitative and qualitative methodologies, that has significantly advanced our understanding of the nature and causes of unmet need. Of the causes of unmet need other than those related to access to services, three emerge from the in-depth studies as especially salient: lack of necessary knowledge about contraceptive methods, social opposition to their use, and health concerns about possible side effects. We argue that the concept of unmet need for family planning, by joining together contraceptive behavior and fertility preferences, encourages an integration of family planning and broader development approaches to population policy. In its emphasis on individual aspirations and their fulfillment, unmet need remains a readily defended rationale for the formulation of population policy and a sensible guide to the design of family planning programs

Trends in the timing of first marriage among men and women in the developing world

The timing of first union merits investigation not only because of the close temporal link between marriage and the onset of childbearing, but also because the age when men and women marry has implications for the organization of family life and for gender relations within society. This paper begins by reviewing the contributions of various social science disciplines to an understanding of the timing of marriage. Using current status data from 73 countries provided by the United Nations Population Division and retrospective data from 52 Demographic and Health Surveys conducted between 1990 and 2001, we then examine recent trends in the timing of first marriage or union for men and women in the developing world. With the exception of South America for both sexes and South and Southeast Asia for men, substantial declines have occurred in the proportion of young men and women who are married. Given the differentials in the timing of marriage by educational attainment and residence, we assess whether the decline in the proportion of young people who are married is related to increases in schooling and urbanization. Expansion of schooling for women has had some impact, but a considerable portion of the reduction in early marriage is not explained by changes in levels of education. We consider other factors that might account for the increase in age at marriage. Finally, we review what is known about the consequences of changing age at marriage with a particular focus on risk of HIV infection