The effect of antenatal care on professional assistance at delivery in rural India

Delivering births in a medical institution or at home with professional medical assistance has been shown to promote safe motherhood and child survival. Yet three-quarters of births in rural India continue to take place at home, most of them without the assistance of any trained health worker. This study examines the role of antenatal care (ANC) in promoting professional assistance at delivery, using data from India’s 1992–93 and 1998–99 National Family Health Surveys (NFHS-1 and NFHS-2). We estimate the effect of number of antenatal care visits (0, 1–2, 3+) on professional assistance at delivery (no assistance, professional assistance at home, delivery in a medical institution), using multinomial logistic regression, controlling for demographic, geographic, and socioeconomic factors, pregnancy complications, and two measures of access to health facilities. The results indicate that, after controlling for other variables (including ANC), pregnancy complications and access to health facilities do not have much effect on assistance at delivery. By contrast, ANC has a large effect, even after all other variables are controlled. The effect of ANC on professional assistance at delivery is larger in South India than in North India, and predicted percentages receiving professional assistance are higher in South India than in North India. A policy implication is that increased antenatal care coverage can be an effective means of increasing professional assistance at delivery, especially delivery in a medical institution

Multivariate analysis of parity progression-based measures of the total fertility rate and its components using individual-level data

For more about the East-West Center, see http://www.eastwestcenter.org/This paper develops multivariate methods for analyzing (1) effects of socioeconomic variables on the total fertility rate and its components and (2) effects of socioeconomic variables on the trend in the total fertility rate and its components. For the multivariate methods to be applicable, the total fertility rate must be calculated from parity progression ratios (PPRs), pertaining in this paper to transitions from birth to first marriage, first marriage to first birth, first birth to second birth, and so on. The components of the TFR include PPRs, the total marital fertility rate (TMFR), and the TFR itself as measures of the quantum of fertility, and mean and median ages at first marriage and mean and median closed birth intervals by birth order as measures of the tempo or timing of fertility. The multivariate methods are applicable to both period measures and cohort measures of these quantities. The methods are illustrated by application to data from the 1993, 1998, and 2003 Demographic and Health Surveys (DHS) in the Philippines

Migration and unemployment in Hawaii

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Factors affecting sex-selective abortion in India and 17 major states

For more about the East-West Center, see http://www.eastwestcenter.org/Birth histories collected during the first and second National Family Health Surveys (NFHS-1 and NFHS-2) show an unusually large proportion of male births in some population groups, which suggests that female fetuses are being aborted. Male births are particularly overrepresented in certain western and northern states, in families that already have daughters but no sons, and among women with a high level of education and media exposure. Analysis of women's ideal sex ratio (the ratio of ideal number of sons to ideal number of daughters) indicates that son preference is declining in almost all states and socioeconomic groups. Nevertheless, ideal sex ratios are still much higher than the biological norm, implying that considerable potential exists for further increases in levels of sex-selective abortion. The NFHS Subject Reports is a series summarizing secondary analysis of data from the 1992-93 National Family Health Survey (NFHS) in India. The NFHS collected information from nearly 90,000 Indian women on a range of demographic and health topics. Conducted under the auspices of the Indian Ministry of Health and Family Welfare, the survey provides national and state-level estimates of fertility, infant and child mortality, family planning practice, maternal and child health, and the utilization of services available to mothers and children. IIPS conducted the survey in cooperation with consulting organizations and 18 population research centers throughout India. The East-West Center and a U.S.-based consulting firm, Macro International, provided technical assistance, and the United States Agency for International Development (USAID) provided financial support. Printed copies are available from the East-West Center Research Program, Population and Health Studies. Single copies are available free by airmail and may be reproduced for educational use

Japan's baby bust : causes, implications, and policy responses

For more about the East-West Center, see http://www.eastwestcenter.org/This paper describes the trend in fertility in Japan, analyzes the causes and implications of the baby bust after 1973, and discusses the Japanese government's efforts to raise fertility, which by 2003 had fallen to 1.29 children (i.e., births) per woman, as indicated by the total fertility rate. Also addressed are the questions of why the government's efforts to raise fertility have not been effective and what additional steps the government might take

Factors affecting sex-selective abortion in India

For more about the East-West Center, see http://www.eastwestcenter.org/Birth histories collected during NFHS-1 and NFHS-2 show an unusually large proportion of male births in some population groups, which suggests that female fetuses are being aborted. Male births are particularly overrepresented in certain western and northern states, in families that already have daughters but no sons, and among women with a high level of education and media exposure. Analysis of women's ideal sex ratio (the ratio of ideal number of sons to ideal number of daughters) indicates that son preference is declining in almost all states and socioeconomic groups. Nevertheless, ideal sex ratios are still much higher than the biological norm, implying that considerable potential exists for further increases in levels of sex-selective abortion. The NFHS Bulletin is a series of four-page policy briefs summarizing secondary analysis of data from the 1992-93 National Family Health Survey (NFHS) in India. The NFHS collected information from nearly 90,000 Indian women on a range of demographic and health topics. Conducted under the auspices of the Indian Ministry of Health and Family Welfare, the survey provides national and state-level estimates of fertility, infant and child mortality, family planning practice, maternal and child health, and the utilization of services available to mothers and children. IIPS conducted the survey in cooperation with consulting organizations and 18 population research centers throughout India. The East-West Center and a U.S.-based consulting firm, Macro International, provided technical assistance, and the United States Agency for International Development (USAID) provided financial support. Printed copies are available from the East-West Center Research Program, Population and Health Studies. Single copies are available free by airmail and may be reproduced for educational use

Comparison of fertility trends estimated alternatively from birth histories and own children

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Fertility in Nepal 1981-2000 : levels, trends, and components of change

For more about the East-West Center, see http://www.eastwestcenter.org/The objectives of this paper are, first, to provide improved estimates of recent fertility levels and trend in Nepal and, second, to analyze the components of fertility change. The analysis is based on data from Nepal's 1996 and 2001 Demographic and Health Surveys. The first part of the analysis assesses the quality of the data from the 1996 and 2001 Nepal Demographic and Health Surveys (DHS) on which the fertility estimates are based. Fertility levels and trends are then estimated using the own-children method of fertility estimation. The own-children estimates incorporate additional adjustments to compensate for displacement of births, and they are compared with previously published estimates derived by the birth-history method. Fertility is estimated not only for the whole country but also by ecological region, development region, urban/rural residence, and woman's education. The own-children estimates indicate that the total fertility rate (TFR) fell from 4.96 to 4.69 births per woman between the 3-year period preceding the 1996 survey and the 3?year period preceding the 2001 survey. About three-quarters of the decline stems from reductions in age-specific marital fertility rates and about one-quarter from changes in age-specific proportions currently married. Further decomposition of the decline in marital fertility, as measured by births per currently married woman during the 5-year period before each survey, indicates that almost half of the decline in marital fertility is accounted for by changes in population composition by ecological region, development region, urban/rural residence, education, age at first cohabitation with husband, time elapsed since first cohabitation, number of living children at the start of the 5-year period, and media exposure. With these variables controlled, another one-third of the decline is accounted for by increase in the proportion sterilized at the start of the 5-year period. About one-fifth of the fertility decline is not accounted for by any of these variables, but this remaining unexplained component does not differ significantly from zero