Number of children ever-born and its associated factors among currently married Ethiopian women: evidence from the 2019 EMDHS using negative binomial regression.

BACKGROUND: Ethiopia's population is growing at about 2.7% annually with a fertility rate of 4.1 births per woman. However, as per the knowledge of the researcher, not enough studies have been done in Ethiopia to identify factors associated with women's fertility levels. OBJECTIVE: To assess the number of children ever born and its associated factors among currently married reproductive-age Ethiopian women. METHOD: Data of 5613 currently married women were extracted from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). Stata version 14 was used for data extraction, processing, and analysis. Descriptive data were summarized using descriptive statistics. A multivariable negative binomial regression was used for the inferential analysis. Incidence rate ratio (IRR) and its 95% CI were respectively used to measure the associations and their statistical significance. RESULT: The median number of children ever born per currently married Ethiopian woman was 3 with an iterquarter range of 4 (1-5) children. Age of a woman at her first birth (aIRR = 0.958, 95% CI: 0.954, 0.961), being protestant (aIRR = 1.128, 95%CI: 1.068, 1.193), being Muslim (aIRR = 1.096, 95% CI: 1.043, 1.151), and being from other religious groups than Orthodox Christianity (aIRR = 1.353, 95% CI: 1.036, 1.766) are positively associated with bearing more children. On the other hands, completing primary education (aIRR = 0.664, 95% CI: 0.640,0.689), secondary education(aIRR = 0.541, 95%CI: 0.504,0.582), higher education(aIRR = 0.527, 95%CI: 0.479, 0.580), being from a richest household(aIRR = 0.899, 95%CI: 0.840, 0.962), using modern contraceptive (aIRR = 0.877, 95%CI: 0.847, 0.908), living in the Afar (aIRR = 0.785, 95%CI: 0.718,0.859), Amhara (aIRR = 0.890, 95%CI: 0.718,0.859), Gambella (aIRR = 0.894, 95%CI: 0.820,0.974), and Addid Ababa(0.845, 95%CI: 0.760,0.939) are negatively associated with bearing more children. CONCLUSION: Promoting women's empowerment, encouraging women's academic advancement, and community-based educational intervention are recommended to have optimal and decreased numbers of children.

Women's independent decision-making power and determinants on not to use contraceptives among currently married women in Ethiopia using demographic and Health Survey data: Multilevel Analysis.

BACKGROUND: Evidence suggests that couples frequently dispute regarding the desirability of pregnancy, as well as whether or not to employ family planning measures. There are numerous unmet needs owing to partner or family objections, according to a scares study that illustrates women's independent decision-making capacity on whether or not to use a contraceptive. As a result, the purpose of this study was to analyze women's independent decision-making power and determinants of not using contraceptives. METHODS: Reproductive age group women aged (15-49 years) currently married who are not pregnant and are currently not using family planning preceding five years the survey was included from the individual record (IR file) file using standard demographic and health survey datasets of Ethiopia. Using multilevel logistic regression models, we investigated the relationship between several independent factors and women's independent decision-making not to use contraception. The adjusted odds ratios were evaluated using 95% confidence intervals. RESULTS: A total of 5,598 currently married women were included in this study. Individual level factors significantly associated with women independent decision making on not to use contraceptive were female-led households (AOR = 2.11; 95% CI = 1.60-2.78), being orthodox ( AOR = 1.84; 95% CI = 1.39-2.44 ) and protestant ( AOR = 1.62; 95% CI = 1.17-2.23), and belonging to more than one union (AOR = 1.48; 95% CI = 1.12-1.95). Whereas, low community education (AOR = 1.19; 95%= 1.00-1.49) and regions: in Tigray (AOR = 2.19; 95%CI = 1.51-3.16), Afar (AOR = 1.74; 95% CI = 1.14-2.64), Amhara (AOR = 2.45; 95% CI = 1.71-3.500), South Nations Nationality (AOR = 1.87; 95% CI = 1.32-2.65), Gambela (AOR = 2.58; 95% CI = 1.73-3.84), Hareri (AOR = 3.93; 95% CI = 2.62-5.88), and Dre DDewa (AOR = 1.66; 95% CI = 1.12-2.45) were community-level factors. CONCLUSION: Women's independent decision-making power not to use contraceptives was low and greatly affected by both individual and community-level factors. Therefore, it is necessary to develop policies and create programs that promote women's empowerment by incorporating their partners in each region of the nation to encourage women's independent decision-making authority to use or not to use a contraceptive.

Inequalities in short-acting reversible, long-acting reversible and permanent contraception use among currently married women in India.

BACKGROUND: In India, the usage of modern contraception methods among women is relatively lower in comparison to other developed economies. Even within India, there is a state-wise variation in family planning use that leads to unintended pregnancies. Significantly less evidence is available regarding the determinants of modern contraception use and the level of inequalities associated with this. Therefore, the present study has examined the level of inequalities in modern contraception use among currently married women in India. METHODS: This study used the fourth round of National Family Health Survey (NFHS-4) conducted in 2015-16. Our analysis has divided the uses of contraception into three modern methods of family planning such as Short-Acting Reversible Contraception (SARC), Long-Acting Reversible Contraception (LARC) and permanent contraception methods. SARC includes pills, injectable, and condoms, while LARC includes intrauterine devices, implants, and permanent contraception methods (i.e., male and female sterilization). We have employed a concentration index to examine the level of socioeconomic inequalities in utilizing modern contraception methods. RESULTS: Our results show that utilization of permanent methods of contraception is more among the currently married women in the higher age group (40-49) as compared to the lower age group (25-29). Women aged 25-29 years are 3.41 times (OR: 3.41; 95% CI: 3.30-3.54) more likely to use SARC methods in India. Similarly, women with 15 + years of education and rich are more likely to use the LARC methods. At the regional level, we have found that southern region states are three times more likely to use permanent methods of contraception. Our decomposition results show that women age group (40-49), women having 2-3 children and richer wealth quintiles are more contributed for the inequality in modern contraceptive use among women. CONCLUSIONS: The use of SARC and LARC methods by women who are marginalized and of lower socioeconomic status is remarkably low. Universal free access to family planning methods among marginalized women and awareness campaigns in the rural areas could be a potential policy prescription to reduce the inequalities of contraceptive use among currently married women in India.

Male involvement in family planning use and associated factors among currently married men in rural Eastern Ethiopia.

Introduction/Objectives: Male involvement in family planning refers to all organizational actions focused on men as a distinct group to increase the acceptability and uptake of family planning among either sex. Despite the growing evidence of male involvement in increasing family planning uptake among couples, a little success has been achieved in Ethiopia, especially in rural areas. Hence, this study aimed to assess male involvement in family planning and its associated factors among currently married men in selected rural areas of Eastern Ethiopia. Methods: A community-based cross-sectional survey was conducted among 577 randomly selected currently married men, using a simple random sampling method in randomly selected rural districts of Eastern Ethiopia. Data were collected using a pretested interviewer-administered questionnaire. The collected data were entered into a computer using Epi-Data Version 3.1. The analysis was performed using the Statistical Package for the social sciences software version 21. Logistic regression analysis was used to analyze the association between the dependent and independent variables. Finally, adjusted odds ratio with 95% confidence intervals at P-value < 0.05 was considered to be significantly associated with the outcome variable. Results: Out of 577, a total of, 555 married men were included in the study, resulting in a response rate of 96.2%. The magnitude of male involvement in family planning use was 59.3% (95% confidence interval: 47.1, 68. 2). Ever use of family planning by a spouse (adjusted odds ratio: 2.37; 95% confidence interval: 1.59, 3.52), ever discussion of spouse on sexual and reproductive health/family planning issues (adjusted odds ratio: 2.05; 95% confidence interval: 1.40, 3.02), and the husband's approval of family planning (adjusted odds ratio: 2.45; 95% confidence interval: 1.34, 4.96) were significantly associated with higher odds of male involvement in family planning use than their counterparts. Conclusion: The number of men involved in the family planning was low. Ever use of family planning methods by a spouse, ever discussion of spouse on sexual and reproductive health/family planning issues, and husband approval on family planning use were found to be important predictors of male involvement in family planning use. To improve modern family planning uptake among men and women, it is imperative to include men in family planning programs, such as family planning messaging, sensitizations, and services.

Desire to limiting child birth and the associated determinants among married females: Sukh Survey-Karachi, Pakistan.

OBJECTIVE: High rates of population growth negatively influence the social and economic development of a country. This study aimed to determine the women's desire to limiting child birth in future (fertility intention) and its determinants among Pakistani women of reproductive age resident of Karachi. METHODS: A community-based, multistage cross-sectional study was carried out among residents of the squatter settlements in Karachi. The were 4,485 married residents, and currently non-pregnant females of 18 to 49 years old. Framework adapted has been based on "Pullum 1980" to operationalize the outcome of determining the desire to limiting childbearing and the factors related with controlling the family size. Multivariable logistic regression using SPSS 13.0 was used. RESULTS: The survey comprised of a total sample of 4485 females who participated and acquiring a median (interquartile range) age of 30 (25 to 35) years. Whereas, the living children count was found to be [median: 3 children; (IQR: 2 to 4)]. From the total, 2109 (47%) wanted to limit the future child birth. Multivariable logistic analysis showed that women who did not want to limit child birth significantly (p-value <0.05) belonged to age groups 18 to 27 years (adjusted odds ratio [aOR]=0.25), and 28 - 37 years (aOR=0.39) compared to the women aged > 37 years (referent category), who belonged to poor wealth category (aOR=0.41), were ever contraceptive users (aOR=0.49), were currently not a contraceptive user (aOR=0.53), not educated (aOR=0.34), and having sons less than the daughters (aOR=0.74). Conversely, females with perceived family structure of ≤two children ideally (aOR=2.62), were autonomous (aOR=1.25) and who had equal daughters and sons (aOR=1.13) rather than more number of sons, had more probability to limiting child birth at a statistically significance (p-value) of less than 0.05. CONCLUSIONS: The survey highlights the strategic independent determinants and there is a need of devising behaviour modification modalities accordingly to expedite the use of contraceptive methods and to encourage fertility decline among women.

Preference on prenatal sex determination and its associated factors among currently married women of reproductive age group in Puducherry, India.

BACKGROUND: Sex determination refers to knowing the sex of foetus during prenatal period for non-medical reasons. Attitude of married women to sex determination is important to improve the sex ratio at birth. AIM AND OBJECTIVES: This study aimed to assess preference on sex determination and associated factors among currently married reproductive age group women. MATERIALS AND METHODS: This cross-sectional community-based study was done during 2016-2017 among 2228 currently married women of 18-49 years' age group in urban and rural Puducherry, India. Information on the demographic characteristics, level of awareness and preference for sex determination was obtained. Multiple logistic regression was used to identify factors influencing preference for sex determination. Unadjusted and adjusted odds ratio (AOR) as a measure of effects was used. RESULTS: Of 1979 respondents, all were aware that sex determination is possible. Majority of them did not prefer sex determination (95.4%, 1888). About 80 (4.0%) preferred, while 11 (0.6%) were undecided about it. Majority of them were aware that sex determination without medical indication is a crime. Common source of information was healthcare workers (76.4%). After adjusting for confounders, age group (18-24, AOR = 5.334; 25-29, AOR = 3.249; 30-34, AOR = 3.857; 35-39, AOR = 2.279), middle level education (AOR = 2.3), those with unmet need for family planning (AOR = 2.970) and urban area (AOR = 67.679) subjects were preferred more; housewife (AOR = 0.481) and those without living son (AOR = 0.406) had preferred lesser for sex determination compared to their counterparts. CONCLUSION: About one in 25 currently married women preferred sex determination. It is comparatively more in urban areas. High-risk groups should be educated to develop correct awareness and attitude on prenatal sex determination.

Differentials of modern contraceptive methods use by food security status among married women of reproductive age in Wolaita Zone, South Ethiopia.

BACKGROUND: In spite of the massive spending and extensive family-planning promotion, many poor people in the third world remain reluctant to use modern contraceptive method. Mostly when they use modern contraceptives, their continuation rates are often low. Reproductive health can improve women's nutrition; in return better nutrition can improve reproductive health. Thus addressing the connection between nutrition and reproductive health is critical to ensure population growth that does not overwhelm world resources. METHODS: A community based cross-sectional study was conducted from March 15-30, 2014 in Soddo Zuria Woreda, Southern Ethiopia. A total of 651 currently married women of reproductive age group were selected using multistage sampling. Probability proportional to the size allocation method was employed to determine the number of households. Multivariable logistic regression was used to assess the association between family planning use and food security status after adjusting for other covariates. RESULTS: Use of modern contraceptive method was significantly low among food insecure women (29.7 %) compared to those who were food secure (52.0 %), (P < 0.001). Women from food secure households were nearly twice likely to use modern contraceptive methods (AOR: 1.69 (CI: 1.03, 2.66)). Similarly, those who had antenatal care (ANC) visit (AOR: 4.56 (CI: 2.45, 7.05)); exposure to media (AOR: 4.92 (CI: 1.84, 13.79)) and those who discussed about contraceptive methods with their partner (AOR: 3.07 (CI: 1.86, 5.22)) were more likely to use modern contraceptive methods. Conversely, women who delivered their last child at home were less likely to use modern contraceptive methods (AOR: 0.08 (CI: 0.03, 0.13)). CONCLUSION: Food insecurity is negatively associated with modern contraceptive method use. Thus food insecurity should be considered as one of the barriers in designing family planning services and needs special arrangement.

Prevalence Pattern and Determinants of Disclosure of HIV Status in an Anti Retroviral Therapy Clinic in the Niger Delta Region of Nigeria.

BACKGROUND: In order to advance the extent of self-disclosure of HIV sero-status in Nigeria, we evaluated the prevalence, pattern and determinants of disclosure of HIV status amongst adult patients in a hospital in the Niger Delta. MATERIALS AND METHODS: In a three month cross sectional study undertaken in March 2012, the demographic and clinical data as well as HIV sero-status disclosure frequency and pattern were obtained using a pre-tested questionnaire from consenting HIV infected adults attending the Anti-Retroviral Therapy Clinic in the Niger Delta. Independent determinants of HIV disclosure to current sexual partner were determined using an unconditional logistic model. P<0.05 was considered statistically significant. RESULTS: A total of 260 patients were studied out of which 184(71%) were females. Disclosure to current sexual partner was found to be 62.0% and students had the least disclosure rate. Majority of study participants preferred to disclose to family members (57%) than past sexual partner (2.5%) or friend (4.9%). Although HIV disclosure was significantly associated with male sex, living with sexual partner, partner being HIV positive; the only independent determinants of HIV disclosure were partner being on ART (OR-12.7, 95% CI 1.2-132.7) and being currently married (OR-8.8, 95% CI 2.1-36.8). CONCLUSION: The results of our study suggest low rate of HIV status disclosure among HIV infected patients in the Niger Delta. We found that receiving ART and being currently married promoted disclosure. There is need for clinicians and policy makers to foster disclosure of HIV sero-status in Nigeria especially among HIV infected students and unmarried sexual partners.

Trends of Infertility and Childlessness in India: Findings from NFHS Data.

Etiology of infertility varies from region to region and from one population to another and even from one locality to another within the same population. Childlessness has serious demographic, social and health implications. Hence an attempt has been made to get some approximation about levels and patterns of infertility and childlessness in India by using National Family Health Survey-2 (1998-1999) and National Family Health Survey-3 (2005-2006) data. The study population consists of women aged 20-49 years married for ≥ 5 years. Age of women, age at first marriage, place of residence, standard of living, working status of women, and region are some of the variables related with the rate of infertility and childlessness. Infertility rate is high among women in urban areas. This may be due to lifestyle or a later age at first marriage. Considering religion, Muslims show the lowest infertility rate. Scheduled tribes have high infertility rate. With increasing levels of educational attainment among women, infertility rate increases. This can be related to the fact that with aspirations for attaining higher educational level, marriage is delayed as a result of which in confirmation with aforementioned causation factors (higher age at marriage, urban living style etc.), infertility rate is high among this sub group of population.

AIDS-related information exposure in the mass media and discussion within social networks among married women in Bombay, India.

Married women are at high risk of acquiring HIV infection in India and health education remains the most feasible preventive tool in their context. In a survey conducted among 350 married women in Bombay, it was found that a majority had acquired information about AIDS from the mass media, especially television. Although 87% of women who knew of AIDS had been exposed to AIDS-related information in the mass media in the past four weeks, only 57% had discussed it within their social networks. Those with more exposure to AIDS information in the mass media were significantly more likely to discuss AIDS within social networks. The women were most likely to discuss AIDS with their husbands as a general social issue, followed by friends and family members and least likely to talk to husbands about AIDS as a personal issue relating to their sexual relationship. Increased frequency and duration of AIDS messages on television will have a positive influence on AIDS knowledge in this group.

PIP: Health education remains the most feasible preventive tool in the context of married women who are at high risk for acquiring HIV infection in India. The sample for the study reported in this paper comprised 350 married women in Bombay. Results showed that a majority of them had acquired information about AIDS from the mass media, particularly television. Sociodemographic analysis revealed 87% of women who knew of AIDS had been exposed to AIDS-related information in the mass media in the past four weeks and that 57% had discussed it within their social networks. Women were most likely to discuss AIDS with their husbands as a general social issue, followed by friends and family members. They were least likely to talk to their husbands about AIDS as a personal risk issue relating to their sexual relationships. Women's strategies for risk assessment may be inadequate owing to their dependency on knowledge and perceptions of AIDS acquired from brief and impersonal messages on television.

The effects of maternal-child health service utilization on subsequent contraceptive use in Morocco.

There are a number of reasons for anticipating that contact by women in developing country settings with modern maternal-child health (MCH) services will lead to increased use of family planning services. Indeed, the expectation of such a relationship underlies the integrated service delivery strategy that has been adopted on a more or less global basis. However, the available empirical evidence in support of this proposition is inconclusive. This study re-examines this issue in Morocco. Household survey data and data on the supply environment for health and family planning services gathered in 1992 are analysed in the study. A full-information maximum likelihood estimator is used to control for the possible endogeneity of health care and contraceptive choices. The findings indicate a substantial and apparently causal relationship between the intensity of MCH service use and subsequent contraceptive use. Policy simulations indicate that sizeable increases in contraceptive prevalence might be realized by increasing the coverage and intensity of use of MCH services.

PIP: This study examined the association between frequency of use of maternal and child health (MCH) services and subsequent contraceptive use (CU) in Morocco. Data were obtained from a 1992 Moroccan Health Survey among 3267 married women with at least 1 live birth and the 1992 Service Availability Module. Analysis was based on full information maximum likelihood estimates and nonparametric, discrete factor strategies. The analysis ignored the possibility that CU can lead to increase MCH use, because few women use contraception before a first birth. Findings indicate that intensity of MCH service use was a statistically significant determinant of subsequent CU. The magnitude of the effect was large. For example, an increase in MCH service use from 2 to 4 would result in an increase of over 71% in contraceptive prevalence, from 32% to 55%. Modern CU would increase from 55% to 65%. Traditional CU would increase from 7% to 19%. Increases were more likely despite controls for individual and household characteristics. Findings do not explain the role of integrated services. Since there are numerous sources of supply, it is likely that counseling and promotion by health facility staff were significant factors. Evidence supports the need to include community-level factors in the analysis, but key community factors remain unmeasured.

Consanguineous marriage and differentials in age at marriage, contraceptive use and fertility in Pakistan.

Fertility rates in Pakistan have remained consistently high over the past three decades. While numerous studies have examined sociodemographic determinants, the role of biological factors, and particularly consanguinity, has received little attention, even though marriage between close biological relatives continues to be the norm in Pakistan. Reproductive behaviour among women in consanguineous (first cousin) and non-consanguineous unions was compared, using data from a 1995 study of multi-ethnic communities in Karachi and the 1990-91 Pakistan Demographic & Health Survey (PDHS). The results show that, although female age at first marriage has been gradually rising in both study samples, women in consanguineous unions married at younger ages and were less likely to use modern contraceptive methods. In the Karachi sample, women in first cousin unions experienced a higher mean number of pregnancies and also reported a higher mean number of children ever born (CEB). However, their mean number of surviving children did not differ from those born to women in non-consanguineous unions, implying higher prenatal and/or postnatal losses in couples related as first cousins. On the other hand, the PDHS showed both lower CEB values for women in consanguineous marriages and a lower number of surviving children. Given the continuing popularity of consanguineous marriage, these findings have important implications for future fertility reduction in Pakistan.

PIP: This study examined fertility among women in consanguineous unions (CUs) in Pakistan and the association between CUs and contraceptive use and marriage age. Macrolevel data were obtained from the 1990 Demographic and Health Survey (DHS) among a subset of 4679 ever-married women. Microlevel data were obtained from a 1995 survey (KS) among a subset of 913 current married women from 4 squatter settlements in Karachi. Marriage age (MA) was 17.4 years in the KS and 17.8 years in the DHS. MA increased from oldest to younger cohorts in both samples. Female education was associated with the increase in MA. Urdu speakers had a much higher MA. Women in CUs had lower MA among all ethnic groups. 49.3% in the KS and 8.8% in the DHS reported current contraceptive use. Contraceptive use in the DHS differed significantly by marriage duration, child survival, and child mortality. Logistic models reveal that women in CUs in the KS were less likely to use contraceptives, after controlling for education. Both samples showed that contraceptive use was related to sex composition of surviving children and ethnicity. Women with only daughters were least likely to use. Place of residence was the strongest predictor of ever use. Duration of marriage was a significant predictor only in the DHS. Women in first cousin CUs in the KS had a higher mean children ever born (CEB) and number of pregnancies; DHS findings were the reverse. Multiple classification analysis showed in the KS that when sociodemography was controlled, CU was unrelated to mean CEB. DHS data showed CUs associated with reduced fertility. In both samples, mortality of children aged under 10 years had the most significant effect on CEB.

Determinants of employment of recently arrived Mexican immigrant wives.

PIP: The work force participation of married, Mexican-origin immigrant women who came to the US in the 1980s was investigated. Determinants of employment utilized in this study are the women's human capital stock, household resources, and labor market structural factors. Nine hypotheses were derived from the analytical model and were examined through logistic regression. Findings showed that all human capital resource and structural labor market factors were significantly related to employment. On the other hand, four of the five family household factors namely: the age and presence of children in the household, husband's income, husband's employment, and non-labor income were significantly related to employment. Furthermore, the positive factors indicating the likelihood of being employed in 1989 for Mexican immigrant wives are: 1) being 25-54 years of age; 2) higher educational levels; 3) speaking fluent English; 4) lower levels of husband's income and non-labor income; 5) employment of husband in 1989; 6) absence of children under age 6 at home; 7) lower non-Hispanic female unemployment rates; 8) higher work force proportion employed in immigrant female-dependent occupations; 9) lower proportions of the Metropolitan Statistical Areas (MSA) population being of Mexican origin; and 10) smaller MSA populations.^ieng

Schooling, fertility and the labour market experience of married women.

PIP: This paper discusses the role of formal schooling and child rearing in the determination of career path choice of women in the US. Data were collected from the adult educational component of the 1991 US National Household Education Survey. Data are available for about 12,568 respondents, of whom 6860 are female. It is established that, amongst others, expected earnings significantly affect the career path and the hours of work chosen by American women. Based on the results of the study, a number of conclusions have been drawn: 1) expectations of earnings affect women's choice of career path, including decisions such as labor market participation, the part-time work versus full-time work decision, and occupational choice; 2) the indirect and indirect effects of schooling and other variables on regime choice has been studied; the impact of schooling and fertility on women's labor supply follows an intuitively plausible pattern; 3) evidence provided here on the private rate of return to education confirms the findings of Bland that part-time workers do not receive a lower return than others; and 4) the importance of correcting for endogeneity and sample selection biases in the problem of earnings determination and career choice has been established.^ieng

Sterilisation of married couples: husband versus wife sterilisation.

Sterilisation has been increasing in the United States in recent decades. Using the National Survey of Families and Households, this paper examines sterilisation among married couples using event history techniques, viewing husband and wife sterilisation as competing risks. Wives are more likely to experience sterilisation and at shorter durations of marriage. Number of children has a curvilinear effect on sterilisation, increasing and then decreasing its likelihood. Wives who are older than their husbands are more likely to get sterilised themselves. Black and Hispanic husbands are more likely to undergo sterilisation.

PIP: This study examines the rate at which married couples utilize sterilization in the US. Data were obtained from the 1988 National Survey of Families and Households conducted at the University of Wisconsin at Madison. The sample includes 3692 couples with spouses at least 19 years old and complete retrospective histories of marriage and fertility. Event history techniques were used in the analysis. Life tables were used to examine the probability of sterilization at each duration of marriage in 2-year intervals. The hazard rate shows increasing and decreasing trends. Findings indicate that the hazard curve increases and peaks at around 85 months and then decreases to 81% after 16 years of marriage. The survival probability was 87% for wife sterilization and 94% for husband sterilization after 16 years of marriage. Husband's sterilization hazard curves peaked at around 82 months and then declined. Wife sterilization peaked earlier and then decreased steadily. Couples with no children had a survival risk of 96% after 16 years of marriage. Couples with 4 or more children had a 90% survival probability. Couples with 2, 3, or 4 children had a survival risk of 76%. Survival probability increased with wife's age at marriage. Logistic models indicate that the number of children had a curvilinear relationship to sterilization. As wife's age at marriage increased, the duration until sterilization increased and the risk of sterilization decreased. Couples with a wife 2 years older than her spouse were more likely to experience sterilization. Catholics were less likely to experience wife sterilization than Protestants. Black or Hispanic husbands were more likely to be sterilized and at shorter durations than White husbands. Black wives were less likely to be sterilized than White or Hispanic wives. Couples married before 1970 had a lower risk of sterilization and longer durations until sterilization.

Coital frequency among married and cohabiting couples in the United States. A comment.

PIP: This commentary refers to Rao and DeMaris' (1995) study of coital frequency among married and cohabiting couples in the US. The findings indicate higher rates of coitus among cohabiting partners. The sample includes couples with relationship durations of under 5 years. The authors of this critique argue that coital rates are more closely associated in nonlinear ways to duration of the relationship than to age of either partner. One 1983 US study indicates that mean coital rates decline by 50% during the first year of marriage, while another (1953) study indicates that rates decline by 50% from age 20 to 40 years. These two findings are compatible with the understanding that coital rates vary widely across couples and that couples marry at varying ages. The authors argue that cohabiting relationships are of shorter mean duration than marriages, and that this explains the higher coital rates among cohabiting couples. Coital frequency research could test the relationship between duration and coital frequency by matching coarse age (5-year intervals) and 1-2 month duration relationships of cohabiting couples with control married couples. It is possible that data are flawed if married couples believe the duration begins at the start of the legal marriage rather than the consensual union leading to marriage.^ieng

Chronic energy deficiency in women from rural Bangladesh: some socioeconomic determinants.

This paper explores a number of socioeconomic factors thought to explain the wide prevalence of undernutrition among rural Bangladeshi women. The 1992 baseline survey data of the BRAC-ICDDR,B Joint Research Project at Matlab were used. Anthropometry was performed on a random sub-sample of 1462 currently married, non-pregnant women between 15 and 49 years of age. Women's nutritional status was defined in terms of Body Mass Index (BMI = wt in kg/ht in m2). Compared with women from better-off households, the mean weight (41.2 vs 43.0 kg; p < 0.0001), mid-upper arm circumference (MUAC) (22.1 vs 22.7; p < 0.0001), and BMI (18.5 vs 19.1; p < 0.0001) of poor women were consistently lower. However, no significant difference in mean height was found between the two groups. The results showed that women aged more than 35 years are twice as likely to have a BMI < 18.5 compared with younger women. Both years of schooling received and socioeconomic status are found to be important predictors of women's BMI. Women who have received one or more years of formal education are nearly half as likely to suffer chronic energy deficiency (BMI < 18.5) than women with no schooling. Again, better-off women are found to be 0.77 times less likely to have chronic energy deficiency than women from poor households. The implications of these findings in improving the nutritional status of rural Bangladeshi women are discussed.

PIP: This study measured undernutrition among a subsample of 1462 currently married, nonpregnant women in the Matlab Project Area of Bangladesh and examined socioeconomic determinants of women's nutritional status. Data were obtained from a 1992 Matlab Baseline Survey among randomly selected married, nonpregnant women aged 15-49 years. Anthropometric measurements were taken and a body mass index (BMI) was computed. Findings indicate that the mean BMI of poor women in 3 age groups ranged from 18.3 to 18.9. The range for better-off women was from 1.8 to 2.1. BMI declined with increasing age among both poor and better-off women. Chronic energy deficiency (CED) increased progressively among women with severe BMI (under 16.0) and moderate BMI (16.0-16.9), regardless of socioeconomic status. Factors unrelated to women suffering from mild CED (under 18.5) were religious affiliation, total number of living children, and involvement in income generation programs. Mild BMI was associated with no schooling and women who were widowed, divorced, abandoned, or married more than once. Logistic regression analysis found that age, years of schooling, and socioeconomic status predicted CED. Better-off women were 0.77 times less likely to have CED. Women in better-off groups had an average of 1.7 years of education compared to only 1.2 years among the poor. Findings indicate that nutritional status increased over time, but not parity. The lack of association with parity is explained by the potential for low parity women to be severely energy deficient.

Economic security, informational resources, and women's reproductive choices in urban Mozambique.

Reproductive changes in sub-Saharan Africa are contingent upon women's socioeconomic conditions and informational and cultural resources. This study focuses on socioeconomic and cultural determinants and correlates of the intention to stop childbearing and of contraceptive use among urban women in Mozambique. It uses data from a survey of 1,585 married women conducted in Greater Maputo in 1993, and it employs logistic regression for multivariate analysis. The results of the analysis indicate that although the stopping intention and contraceptive use are interrelated and similarly affected by such factors as education or the area of residence, the intention to stop childbearing is mainly driven by women's perception of their material conditions and socioeconomic security, while contraceptive use is largely a product of social diffusion and the legitimization of innovative, Western-origin information and technologies. The study proposes that these findings may help explain the unique features of the fertility transition in sub-Saharan Africa.

PIP: Reproductive changes in sub-Saharan Africa depend upon women's socioeconomic conditions, as well as their informational and cultural resources. Reproductive changes have been most marked in sub-Saharan cities because compared to small-town and rural residents, urban residents have greater exposure to and choice among alternate economic strategies, cultural styles, and social networking. The socioeconomic and cultural determinants and correlates of the intention to stop childbearing and of contraceptive use were assessed among 1585 married, urban women surveyed in 1993 in Greater Maputo. Each woman had recently given birth. Multivariate analysis determined that while the women's intentions to stop childbearing and use contraception were interrelated and affected by factors such as education and the area of residence, the intention to stop childbearing was mainly driven by the women's perception of their material conditions and socioeconomic security, and contraceptive use was mainly a product of social diffusion and influences by innovative, Western-origin information and technologies.

Third birth intentions and uncertainty in Canada.

Using data from the 1995 Canadian General Society Survey (GSS-95), we study the intention to have a third child among a sample of women and men who have already had two children (N = 505). Our results show that 15 per cent of the respondents intend to have a third child. Nearly 20 per cent of the respondents are uncertain about their fertility intentions. We found that the same factors that predict intentions also predict uncertainty, and that the effects of these predictors are remarkably similar. In particular, intentions and uncertainty generally decline with age, but increase with regular church attendance, remarriage, and being Catholic. Unlike earlier studies, we found that the sex of previous children has virtually no impact on third-birth intentions or uncertainty.

PIP: Data from the 1995 Canadian General Society Survey (GSS-95) were used to study the intention to have a third child among a sample of 252 men and 253 women who already have 2 children. As in many industrial societies, a large part of Canadian fertility decline is attributable to the decline in third-birth rates. Moreover, the third birth is important in and of itself and represents the dividing line between below and above replacement-level fertility. Social norms against childlessness and 1-child families have also been persistent throughout most of the century, with census data showing the 2-child family to have been the most common family size in North America in recent decades. Respondents were chosen based upon a national probability sample of 4835 men and 5914 women aged 15 years and older, excluding residents of the Yukon and Northwest Territories, and full-time institutionalized residents. 15% of the men and women surveyed intended to have a third child, and almost 20% of the respondents were uncertain of their fertility intentions. Survey responses indicate that the same factors which predict intentions also predict uncertainty, and the effects of those predictors are highly similar. Intentions and uncertainty generally declined with age, but increased with regular church attendance, remarriage, and being Catholic. The sex of previous children had almost no impact upon third-birth intentions or uncertainty.

HIV / AIDS among men who have sex with men in Pakistan.

PIP: 1200 South Asian men from India, Pakistan, and Bangladesh who lived in either South Asia or the UK participated in focus group discussions conducted by the Naz Foundation to gain insight into the sociocultural dimensions of sex between men in the region. Although participants noted the lack of accessibility to women as the main reason for such behavior, the overwhelming majority of these men who have sex with men were married. Those aged 14-16 years had an average of 2 sex partners per year, while those aged 17-20 had 5, those aged 21-35 had 42, and those aged 36-45 had 35. There are many anecdotal reports of young men in South Asia who have sex with men and/or women in exchange for money or other tangible goods. By early 1997, 1232 cases of HIV infection had been reported in Pakistan, of which 88.4% were in men. These data come from the National AIDS Program, and consist largely of cases reported from 4 provinces. While the mode of HIV transmission was not recorded in 41% of cases, male-male sex was the acknowledged mode of transmission among 3.2% of HIV-positive men. Male-male sex appears to exist among married men who have extramarital sex contacts, prisoners, seafarers, IV drug users, truck drivers, and male prostitutes. In Pakistan, men who have sex with men comprise a highly vulnerable group which needs to be targeted for HIV/AIDS awareness-raising interventions.^ieng