Validation and measurement properties of the Male and Female Fertility Knowledge Inventories (MFKI and FFKI) in Iranian couples.

BACKGROUND: One of the most important population challenges during the last three decades has been the significant decrease in the fertility rate worldwide. Since the validity and reliability of the Male and Female Fertility Knowledge Inventories (MFKI and FFKI) have not been determined in Iran, we conducted this study to assess psychometric characteristics of the MFKI and FFKI in couples in Tabriz and Urmia, Iran. METHODS: This was a cross-sectional study, as the first part (quantitative phase) of a sequential explanatory mixed-method study. The current study was done on 1200 participants (600 women with their husbands) living in the northwestern region of Iran, between January 2023 and September 2023. The psychometric properties of the Persian version of the tool (MFKI and FFKI) were performed in 5 stages, including translation process, content validity, face validity, construct validity and reliability assesment. RESULTS: In this study, the CVI, CVR, and impact scores of the MFKI tool were equal to 0.90, 0.88, 3.26 and CVI, CVR, and Impact scores of the FFKI tool were respectively equal to 0.95, 0.91 and 3.59, that it indicated a satisfactory level of content and face validity. Then, to check the construct validity, the results of the exploratory factor analysis of the MFKI tool on 13 items led to the identification of 3 factors, including Environment and reproductive health (ERH), Lifestyle factors (LSF) and Sperm quality (SQ), which explained 66% of the cumulative variance. The results of the exploratory factor analysis of the FFKI tool on 15 items led to the identification of 4 factors, including Reproductive health (RH), Lifestyle factors (LSF), Chance of conception (CHC) and Ovarian reserve and preservation (ORP), which explained 68% of the cumulative variance. CONCLUSIONS: The findings of this study indicated that the Persian version of MFKI and FFKI has acceptable psychometric properties to measure the awareness of Iranian couples regarding fertility, which can be used as a screening tool for fertility knowledge by health care professionals and also as a reliable tool in research.

The right to sexual and reproductive health (SRH) is considered one of the basic rights of couples all over the world. Increasing childbearing age is a global social issue. In spite of the policies of having children in the previous decade, fertility reduction and involuntary childlessness are still the foremost global health problems. The fertility rate in Iran has reduced significantly in the last thirty years. This reduction can be attributed not only to economic difficulties but also to the postponement of marriage and having children, as well as infertility issues, which, by increasing the awareness of couples about fertility, seems to be able to overcome this problem to some extent. Consequently, we decided to conduct this study with the aim of determining the psychometric properties of the Male and Female Fertility Knowledge Inventories (MFKI and FFKI) in Iranian couples. The results of the current study revealed that this questionnaire, having acceptable psychometric properties to evaluate the state of awareness of Iranian couples regarding fertility, can be used as a valid and reliable tool in Iranian couples. It appears that it is essential for health care providers to play an active role in advising couples about the appropriate age of fertility, the problems of delay in having children, overcoming the value of having few children in society. Accordingly, health policymakers should recommend the use of valid screening tools to identify the knowledge of women and men about fertility in health centers.

Modelling period fertility: Schooling and intervals following a birth in Eastern Africa.

We describe a regression-based approach to the modelling of age-, order-, and duration-specific period fertility, using retrospective survey data. The approach produces results that are free of selection biases and can be used to study differential fertility. It is applied to Demographic and Health Survey data for Ethiopia, Kenya, Tanzania, and Zimbabwe to investigate differential trends in fertility by education. Parity progression fell and the intervals following each birth lengthened between the 1970s and 2000s in all four countries. Fertility fell most among women with secondary education. In contrast to other world regions, postponement of successive births for extended periods accounted for much of the initial drop in fertility in these African countries. However, family size limitation by women with secondary education in Ethiopia and Kenya and longer birth spacing in Zimbabwe also played significant roles. Thus, birth control is being adopted in Eastern Africa in response to diverse changes in fertility preferences.

The effect of changes in population characteristics on breastfeeding trends in fifteen developing countries.

BACKGROUND: Extended breastfeeding is known to benefit the health of children in developing countries and despite widespread expectations of a decline in breastfeeding in these countries, it has been demonstrated that the incidence and duration of breastfeeding are in fact increasing many countries. METHODS: In this paper, trends in breastfeeding duration are examined in 15 developing countries, using data from two comparable surveys for each country, the World Fertility Survey (conducted in the late 1970s) and the Demographic and Health Survey (conducted in the late 1980s). Multivariate regression models are used to examine differentials in breastfeeding behaviour across population subgroups in these countries for each time period, and these differentials are used to determine the extent to which the observed trends are due to changes in population characteristics and to what extent behaviour has changed within population subgroups. RESULTS: Results show that changes in the characteristics of the population have almost universally pushed breastfeeding durations in the downward direction. On the other hand, trends within population subgroups have been positive in all but two of the 15 countries examined. CONCLUSIONS: Changes in population characteristics can be expected to continue for most developing countries, exerting a downward pressure on breastfeeding. Policies that promote breastfeeding are needed to counter these changes, especially in the most vulnerable population subgroups.

Contraception and prevalence of sexually transmitted diseases among adolescents and young adults in Uganda.

The study is aimed at (i) exploring the knowledge and attitudes of adolescents (15-19 years old) and young adults (20-24 years old) towards sex and contraception (condoms) and (ii) determining their level of knowledge and attitudes towards sexually transmitted diseases (STD) as well as the prevalence of the latter among the sexually active adolescents and young adults. A sample of 4510 respondents (1545 males and 2965 females) aged 15-24 years from urban and rural areas were interviewed. The majority of adolescents and young adults surveyed have a negative attitude towards the use of condoms although most of them agreed that they prevent STD. Over 95% of the respondents have heard about STD and their level of knowledge is relatively high; slightly higher for urban residents and for young males. Approximately 21% of the male and 8% of the female respondents admitted having ever contracted STD. The gap between contraceptive knowledge and practice is rather wide. Only a small proportion of the respondents were using condoms at the time of the survey.

PIP: Between 1988 and 1990, researchers conducted the Adolescent Fertility Survey in the districts of Jinja, Kampala, Masaka, Kabale, Hoima, and Mbale in Uganda among 4510 15-24 year old urban and rural youth to examine their knowledge and attitudes toward sex, contraception, and sexually transmitted diseases (STDs). Males were more likely to experience 1st sexual intercourse at an earlier age than females. Many youth experienced their 1st sexual intercourse before age 15 and they had had more sexual partners than females. 83.9% of males and 87% of females used no contraception. Overall knowledge of condoms was high (78.2% for males and 56.6% for females) except among rural females (31.1%), especially among urban males (85.8%). Almost everyone was knowledgeable about STDs (96.1% males, 93.5% females). They tended to agree that condoms prevent STDs (urban males, 80.2%; urban females, 76%; rural males, 89.8%; and rural females 83.7%). Despite these high knowledge levels and positive attitude toward condoms, condom use levels were low, e.g., only 12.7% of males and 0.4% of females who were familiar with condoms used them. 40% of all respondents knew about the 3 most common STDs: gonorrhea, syphilis, and AIDS. Urban males were a bit more knowledgeable about these 3 STDs than were the other groups (48.8% vs. 41.2% for urban females, 41.3% for rural males, and 41.6% for rural females). In addition, STD prevalence was quite high especially among males (21.4% for males vs. 7.8% for females). The unsafe sexual practices revealed in this study indicated the need for sex education earlier than it is presently being offered in the school system and the establishment of health clinics geared toward adolescent needs.

Adolescent contraceptive use and its determinants in Bangladesh: evidence from Bangladesh Fertility Survey 1989.

This study is concerned with contraceptive use among the currently married adolescents in Bangladesh utilizing the 1989 Bangladesh Fertility Survey (BFS) data. The study analyzes the factors affecting the current use of contraception among the adolescents through bivariate and multivariate logistic regression analysis. The results indicate that although adolescents have almost universal knowledge about contraceptive methods, only 15 percent are currently using any method of contraception. The corresponding figures for the adults and for the nation as a whole are 34.4 percent and 31.4 percent, respectively. Among the individual methods currently used by the adolescents, the pill appears as the most popular method, followed by safe period. A substantial proportion of the adolescents were found to rely on the traditional methods of contraception. Among the socio-economic variables (as revealed by the logistic regression analysis), respondents' education, participation in the family planning decision, visit by family planning workers, region of residence, husband's occupation and possession of electricity in the household appear as the most significant factors determining the current use of contraception among the adolescents.

PIP: The 1989 Bangladesh Fertility Survey recorded a contraceptive prevalence rate of only 15.3% for married women under 20 years of age compared to 34.4% for respondents 20 years of age and older. 10.7% of married adolescents were using a modern method, primarily the pill, compared to 25.7% of adult women. A lack of knowledge does not appear to play a role in this pattern, since awareness of contraceptive methods is only slightly lower among adolescents. Rather, the low contraceptive prevalence rate for married adolescent women seems to reflect socioeconomic factors. The contraceptive use rate was 29% among adolescents with a higher secondary and above level of education compared to 10.3% among those with less education. This rate ranged from a low of 9.4% in the conservative Chittagong administrative division to a high of 17.2% in the more developed Khulna division. Logistic regression analysis identified education, participation in family planning decisions, visits from family planning workers, administrative division, husband's occupation, and electricity in the household as significant predictors of adolescent contraceptive usage. Place of residence, husband's education, and religion were not significant. These results suggest that use of modern contraceptive methods by young married women in Bangladesh will be increased through measures to improve women's status and bring them into contact with family planning outreach workers.

The World Fertility Survey: charting global childbearing.

Interviewing some 350,000 women in 42 developing countries and 20 developed countries representing nearly 40% of the world's population, the World Fertility Survey (WFS) is in a unique position to document the historic 1970s slowdown in global population growth. This Bulletin describes efforts begun in 1972 to ensure high quality, internationally comparable, accessible data, the data's importance for policymakers, planners and researchers, and major findings available by early 1982 from directly assisted WFS surveys in 29 developing countries and contraceptive use data from WFS-type surveys in 16 developed countries. Marital fertility has declined in all developing regions except Africa but still averages from 4.6 children/woman in Latin America to 6.7 in Africa, while preferred family size ranges from 3.0 children in Turkey to 8.9 in Senegal--far above the average 2.2-2.5 children/woman needed to end developing countries' population growth in the long run. However, women ages 15-19 prefer nearly 2 children fewer than the oldest women ages 45-49; 3.8 vs. 5.7 on the average. Nearly 1/2 (48%) of married women surveyed in 27 countreis said they wanted no more children. Preventing all unwanted births would reduce birth rates up to 15 births/1000 population in these countries. Overall, 32% of married, fecund women in developing countries are using contraception compared to an average 72% in 16 developed countries. Education, literacy, and more available family planning services increase contraceptive use. Age at marriage is rising in Asia, but this factor alone has little effect on fertility. Infant mortality is higher in many developing countries than previously thought. Breastfeeding is an important restraint on fertility in most developing countries but is declining among more educated, employed, and urban women which could raise fertility if not compensated for by gains in contraceptive use.

Understanding U.S. fertility: findings from the National Survey of Family Growth, Cycle III.

PIP: The 1st overview of findings from Cycle III of the National Survey of Family Growth, the latest of 7 such surveys of US fertility since 1955 and the 1st to cover all women of childbearing age in the conterminous US is presented. Interviews between August 1982 and February 1983 with 7969 women, representative of 54 million women aged 15-44, reveal that sterilization is now the leading contraceptive method in the US, used by 33% of all contraceptors in 1982 (22%, female sterilization; 11% male sterilization), followed by the pill (29%), condom (12%), diaphragm (8%), and IUD (7%). Linked to this is the continuing decline in unwanted births since the baby boom peak in 1957, which accounted for nearly 1/2 of the drop between 1973 and 1982 in ever-married women's children ever born, from 2.2 to 1.9/woman. However, births conceived sooner than planned increased slightly among younger married women, probably due to the large drop in pill use since 1973 and increased use of the less effective diaphragm and condom among couples still intending to have more children. Black women are now more likely than white women to use the most effective female methods: female sterilization, pill, and IUD. Only 45% of women aged 15-44 in 1982 had used a contraceptive method at 1st intercourse. 4 out of 5 women married for the 1st time between 1975 and 1982 had intercourse before marriage. However, premarital sexual activity may be leveling off among white teenagers after a steep rise since the early 1970s and declining moderately among black teenagers. 16% of 1st marriages among ever-married women aged 15-44 in 1982 had been dissoved within 5 years, mostly by divorce or separation. 59% of black women with children in 1982 had their 1st birth before marriage, compared to 11% of white mothers. The proportion of babies who were breastfed more than doubled between 1970-71 and 1980-81, from 24 to 53%.^ieng

Problems of selecting a plausible fertility measure for Addis Ababa (based on the 1984 census data).

PIP: Addis Ababa Population and Housing Census data from 1984 were analyzed by 4 methods to approach the best fertility estimate for the city. This survey asked every woman aged 10 years or older how many children were born within the last 12 months, and the total number of live-born children ever born. These data could be in error due to misreporting of other children of extended families, including stillbirths, omitting infants who died, adult children or offspring of other husbands, all tending to make reported fertility decrease with age. According to United Nations classification, these data were highly inaccurate, particularly the age-sex reporting. The reported age-specific fertility and average parity by age groups are tabulated. The estimated total fertility rate by the Coale and Demeny formula is 5.89, compared to that from raw data of 3.14. Fertility by the Brass method produced a median of 6.5. The Gompertz relational method of Brass resulted in a median total fertility rate of ranging from 1.99-5.29 at various age points. The Brass-Arriaga method generated a median estimate of 6.39 and a mean of 6.06. Taking all the estimates into account the most plausible estimate of fertility is around 6.^ieng

The transition to motherhood: the intersection of structural and temporal dimensions.

PIP: Prior work on the determinants of the 1st-birth process can be divided into 3 approaches: 1) time-series analysis focusing on description and determinants of trends; 2) cross-sectional studies examing childlessness or adolescent fertility; and 3) life-course studies dealing with the timing of fertility relative to other events. Drawing on these traditions, the conceptual framework places the 1st-birth process within, respectively, an aggregate-time dimension indicated by period or cohort, an individual-time dimension indicatedd by the respondent's age, and a social-structural dimension indicated by the respondent's spanning the 1955-1976 period, and examining conditional birth probabilities, the analysis incorporates each of these dimensions. Each dimension is important. Aggregate time exerts powerful and pervasive effects. Socio-structural variables have nonproportinal effects--tht is, their effects vary with time. The effects of the social-structural variables tend not to interact with the aggregate-time dimension. Finally, predictive power generally declines with inndividual time.^ieng

Epidemiological factors associated with neonatal tetanus mortality: observations from a cluster survey in Nigeria.

A cluster survey on neonatal tetanus (NNT) mortality was conducted in Kano Metropolis, Northern Nigeria, to investigate epidemiological factors associated with NNT mortality. The survey was a two-stage cluster sampling technique and lasted for two weeks. A total of 2,623 live-births were recorded over a 12-month period. Less than 40% of the births followed two or more antenatal visits and tetanus toxoid coverage was 32.0%. Over 60% of births were outside hospitals and related facilities. Of the epidemiological factors investigated, only antenatal care, tetanus toxoid coverage, hospital delivery, poor cord management and traditional surgery showed significant association with NNT death. It is suggested that an appropriate community-specific prevention strategy for the region should include health education to improve utilisation of antenatal and hospital-delivery facilities, discourage traditional surgery and improve tetanus toxoid coverage. A case is also made for training and involvement of traditional birth attendants (TBAs) since most deliveries occurred outside hospitals and related facilities.

PIP: Data obtained from a survey conducted in Kano Metropolis in northern Nigeria in July 1990 on a cluster sample of 2623 live births within the year were used to investigate epidemiological factors associated with neonatal tetanus (NNT) mortality. The sample included 1283 males and 1340 females, of which 79 died (54 from NNT). The NNT mortality rate is a high 20.6/1000. 51% of births in the sample were to mothers who received at least one prenatal visit. 37.9% of births involved mothers who received two or more prenatal visits, which is the typical pattern in developing countries. 32% were immunized with a tetanus toxoid vaccine, which is much higher than the typical 14% in developing countries. 40% were hospital or related health facility births. Low socioeconomic status was attributed to 60% of the infants. Over 80% of mothers practiced purdah, and 83% had a health facility within their cluster. Prenatal care, tetanus toxoid vaccine coverage, hospital delivery, poor cord management, and traditional surgery were related to NNT. Poor cord management and traditional surgery increased the risk of mortality, and the other factors reduced the risk. There were relative, but insignificant, risks associated with a male birth, low socioeconomic status, and the purdah system. One recommendation is for improvements in traditional birth attendant training. Affordability and use of health facilities are affected by the purdah system and the low socioeconomic status of most mothers. Prevention should stress good cord management, which Chinese studies show to be effective in reducing NNT mortality. Tetanus toxoid vaccine is recommended for all mothers who are attending any health facility for any reason. Mass immunization campaigns are an additional means of supplementing coverage. Traditional surgery such as circumcision, vulvectomy, ear piercing, and facial marking should be discouraged. Health education is recommended as a means of increasing use of health care facilities, discouraging unhealthful practices, and increasing immunization.

Female first marriage in East and Southeast Asia: a Kiefer-Neumann model.

Many studies have shown that schooling levels of husband and wife are important determinants of household behavior in developing countries. This article asks how the schooling levels of husband and wife come to be associated with each other through the marriage market. The Kiefer-Neumann model of labor market search is adapted to marital search, the aim being to explain both the positive sorting on educational levels for spouses, and the positive relationship between female schooling and age at 1st marriage. World Fertility Survey data for Indonesia, Korea, and Malaysia are employed in the analyses.

Statistical modeling of selected aspects of the childbearing process with application to World Fertility Survey countries.

"A mathematical model for estimation of certain aspects of the childbearing process, which requires only data on age-specific fertility rates, is developed. Synthetic maternal childbearing indices, namely, mean ages at first and last birth, length of reproductive life span, inter-birth spacing, and proportion of childless women, in addition to the well-known mean age at childbearing, for the WFS [World Fertility Surveys conducted in developing] countries are obtained using the proposed model. The indices are free from age truncation effects, and, under certain assumptions, provide information about a cohort's completed fertility before the women stop reproducing. The effects of women's residence and education on fertility are also examined." (SUMMARY IN FRE)

Fertility differentials and their impact on population distribution and composition in Northern Ireland.

The geographical variability of fertility in Northern Ireland is described and related to the factors of religious denomination, social class, and proportion of the population who are married. Although the substantial differences in birthrate from 1 region to another have a significant impact on population composition, it is concluded that internal migration rather than natural increase is the more important component of regional population growth and changing population.

Internal migration and regional population dynamics in China.

PIP: This monograph provides a systematic analysis of interprovincial migration in China and regional population dynamics since the 1950s. Data were obtained from the 1% sample survey of 1987. Chapters are devoted to an examination of the main features of population distribution and spatial differences of major demographic indicators, the causes and selectivity of migration, and the structure of migration. Explanatory models are used to estimate regional in- and out-migration rates and to identify factors that determine regional differences between those rates. The analysis of regional population trends since the 1950s is used to produce multiregional population projections at the provincial level for the period 1987-2087. The final chapter discusses the implications for socioeconomic development of regional population trends. Employment, marriage, and reunions with family are the three main causes of migration in China. City migrants tend to move between cities, while town and county migrants move to other towns in the same province or cities in other provinces. The eastern economic zones (Zhejiang, Fujian, and Guangxi) had net in-migration during 1982-87. Other regions with net in-migration included the middle and western economic zones, with the exception of Hubei and Ningxi provinces, which had net out-migration. Most interprovincial migration flows were between neighboring provinces. The direction of flows was from less developed middle and western economic zones to more developed eastern economic zones. The migration pattern during 1982-87 reversed the pattern during 1949-78. The migration flows were sensitive to the shift in migration policy, to economic reforms, and to strategies of economic development that favored the east coast. The natural components of population change will have a vital impact on regional population changes, which are unevenly distributed across the nation.^ieng

The socio-cultural context of high fertility among Igbo women.

PIP: This study examines the influence of women's status on fertility and desired family size (supply and demand for children) in different cultural settings. Data were obtained from the 1987 Bridewealth, Age at Marriage, and Fertility Study among a sample of 2105 Igbo respondents (838 ever married women) in 10 local government areas in Nigeria. Logistic models and ordinary least squares techniques were used in the analysis. The results showed that desire for more than six children was determined by the cultural factors of 1) acceptance of the Igbo strong son preference, 2) living in a strong patriarchal setting, and 3) living in areas where the custom of bearing 10 children prevailed. Igbo women with son preference norms had 1.7 more children than those without; fertility was 0.29 times higher with a strong patriarchal setting and 0.21 times higher with a parity of 10 setting. Secondary and higher education, urban residence, and marriage age showed a negative relationship with fertility. Contrary findings were that fertility and interspousal communication about family planning, monogamy, and interspousal age differences were positively related. Cultural factors reduced the impact of social status factors. The trends were similar for desired family size. The analysis by aged 20-34 years and 34-49 years showed only son preference and patriarchy affecting younger women, but for older women all three cultural factors were significantly related. Education, urban residence, and marriage had significant effects on children ever born and desired family size among younger women. Culture was more important for older women. In the reduced model, urban residence, higher education, and interspousal communication were significantly and inversely related to the desire for six or more children. Desire for more children was inversely related to number of surviving children; surviving children was positively related to current contraceptive use, particularly among younger women. Contraceptive use was inversely related to the three cultural variables. Among older women, closer spouse age was related to a lower likelihood of contraceptive use. Status factors were significantly related to contraceptive use.^ieng

Religious homogamy and voluntary childlessness in Canada.

PIP: The aim of this study was to determine the influence of religious affiliation, religious homogamy, religiosity, and religious marriage on voluntary and temporary childlessness and to compare childlessness patterns among Canadian-born and foreign-born women. Data were obtained from the 1984 Canadian Fertility Survey of 2863 women aged 18-49 years who were married to their first husband or living in consensual unions. The sample included 216 childless women, of whom 98 were voluntarily childless and 91 were temporarily childless. Analysis performed with probit maximum likelihood techniques and bivariate forms revealed that homogamous Catholics were less likely to remain temporarily childless but more likely to be voluntarily childless than non-Catholics. Multivariate analysis found that age, marriage age, education, and husband's income were statistically significantly related to voluntary childlessness. The likelihood of childlessness was also influenced by young age, later marriage, higher education, employment, women with husbands with lower income, and women who attend church services less frequently. Religious homogamous marriage was unrelated to childlessness. Frequent church attendance decreased the odds of deciding not to have children. Neither Catholic homogamy nor non-Catholic homogamy had an important effect after interaction terms for both religiosity and homogamy were included. Childlessness among foreign-born women was significantly more likely among those whose husbands had lower income, nonreligious women, and non-Catholic women who married heterogamously. Canadian women's childlessness was significantly related to education, husband's income, religiosity, and non-Catholic homogamy.^ieng

An epilogue to the World Fertility Survey.

PIP: The author reviews the experience gained from the World Fertility Survey, which was conducted between 1972 and 1984. The author is particularly critical of the project's failure to develop the capacity of the United Nations to undertake such statistical surveys and to contribute to statistical development in developing countries. (SUMMARY IN GER)^ieng

[The World Fertility Survey: a global demographic research project. Part 2: results of the WFS so far]. / Der World Fertility Survey: ein weltumspannendes bevolkerungswissenschaftliches Forschungsprojekt. 2. Teil: bisherige Ergebnisse des WFS

PIP: An outline of the results currently available from the World Fertility Survey is presented. Seven WFS publication series are first described, and the discussions that took place at the World Fertility Conference held in London in 1980 are summarized. The future of the World Fertility Survey is also considered. (summary in ENG)^ieng

[World Fertility Survey: results and further research activities]. / World Fertility Survey: Ergebnisse und weitere Forschungsaktivitaten.

PIP: The World Fertility Survey, completed in 1984, its results, and plans for future research are described. The paper is presented in four sections and includes a discussion of the origin and purpose of the World Fertility Survey; an overview of World Fertility Survey participant publications; comments on coverage of the World Fertility Survey, including its contributions to both the social sciences and demography; and a discussion of the continuation of the fertility surveys.^ieng

[The World Fertility Survey: a global demographic research project. Part 1: tasks and approaches of the WFS]. / Der World Fertility Survey: ein weltumspannendes bevolkerungswissenschaftliches Forschungsprojekt. 1. Teil: Aufgaben und Losungsansatze des WFS

PIP: A review of the background and methodological aspects of the World Fertility Survey is presented. The objectives of the survey, its organizational structure, the sample design, and topics included in the survey questionnaire are discussed.^ieng