Studies in Family Planning最新文献

There are significant gaps in our understanding of how the experience of an unintended pregnancy affects subsequent contraceptive behavior. Our objective was to explore how three measures of pregnancy preferences-measuring timing-based intentions, emotional orientation, and planning status-were related to the uptake of postpartum family planning within one year after birth. Additionally, we tested whether the relationship between each measure and postpartum family planning uptake differs by parity, a key determinant of fertility preference. Adjusted hazards regression results show that the timing-based measure, specifically having a mistimed pregnancy, and the emotional response measure, specifically being unhappy, were associated with contraceptive uptake in the extended postpartum period, while those related to pregnancy planning, as measured by an adapted London Measure of Unplanned Pregnancy, were not. This effect differed by parity; high parity women were consistently the least likely to use contraception in the postpartum period, but the effect of experiencing an unwanted pregnancy or having a mixed reaction to a pregnancy was significantly stronger among high parity compared to low parity women. Greater attention to the entirety of women's responses to unanticipated pregnancies is needed to fully understand the influence of unintended pregnancy on health behaviors and outcomes for women and their children.

This paper describes discrepancies in spouses' reports of the use of female-controlled, nonvisible contraceptive methods using data from rural Nepal that were collected monthly from both spouses of 822 couples between 2008 and 2016. We find that spouses in about half of couples provided discrepant reports during the period of observation, and these discrepancies occurred in 14 percent of the months of observation. We then investigate these discrepant reports as possible indicators of incomplete transparency regarding reproductive choices and examine whether they are associated with wives' education and spouses' relative education levels. We find, first, that wife's educational attainment was negatively associated with discrepant reports of contraceptive use, independent of spouses' relative educational attainment. At the same time, these models suggest that educational differences between husbands and wives were associated with discrepant reports. Couples in which wives had more education than their husbands faced greater odds of discrepant reports of contraceptive use, relative to couples in which spouses had similar education. Among couples in which husbands had more education than wives odds of wife-only reporting were lower, relative to couples with similar levels of education. These findings offer important new insights into spousal dynamics that may influence transparency regarding contraceptive use.

Eliminating child marriage is seen by policy makers and advocates as a path toward reducing births to girls below age 18, as most early births have been previously found to occur within marriage. There has been little recent evidence, however, of the marital context in which early childbearing occurs or how this relationship varies across space and levels of development. Using survey and vital registration data covering approximately 95 percent of the world's births to mothers younger than 18 years, we estimated the share of first births that occur within marriage at the global, regional and national levels. We found that more than half of births to mothers below age 18 worldwide take place in sub-Saharan Africa, and this share will continue to grow. Globally, 76 percent of first births to mothers below age 18 occur within marriage and there are large regional differences. Over the past two decades, the share of first births to mothers below age 18 occurring within marriage declined in most countries with data available, but there are important exceptions. Although most first births to women below age 18 occur following seven months of marriage, the sequencing of child marriage and early childbearing varies widely across countries.

Globally, there is a need for more family planning method options as currently, available options do not adequately meet the needs of women, specifically those who have infrequent sex. Levonorgestrel (LNG) 1.5 mg is widely available as emergency contraception pills (ECP), and recent research has shown that certain women take it as their main form of contraception. Furthermore, limited studies have found repeat, on-demand use safe and efficacious. This 12-month prospective, single-arm, interventional study in Ghana tested whether a single LNG 1.5 mg on-demand or pericoital ("around the time of sex") dose contraceptive was acceptable to women who have infrequent sex and if pharmacy provision was feasible. The study sample (1,890) comprised women of reproductive age recruited from urban areas, having infrequent sex (i.e., coital frequency ≤ 6× per month), and not using any other modern methods except condoms or ECP at the time of study inclusion. Results indicated that there is demand and acceptability for a pericoital pill and that pharmacy provision is feasible. Furthermore, precoital use of the pill had high levels of satisfaction and was popular with new users. Adding LNG 1.5 mg for pericoital use to the family planning method mix has the potential to address an important segment of the population currently underserved, decrease unwanted pregnancies, and increase modern contraceptive prevalence rates.

Female genital mutilation (FGM) is a harmful practice rooted in gender inequality. Its elimination is part of national and international agendas including the Sustainable Development Goals of the United Nations. Understanding its geographical evolution is crucial for targeted programming. However, due to sparse data, it is challenging to establish international comparability and statistical reliability. Data on FGM is observed at different points in time and periodicity across countries and in contexts with varying age-risk patterns, all of which can be a source of inaccurate and biased estimates. We perform an exemplary analysis, drawing on survival and complex survey analysis in Ethiopia, Kenya, and Somalia. This novel approach addresses measurement challenges specific to FGM data and produces an internationally comparable indicator-the probability of not experiencing FGM by age 20. We pinpoint the onset of statistically significant FGM decline at the subnational level from cohorts born in the 1970s until the 1990s. In the same period, we observe no decline in FGM risk across regions clustered around international borders and increasing subnational inequalities within countries. Our methods thus provide crucial insights into the geographical pattern of temporal trends in FGM risk.

Within the last decade, declining son preference in Asia has given rise to gender-equitable fertility preferences. These include daughter preference, gender indifference, and gender balance. Using five rounds of the India National Family Health Surveys, I investigate the sources of the trends in shifting parental preferences for the gender of their children. Over more than a quarter-century period (1992-1993 to 2019-2021), I find a significant decline in son preference from 40 to 18 percent and an increase in gender-equitable preferences among most subpopulations. Multivariate analysis shows that for all survey years, education and frequent exposure to television significantly increased the odds of gender-equitable preferences. In the last decade, community norms supporting women's employment are also associated with gender-equitable preferences. In addition, decomposition analysis shows that compared to compositional change, social norm change accounts for two-thirds of the rise in gender-equitable preferences. These findings suggest that rising norms of gender equality have the potential to dismantle gender-biased preferences in India.

Contraceptive discontinuation for method-related reasons, while presumably wanting to avoid pregnancy, is a common phenomenon and can contribute to high levels of unmet need and unplanned pregnancies. Some women discontinue contraceptive use and do not quickly resume a method ("stopping"), while others are able to quickly switch to another method to achieve their reproductive goal of avoiding pregnancy ("switching"). We use Demographic and Health Survey data from 48 countries to examine what differentiates women who were able to switch to another method versus those who ultimately stopped entirely, among women who discontinued contraception for method-related reasons. Results show that wanting to limit births, having ever been married, and recent prior use are all associated with switching versus stopping. In addition, we find that women in West and Middle Africa were more likely to stop use compared to women in other regions. Addressing obstacles to contraceptive continuation, including effective method switching, among women who wish to delay or avoid pregnancy should be a priority for global and country initiatives aiming to deliver client-centered care that supports women and couples to make their best family planning choices.

Urbanization has played a key role in shaping twentieth-century demographic changes in Latin America and the Caribbean (LACar). As a result, scholarly research on domestic migration and the family has primarily focused on fertility differentials by migration status in urban areas, finding a robust negative correlation between internal migration and fertility. This research has overlooked how this relationship varies across types of migration flows other than rural-to-urban migration and by women's age at migration and social class. Additionally, not enough attention has been paid to the family formation and dissolution trajectories underlying the lower fertility of rural migrants. I use a life-course inductive approach to examine these overlooked aspects among women from 10 LACar countries, including the three largest countries by population. Using retrospective information on women's childbearing and marital histories from the Demographic and Health Surveys, I build an eight-category typology of family paths and study the conditional distribution of this typology by women's age at migration, educational attainment, and origin/destination area. This examination demonstrates that social class is the primary source of differentiation across family formation and dissolution trajectories and that low-class young rural migrants played a crucial role in the demographic transformations that occurred in the region.

IPUMS Demographic and Health Surveys (IPUMS DHS), through its intuitive website (http://dhs.ipums.org/), eliminate barriers to overtime and cross-national analyses with the DHS. IPUMS DHS recently released simplified reproductive calendar data. These calendar data are harmonized across samples, distinguish "not in universe" cases from "no" responses, and do not require destringing. Variable names are hot links to important documentation, such as survey-question text and comparability concerns. Analysts can also select consistently coded variables relating to the woman, her household, and her social and environmental context without merging files.

Few longitudinal studies have measured contraceptive continuation past one year in sub-Saharan Africa. We surveyed 674 women who had been randomized to receive the three-month intramuscular contraceptive injectable (DMPA-IM), levonorgestrel (LNG) implant, or copper intrauterine device (IUD) during the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial in South Africa and Zambia and were subsequently followed for two additional years to explore method continuation, reasons for discontinuation, and access to implant and IUD removal services. We also conducted in-depth qualitative interviews with 39 participants. We estimated cumulative discontinuation probabilities using Kaplan-Meier estimates and assessed factors associated with discontinuation using Cox-proportional hazards models. The LNG implant continuation rate over the maximum 44-month study period was 60 percent, while rates for the copper IUD and DMPA-IM were 52 percent and 44 percent, respectively. Reasons for method discontinuation included side effects, particularly menstrual changes, and method stock-outs. Most implant and IUD users who sought removal were able to access services; however, room for improvement exists. In this cohort originally randomized to receive a contraceptive method and attend regular study visits, implants and IUDs continued to be highly acceptable over an additional two years, but facilities should continue to ensure that insertions and removals are available as requested.