Studies in Family Planning最新文献

Over the past six decades, significant demographic and familial changes, including rapid fertility decline, have occurred in Latin America and the Caribbean (LAC), impacting household structure and formation. We document trends in and changes to household size and composition in the region, leveraging 144 country-year samples from census and survey microdata across 27 LAC countries. We measure changes in average household size, household composition by member relationship to the household head, and the evolution of female headship. Our findings show a general reduction in household size that mirrors the trend in fertility decline, albeit with subregional variations. An analysis of changes in members' relationships over time reveals that children are the main drivers of household shrinkage. The analysis also unveils the enduring complexity of household composition, namely of extended family structures. Female-headed households, which are characterized by more complex household structures than their male-headed counterparts, significantly increased over time. This trend partly explains the persistence of extended households in LAC. In addition, we document a gradual convergence in the average number of children per household between male- and female-headed households. These results challenge theories positing a global convergence towards nuclear family structures. Overall, LAC's demographic and familial transformations underscore the interplay between shrinking household size and persistent household complexity.

Measurement of reproductive empowerment (RE) is necessary to understand and address barriers to RE and to evaluate the impact of policies and practices that increase RE as a pathway to improving reproductive health. This study validated an existing RE scale, developed in 2016 for sub-Saharan African (SSA) contexts, using longitudinal survey data from a cohort of women in Plateau State, Nigeria. Psychometric properties were assessed through confirmatory factor analysis, and invariance tests evaluated the scale's consistency across baseline and endline. Longitudinal logistic regression models examined whether changes in RE levels predicted family planning outcomes. The results demonstrate the final RE scale is a valid and predictive tool, comprising 24 items across five subscales that measure empowerment at individual, immediate relational, and distant relational levels. The RE scale also predicts the use of family planning and intention to use modern contraception in the future. This is one of the few RE scales designed specifically for SSA contexts and the only one known to be validated longitudinally. The RE scale provides a robust framework for measuring RE across levels and over time and can be used in SSA contexts to measure RE as a dynamic process and as an outcome.

As educational access has expanded across Africa, birth timing has remained quite stable. Using data representing 51 birth years and 34 countries, we show that these modest aggregate changes mask more dramatic changes within educational groups. Over time, educational attainment has become an increasingly salient predictor of birth timing, as highly educated women have delayed first births and lengthened subsequent birth intervals more. The educational differentiation of birth timing also varies across contextual factors (educational access and family planning effort). In recent cohorts, women of all educational levels have experienced earlier first births in higher education contexts, suggesting that entry into motherhood is influenced by relative position within one's peer group. Aggregating across educational levels, however, women experience later first births in higher education contexts, driven by the greater share of highly educated women. For women at all levels of educational attainment, first birth timing is responsive to family planning context; in aggregate, women in countries with high family planning investments become mothers one year later than those in countries with lower family planning efforts. Notably, highly educated women lengthen their second birth intervals more when education and family planning are widely available, suggesting further potential for public investments to enable women to achieve their reproductive preferences.

Depression and anxiety symptoms are associated with increased unmet need for family planning (FP) postpartum, yet solutions promoting the integration of mental health into FP service settings remain scarce. The aims of this study were to quantitatively examine the immediate and longer term effects of participation in a group-based cognitive behavioral therapy (CBT) intervention called Mothers Time on (1) symptoms of depression and anxiety, (2) the use of a modern family planning method, and (3) intermediate FP-related factors among postpartum women in Ethiopia. Building from lessons learned during a feasibility study, we implemented a cluster randomized controlled design, with structured interviews delivered before (baseline), immediately following (endline), and fourxst months after implementation of the intervention (follow-up). A total of 302 postpartum women were recruited from 10 health clusters in northwest Ethiopia. In comparison to control clusters where participants received standard of care, intervention clusters showed significantly greater reductions in symptoms for both depression and anxiety from baseline to follow-up. Modern FP use also increased significantly more in intervention clusters as compared to control clusters from baseline to follow-up. Results suggest that more holistic FP services that consider postpartum mental health can both reduce postpartum depression and anxiety and support women in fulfilling their reproductive intentions.

In sub-Saharan Africa, child out-fostering is a traditional social practice, and research suggests stable levels of out-fostering over time, yet the underlying demographic and socioeconomic factors driving this stability have remained largely unexplored. To gain insight into the prevalence and associations of child out-fostering and mothers' individual and household characteristics, we analyzed nine rounds of Demographic and Health Survey (DHS) data of Senegalese mothers of children aged 0-14, collected between 1986 and 2019. Child out-fostering has remained stable, with nearly one-third of mothers of children aged 0-14 living apart from at least one child. Our findings indicate that at the macro-level, counteracting fertility and child mortality dynamics contribute to this stability. At the micro-level, out-fostering is influenced by a complex interplay of maternal demographic, socioeconomic, and household characteristics. The role of demographic macro-level factors demands further research attention in the context of persisting child fostering across sub-Saharan Africa. The results further suggest that changes, such as postponement of motherhood, as well as further declines in fertility and infant mortality, could affect fostering arrangements in the future.