Economic strategies and the risk of early pregnancy loss in a rural Bolivian population.
Virginia J. Vitzthum1, Hilde Spielvogel2, Jonathan Thornburg3.
1Anthropology Department, Indiana University & Institute for Primary & Preventative Health Care, Binghampton, NY.
2Department of Bioenergetics, Instituto Boliviano de Biologia de Altura, La Paz, Bolivia
3Max-Planck-Institut fűr Gravitationphysik, Germany
Rural-to-urban migration is a common economic strategy, particularly in regions where labour-intensive small-scale farming is difficult to sustain. However, because of numerous lifestyle differences between rural and urban residents, it is difficult to ascertain the specific consequences for women's reproductive health of abandoning an agrarian regime in favour of greater reliance on monetary income. In the Bolivian altiplano, however, husbands often intermittently migrate alone to secure wages, returning frequently to their rural families. This arrangement provides an opportunity to analyze the effects of different economic strategies, less encumbered by wholesale changes in lifestyle, on women's reproductive functioning.
Project REPA (Reproduction and Ecology in Provincía Aroma) monitored 191 currently cycling women from 30 rural altiplano communities for 1-8 sequential ovarian cycles, and assayed serial urine samples for hCG (human chorionic gonadotrophin), which rises with conception and falls with miscarriage. Of 65 detected conceptions, there were 18 early pregnancy losses (EPL; pregnancies ending within 5 weeks of conception), 40 sustained conceptions (SC), and 7 lost to follow-up.
The adjusted odds ratio for an EPL among agropastoralists was 35 times that of non-farmers (95%CI: 2.9-408) and 15 times greater (95%CI: 2.3-93.0) during the planting and harvesting seasons (when food reserves are relatively low and labour demands are especially high) compared to other periods. Women experiencing EPL or SC did not differ in any other lifestyle indicators (e.g., housing, sanitation, water sources). These data suggest that economic strategies that reduce women's direct participation in agropastoralism, but do not modify other aspects of a rural lifestyle, have relatively lower risks of EPL.
Funding: U.S. National Science Foundation; University of California; Binghamton University.
Email: vitzhum@indiana.edu
Exploring the circumstances surrounding later abortions
Roger Ingham, Steve Clements, Ellie Lee* & Nicole Stone
Centre for Sexual Health Research, School of Psychology, University of Southampton
*SSPSSR, University of Kent
In 2005, 11% (19,935) of abortions to England and Wales residents occurred at 13 or more weeks gestation. There is a commonly perceived problem of accessing abortion after the first trimester (12 weeks) of a pregnancy in the UK. Other factors that may influence the timing of an abortion include age, socio-economic circumstances, late awareness of pregnancy, delays in contacting service providers due to indecision about abortion and changes in relationship circumstances. However, there is little evidence as to the relative importance of these factors.
The study aimed to explore historical patterns and sub-national variations in later abortions using routinely collected data. Secondary analysis of surveys conducted with GPs and hospital consultants, plus data obtained from an independent sector provider were used to further understanding of the circumstances surrounding later abortion. Finally, a national questionnaire survey of women attending for later abortion at a number of independent sector clinics has been conducted. This collected information on the timings of each stage of the abortion process (taking a pregnancy test, deciding to have an abortion, contacting health services, obtaining an abortion) and what factors may have delayed the abortion. The presentation will concentrate on findings from this questionnaire survey, which suggests that late awareness of pregnancy is the major factor behind later abortions.
Email: src@soton.ac.uk
Fertility limiting behaviour and contraceptive choice among men in Nepal
Govinda P. Dahal* and Andrew Hinde**
* Demographic and Statistics Division, United Nations Economic Commission for
Europe, Geneva Switzerland
** Division of Social Statistics, University of Southampton UK
This paper examines the contraceptive use pattern among men in Nepal who want to limit their childbearing and the associated factors. Information for this study is drawn from 'couple data set of Nepal DHS 2001'. For analysis, we consider only 1166 men who were 20 to 59 years old, who have had at least one living child and who want no more children. Both bivariate and multivariate techniques were used to analyze the data. The results indicate that men who have at least one and three boys in the family compared to those with at least two boys were significantly less likely to undergo male sterilization. It is also clear from the results that men having had only daughters in the family were significantly highly less likely to use any contraceptive methods than their counterparts of having at least two boys in the family. Undergoing male sterilization significantly increases with education and with upper caste hill Hindus. However, men with manual jobs and those who reside in urban areas were more likely to rely on female contraceptive methods. Nonetheless, men's reliance on female reversible methods significantly decreases if couples jointly make decisions about women's health care in the household.
Email:
Trends in protective behaviour among single vs. married young women in sub-Saharan Africa
John Cleland, Mohamed M Ali
London School of Hygiene & Tropical Medicine
Data from 18 countries in sub-Saharan Africa where two or more Demographic & Health Surveys have been conducted, show little change in sexual abstinence between 1993 and 2001. The trends in contraceptive uptake and condom use among single and married young women show distinct patterns. A large median increase of 1.4 percentage points per year in condom use by single young women for pregnancy prevention occurred. In contrast, little change in condom use was noted for married or cohabiting young women. Condom promotion in Africa has been, therefore, a success for single women. Its promotion for pregnancy rather than disease-prevention offers even greater potential, as pregnancy prevention is the main or partial motive of most single women who use condoms. While a myriad of research studies on condom use among young single people have conducted and published, the needs of the married and cohabiting population have been neglected by researchers and programme staff alike, despite the fact that more than half of HIV infections in the severe epidemics of Southern and East Africa are occurring in this group. The barriers to condom adoption by married couples may not be as severe as is often assumed.
Email: john.cleland@lshtm.ac.uk
The link between HIV/AIDS and recent fertility patterns in Kenya
Monica Magadi1 & Alfred Agwanda2
1Centre for Research in Social Policy (CRSP), Loughborough University, UK
2Population Studies and Research Institute (PSRI), University of Nairobi, Kenya
The relationship between fertility and the HIV/AIDS epidemic is not well understood. Although existing studies elsewhere generally point to the epidemic resulting in fertility reduction, earlier evidence from the 2003 Kenya Demographic and Health Survey (KDHS) showed interesting patterns, with regions most adversely affected with the HIV/AIDS epidemic showing the clearest sign of a reversal trend in fertility decline. HIV/AIDS may influence fertility through one or more behavioural and/or biological proximate fertility determinants. In this paper, we explore: (i) possible mechanisms through which HIV/AIDS may influence fertility; and (ii) the effect of individual and contextual community-level HIV/AIDS factors on fertility.
The study is based on secondary analysis of the 2003 KDHS data which involved interviews with a nationally representative sample of 8195 women of reproductive age. The 2003 KDHS provides a unique opportunity to explore the impact of the HIV/AIDS epidemic on the affected populations, being the fourth survey in the international DHS programme to include HIV testing, and the first to anonymously link the HIV results with key behavioural, social and demographic factors at individual and household level. Multilevel models are used to examine the effect of individual and contextual community-level HIV/AIDS factors on fertility. The modelling is carried out in stages, starting with the key variables relating to HIV/AIDS, before introducing various proximate fertility determinants in successive stages, to explore possible mechanisms through which HIV/AIDS may influence fertility.
An examination of the effect of HIV/AIDS infection on recent fertility corroborates findings from earlier studies of the fertility inhibiting effect of HIV/AIDS among infected women. There is evidence that the effect of HIV/AIDS on fertility is partly through the proximate determinants relating to sexual exposure, breastfeeding duration, and child/foetal loss. After controlling for the effect of background characteristics, child mortality experience, and these proximate determinants of fertility, HIV/AIDS infected women have 33 per cent lower odds of having had a recent birth than those who are not infected. However, there is no evidence of a significant association between community level HIV/AIDS prevalence and fertility.
The results suggest that although recent trends in sexual exposure factors (e.g. rising age at first sex and age at first marriage and a decline in the proportion of women in union) might be expected to sustain a declining trend in fertility, trends in some of the proximate determinants, including reduced duration of breastfeeding and increased child mortality coupled with reduced desire to stop childbearing may have contributed to the stalled fertility decline in Kenya. Whilst HIV/AIDS may have influenced the recent changes in sexual exposure factors, it is also likely that it has contributed to increasing infant and child mortality and reduced duration of breastfeeding, which are partly responsible for the stall in fertility decline.
Acknowledgement
Funding for this study has been provided by the MEASURE Evaluation project of the U.S. Agency for International Development. MEASURE Evaluation is funded by USAID through Cooperative Agreement GPO-A-00-03-00003-00 and is implemented by the Carolina Population Centre at the University of North Carolina at Chapel Hill, in partnership with Future's Group, John Snow, Inc., ORC Macro and Tulane University. The authors' views expressed in this paper do not necessarily reflect the views of USAID .
Email: m.magadi@lboro.ac.uk
Fear of side effects as a barrier to modern contraceptive use among Ghanaian women.
Claire Bailey
University of Southampton
Knowledge of contraceptive methods in Ghana is almost universal with 98% of all women aged 15-49 reporting knowledge of at least one method. However the overall contraceptive prevalence rate remains relatively low at 20.7% for all women aged 15-49 in 2003. According to the 2003 Ghana Demographic and Health Survey (GDHS), fear of side effects was the most cited method-related reason for non-use among all women and is particularly cited by women aged less than 30. Fear of side effects has increased in importance as a reason for non-use between 1998 and 2003, from 18% to 26%.
This study investigates the association between exposure to family planning information, through mass media and interpersonal channels, and the probability that a respondent will cite fear of side effects as their main reason for not intending to use a contraceptive method in the future. Literature proposes that exposure to mass media messages promoting family planning may reduce fear of side effects by providing trustworthy information. Discussing family planning with others is shown to be associated with increased probability of current use; however the effect for non-users is more complex as rumours and misinformation can also be spread through a social network.
The data to be analyzed is a sub-sample of women aged 15-49 from the individual women's questionnaire of the 2003 GDHS. Respondents included in the study are those who are not currently using any form of contraception and who state that they do not intend to do so in the future. The methodology employed is multiple logistic regression modelling, used to determine which variables explain variation in the probability of fear of side effects being the main reason for non-use.
Email: ceb504@soton.ac.uk
Mohammad Amirul Islam, Sabu S. Padmadas and Peter W.F. Smith
University of Southampton
This paper investigates the influence of the decision-making process in family planning (FP) on male method use in Bangladesh using the couple data set of the recent Demographic and Health Survey. This study further explores the associated determinants of the decision-making process in FP (decision taken by mainly wife, mainly husband and jointly). Among the current users of FP more than 81% reported the use of female methods which is dominated by pill (53.1%). Analysis of the data reveals that about 69% of the women reported that they took the FP decision jointly, whereas, 18% mentioned that they alone took the FP decisions. Slightly more than 12% of the women mentioned that their husbands took the FP decisions alone. Logistic regression analysis suggests that the sex of the spouse who takes the decision regarding FP (if not joint decision) is associated with the type of method in use (male/female). Further analysis suggests that division, area of residence, education of the spouses, marital duration, and approval of FP by the spouses are the significant determinants of couple's decision-making process in FP. It is recommended that shifting the target of the FP program from a women only approach to a couple based approach may help improving the situation.
Email: islam@soton.ac.uk