Contraceptive choice of limiters ages 35-44 in the United States: an examination of selection of method from among a number of possible choices.
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Adult↗
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Postpartum sexual abstinence, breastfeeding, and childspacing, among Yoruba women in urban Nigeria.
This paper examines the extent to which the traditional practice of sexual abstinence during lactation has broken down among Yoruba women residents in urban areas. The first major finding is that there is a gradual erosion of the tradition, and the dominant factors of modernization are education of the woman and the use of contraception. The second major finding is that the breakdown of postpartum sexual taboos has statistically significant negative consequences on duration of lactation, although the negative impact of woman's education is greater. The third major finding is that duration of breastfeeding reduces birth interval significantly only when it is less than 15 months, and that both durations of breastfeeding and birth intervals have declined over time. The first two findings suggest further reductions in the proportion of women who abstain from sexual relations during lactation and in durations of breastfeeding as more women become more educated. Significant declines in birth intervals may follow soon after.
Adult↗
Female education, age, parity, and reproduction cessation in Ghana.
Data from the 1988 Ghana Demographic and Health Survey is employed to determine the existence of a relationship between the amount of education a woman has and her intent to cease childbearing. The findings are that with increasing levels of education, a female's desire to cease reproduction also increases. However, this relationship is obscured if parity is not controlled.
Adult↗
Menstrual function after tubal sterilization.
More than 10 million women in the United States have undergone tubal sterilization. There has been concern that this procedure may increase the risk of later menstrual dysfunction. The Collaborative Review of Sterilization (CREST) is a large, multicenter, prospective study of tubal sterilization in the United States. This report describes CREST participants who were interviewed immediately before sterilization and again in annual poststerilization interviews for up to 5 years between 1978 and 1988. The authors analyzed reported changes in six menstrual cycle characteristics for 5,070 women undergoing interval sterilizations. Longitudinal, multivariate regression was used to adjust for baseline menstrual function and other potential confounders. Five years after sterilization, 35% of the CREST participants reported high levels of menstrual pain, 49% reported heavy or very heavy menstrual flow, and 10% reported spotting between periods. In contrast to the fifth year, the first year of follow-up was similar to presterilization menstrual function; in the first year, 27% of participants reported high menstrual pain, 41% reported heavy menstrual flow, and 7% reported spotting. These findings may be affected by aging of the cohort and other study limitations, but they suggest that if tubal sterilization leads to changes in menstrual function, such changes may take some time to develop.
Adolescent↗
Child anthropometry in cross-sectional surveys in developing countries: an assessment of the survivor bias.
In cross-sectional surveys, the sample of children with anthropometric measurements is not representative of all children in a birth cohort, since only children surviving to the survey date are measured. This survivor bias may have implications for studies of trends and differentials in anthropometric indicators. In this paper, the effects of the survivor bias on the estimates of child anthropometric indicators are assessed by 1) reviewing evidence from longitudinal studies on the prevalence of malnutrition among deceased children and among surviving children and by 2) analyzing retrospective data on child mortality and cross-sectional data on child anthropometry in 17 national surveys that are part of the Demographic and Health Surveys Program. It is concluded that comparisons of anthropometric data across geographic units, population subgroups, and calendar time are marginally affected by the survivor bias, unless mortality differences between the birth cohorts are very large (e.g., well over 50 per 1,000 births).
Anthropometry↗
Barrier and spermicidal contraceptive methods and risk of invasive cervical cancer.
The effects of barrier and spermicidal methods of contraception on cervical cancer risk were examined by studying 479 cases of histologically confirmed invasive cervical cancer cases and 788 random digit dialing controls. In addition to a detailed history of contraceptive practices, information was available on numerous potential confounders, including demographic characteristics, sexual behavior, reproductive factors, Pap smear screening history, and smoking. After adjustment for relevant confounders, diaphragm and condom use were found not to be significantly associated with risk of cervical cancer. Although there was a small reduction in risk (OR = 0.8) associated with long-term use (5+ years) of the diaphragm, the effect appeared to relate to concomitant spermicide use, since there was evidence of further decreases in risk for women using spermicides alone for extended periods (OR = 0.7 for 5+ years). Effects were only seen among subjects of higher income and education levels, suggesting that patterns of usage may be important. The potential ability of spermicides to reduce cervical cancer risk by neutralizing viral agents warrants further attention.
Adult↗
Patterns and predictors of high-risk sexual behavior in female partners of HIV-infected men with hemophilia.
OBJECTIVE: To characterize and quantify high-risk heterosexual activity in HIV-discordant couples. DESIGN: Analysis of cross-sectional and longitudinal questionnaire data from 217 HIV-negative female sexual partners of HIV-infected hemophilic men. METHODS: Comparison of prevalence rates of anal sex, oral sex, vaginal intercourse with or without condoms, and use of other contraceptives between 1985 and 1991. Logistic regression analysis of demographic, sexual and clinical variables to predict unprotected vaginal sex. Actuarial estimates of semi-annual relapse rates to unsafe sex. RESULTS: The proportion of women at low risk increased from 7 to 69% between 1985 and 1991, mainly because more women were using condoms during all acts of vaginal intercourse. Other contraceptive practices did not change during this time. The proportion engaging in oral or anal sex decreased (from 26 to 13% and 13 to 4%, respectively). Unprotected vaginal sex was more common among women who enrolled earlier, had less education, engaged in oral or anal sex, and among those whose partners had not had AIDS. Unprotected vaginal sex before enrollment was the strongest predictor of this high-risk activity during follow-up. Two-year rates of relapse to high-risk behavior were significantly higher among women who enrolled at high risk compared with those who enrolled at low risk (39 versus 8%, P = 0.005). CONCLUSIONS: Although high-risk sexual behavior became much less prevalent in this population between 1985 and 1991, many continued to have unprotected vaginal sex occasionally. Counseling efforts should target couples who have been the most sexually active or have less education, and should emphasize not only initial risk reduction but also maintenance of low-risk behavior.
Adolescent↗
Predictors of repeat pregnancy outcome among black and Puerto Rican adolescent mothers.
This prospective study investigated predictors of repeat pregnancies by 12 months after the delivery of a first child and their outcomes in inner-city adolescent mothers. The sample included four groups: those who had therapeutic abortions, miscarriages, full-term deliveries, and no repeat pregnancy. The therapeutic abortion group had more pregnancies before their first delivery (41%) than did full term (20%) and no repeat (15%), p less than .01. More delayed grade placement was found in therapeutic abortion -1.6 years (1.3) and full term -1.8 years (.9) than in no repeat pregnancy -.6 years (1.1), p less .001. Reading achievement scores were higher in no repeat 86.3 (17.1) than in full term 75.0 (16.5), p less than .05. School attendance was higher in no repeat (65%) than in therapeutic abortion (35%) and full-term (24%) p less than .01 groups. Depressive symptoms at baseline were higher among therapeutic aborters 18.9 (9.9) than among full term 10.2 (8.2) and no repeat pregnancy groups 12.2 (6.2). Logistic regression analyses identified delayed grade placement as the most important predictor of pregnancy outcome.
Achievement↗
The relationship between previous elective abortions and postpartum depressive reactions.
To test the hypothesis that primiparas who have had a previous elective abortion will have a higher incidence of depressive reactions postpartum than will primiparas who have not, 48 women pregnant for the first time and 25 who had had one abortion were interviewed six to eight weeks postpartum. No significant difference in the incidence of depression between the two groups could be found. In addition, when associations between their mean depression scores and other variables such as planned pregnancy, preferred infant sex, identified obstetrical problems, help at home, experiencing the baby blues, and an identified recent sad life event were calculated, no significant differences were noted. Spontaneous comments from the previously aborted women suggested that anxiety during pregnancy concerning the infant's health was a greater source of discomfort than was postpartum depression.
Abortion, Legal↗
The impact of a health education course on maternal knowledge: a comparative study in a low socioeconomic rural region.
A comprehensive health education course was designed for mothers in West Bank villages, a relatively low socioeconomic population. The course focused on nutrition, hygiene, child development, and first aid. It was taught by specially trained local instructors in small classes characterized by an individualized teaching method. To evaluate the contribution of the course, the level of knowledge in topics taught in the course was tested. The test was personally administered by trained interviewers to 241 course participants and to a comparison group of 284 mothers who had not participated. As expected, participants demonstrated higher level of knowledge than nonparticipants, regardless of the time since having taken the course. The course seems to have contributed to all participants, but mostly to women of lower education. In a multiple linear regression the two most significant predictors of knowledge were course participation and level of maternal formal education.
Educational Status↗
The association of AIDS education and sex education with sexual behavior and condom use among teenage men.
According to a 1988 nationally representative survey, most 15-19--year-old men in the United States have received formal instruction about AIDS (73%), birth control (79%) and resisting sexual activity (58%). Results of multivariate analyses show the receipt of AIDS education and sex education to be associated with modest but significant decreases in the number of partners and the frequency of intercourse in the year prior to the survey. Having received instruction in these topics was also associated with more consistent condom use. Instruction in some topics was associated with increases in knowledge and attitudes about AIDS, but these increases were not always correlated with safer behavior.
Acquired Immunodeficiency Syndrome↗
Characteristics of fragile X relatives with different attitudes toward terminating an affected pregnancy.
Female relatives of individuals with fragile X syndrome were asked whether they would terminate an affected pregnancy. Women were grouped according to how they answered this question and compared according to demographic characteristics, knowledge about the syndrome, perception of their risk for having an affected child, factors they considered important in family-planning decisions, and the magnitude of individual problems they perceived to be associated with raising an affected child. Important differences were identified between women willing to consider abortion and those who would not abort and between women who indicated what they would do and those who were unsure.
Abortion, Eugenic↗
A comparison of the fertility of Dominican, Puerto Rican and mainland Puerto Rican adolescents.
Data from three fertility surveys are used to examined the probabilities and determinants of adolescent births among Dominican and Puerto Rican women. Young women in the Dominican Republic are the most likely to have had a child by each year of age from 14 through 24, followed by young women on the Island of Puerto Rico; the probability of an early birth is lowest for Puerto Rican women on the U.S. mainland. Eighteen percent of Dominican women have had a child before their 18th birthday, compared with 13% of women living in Puerto Rico, and 10% of Puerto Rican women in metropolitan New York. The cumulative probabilities that Puerto Rican women will have borne a child before their 20th birthday are almost identical, whether the women live on the island or the U.S. mainland, but the difference between Puerto Rican and Dominican women widens. The order is reversed, however, in the analysis of premarital births: The probability of a premarital birth during adolescence is highest for Puerto Rican women in New York, and lowest for Dominican women. In a separate logistic regression analysis, education and age at first sexual intercourse are shown to be important determinants of adolescent fertility in all three populations.
Adolescent↗
Determinants of unintended childbearing among ever-married women in the United States: 1973-1988.
A downward trend in unwanted childbearing has reversed among large segments of the population, according to data from the 1988 National Survey of Family Growth. The proportion of births in the previous five years that were unwanted at conception fell from 14 percent in 1973 to eight percent in 1982, but increased to 10 percent in 1988. Between the 1982 and 1988 surveys, increases were most pronounced among women with less than a high school education and among women living below the federal poverty level. Differences between black women and white women in levels of unwanted childbearing, which were converging prior to 1982, have since grown considerably, particularly among the poor and the less educated.
Adolescent↗
Abortion in Canada: religious and ideological dimensions of women's attitudes.
This paper examines a number of demographic and sociocultural factors (e.g., age, marital status, family size, religion, religious assiduity, sex-role ideology) as predictors of women's attitudes toward abortion, using data from the Canadian Fertility Survey of 1984. The findings suggest that women's abortion attitudes are to a greater extent based on ideological positions. It appears that anti-abortion stance affects those women who are religious, presumably by increasing the relationship between their general sex-role ideological stances and abortion attitudes. Abortion attitudes also vary according to a woman's education, her size, and province/region of residence.
Abortion, Induced↗
Socioeconomic development, health interventions and mortality decline in Costa Rica.
Costa Rica, whose life expectancy was 74 years by 1985, has reached a health level comparable to a developed country. The health achievements of this country are product of political and socioeconomic circumstances as well as of right public health policies. Until about 1970 the features of Costa Rica mortality, although somewhat better than the Latin American average, evolved in a similar way to the rest of the region. In particular, the decades of 1940s and 1950s saw dramatic improvements in life expectancy, thanks mainly to the import of low-cost, high-effectiveness health technologies. In the 1970s, however, Costa Rica departed from a regional pattern of stagnation and managed to close the gap with developed countries in terms of mortality levels. A dramatic decline in the infant mortality rate from 60 to 19 per 1,000 took place in this decade. The main determinants of this breakthrough were health interventions, notably a primary health care program, even though favorable socioeconomic conditions and a reduced fertility also played a role. Ecological data and other evidence suggest that up to three fourths of the mortality decline was accounted for contemporary improvements in public health services, with about 40 percent attributable to primary health care interventions. Furthermore, by targeting interventions on the less privileged population, these interventions had the merit of reducing geographic and socioeconomic differentials in child mortality.
Cause of Death↗
Birth spacing patterns and correlates in Shaanxi, China.
This study shows that most women in Shaanxi Province, China try to have their first birth as soon as possible after their first marriage, and that the length of the interval between marriage and first birth is strongly correlated with the woman's age at first marriage. The length of the second and third birth intervals and the likelihood of going on to have a second or third birth are strongly influenced by the sex composition of children already born, the survival time of the child initiating the interval, the duration of breastfeeding, and the woman's occupation. There is significant regional variation in the length of birth intervals and in the prevalence of second and third births in Shaanxi. The findings indicate that China's one-child policy is far from being universally accepted in Shaanxi, including its urban areas. The persistence of many social, economic, institutional, and cultural factors promoting high fertility poses many obstacles to further fertility decline.
Adult↗
Do intentions predict fertility? The experience in Taiwan, 1967-74.
Are responses to survey questions about desire for additional children useful in predicting future fertility? Data from Taiwan covering the years 1967--74, a period of rapid fertility decline and increasing contraceptive practice, indicate that reproductive intentions and contraceptive use were very good predictors of subsequent fertility. Whether more children were wanted was itself the most important determinant of contraceptive use. Aggregate consistency between attitudes and behavior was higher than found in US surveys during the same period. Similar studies are needed to determine whether statements of intentions have predictive value in other settings as well.
Adolescent↗