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Effects of family planning on fertility behaviour across the demographic transition.

ABSTRACT: The adoption of contraception often coincides with market integration and has transformative effects on fertility behavior. Yet many parents in small-scale societies make decisions about whether and when to adopt family planning in an environment where the payoffs to have smaller families are uncertain. Here we track the fertility of Maya women across 90 years, spanning the transition from natural to contracepting fertility. We first situate the uncertainty in which fertility decisions are made and model how childbearing behaviors respond. We find that contraception, a key factor in cultural transmission models of fertility decline, initially has little effect on family size as women appear to hedge their bets and adopt fertility control only at the end of their reproductive careers. Family planning is, however, associated with the spread of lower fertility in later cohorts. Distinguishing influences on the origin versus spread of a behaviour provides valuable insight into causal factors shaping individual and normative changes in fertility.

SUBMITTER: Kramer KL

PROVIDER: S-EPMC8065026 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Effects of family planning on fertility behaviour across the demographic transition.

Kramer Karen L KL Hackman Joe J Schacht Ryan R Davis Helen E HE

Scientific reports 20210423 1

The adoption of contraception often coincides with market integration and has transformative effects on fertility behavior. Yet many parents in small-scale societies make decisions about whether and when to adopt family planning in an environment where the payoffs to have smaller families are uncertain. Here we track the fertility of Maya women across 90 years, spanning the transition from natural to contracepting fertility. We first situate the uncertainty in which fertility decisions are made ...[more]

PMID: 33893324

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Project description:ImportanceFemale oncologists often spend their childbearing years in training and establishing careers, with many later experiencing fertility issues when starting a family. Physician fertility and family planning are rarely discussed during training. Attitudes among female oncologists regarding family planning are unknown.ObjectivesTo understand barriers to family planning as well as the association of fertility treatment with career decisions and to assess experiences of pregnancy-based discrimination among female oncologists.Design, setting, and participantsIn this survey study, a novel 39-item questionnaire was distributed to US female oncologists from May 7 to June 30, 2020, via email and social media channels. Questions regarding factors associated with family planning, maternity leave, and discrimination were included.Main outcomes and measuresThe distribution of survey responses was compared by oncology subspecialty. Multivariable logistic regression was performed to determine independent variables for discrimination experienced during maternity leave.ResultsResponses were collected from 1004 female oncologists. Most respondents (847 [84.4%]) were married, and 713 (71.0%) were currently working full-time. A total of 351 oncologists (35.0%) worked in radiation oncology, 344 (34.3%) in medical oncology, 186 (18.4%) in surgical oncology, and 91 (9.1%) in pediatric oncology. A total of 768 respondents (76.5%) had children, and of these, 415 (41.3%) first gave birth during postgraduate training, and 275 (27.4%) gave birth in years 1 to 5 as an attending physician. Almost all respondents (951 [94.7%]) stated that their career plans were at least somewhat associated with the timing of when to start a family. Having a supportive partner was the most commonly cited positive association with family planning (802 [79.9%]), while long work hours and heavy workload (669 [66.6%]) were the most common negative factors. One-third (318 [31.7%]) had miscarried, and 315 (31.4%) reported difficulty with infertility that required fertility counseling and/or treatment; 660 (65.7%) thought fertility preservation should be discussed with women during medical school and/or residency. One-third (312 [31.1%]) reported experiencing discrimination during pregnancy, and 332 (33.1%) stated they experienced discrimination for taking maternity leave. On multivariable logistic regression, having more than 1 child was associated with increased likelihood of experiencing discrimination during maternity leave (2 children: odds ratio, 1.62 [95% CI, 1.10-2.39]; P = .02; ≥3 children: odds ratio, 1.84 [95% CI, 1.14-2.95; P = .01).Conclusions and relevanceIn this survey study of female oncologists, 1 in 3 reported experiencing infertility and 1 in 3 stated they experienced discrimination during pregnancy and/or for taking maternity leave. Systemic changes are necessary to ensure women are supported and able to advance equitably in the field.

Project description:BackgroundThe world population is expected to increase greatly this century, aggravating current problems related to climate, health, food security, biodiversity, energy and other vital resources. Population growth depends strongly on total fertility rate (TFR), but the relative importance of factors that influence fertility needs more study.MethodsWe analyze recent levels of fertility in relation to five factors: education (mean school years for females), economy (Gross Domestic Product, GDP, per capita), religiosity, contraceptive prevalence rate (CPR), and strength of family planning programs. We compare six global regions: E Europe, W Europe and related countries, Latin America and the Caribbean, the Arab States, Sub-Saharan Africa, and Asia. In total, 141 countries are included in the analysis. We estimate the strength of relationships between TFR and the five factors by correlation or regression and present the results graphically.ResultsIn decreasing order of strength, fertility (TFR) correlates negatively with education, CPR, and GDP per capita, and positively with religiosity. Europe deviates from other regions in several ways, e.g. TFR increases with education and decreases with religiosity in W Europe. TFR decreases with increasing strength of family planning programs in three regions, but only weakly so in a fourth, Sub-Saharan Africa (the two European regions lacked such programs). Most factors correlated with TFR are also correlated with each other. In particular, education correlates positively with GDP per capita but negatively with religiosity, which is also negatively related to contraception and GDP per capita.ConclusionsThese results help identify factors of likely importance for TFR in global regions and countries. More work is needed to establish causality and relative importance of the factors. Our novel quantitative analysis of TFR suggests that religiosity may counteract the ongoing decline of fertility in some regions and countries.

Project description:BackgroundMost women with multiple sclerosis (MS) have childbearing potential. Although fertility and pregnancy are not affected by MS, the fertility preferences of women with MS can change due to the risk of complications for the mother and/or adverse pregnancy outcomes resulting from the disease or its treatment.ObjectivesTo describe fertility preferences (FPs) and their associated factors, to estimate the Unmet Need for Family Planning (UNFP), use of contraceptives, and history of exposure to disease-modifying therapies (DMTs) during pregnancy in women with MS.MethodsIn a cross-sectional observational study, a random sample of women with MS were surveyed with the FP subset of the Demographic and Health Survey of Colombia. Factors associated with FP were evaluated through bivariate and logistic regression analysis. The proportion of pregnancies exposed to DMTs, UNFP, and use of contraceptives was estimated.ResultsOf the 141 women interviewed, 101 women had childbearing potential, of whom 49 did not want to have children, 38 were sterilized, 33 wanted to have more children, 19 were undecided, and 2 stated they were unable to bear children (menopause or hysterectomy). No MS-related variables were associated with the preference to have more children. Age (OR 0.91; 95% CI 0.84-0.98) and the number of children (OR 0.23; 95% CI 0.09-0.58) decreased the likelihood of desire for children. Of 116 sexually active women, 87.06 % (101) were using contraceptives, and among them, four were using fertility awareness methods and withdrawal. The UNFP was estimated at 6.03% and was not significantly different from the general population. Eighty-two pregnancies were identified, of which 48 occurred after diagnosis, and 25 were exposed to DMTs.ConclusionFertility preference in women with MS is not associated with clinical variables. A large proportion of women choose not to have children and prefer to use permanent contraceptive methods. Although the frequency of contraceptive use was high, some women have the UNFP and use low-efficacy contraceptive methods, which may result in unplanned pregnancies.

Dataset Information

Effects of family planning on fertility behaviour across the demographic transition.

Publications

Effects of family planning on fertility behaviour across the demographic transition.

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