Caesarean deliveries, subsequent reproductive behaviour and children ever born in India

Against the backdrop of the alarming rise in Caesarean section (C-section) births in India, this study aimed to examine the association between C-section births, fertility decline and female sterilization in the country. A cross-sectional design was used to investigate the association between C-section delivery and subsequent reproductive behaviour in women in India. Data were from the National Family Health Survey (NFHS-4). The study sample comprised 255,726 currently married women in the age group of 15–49 years. The results showed a strong positive relationship between C-section births and female sterilization. The predicted probabilities (PP) from the multivariate regression model indicated a higher chance of female sterilization in women with C-section births (PP = 0.39, p<0.01) compared with those with non-C-section births (PP = 0.20, p<0.01). Both state-level correlation plots and Poisson regression estimates showed a strong negative relationship between C-section births and mean children ever born (CEB). Based on the results, it may be concluded that the use of C-sections and sterilization were strongly correlated in India at the time of the NFHS-4, thus together contributing to fertility decline. A strong negative association was found between the occurrence of C-sections and CEB. The increased and undesired use of C-section births and consequent female sterilization is a regressive socio-demographic process that often violates women’s rights. Fertility decline should happen through informed choice of family planning and must protect the reproductive rights of women.

Impact of unemployment by sex and marriage rate on fertility decline: Estimates for Turkey and Greece using CCR model

The article analyses the effect of unemployment by sex and marriage rate on fertility changes in Greece and Turkey. The empirical part of the study is based on annual time series data retrieved from the World Bank and National Statistical Offices of Turkey and Greece for 1991–2019. Canonical Cointegrating Regression model is applied for the two countries separately, allowing to quantify the effects of the determinants (crude marriage rate and unemployment rate by sex) on the variation of fertility rate. CCR models show these determinants to be the most significant factors of fertility dynamics in both countries. The results from Engle-Granger and the Phillips-Ouliaris tau (t-statistics) tests confirm the cointegration, i.e., long-term relationship between the variables only for Turkey’s CCR model. However, it was found that in Greece, female unemployment impacts fertility rate negatively and male unemployment has a positive effect on fertility rate; for Turkey modelling shows the opposite relationship. The results of the study suggest that economic uncertainties might be one of the factors contributing to fertility decline in these countries, long-term or in the coming years.

Fertility and Modernity

We investigate the determinants of the fertility decline in Europe from 1830 to 1970 using a newly constructed dataset of linguistic distances between European regions. The decline resulted from the gradual diffusion of new fertility behavior from French-speaking regions to the rest of Europe. Societies with higher education, lower infant mortality, higher urbanization, and higher population density had lower levels of fertility during the 19th and early 20th century. However, the fertility decline took place earlier in communities that were culturally closer to the French, while the fertility transition spread only later to societies that were more distant from the frontier. This is consistent with a process of social influence, whereby societies that were culturally closer to the French faced lower barriers to learning new information and adopting novel attitudes regarding fertility control.

The Role of Proximate Determinants and Distal Variables On Recent Fertility in Dabat Health and Demographic Surveillance System Site, Northwest Ethiopia: A Mediation Analysis

Background In Ethiopia, previous studies have explored the role of the proximate determinants for recent fertility decline at national and regional levels. However, none of these studies have examined the role of socioeconomic factors on the observed fertility decline through these proximate variables. This study aimed to estimate the effects of proximate determinants of fertility and the contribution of distal variables in recent fertility in Dabat Health and Demographic Surveillance Site, northwest Ethiopia. Methods A community based cross-sectional survey was carried out in 2020 among 1649 women of reproductive age group. Data were collected using structured and interviewer administered questionnaire. Generalized structural equation model was employed for the mediation analysis to estimate the relationships among distal and mediating variables with outcome variable, children ever born, simultaneously. A difference approach was used to test whether the effects of predictor variables were mediated. Results The Total Fertility Rate (TFR) for the three years preceding the survey was estimated at 3.4 children per woman. The Age Specific Fertility Rate (ASFR) in the study area reached its peak in the age group of 25–29 with 191 children per 1000 women. Among the proximate determinants, only marriage was a significant proximate determinant of recent fertility. The probability of having birth was more than fivefold higher among currently married women (IRR = 5.6 with a P-value = 0.000) than their unmarried counterparts. Age of women, occupation of women, household wealth status, ideal number of children, and experiencing child death had a significant total effect on recent fertility that were decomposed to direct and indirect or mediated effects of variables. Conclusion Marriage was the only proximate determinant that stood out as a significant mediated variable through which the distal variables affected fertility. Findings also clearly indicated that female participation in non-agricultural occupation affected the recent fertility. Hence, women's level of employment should be raised to increase their economic independence that will reduce the desirability of early marriage which in turn lower the number of children. In addition, the prevailing strategies on family planning programs should be improved to enhance the prevalence of contraceptive use among married women that will accelerate the current fertility transition.