When ART fails: figures, experiences, interventions and a plea for the ‘plan B’

Infertility is perceived by many of those affected by it as one of the most stressful episodes in life. Assisted reproduction can help only some of the people with a desire for children to experience the birth of a biological child. Most people who remain involuntarily childless eventually come to terms with the situation; their psychological well-being is not lastingly affected. However, they should envisage a ‘plan B’ as early as possible. The prospect of permanent childlessness should not be an unmentionable topic, neither for couples themselves nor for the doctors treating them.

Application of Multinomial Logistic Regression Model on Factors That Affects The Need for Children Among Ethiopian Women

Background: Need for children (desire for children), is one of the major factors influencing the population dynamics. Like other fertility preferences, it is not fixed but changes over the family life course in respect to actual fertility experiences and outcomes. The objective of this study was to identify socio-economic and demographic factors that affect the need for another child (desire for more children) among Ethiopian women of reproductive age (15-49).Methods: The study was based on Ethiopian Demographic and Health Survey (EDHS), 2016 data. A total of 15,683 women with complete information were considered in the study. A Multinomial Logistic Regression Model, a family of generalized non-linear models, were used to identify determinant factors for the need to children (desire for children) among women in Ethiopia using STATA 14 and SPSS 23.Results: Results showed that among the reproductive age women’s 65.51% were need to have childe, and their average age was 25.05, 27.18% were don’t like to have child and their average age was 35.73, the rest 7.31% of the women were not decide where they need children or not and their average age was 24.8. From multinomial logistic regression model, Region, contraception using (for yes 0.658293 (0.58889, 0.73586) for undecided 0.6310024 (0.50151, 0.79394)), marital status, age of women (for yes 0.896552 (0.88968, 0.90348) for undecided 0.9282431 (0.91632, 0.94033)), number of living children, religion, age at first marriage ( for yes1.057528 (1.04363, 1.07161) for undecided 1.041 (1.01434, 1.06836)), wealth index, women’s employment and women’s education were significant effect on the need for children among Ethiopian women.Conclusions: This study was based on a nationwide large sample demographic and survey conducted by the Ethiopian Statistical Agency. The study has empirically investigated and identified the determinants factors that affect the need for children among Ethiopian women. The multinomial logistic regression model analysis identified that variables such as marital status, contraception using, number of living children, age at first marriage and age of women play vital role in deciding on weather women need to have children or not. Region contraceptive using women’s employment, women’s education level and number of living children have negatively associated with outcome variable.

Refusal versus massive investment: Qualitative study of parenthood among adopted adults in France

Adoptees are studied more as children than as adults. While there is nevertheless a large body of research on adopted adults, little of this has focused on the families they build. Adoptees’ parenthood has been particularly neglected. The few studies conducted on this subject up to now all had serious methodological flaws, and were not interested in adoptees who either refuse to become parents or, at the other extreme, invest massively in parenthood. In the present study, our objective was therefore to better understand the experience and determinants of two specific attitudes toward parenthood among adoptees: refusal and massive investment. We carried out semistructured interviews with 13 adopted adults who held just such attitudes toward parenthood. The interview transcripts were submitted to a thematic analysis using QDA Miner 5 software. This analysis shed light on the experiences of adoptees who either refuse parenthood (satisfaction, parenting by proxy, views on child adoption) or invest massively in it (parenting style, desire for children, difficulties encountered), as well as on the determinants of these positions (impact of adoptee status, relationships with adoptive parents and with partners). These results enhance current understanding of the potential distress of adoptees regarding parenthood, as well as the challenges that this life stage can pose for them and their children. We discuss the theoretical and clinical implications.

The association between paternal characteristics and exclusive breastfeeding in Ghana

Background Studies have shown that partners play an influential role in exclusive breastfeeding practice and that they can act as either deterrents or supporters to breastfeeding. However, there are limited studies on the influence of partners’ characteristics on exclusive breastfeeding in Ghana. This study examined the association between partners’ characteristics and exclusive breastfeeding in Ghana. Methods This cross-sectional study used data from the 2014 Ghana Demographic and Health Survey. Infants less than 6 months old (exclusively breastfed or not) with maternal and paternal characteristics were included in the study. A total of 180 participants were used for the study. A binary logistic regression was used to examine the influence of partners’ characteristics on exclusive breastfeeding. Results Partners’ characteristics such as education, desire for children, religion, and children ever born were associated with exclusive breastfeeding. Mothers whose partners had primary education (AOR = 0.12; CI 95%: 0.02–0.93; p = 0.04) were less likely to practice exclusive breastfeeding compared to those whose partners had no formal education. Also, mothers whose partners desired more children (AOR = 0.20; CI 95%: 0.06–0.70; p = 0.01) were less likely to practice exclusive breastfeeding compared to those whose partners desire fewer children. Conclusion Improving EBF requires the involvement of partners in exclusive breastfeeding campaigns/programmes. A more couple-oriented approach is required by health practitioners to educate and counsel both mothers and partners on the importance of exclusive breastfeeding in Ghana.

Transvaginal Hybrid-NOTES procedures—do they have a negative impact on pregnancy and delivery?

Purpose We conducted a retrospective observational study in order to identify negative effects of NOTES procedures (Natural Orifice Transluminal Endoscopic Surgery) with transvaginal specimen removal on pregnancy and delivery. Methods From the total population of 299 patients in our NOTES registry, we tried to contact the 121 patients who were of reproductive age (≤ 45 years) at the time of a transvaginal NOTES procedure. They were interviewed by telephone regarding their desire for children, post NOTES-operation pregnancies, and type of delivery using a structured questionnaire. The collected data was analyzed and compared with current data. Results We were able to contact 76 patients (follow-up rate: 62.8%) with a median follow-up of 77 months after surgery (33–129 months). Twenty of 74 participating patients had a desire for children (27.0%). One of them and another's male partner were diagnosed as infertile. Regarding the remaining 18 patients, 14 became pregnant, and three of them became pregnant twice. Considering these 17 pregnancies, there was one miscarriage (5.9%) and one twin birth (5.9%). On average, childbirth occurred 44 months after the NOTES procedure. With regard to the type of delivery, 10 vaginal births (58.8%) and 7 caesarean sections (41.2%) occurred. Thus, the rate of fulfilled desire for children was 77.8%. Compared with the literature, no difference to the normal course could be detected. Conclusion There is no sign that the transvaginal approach in Hybrid-NOTES, with removal of the specimen through the vagina, has a negative effect on conception, the course during pregnancy, or the type of delivery.

Societal and individual drivers of fertility desires and intentions among people living with HIV: a cross sectional study of HIV clinic attendees in Soweto, South Africa

<abstract><sec> <title>Background</title> <p>High proportion of people living with HIV (PLHIV) who are in the prime of their reproductive years desire to have children. There are limited studies that explore the range of fertility intentions for PLHIV. This study investigated the fertility desires and intentions of PLHIV and the associated factors.</p> </sec><sec> <title>Methods</title> <p>This was a cross-sectional study of 442 PLHIV receiving antiretroviral treatment (ART) in health facilities in Soweto, an urban township that is situated in the City of Johannesburg in South Africa. STATA version 13 was used to analyze the data.</p> </sec><sec> <title>Results</title> <p>The participants' mean age was 36.3 years, 70% were females, 79.6% had at least one biological child, and 36% had 3+ children. Almost half (47%) expressed the desire for children, saying that this was because they had no biological children, or their partners wanted children, or they wanted children of a particular sex, or were feeling healthy after taking ART. An increased fertility desire was associated with absence of biological children (AOR = 5.06, 95% CI: 2.11–12.1) and with being married (AOR = 2.63, 95% CI: 1.31–5.27). A decreased fertility desire was associated with being aged 36+ (AOR = 2.63, 95% CI: 1.31–5.27), having primary education (AOR = 0.11, 95% CI: 0.01–1.30) and having ≥4 years of ART duration (AOR = 0.45, 95% CI: 0.24–0.81).</p> </sec><sec> <title>Conclusion</title> <p>Individual factors played a significant role in shaping the fertility desires of PLHIV in this setting. The high desire for children underscore the need to integrate reproductive health services in HIV and AIDS care and treatment services and develop safer conception programmes to help PLHIV to conceive and have children safely.</p> </sec></abstract>

‘British Values Are Also Values All Around the World’: Teaching Fundamental British Values through a Human Rights Lens

Since 2014, the promotion of Fundamental British Values (FBV) has been a requirement across formal schooling in England. The agenda has, however, faced criticism from various stakeholders. Much of this denunciation has been directed at the opaque nature of FBV, but the agenda is problematic for more concerning reasons. It is arguable that, in light of the current threat from ethno-nationalism, frameworks such as FBV that focus on a particular definition and formulation of national values run the risk of being interpreted in a manner that is exclusionary and liable to ‘other’ different ethnic groups in the classroom. The FBV framework furthermore overlooks the fact that the UK isalready subject to numerous international human rights obligations, including many that mandate the provision of holistic and effective human rights education at all levels of formal education. This article therefore draws upon the findings of a pilot study conducted with Year 5 learners in four primary schools in the West Midlands showing that teaching about human rights through the FBV agenda is possible, by linking discussion of values at the national level to broader human rights principles. Such an approach satisfies the government’s desire for children to learn about FBV, whilst highlighting that these values also exist in a global context. This, in turn, is likely to be a more effective way of encouraging learners to be global citizens who will contribute to the building of a broader culture that is respectful of human rights.

A Great Desire for Children: The Beginning of Transnational Adoption in Denmark and Norway during the 1960’s

This article examines the beginning of transnational adoption in Denmark and Norway to illuminate the role of private actors and associations in Scandinavian welfare systems. Utilizing case studies of two prominent private adoption actors, Tytte Botfeldt and Torbjørn Jelstad, the article analyzes how these Nordic welfare states responded to the emergence of transnational adoption in comparison with both each other, neighboring Sweden, and the United States. This study shows that private actors and associations strongly influenced the nascent international adoption systems in these countries, by effectively promoting transnational adoption as a progressive and humanitarian form of global parenthood; while simultaneously emphasizing the responsibility of the welfare state to accommodate and alleviate childless couples’ human rights and need for children. A need that was strong enough that couples were willing to transcend legal, national, and racial borders. Ultimately, Danish and Norwegian authorities not only had to show leniency towards flagrant violations of adoption and child placement rules, but also change these so that families could fulfill their great need for children by legally adopting them from abroad.