Birth Spacing and Fertility in the Presence of Son Preference and Sex-Selective Abortions: India's Experience Over Four Decades

Since the advent of prenatal sex-determination technologies in the mid-1980s, India has experienced an increasingly male-biased sex ratio at birth, presumably from sex-selective abortions. Abortions lengthen birth intervals, but we know little about how birth spacing has changed or the effects of these changes. I show that, although the overall length of birth intervals increased from 1970 to the mid-2010s, well-educated women with no sons had the most substantial lengthening, as well as the most male-biased sex ratios. Furthermore, most of these changes took place immediately after the introduction of prenatal sex-determination technologies. Consequently, some women without sons now have longer birth intervals than those with sons, reversing India's traditional spacing pattern. Women with low education continue short birth spacing when they have no sons, with only limited evidence of male-biased sex ratios. Because of the rapid lengthening of birth intervals, period fertility rates substantially overestimated how fast cohort fertility fell. Moreover, predicted cohort fertility is still 10%–20% above the period fertility rate. If the lengthening of birth intervals arises from repeated abortions, the associated short pregnancy spacing may counteract any positive effects of longer birth spacing. There is, however, no evidence of this effect on infant mortality. Judging from sex ratios, sex-selective abortion use is not declining.

PSVI-3 Effect of feeding resistant starch on sow and piglet farrowing performance and blood parameters

Hyperprolific sows can have a long duration of farrowing, negatively impacting piglet survival and vitality. This study’s objective was to assess the effect of a diet containing 6.6% resistant starch (RS) on sow and piglet farrowing performance. We hypothesized that a diet containing RS would decrease sow farrowing duration and improve piglet survival. Forty-two sows were balanced for parity and randomly assigned to 1 of 2 treatments: standard lactation diet (n = 21) or diet containing RS (n = 21). Sows were fed their respective diets from approximately 7d prefarrowing throughout lactation. Sow blood was drawn at three time points on d106±1.0 and d113±1.0 of gestation (pre-feeding, 2 and 6 h post-feeding) and during farrowing to measure blood glucose. Piglet umbilical blood (~3/litter; beginning, middle, end of birth order) was collected at birth and analyzed for glucose, lactate, pH, PCO2, PO2, TCO2, HCO3, BE, and sO2. Piglets were visually assessed at birth to score meconium staining. Data collected included farrowing duration, piglet birthing intervals, number of stillborn piglets/litter, sow and piglet weights, piglet mortality, and sow feed and water intake. Average litter sizes post-crossfoster for control and RS were similar, 12.1±0.4 and 11.6±0.4 piglets, respectively. Litter weight gain was similar between control and RS (44.97 vs. 47.54 kg, P = 0.33), respectively. Feeding resistant starch had no effect on number of stillborn piglets or pre-weaning survival (P > 0.75). Farrowing duration (178.9±17.6 min vs 165.2±18.0 min, P = 0.59) and piglet birth intervals (16.57±1.7 min and 14.89±1.8 min, P = 0.51) did not differ between control and RS, respectively. There was difference in sow blood glucose between diets (P = 0.02), day of sample (P < 0.0001), time point (P < 0.0001), and a day by time point interaction (P < 0.0001). Feeding RS to sows prefarrowing can modify sow blood glucose, but did not result in reduced farrowing duration or improved piglet survival.

The Influence of Reproductive History on Post-Reproductive Mortality: A Case Study of Amish Women

The reproductive choices women make affect their health outcomes; however, the relevance of reproductive history on post-reproductive mortality varies according to the population under study. We examine whether the number of children a woman gives birth to, short birth intervals, late childbearing, having twins, and having children who die young have an influence on maternal mortality among the Amish. We use information from Amish directories to examine reproductive patterns of 228 women in this high fertility group. Our results indicate the patterns typically found for maternal mortality in the general population do not hold in our sample of Amish women. We suggest the mediating role of family and community is integral to understanding the maternal health patterns within the Amish community.

A comparative analysis of the influence of contraceptive use and fertility desire on the duration of second birth interval in four sub-Saharan African countries

Background Fertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries. Methods We analysed cross-sectional data on women aged 15–49 years who participated in the recent Demographic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level. Results The median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR = 0.93; CI: 0.89–0.97), Ethiopia (aHR = 0.64; CI: 0.61–0.67) and South Africa (aHR = 0.51; CI: 0.47–0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status. Conclusion Findings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA.

The Crucial Role of Mothers and Siblings in Child Survival: Evidence From 29 Health and Demographic Surveillance Systems in Sub-Saharan Africa

A considerable body of research has studied the effects of siblings on child mortality through birth intervals. This research has commonly focused on older siblings. We argue that birth intervals with younger siblings may have equal or stronger effects on child mortality, even during a mother's pregnancy. Moreover, we contend that birth interval effects need to be considered only when siblings are coresident. Using longitudinal data from 29 Health and Demographic Surveillance Systems across sub-Saharan Africa, covering more than 560,000 children, we examine the proximate role of siblings and mothers in child mortality. We find that a birth interval of 24 months or more is advantageous for both older and younger siblings. The effect of a younger sibling on child mortality is more pronounced than that of an older sibling and adds to the effect of an older sibling. Moreover, child mortality is particularly low during a mother's subsequent pregnancy, contrasting the shock resulting from a younger sibling's birth. Further, we find that a mother's or sibling's absence from the household results in a higher risk of mortality, and the death of either reduces child survival up to six months before the death.

Preceding child survival status and its effect on infant and child mortality in India: An evidence from National Family Health Survey 2015–16

Background India has achieved impressive gains in child survival over the last two decades; however, it was not successful in attaining MDG 2015 goals. The study’s objective is to inquire how the survival status of the preceding child affects the survival of the next born child. Methods This is a retrospective analysis of data from the National Family Health Survey, 2015–16. Analysis was restricted to women with second or higher-order births because women with first-order births do not have a preceding child. Proportional hazards regression, also called the Cox regression model, has been used to carry out the analysis. Kaplan–Meier (K–M) survival curves were also generated, with a focus on preceding birth intervals. Results Results found that female children were more likely to experience infant mortality than their male counterparts. Children born after birth intervals of 36+ months were least likely to experience infant mortality. Mother’s education and household wealth are two strong predictors of child survival, while the place of residence and caste did not show any effect in the Cox proportional model. Infant and child deaths are highly clustered among those mothers whose earlier child is dead. Conclusion Maternal childbearing age is still low in India, and it poses a high risk of infant and child death. Education is a way out, and there is a need to focus on girl’s education. The government shall also focus on raising awareness of the importance of spacing between two successive births. There is also a need to create a better health infrastructure catering to the needs of rich and poor people alike.

Effect of Birth Interval on Foetal and Postnatal Child Growth

Background. Although available evidence suggests short birth intervals are associated with adverse perinatal outcomes, little is known about the extent to which birth spacing affects postnatal child growth. The present study assessed the independent association of birth interval with birth weight and subsequent postnatal growth indices. Methods. This retrospective cohort study carried out in the rural areas of Kassena-Nankana district of Ghana compared postnatal growth across different categories of birth intervals. Birth intervals were calculated as month difference between consecutive births of a woman. The study population comprised 530 postpartum women who had delivered a live baby in the past 24 months prior to the study. Results. Using the analysis of covariance (ANCOVA) that adjusted for age of the child, gender of the child, weight-for-length z-score (WLZ), birth weight, adequacy of antenatal care (ANC) attendance, and dietary diversity of the child, the mean length-for-age z-score (LAZ) among children of short preceding birth interval (<24 months) was significantly higher than among children of long birth interval (that is, at least 24 months) ((0.51 versus −0.04) (95% CI: 0.24–0.87), p = 0.001). The adjusted mean birth weight of children born to mothers of longer birth interval was 74.0 g more than children born to mothers of shorter birth interval (CI: 5.89–142.0, p < 0.03). Conclusions. The results suggest that a short birth interval is associated positively with an increased risk of low birth weight (an indicator of foetal growth), but birth spacing is associated negatively with the LAZ (an indicator of postnatal growth).

Microanálisis comparado de la transición demográfica en tres islas de las Azores, siglos XVIII-XX: Diferencias en el pasado, semejanzas en el presente.

The demographic transition is a global phenomenon. However, previous studies have demonstrated the existence of differences in its development between areas that are in close proximity. The aim of this article is to compare the process of demographic transition in the rural communities of three islands in the archipelago of the Azores (Pico, Flores and Corvo) using life course data for more than 250 years. Throughout the article several variables related to nuptiality, fertility, mortality and mobility have been analysed. Our results show clear differences between communities prior to the demographic transition and, to a lesser extent, during the demographic transition process. The island of Flores, for instance, has historically presented higher fertility because of a lower age at marriage. The island of Pico, on the other hand, had a lower fertility level, higher age at marriage and longer birth intervals. During the demographic transition, infant mortality first began to fall in Flores, therefore increasing population pressure. Since 1840, international migration and the abandonment of children served as mechanism to reduce the population pressure.

Does Birth Interval Matter in Under-Five Mortality? Evidence from Demographic and Health Surveys from Eight Countries in West Africa

In sub-Saharan Africa (SSA), every 1 in 12 children under five dies every year compared with 1 in 147 children in the high-income regions. Studies have shown an association between birth intervals and pregnancy outcomes such as low birth weight, preterm birth, and intrauterine growth restriction. In this study, we examined the association between birth interval and under-five mortality in eight countries in West Africa. A secondary analysis of the Demographic and Health Survey (DHS) data from eight West African countries was carried out. The sample size for this study comprised 52,877 childbearing women (15-49 years). A bivariate logistic regression analysis was carried out and the results were presented as crude odds ratio (cOR) and adjusted odds ratios (aOR) at 95% confidence interval (CI). Birth interval had a statistically significant independent association with under-five mortality, with children born to mothers who had >2 years birth interval less likely to die before their fifth birthday compared to mothers with ≤2 years birth interval [ cOR = 0.56 ; CI = 0.51 − 0.62 ], and this persisted after controlling for the covariates [ aOR = 0.55 ; CI = 0.50 − 0.61 ]. The country-specific results showed that children born to mothers who had >2 years birth interval were less likely to die before the age of five compared to mothers with ≤2 years birth interval in all the eight countries. In terms of the covariates, wealth quintile, mother’s age, mother’s age at first birth, partner’s age, employment status, current pregnancy intention, sex of child, size of child at birth, birth order, type of birth, and contraceptive use also had associations with under-five mortality. We conclude that shorter birth intervals are associated with higher under-five mortality. Other maternal and child characteristics also have associations with under-five mortality. Reproductive health interventions aimed at reducing under-five mortality should focus on lengthening birth intervals. Such interventions should be implemented, taking into consideration the characteristics of women and their children.

Community views on short birth interval in Northern Uganda: a participatory grounded theory

Background Short birth interval is associated with adverse perinatal, maternal, and infant outcomes, although evidence on actionable factors underlying short birth interval remains limited. We explored women and community views on short birth intervals to inform potential solutions to promote a culturally safe child spacing in Northern Uganda. Methods Gendered fuzzy cognitive mapping sessions (n = 21), focus group discussions (n = 12), and an administered survey questionnaire (n = 255) generated evidence on short birth intervals. Deliberative dialogues with women, their communities, and service providers suggested locally relevant actions promote culturally safe child spacing. Results Women, men, and youth have clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice as women are disempowered to exercise child spacing. Women who use contraceptives without their husbands’ consent risk losing financial and social assets and are likely to be subject to intra-partner violence. Women were not comfortable with available contraceptive methods and reported experiencing well-recognized side effects. They reported anxiety about the impact of contraception on the health of their future children. This fear was fed by rumors in their communities about the effects of contraceptives on congenital diseases. The women and their communities suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives. Conclusions The economic context, gender power dynamics, inequality, gender bias in land tenure and ownership regulations, and the limited contraceptive supply reduce women’s capacity to practice child spacing.