The impact of COVID-19 on fertility behaviour and intentions in a middle income country

The COVID Pandemic may affect fertility behaviour and intentions in many ways. Restrictions on service provision reduce access to family planning services and increase fertility in the short term. By contrast, the economic uncertainty brought about by the pandemic and its impact on mental health and well-being may reduce fertility. These various pathways have been explored in the context of high income countries such as the United States and Western Europe, but little is known about middle income countries. In this paper we asses the impact of the COVID pandemic on fertility intentions and behaviour in the Republic of Moldova, a middle income country in Eastern Europe, using the Generations and Gender Survey. This survey was conducted partially before and partially after the onset of the pandemic in 2020, allowing for detailed comparisons of individual circumstances. The results indicate that the pandemic reduced the used of intrauterine devices, and increased the use of male condoms, but with no overall decrease in contraceptive use. Conversely individuals interviewed after the onset of the pandemic were 34.5% less likely to be trying to conceive, although medium term fertility intentions were unchanged. Indicators therefore suggest that in the medium term fertility intentions may not be affected by the pandemic but restricted access to contraception requiring medical consultation and a decrease in short-term fertility intentions could disrupt short term family planning.

Determinants associated high-risk fertility behaviours among reproductive aged women in Bangladesh: a cross-sectional study

Background The high prevalence of maternal high-risk fertility behaviour (HRFB) has multiple negative consequences for both the mother and the child. However, very few studies to date have been done on this issue, thus, we set out to determine the factors that increase the risk of HRFB in Bangladeshi women of reproductive age 15-49 years. Methods The study utilised the latest Bangladesh Demographic and Health Survey (BDHS) 2017-18 dataset. The Pearson's chi-square test was performed to determine the relationships between the outcome and the independent variables, while multivariate logistic regression analysis was used to identify the potential determinants associated with HRFB. Results Overall 67.7% women had HRFB among them 45.6% were at single risk and 22.1% were at multiple high-risks. Women’s age (35-49 years: AOR=6.42 95% CI: 3.95-10.42 & 15-24 years: AOR=1.19, 95% CI: 1.03-1.38), practicing Islam (AOR=2.30, 95% CI: 1.18-7.58), having normal childbirth (AOR=1.37, 95% CI: 1.12-1.68), had more than three children (AOR=4.60, 95% CI: 4.14-6.15), unwanted pregnancy (AOR=9.98, 95% CI: 5.61-17.74) and not using birth control tools (AOR=1.33, 95% CI:1.14-1.55) were significantly associated with increasing risk of having HRFB. Alternatively, women and their partners’ higher education were associated with reducing HRFB. Conclusion A significant proportion of Bangladeshi women had high-risk fertility behaviour which is quite alarming. Therefore, the public health policy makers in Bangladesh should emphasis on this issue and design appropriate interventions to reduce the maternal HRFB.

Rural Small-Scale Women Farmers and Preference for Family Size in South-East Nigeria

Among other things, fertility control in Nigeria may not be feasible without recourse to socioeconomic issues such as micro-occupation classification and dominant family cultural traditions facing women and their relationship to fertility behaviour. Rural small-scale women farmers are a relatively closed group with some uniqueness for the understanding of the value of children (VOC) in socioeconomic and cultural contexts and its relationship with fertility behaviour in developing nations. This study, guided by the VOC model, focuses on determining factors for preference for family size (0-4 children) among rural small-scale women farmers in Eha-Amufun in Enugu state. 200 married women (mean age = 33.9; mean age at marriage = 24.5) from 20 agricultural co-operative societies were selected for the study. The study adopted a survey and quantitative research design. Besides the sociodemographic information of the study participants, the study elicited from the respondents information on their choice of family size, the connection of family size with their occupation and the circumstances surrounding son preference and son adoption in the family and rural contexts. The collected data were analysed using the ordinal logistic regression model. The findings show that economic independence, son preference and male child adoption negates limiting family sizes to 0-4 (p<.05) however, age, formal education, children as source of labour and economic independence were positively correlated with the desire for a family size of 4 children and above. In view of the limitations of the study and the ability of the VOC model to unveil spurious factors for fertility behaviour among women, there is a need for comparative studies of rural closed groups in developing nations and their fertility behaviour.Among other things, fertility control in Nigeria may not be feasible without recourse to socioeconomic issues such as micro-occupation classification and dominant family cultural traditions facing women and their relationship to fertility behaviour. Rural small-scale women farmers are a relatively closed group with some uniqueness for the understanding of the value of children (VOC) in socioeconomic and cultural contexts and its relationship with fertility behaviour in developing nations. This study, guided by the VOC model, focuses on determining factors for preference for family size (0-4 children) among rural small-scale women farmers in Eha-Amufun in Enugu state. 200 married women (mean age = 33.9; mean age at marriage = 24.5) from 20 agricultural co-operative societies were selected for the study. The study adopted a survey and quantitative research design. Besides the sociodemographic information of the study participants, the study elicited from the respondents information on their choice of family size, the connection of family size with their occupation and the circumstances surrounding son preference and son adoption in the family and rural contexts. The collected data were analysed using the ordinal logistic regression model. The findings show that economic independence, son preference and male child adoption negates limiting family sizes to 0-4 (p<.05) however, age, formal education, children as source of labour and economic independence were positively correlated with the desire for a family size of 4 children and above. In view of the limitations of the study and the ability of the VOC model to unveil spurious factors for fertility behaviour among women, there is a need for comparative studies of rural closed groups in developing nations and their fertility behaviour.

STALLED FERTILITY DECLINE IN EAST NUSA TENGGARA, INDONESIA, 2002-2017: UNDERSTANDING ITS DETERMINANTS

Indonesia is one of the countries that has been relatively successful in completing a fertility transition. However, provincial differences in fertility still exist, with East Nusa Tenggara (Nusa Tenggara Timur – NTT) having the highest Total Fertility Rate in 2017 (TFR, 3.4 births per woman). By employing a document analysis method, this study explores the indirect and direct determinants of the stalled fertility decline in NTT. It is revealed that all indirect determinants of fertility –culture, socioeconomics, and governance– have shaped women's persistent fertility behaviour in NTT. Meanwhile, among three direct determinants of fertility –marriage, contraception, and postpartum infecundability–, contraception is the only determinant that has been responsible for the stall of fertility transition in this province. These findings suggest that to foster the fertility decline in NTT, the government plays an essential role in boosting the provision of contraception, information and education, and providing incentives for having fewer children.

The Impact of COVID-19 on Fertility behaviour and Intentions in the Republic of Moldova

The COVID Pandemic could affect fertility behaviour and intentions in many ways. Restrictions on service provision may reduce access to family planning services and increase fertility in the short term. By contrast, the economic uncertainty brought about by the pandemic and its impact on mental health and well-being may reduce fertility. These various pathways have been explored in the context of high income countries such as the United States and Western Europe, but little is known about middle income countries. In this paper we asses the impact of the COVID pandemic on fertility intentions and behaviour in the Republic of Moldova, a middle income country in Eastern Europe, using the Generations and Gender Survey. This survey was conducted partially before and partially after the pandemic, allowing for detailed analysis of individual circumstances. The results indicate that the pandemic reduced contraceptive use by 40%. Conversely couples were also 41% less likely to be trying to conceive after the onset of the pandemic, although medium term fertility intentions were unchanged. Indicators therefore suggest that in the medium term fertility intentions may not be affected by the pandemic but access to family planning services and deferring attempts to conceive may change which individuals have children and when.

Impact of High-Risk Fertility Behaviour on Under-five Mortality in Asia and Africa: Evidence from Demographic and Health Surveys

Background: Younger or older maternal age, short inter-pregnancy birth interval, and higher birth order of the child are considered to be high-risk fertility behaviour (HRFB). Under-five mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and under-five mortality in selected Asian and African countries.Methods: This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in Sub-Saharan Africa, Middle East, North Africa, and South Asia from 1986 to 2017 (N=1,467,728). Previous evidence hints at four markers of HRFB: women’s age at the birth of index child <18 years or >34 years, short preceding birth interval (PBI) <24 months, and child’s birth order >3. Using logistic regression, we analysed the change in the odds of under-five mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. Results: Mother’s age at the birth of index child <18 years and preceding birth interval (PBI) <24 months were significant risk factors of under-five mortality, while a child’s birth order >3 was a protective factor against under-five mortality. Presence of any single HRFB was associated with 1.067 times higher risk of under-five mortality (OR = 1.067; 95% CI: 1.042 - 1.090; P < 0.001). Presence of multiple HRFBs was associated with 1.392 times higher risk of under-five mortality (OR = 1.392; 95% CI: 1.355 - 1.431; P < 0.001). Some specific combinations of risky fertility behaviour such as younger maternal age (<18 years) and short preceding birth interval (PBI <24) significantly increased the odds of under-five mortality.Conclusion: Younger maternal age and short preceding birth interval significantly increase the risk of under-five mortality. This highlights the need for effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for an optimal interpregnancy interval.