Women's empowerment and fertility preferences of married women: analysis of demographic and health survey’2016 in Timor-Leste

<abstract> <p>A recently independent state, Timor-Leste, is progressing towards socioeconomic development, prioritizing women empowerment while its increased fertility rate (4.1) could hinder the growth due to an uncontrolled population. Currently, limited evidence shows that indicators of women's empowerment are associated with fertility preferences and rates. The objective of this study was to assess the association between women empowerment and fertility preferences of married women aged 15 to 49 years in Timor-Leste using nationally representative survey data. The study was conducted using the data of the latest Timor-Leste Demographic and Health Survey 2016. The study included 4040 rural residents and 1810 urban residents of Timor-Leste. Multinomial logistic regression has been performed to assess the strength of association between the exposures indicating women's empowerment and outcome (fertility preference). After adjusting the selected covariates, the findings showed that exposures that indicate women empowerment in DHS, namely, the employment status of women, house and land ownership, ownership of the mobile phone, and independent bank account status, contraceptive use, and the attitude of women towards negotiating sexual relations are significantly associated with fertility preferences. The study shows higher the level of education, the less likely were the women to want more children, and unemployed women were with a higher number of children. Our study also found that the attitude of violence of spouses significantly influenced women's reproductive choice. However, employment had no significant correlation with decision-making opportunities and contraceptive selection due to a lack of substantial data. Also, no meaningful data was available regarding decision-making and fertility preferences. Our findings suggest that women's empowerment governs decision-making in fertility preferences, causing a decline in the fertility rate.</p> </abstract>

The Continuing Impacts of the COVID-19 Pandemic in the United States: Findings from the 2021 Guttmacher Survey of Reproductive Health Experiences

In this report, we analyze the 2021 data, focusing on how respondents feel the COVID-19 pandemic has influenced their sexual and reproductive health in two core areas: fertility preferences and access to care, including use of telehealth. We note disparities according to individuals’ race and ethnicity, sexual orientation, gender identity, income level and economic well-being. To assess the ongoing scope and magnitude of the impacts of the pandemic, we also examine findings on comparable measures from the 2020 and 2021 GSRHE studies. These data provide four key findings: The pandemic has continued to shift fertility preferences and impede access to sexual and reproductive health care, including contraceptive services. The impacts reported in the summer of 2021 are smaller than those reported earlier in the pandemic but remain pervasive. The pandemic continues to have disproportionate effects on the sexual and reproductive health of those already experiencing systemic social and health inequities. Telehealth services are bridging gaps in sexual and reproductive health care resulting from pandemic-related upheaval, particularly for those who already experience barriers to accessing health care.

Quantifying the potential market for new contraceptive technologies: global projections of 2040 contraceptive needs and preferences

Background: Despite a wide range of contraceptive methods, unmet need persists. New contraceptive technologies (CTs) have the potential to improve uptake and continuation. CT development has a long-time horizon; products will be introduced into markets that look very different than today. Identifying viable investments requires an understanding of these future markets. For this work the 2040 potential contraceptive market is described utilizing seven market segments based on marital status, fertility preferences, and patterns of sexual activity outside of marriage. Methods: Market size estimates are developed by country for all countries in the world for a current market (2020) and a future market (2040). United Nation’s (UN) population projections of the number of women of reproductive age (WRA) form the basis of this work. WRA are then segmented into market segments based on marital status, fertility intentions, and patterns of sexual activity outside of marriage. Each segment is further subdivided by contraceptive use versus non-use. Segmentation draws from UN projections, household surveys, census data, and modeling techniques developed for this work. Results: The largest market increases will be seen in Africa; most notably among the segment of married women wanting no more children. By contrast, Asia will see declines across all three married segments, coupled with increases among sexually active unmarried segments. Levels of contraceptive use are projected to vary widely by segment, with differential patters across regions. Conclusions: This analysis projects the impact of demographic changes, evolving fertility preferences, shifts in sexual activity outside of marriage and increased utilization of contraceptives in shaping the contraceptive market of 2040. Results show that there is not one global market, but distinct markets that vary in size and shape across the world. This diversity suggests that a range of different new CTs could have potential for uptake.

Method Related Attributes and Contraceptive Discontinuation: Results from A Prospective Study from Nairobi and Homa Bay Counties in Kenya.

Background: Rates of contraceptive discontinuation are high in many low and middle countries contributing to unmet need for contraception and other adverse reproductive health outcomes. Few studies have investigated how method specific beliefs and strength of fertility preferences affect discontinuation rates. This study examines this question using primary data collected in Nairobi and Homa Bay counties in Kenya.Methods: We used data from two rounds of a longitudinal study of married women ages 15-39 years (2812 and 2424 women from Nairobi and Homa Bay respectively at round 1) from two communities in Kenya. Information on fertility preferences, past and current contraceptive behavior, and method-related beliefs about six modern contraceptive methods were collected, along with a monthly calendar of contraceptive use between the two interviews. The analysis focused on discontinuation of the two most commonly used methods in both sites, injectable and implants. We carry out competing risk survival analysis to identify which method related beliefs predict discontinuation among women using at the first round. Results: The percentages of episodes discontinued in the 12 months between the two rounds was 36%, with a higher rate of discontinuation in Homa Bay (43%) than in the Nairobi slums (32%) and higher for injectables than implants. Method related concerns and beliefs were the major self-reported reasons for discontinuation in both sites. The competing risk survival analysis showed that the probability of method related discontinuation of implants and injectables was significantly lower among respondents who believed that the methods do not cause serious health problems (SHR=0.78, 95% CI 0.62-0.98), do not interfere with regular menses (SHR=0.76, 95% CI 0.61 - 0.95) and do not cause unpleasant side effects (SHR=0.72, 95% CI 0.56-0.89). By contrast, there were no net effects of three method related beliefs that are commonly cited as obstacles to contraceptive use in African societies: safety for long-term use, ability to have children after stopping the method, and the approval of the husband.Conclusion: This study is unique in its examination of the effect of method specific beliefs on subsequent discontinuation for a method-related reason, using a longitudinal design. The single most important result is that concerns about serious health problems, which are largely unjustified and only moderately associated with beliefs about side effects, are a significant influence on discontinuation. The negative results for other beliefs show that the determinants of discontinuation differ from the determinants of method adoption and method choice.

Investigating the Structure of Son Bias in Armenia With Novel Measures of Individual Preferences

Sex ratios at birth favoring boys are being documented in a growing number of countries, a pattern indicating that families selectively abort females. Son bias also explains why, in many countries, girls have more siblings and are born at relatively earlier parities compared with their brothers. In this study, we develop novel methods for measuring son bias using both questionnaire items and implicit association tests, and we collect data on fertility preferences and outcomes from 2,700 participants in Armenia. We document highly skewed sex ratios, suggesting that selective abortions of females are widespread among parents in our sample. We also provide evidence that sex-selective abortions are underreported, which highlights the problem of social desirability bias. We validate our methods and demonstrate that conducting implicit association tests can be a successful strategy for measuring the relative preference for sons and daughters when social desirability is a concern. We investigate the structure of son-biased fertility preferences within households, across families, and between regions in Armenia, using measures of son bias at the level of the individual decision-maker. We find that men are, on average, considerably more son-biased than women. We also show that regional differences in son bias exist and that they appear unrelated to the socioeconomic composition of the population. Finally, we estimate the degree of spousal correlation in son bias and discuss whether husbands are reliably more son-biased than their wives.

Can Targeted Child Benefits Affect Fertility? Evidence from a Natural Experiment

This paper contributes to the literature on whether targeted cash child benefits can affect fertility and, specifically, induce families to have more than two children. We exploit the introduction of a monthly non-means tested cash child benefit paid only to families with at least four children. We apply a quasi experimental methodology since the reform is expected to have increased births of fourth child relative to births of third child or higher than four. We find robust evidence that the reform increased significantly the treated family’s probability to have a (fourth) child by about 5% and had no effect on births greater than four. In the post reform period, the control group’s probability to have a (third) child was not significantly different than before the reform. In particular, the finding that the probability of birth among parities greater than four was not affected by the reform supports that what we are estimating is a response of the targeted family to the introduction of the child benefit and not a change in the fertility preferences of families with many children. Other changes (besides the reform) had a negative effect on the probability to have a child that was reversed only for the birth of fourth child among treated families due to the economic incentives created by the reform.

PEER EFFECTS AND FERTILITY PREFERENCES IN CHINA: EVIDENCE FROM THE CHINA LABOR-FORCE DYNAMICS SURVEY

Despite empirical evidence that individuals form their fertility preferences by observing social norms and interactions in their environments, the exact impact of these peer effects remains unclear. We thus use data from the 2014 and 2016 China Labor-force Dynamics Survey to investigate the association between community-level peer effects and fertility preferences among Chinese women aged 18–49. Whereas our baseline results indicate that 11.96% of these women would prefer 1 or no children, 74.1% would like 2 children and 13.93% would prefer 3 or more children. A one unit increase in community-level peer fertility reduces the preference of wanting only one child by 14.3%, whereas it increases the probability of preferring three children by 9.3% and four or more children by 4.8%. Hence, overall, we find a relatively strong peer effect on individual fertility preferences in communities characterized by generally low fertility rates, which provide support for the role of social norms in the fertility choices of reproductive-aged Chinese women.

Variations in Desired Fertility Preferences among Young and Older Women in Nigeria: Evidence from Demographic Health Survey 2018

Background: Despite many countries of the world with fertility below replacement level, fertility rate in Nigeria remains high with contributing factors associated with high fertility preference and the desire for large families. Objectives: This paper explores variations in desired fertility preference among Nigerian women within the reproductive ages 15 to 49. It considers the impact of proximate factors of age, wealth, education, use of contraceptives, and other associated factors on fertility preference. Methods: Using Nigeria Demographic and Health Survey (NDHS 2018) data, responses of 33924 women with children of 0-60months (birth recode file) were considered. Fertility preference is measured by “ideal no of children”. Responses from the dataset were coded into two groups (desire 1-4 children and desire more than 4 children) based on the implicit Four-child Policy of National Policy on Population for Development, Unity, Progress, and Self-reliance of 1988. We use descriptive statistics, logistic regression and cox proportional regression to identify the size and associating impacts of identified explanatory variables on the two groups. Results: Many Nigerian women desire more than four children, with ideal family desire of more than four children higher in rural areas than in urban areas. Wealthy and educated households have lower fertility preferences. Younger women within ages 15-29 tend to desire lower fertility but use fewer contraceptives than middle-aged women 30-49. Only 12% of Nigerian women within the reproductive ages use contraceptives. Conclusion: Educating younger women through community-based sensitization programs would reduce the desire for large family size and prevent unintended pregnancy.