Decisional Regret in Female Oncofertility Decision Making—An Integrative Narrative Review

It is well established that fertility is an important issue for young women with cancer at reproductive age, as many have not initiated or completed their parenthood goals when diagnosed. Because cancer treatments may impair fertility, women face fertility decisions that are often complex and surrounded by uncertainty. This may put patients at risk for psychological distress and the experience of regret regarding decisions made at diagnosis, which may be associated with a negative impact on women’s QoL. This narrative review addresses current knowledge about decisional regret regarding fertility preservation decisions in adult female cancer patients at reproductive age. Electronic searches were conducted on Pubmed database for articles published in English from 1 January 2000 to 1 July 2021 that assessed decisional regret following fertility decisions in young women diagnosed at childbearing age. Of the 96 articles identified, nine provided information on decisional regret regarding fertility decisions. Studies reported that, overall, decisional regret regarding oncofertility decisions was low. Factors associated with the experience of decisional regret were patients’ perceived quality and satisfaction with fertility counseling received, the decision to undergo fertility preservation, desire for children and decisional conflict. Health providers should be aware of the factors that are potentially modifiable and prone to improvement in order to reduce decisional regret. All efforts should be made to improve availability of and access to tailored high quality fertility counseling and fertility preservation. Given the growing evidence that decision aids (DAs) are effective in increasing knowledge and reducing decisional conflict and regret, their use in a routine and timely manner to complement fertility counseling is recommended.

Perceived consequences of the COVID-19 pandemic and childbearing intentions in Poland

Objective: We aim to investigate how the perceived consequences of COVID-19 affect people's childbearing intentions in Poland. Background: With the pandemic having an impact on virtually all spheres of people's lives, some evidence already exists that it will lead to fertility postponement, as people are reluctant to make their reproductive choices in such uncertain times. Method: We analyse a nationally representative sample of 1000 respondents aged 18-49. In the sample, 234 respondents declared that they had intended to have a child before the outbreak of the pandemic and about 20% of them stated having postponed or foregone their intention because of COVID-19. We perform logistic regression analyses to verify which perceived consequences of the pandemic are most decisive for this choice. We supplement our analyses with insights from qualitative, open-ended question on the effects of the pandemic. Results: We find that people’s decision to postpone childbearing is related to respondents' perceived lower sense of financial security and worse mental well-being in the pandemic. In the model, where both factors are included, only mental well-being remains significant. Qualitative analyses point to several other factors important to fertility decisions in the pandemic, e.g., women’s fear of lonely childbirth. Conclusion: People’s decision to postpone childbearing because of COVID-19 is mostly related to pandemic-induced financial insecurity and this effect seems to be mediated by the psychological reaction to the situation.

The Determinants of Fertility and Economic Uncertainty: An Application of the NARDL Model for Hong Kong and South Korea

This article examines the determinants of fertility, using annual data sets from 1980 to 2017 for two major developed economies of the Asian region, namely Hong Kong (China) and South Korea. The article applies the non-linear autoregressive distributed lag model to study the impact of economic uncertainty on fertility decisions in these two countries. Using output volatility measure of economic uncertainty, the study shows that there is an asymmetric impact of economic uncertainty upon fertility decisions. Such an exploration demonstrates the extent of the impact of insecurity in the economy on fertility decisions. Furthermore, the study also explores the impact of infant mortality rate, old-age population, urbanization, income per capita, female employment levels, percentage of women in marriage or union, contraceptive prevalence and human capital formation on fertility decisions in these two advanced economies. The results confirm the asymmetry because the impact of the positive change of uncertainty and the impact of the negative change are not identical. The study concludes that for these major industrialized economies of Asia, economic uncertainty apart from the traditional demographic and economic factors appears to be a crucial factor in impacting fertility decisions.

Under- and over-investment in education: the role of locked-in fertility

This research argues that, in the presence of idiosyncratic ability shocks after childbirth, irreversible fertility decisions distort the resource allocation between the quantity and quality of children. In underdeveloped environments, where family size is locked into large levels, education investment places a heavy financial burden on households, which deprives some competent children of learning opportunities. In contrast, in more developed environments, family size is locked into smaller levels, which facilitates education investment even for some children with low aptitude. A redistributive policy to mitigate the distortion is proposed for each stage.

Adaptation of community-based distribution of family planning services to context-specific social networks: a case of marriage counsellors in Lusaka district, Zambia

Background The significant contribution of community-based distribution (CBD) of family planning services and contraceptives to the uptake of contraceptives in hard-to-reach communities has resulted in the scaling-up of this approach in many Sub-Saharan countries. However, contextual factors need to be taken into consideration. For example, social network influence (e.g. spouse/partner, in-laws, and parents) on fertility decisions in many African and Asian societies is inevitable because of the social organisational structures. Hence the need to adapt CBD strategies to the social network context of a given society. Methods Data collection involved structured interviews from August 2018 to March 2019. Randomly selected respondents (n = 149) were recruited from four purposively selected health facilities in Lusaka district, Zambia. Respondents were screened for age (> 15 yrs.) and marital status. A mix of categorical and qualitative data was generated. The Statistical Package for Social Sciences (SPSS®24) was used to carry out descriptive analysis and tests of association (Fisher’s exact) while Nvivo®12 was used to analyse the qualitative data using a deductive thematic approach. Results The results indicate that pre-marriage counselling (pre-MC) influences key elements of the husband-wife relationship (p > 0.005), namely; sexual relationship, inter-personal communication, assignation of roles and responsibilities, leadership and authority. These elements of the husband-wife relationship also affect how spouses/partners interact when making fertility decisions. More importantly, the majority (86%) of the respondents indicated having a continuing relationship with their marriage counsellors because of the need to consult them on marital issues. Conclusion Marriage counsellors, though hardly reported in fertility studies, are important ‘constituents’ of the social network in the Zambian society. This is because marriage counsellors are trusted sources of information about marital issues and often consulted about family planning but perceived not to have the correct information about modern contraceptives. In this context, pre-MC offers a readily available, sustainable and culturally appropriate platform for disseminating accurate information about modern contraceptives provided in a private and personal manner. Therefore, the CBD strategy in Zambia can harness marriage counsellors by recruiting and training them as community agents.

Effects of family planning on fertility behaviour across the demographic transition

The adoption of contraception often coincides with market integration and has transformative effects on fertility behavior. Yet many parents in small-scale societies make decisions about whether and when to adopt family planning in an environment where the payoffs to have smaller families are uncertain. Here we track the fertility of Maya women across 90 years, spanning the transition from natural to contracepting fertility. We first situate the uncertainty in which fertility decisions are made and model how childbearing behaviors respond. We find that contraception, a key factor in cultural transmission models of fertility decline, initially has little effect on family size as women appear to hedge their bets and adopt fertility control only at the end of their reproductive careers. Family planning is, however, associated with the spread of lower fertility in later cohorts. Distinguishing influences on the origin versus spread of a behaviour provides valuable insight into causal factors shaping individual and normative changes in fertility.