Fertility desire and associated factors among people on antiretroviral treatment at a public health facility in Hawassa city, Southern Ethiopia

Background: Fertility desire is the plan of people to have a child or more children in the face of being diagnosed with HIV and plan to a commitment to implement the desire. Methods: An institutional-based cross-sectional study was conducted in Hawassa city public health facilities from May 09 ­July 07/07/2019. Four hundred (400) study participants were selected using a simple random sampling technique. Data were collected by using interviewer-administered pre-tested structured questionnaires and chart review. The collected data were entered into EPI data version 3.1 software and then transported to SPSS version 20 for cleaning and data analysis. Bivariate and multivariate logistic regression was used to identify associated factors at p<0.05 was taken as a significant value with a 95% confidence level. Results: A total of 400 clients were included in the study giving a response rate of 97 %. The overall fertility desire was 53.6 % (95%CI: 48.7%, 58.2%). Age, sexual practice in the last six months and discussing reproductive health with ART providers were significantly associated with fertility desire. Younger age was positively associated with fertility desire, age group (18-29), [Adjust odds ratio = 5.75 95%CI (2.85, 11.57)], age group (30-39), [Adjust odds ratio= 4.71 95%CI:(2.55, 8.71)] Sexual practice in the last six months [Adjust odds ratio = 3.00 95%1.46, 6.16)] and counseling reproductive health with ART provider [Adjust odds ratio = 3.10 95%CI:(1.86,5.15)] Conclusion: The prevalence of fertility desire in this study was higher than previous studies while factors associated with fertility desire were age, sexual practice in the last six months, and discussing reproductive health with ART providers

Provincial differentials of the effect of internal migration on teenage fertility in South Africa

This study investigated the association between internal migration and teenage fertility in South Africa. Data were from the 2007 and 2016 South African community surveys, N2007= 89800 and N2016=239733, age range 12 to 19, black teenagers= 81.5% and 89.4%, respectively. Results showed that between 2007 and 2016 internal migration levels decreased by 2% nationally, but increased for Gauteng, Western Cape and KwaZulu Natal provinces. Teenage fertility levels decreased in all provinces except the Northern Cape in the study period. In both years teenage fertility was observed at higher levels among girls that were older, heads of households, and who were in secondary schooling. Random-intercept multilevel binary logistic regression revealed that the risk of teenage fertility differed between more rural and urban provinces. In provinces that were predominantly rural the risk of teenage pregnancy increased as community-levels of internal migration increased while the risk decreased as internal migration increased in provinces that were predominantly urban. Findings suggest that the effects of internal migration on teenage pregnancy are largely dependent on the local context making it necessary to create interventions that are context-specific at sub-national levels.

Religion and non-marital fertility: A qualitative study of the perspectives and experiences of South African Muslim women

In light of the rising number of children born outside of formal marriage, there is increasing concern about the well-being of these mothers and children, especially since they mostly come from disadvantaged populations. This study aims to determine the role religion plays in the experience of non­marital fertility. This study draws on data from ten in-depth interviews with women in Durban, South Africa. The study found that women did not anticipate the negative impact of non­marital fertility prior to experiencing their first birth. The main reason contributing to the experience of non­marital fertility was the lack of sex education.Many women believed that Islam allowed only married women to use contraceptives because unmarried women are expected to practice celibacy and their religion advocates for a two-parent household. As a result, unmarried women with children found themselves often ostracised from their community. The study recommends a comprehensive sexual education regime to address the challenges associated with non-marital fertility. (Afr J Reprod Health 2022; 26[7]: 49-58).

Child's risk attributes at birth and infant mortality disparities in Nigeria

Births in avoidable high-risk contexts defined by the interplay of sub-optimal childbearing age, short spacing, and first and high birth order incur elevated risks of childhood death. However, the extent of disparities in risks of dying in infancy vis-à-vis the continuum of non-high-risk and (un)avoidable high-risk attributes at birth as determined by mother's age at childbirth, child spacing, and birth order characteristics is yet to be adequately explored in Nigeria as elsewhere. To fill this gap, chi-square association test and Cox's proportional hazards regression were used to analyze data of 31,260 nationally representative children aged 0-59 months drawn from 2013 Nigeria Demographic and Health Survey. Disparities in infant mortality risks were mainly examined across the spectrum of birth-related risk attributes at birth broadly categorized as no extra high-risk, unavoidable firstorder risk and combined avoidable high-risk. The risks of dying in infancy differed significantly by risk attributes to the extentdictated by other confounders. Also, infant mortality risks varied significantly by all moderating factors excluding religion, water source, toilet type and place of delivery. Interventions targeted at reducing avoidable high-risk fertility rate and strengthening health system to provide life-saving care to most-at-risk children would engender rapid improvement in infant survival

Impact of internal migration on fertility in Cotonou, Benin Republic

Context/Background: In developing countries, fertility is usually higher in rural than urban areas. This is partly due to lower access to and utilization of reproductive health services in rural areas. However, migration to cities may alter the fertility behaviour of migrants from rural areas. Data Source and Methods: The study used 2012 Benin Republic Demographic and Health Survey data and focused on married women aged 15-49 years and residing in Cotonou (n=722). Tobit regression was employed for the multivariate-level analysis. Findings: The results showed that migrants adapt gradually to the fertility patterns of non-migrants. This gradual adaptation is compounded by a relative selectivity of migrants whose fertility preferences are similar to those of non-migrants. Finally, recent migrants for employment or school reason had the lowest number of births over the past five years, which supports the disruption hypothesis. Conclusion: The migration-fertility relationship depends on the length of residence, migrant' socioeconomic characteristics and reason for migration

Too young to be a wife! analysis of the factors influencing child marriages and its influence on the preferred number of children among women in Zambia

Context/Background: Zambia has one of the highest rates of child marriages in the world. This study sought to establish the determinants of child marriage in rural and urban areas of Zambia, and to determine the influence of child marriage on fertility preferences of women in Zambia.Data source and methods: The study utilized data from the 2013-2014 Zambia Demographic Health Survey. Data was analysed using the Binary Logistic and Poisson regression models.Results: Timing of conception, age at first sex, region of residence, education level of respondent and their partners, and family size were significant predictors of child marriages in urban areas. In rural areas, region of residence, age at fist sex, education level of respondent and their partners, and family size had significant influence on child marriages. The study further found that women who got married below the age of 18 preferred a higher number of children.Conclusion: The study established that various factors influence child marriages in urban and rural Zambia and in turn child marriages influence the preferred number of children. The findings suggest a multipronged approach to addressing the root cause of the problem

Is technical demography becoming less relevant? two decade review of published articles in selected demography journals

Background: In this paper, we reviewed development in the field of technical demography and empirically demonstrate that there has been a decline in the proportion of technical demographic studies published in the last two decades. Methods: All original articles published in nine demographic journals from Africa, Europe, Australia, Canada and United States were reviewed. We derived yearly aggregate for total number of articles and number of technical demographic papers from 1994 to 2015. We illustrated the trends in the proportion of technical demographic studies in a graph and also estimated the annual rate of decline using least square regression techniques. Results: A total of 4091 studies were published in 465 issues of the selected journals between 1994 and 2015 of which 371 (9.0%) were related to technical demography. The proportion of technical demographic papers declined gradually at an annual rate of 0.42% (CI= 0.29-0.62) between 1994 (12.0%) and 2015 (10.0%). Conclusion: Technical demography need to be strengthened in order to provide the critical data and evidence required to objectively monitor the post-2015 development goals

Review on the use of dexamethasone and its impact on fertility and pregnancy

Purpose: Although benefit/risk analysis is usually undertaken prior to starting a treatment, some conditions will inevitably require the use of drugs with known side effects even during pregnancy. This is the case with dexamethasone use in ante natal care. The purpose of this review was to provide an overview of the uses of dexamethasone and its impacts on pregnancy and fertility in humans. Data source: The review is based on literature searches using PubMed and MeSH and authors' personal manuscript/abstract files and citations of known references. Study selection: The selection of articles reflects the authors' opinion as to originality and importance in the context of the review. The review included human and some aspects of animal study.Data extraction: The electronic searches were scrutinized and full manuscripts of all quotes considered relevant to the study were obtained. All the articles whose abstracts were not available were excluded.Results: Dexamethasone use has evolved over the years to include fertility treatment in both males and females in addition to its use in pregnancy to prevent respiratory distress syndrome in neonates despite its side effects due to the fact that its benefits outweigh the risks. Conclusions: Dexamethasone use has evolved over the years to include fertility treatment in addition to use in the prevention of respiratory distress syndrome. Low doses have no major adverse effects; however, repeated doses and long-term therapy are associated with more serious sequelae. It is recommended that dexamethasone therapy be incorporated into maternal and neonatal health care services

Fertility Following Myomectomy at Aba; Southeastern Nigeria

Background: While hysterectomy remains the gold standard treatment for fibroids; it is an unacceptable treatment option for women who wish to conserve their fertility. The actual effects of myomectomy on fertility remain uncertain though. Objective: The objective was to ascertain pregnancy and live birth rates among a small group of women undergoing abdominal myomectomy. Methods: The study population consisted of women of reproductive age intending to conceive soon after undergoing abdominal myomectomy. A total of 40 women who met the inclusion criteria were recruited for the study and followed-up for 4 years. Women who achieved pregnancy within the study period were analyzed in terms of their demographics and intra-operative findings. Results: The mean age of the women was 28 years (range 24-35) married for about 3 years. Majority of the women (50%) had more than 11 fibroid nodules; and the largest nodule was bigger than 5 cm in 35 women (87.5%). Cumulative pregnancy rate was 60% (24/40) while live birth rate was 22/40 (55%) following myomectomy and majority 19/22 achieved this within 2 years of myomectomy. Conclusion: Myomectomy for fibroid-associated infertility increase pregnancy rates such that approximately 60% of women undergoing the procedure subsequently conceive

Role of Conflict in Shaping Fertility Preferences in Rwanda

Conflicts affect the social and economic conditions that could account for the stall in fertility decline in Sub-Saharan Africa. For Rwanda; the total fertility rate decreased very rapidly to 6.1 in the eighties but stalled at that level in the nineties. Part of the stall can be attributed to a lack of fertility control; but the question is whether social upheaval also affects fertility preferences. We identify three mechanisms through which the Rwanda conflict have led to a preference for larger families: mortality experience; modernization and the attitudes of third parties. Using data from DHS; we tested the contribution of these mechanisms to the preference for small; medium or large families. With the exception of sibling mortality; there is a strong impact of these mechanisms on the preference for large families; yet they do not fully account for the shifts in preferences over the years

Family Planning and Its Implications

Background: Sub-Saharan Africa has the highest average fertility rate in the world. In 2009; the average number of births per woman was 5.1-more than twice as many as in South Asia (2.8) or Latin America and the Caribbean (2.2). More than 100 million women in less developed countries; or about 17 percent of all married women; would prefer to avoid a pregnancy but are not using any form of family planning. Currently; approximately 24.8 percent of African women have unmet needs for family planning; this simply means 24.8 million women of reproductive age who prefer to avoid or postpone childbearing are not using any method of contraception. Objective: To make a review of trends of family planning practice in Sub Saharan Africa from 1980 to 2010 among women of reproductive age. Methodology: Meta-analysis of detailed literature by authors of articles published since 1980 from various sources; including Demographic Health Survey (DHS) of 1990 to 1995; 2000 to 2005; and of 2005-2010 from Sub-Saharan Africa such as South Africa Demographic Health Survey (SADHS) and Tanzania (TDHS); and observation on the relationship between family planning use and fertility in Africa. Findings: An analysis of fertility trends in 23 countries of Sub-Saharan Africa from 1980 to 1995 showed that in twothirds of the countries there was evidence of fertility decline; with a particularly rapid decline in Kenya and Zimbabwe. Furthermore 2010 statistics show the African total fertility rate to be standing at 4.7. These rates reflect contraceptive prevalence of these specific regions.Generally in all world regions; contraceptive use corresponds with fertility patterns. In regions where contraceptive use is widespread; fertility is low but in regions where contraceptive use is uncommon; fertility is high. Conclusion: The paper has shown that the high fertility pattern in Africa is among others; a result of the ineffectiveness of family planning programs. Recommendation: The overall low rate of contraceptive prevalence and high unmet need for family planning suggests the need for African national governments and population policy makers to rethink access to contraceptives

Family Planning and its Implications

Background: Sub-Saharan Africa has the highest average fertility rate in the world. In 2009; the average number of births per woman was 5.1-more than twice as many as in South Asia (2.8) or Latin America and the Caribbean (2.2) [1]. More than 100 million women in less developed countries; or about 17 percent of all married women; would prefer to avoid a pregnancy but are not using any form of family planning.[4].Currently; approximately 24.8 percent of African women have unmet needs for family planning; this simply means 24.8 million women of reproductive age who prefer to avoid or postpone childbearing are not using any method of contraception.[5] .Objective: To make a review of trends of family planning practice in Sub Saharan Africa from 1980 to 2010 among women of reproductive age.Methodology: Meta-analysis of detailed literature by authors of articles published since 1980 from various sources; including Demographic Health Survey of 1990 to 1995 and 2000 to 2005; and of the current 2010 from Sub-Saharan Africa such as SDHS and TDHS; and observation on relationship between family planning use and fertility in Africa. Findings: An analysis of fertility trends in 23 countries of Sub-Saharan Africa from 1980 to 1995 showed that in two-thirds of the countries there was evidence of fertility decline; with a particularly rapid decline in Kenya and Zimbabwe[7].Furthermore 2010 statistics show the African total fertility rate to be standing at 4.7. These rates reflect contraceptive prevalence of these specific regions.Generally in all world regions; contraceptive use corresponds with fertility patterns.[12;13]. In regions where contraceptive use is widespread; fertility is low but in regions where contraceptive use is uncommon; fertility is high.[14;15]Conclusion: The paper has shown that the high fertility pattern in Africa is among others; a result of the ineffectiveness of family planning programs.Recomendation: The overall low rate of contraceptive prevalence and high unmet need for family planning suggests the need for African national governments and population policy makers to rethink access to contraceptives

Factors Affecting Unmet Need for Family Planning in Southern Nations; Nationalities and Peoples Region; Ethiopia

BACKGROUND: High fertility and low contraceptive prevalence characterize Southern Nations; Nationalities and Peoples Region. In such populations; unmet needs for contraception have a tendency to be high; mainly due to the effect of socio-economic and demographic variables. However; there has not been any study examining the relationship between these variables and unmet need in the region. This study; therefore; identifies the key socio- demographic determinants of unmet need for family planning in the region. METHODS: The study used data from the 2000 and 2005 Ethiopian Demographic and Health Surveys. A total of 2;133 currently married women age 15-49 from the 2000 survey and 1;988 from the 2005 survey were included in the study. Unmet need for spacing; unmet need for limiting and total unmet need were used as dependent variables. Socio- demographic variables (respondent's age; age at marriage; number of living children; sex composition of living children; child mortality experience; place of residence; respondent's and partner's education; religion and work status) were treated as explanatory variables and their relative importance was examined on each of the dependent variables using multinomial and binary logistic regression models. RESULTS: Unmet need for contraception increased from 35.1in 2000 to 37.4in 2005. Unmet need for spacing remained constant at about 25; while unmet need for limiting increased by 20between 2000 and 2005. Age; age at marriage; number of living children; place of residence; respondent's education; knowledge of family planning; respondent's work status; being visited by a family planning worker and survey year emerged as significant factors affecting unmet need. On the other hand; number of living children; education; age and age at marriage were the only explanatory variables affecting unmet need for limiting. Number of living children; place of residence; age and age at marriage were also identified as factors affecting total unmet need for contraception. CONCLUSION: unmet need for spacing is more prevalent than unmet need for limiting. Women with unmet need for both spacing and limiting are more likely to be living in rural areas; have lower level of education; lower level of knowledge about family planning methods; have no work other than household chores; and have never been visited by a family planning worker. In order to address unmet need for family planning in the region; policy should set mechanisms to enforce the law on minimum age for marriage; improve child survival and increase educational access to females. In addition; the policy should promote awareness creation about family planning in rural areas

Fertility desires and condom use among HIV-positive women at an antiretroviral roll-out program in Zimbabwe

As access to anti-retroviral therapy (ART) increases in sub-Saharan Africa, fertility and contraception patterns are likely to change. Two hundred HIV-positive women at an ART roll-out site in Zimbabwe responded to a questionnaire on fertility desires and condom use. Ten women (5%) reported planning a pregnancy in the next year, comprising 0% of women not yet eligible for ART, 8.22% of women on the waitlist for ART, and 4.17% of women on ART. Younger age, fewer living children, and higher quality of life were individually associated with intended pregnancy in the next year; however in multivariate analysis only the association with higher quality of life remained significant. Reported ever use of condoms was relatively low (46.5%) and condom use varied by neither ART status nor by fertility desires. In conclusion, our data demonstrates fertility desires among HIV-positive women in Zimbabwe correlate with higher perceived quality of life (Afr. J. Reprod. Health 2010; 14[2]: 27-35)

Determinants of adolescent fertility in Ethiopia

Background: Worldwide, adolescents suffer from a disproportionate share of reproductive health problem. Throughout the world, over 14 million adolescents aged 15-19 years give birth annually. The purpose of this study was to assess the level and identify proximate and other determinants of adolescent fertility in Ethiopia. Methods: Raw data collected from all part of the country using stratified cluster sampling method by the Ethiopian Demographic Health Survey 2005 (EDHS-2005) was used. After the data for adolescents aged from 15 to 19 years were extracted from the large data set, Multivariate logistic regression model was applied to identify socio-demographic and economic determinants whereas Bongaarts model was used to determine proximate determinantsfertility. Results: Of the 3,266 adolescent women, 443 (13.6%) had given birth at least once prior to the survey and 133 (4.1%) were pregnant. Of the 443 adolescents who had at least given birth, the majority (72.7%) had one child while about a quarter (23.2%) had 2 live births and the rest 1.0% gave four live births with a mean number of child ever born of 1.33±0.6. The major factors associated with adolescent fertility were age, educational status, place of residence, employment, marriage, contraceptive use and postpartum infecundability. The odds for increased adolescent fertility was significantly higher in early adolescents (AOR=7.6; 95% CI=6.0 to 9.9), had lower education(AOR=6.7; 95%CI=4.1 to10.9), among rural teens (AOR=3.6; 95%CI=1.9 to 6.9) and currently not working (AOR=1.7; 95%CI= 1.3 to 2.2) than their counterparts. The observed fertility rate of 0.52 children per woman obtained from Bongaarts model of fertility indicated about 1.98 births per woman were averted due to non-marriage, delayed marriage, contraceptive use and postpartum infecundability.Conclusion: Since adolescent fertility is felt to be a problem, concerted efforts are needed to empower adolescents to fight early marriage, promote education and encourage the utilization of family planning targeting the rural teenagers

Factors Affecting Fertility Decisions of Married Men and Women Living with HIV in South Wollo Zone; Northeast Ethiopia

Background: In a setting with high HIV prevalence and high fertility rates; addressing fertility issues of People Living with HIV/AIDS (PLWHA) is crucial. However; understanding of the factors associated with fertility decisions of PLWHA in Ethiopia is remarkably low. Objective: The study was conducted to assess factors associated with fertility decisions of PLWHA in South Wollo Zone; Northeast Ethiopia. Methods: The study was conducted from February 1 to March 30; 2008 using cross-sectional design. Quantitative data were collected from a sample of 458 men and 458 women using structured questionnaire. Qualitative data were also collected from six health care providers. Logistic regression was used to analyze the quantitative data. Results: The study showed that 18.3of currently married PLWHA have decided to have a child. The factors found to be independently associated with current decision to have a child were higher family income [OR (95CI) = 2.29 (1.23; 4.26)]; partner's decision to have a child [OR (95CI) = 36.4 (17.0; 77.5)]; having knowledge on PMTCT [OR (95CI) = 2.26 (1.44; 3.54)] and having partner with negative HIV test result [OR (95CI) = 0.408 (0.219; 0.759)]. During in-depth interview the health care providers indicated the fertility related counseling service to be low. Conclusion: In spite of the fact that significant proportion of married PLWHA had decided to have a child; the fertility related counseling service is low. Improving fertility related counseling services to enable clients make informed fertility decision is mandatory. The factors identified to be associated with fertility decision could be of major importance and as such should be investigated further. [Ethiop. J. Health Dev.2010;24(3):214-220]

Premarital fertility and HIV/AIDS in Sub-Saharan Africa

The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub-Saharan African countries. The DHS surveys provided data to compute the prevalence of premarital fertility, defined as any birth before the first marriage. The UNAIDS database provided data to compute the prevalence of HIV infection among pregnant women. Results indicate a moderate association between the prevalence of premarital fertility and the prevalence of HIV infection (correlation coefficient = 0.64, P< 0.0001), and similar geographical patterns. Compared with the average pattern, outlier countries had either high levels of premarital fertility and relatively low HIV prevalence (Liberia, Madagascar, Gabon, Congo), or high levels of HIV prevalence despite low levels of premarital fertility (Lesotho, Malawi, Zambia, Zimbabwe). The overall relationship is discussed in light of the relationships between age at marriage, permissiveness and lack of protection during intercourse and their impact on premarital fertility and HIV infection among women. (Afr J Reprod Health 2008; 12[2]:64-74)

Social context of premarital fertility in rural South-Africa

A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the perceptions and attitudes towards premarital fertility and late marriage among young adults of both sexes. Two focus groups and 35 individual interviews were conducted among 17-30 year olds, randomly selected. Most interviewees perceived premarital fertility as undesirable, and a new phenomenon in a context of major social changes, in particular loss of authority of parents and increasing freedom of the youth. In contrast, late marriage was perceived as positive, by both sexes, primarily for economic reasons. Much stigma was associated with premarital fertility, from friends, institutions and families who occasionally apply mild or severe sanctions. Consequences of premarital fertility were numerous: school abandonment, economic adversity, health risks, stigmatization. In extreme cases, premarital fertility might lead to exclusion and deviant behavior. Premarital fertility was ultimately due to a lack of contraception among young women, and to refusal of abortion for religious reasons, and is associated with the risk of contracting STD's. (Afr J Reprod Health 2008; 12[2]:98-110)