Measuring potential interest in a postpartum contraceptive vaginal ring among breastfeeding women in India.

Access to safe and effective contraception for postpartum women is an important priority in India, where the unmet need for postpartum contraception is high. In this paper, we estimate the potential market size in India for the progesterone vaginal ring (PVR), a novel user-controlled contraceptive method that offers additional contraceptive choice for lactating women. We integrated results of a one-year phase-3 multicenter clinical trial for the PVR conducted in India with an analysis of the National Family Health Survey (2015-16) and 2019 United Nations Population Division data to generate three estimates of potential market size for the PVR among postpartum breastfeeding women in India. We estimate the potential market size for the PVR ranges from a low estimate of 543,262 women to a high estimate of 1.3 million women, with a separate intermediate estimate of 737,460 women. Our analysis indicates the PVR could play an important role in decreasing unmet need among postpartum women in India, thereby reducing risks to mothers and children associated with short birth intervals, helping to prevent unintended pregnancies, and helping to address access-related issues heightened by the COVID-19 pandemic.

Social dimensions of fertility behavior and consumption patterns in the Anthropocene.

We consider two aspects of the human enterprise that profoundly affect the global environment: population and consumption. We show that fertility and consumption behavior harbor a class of externalities that have not been much noted in the literature. Both are driven in part by attitudes and preferences that are not egoistic but socially embedded; that is, each household's decisions are influenced by the decisions made by others. In a famous paper, Garrett Hardin [G. Hardin, Science 162, 1243-1248 (1968)] drew attention to overpopulation and concluded that the solution lay in people "abandoning the freedom to breed." That human attitudes and practices are socially embedded suggests that it is possible for people to reduce their fertility rates and consumption demands without experiencing a loss in wellbeing. We focus on fertility in sub-Saharan Africa and consumption in the rich world and argue that bottom-up social mechanisms rather than top-down government interventions are better placed to bring about those ecologically desirable changes.

Trends in Contraceptive Prevalence in Sub-Saharan Africa: The Roles of Family Planning Programs and Education.

Since the 1990s some countries in Africa have experienced very rapid increases in contraceptive prevalence (e.g. Ethiopia, Malawi, Rwanda), while others (e.g. Nigeria) have seen little change. This study aims to shed light on the causes of these different trends which remain controversial. We assess the role of family planning programs vs. socioeconomic development (especially, women's educational attainment). Estimates of the effects of different explanatory factors are obtained by country level regressions in which the prevalence of modern contraception is the dependent variable and women's educational attainment, Gross National Income (GNI) per capita, percent urban and child mortality as well as the family planning program score are the independent variables. The statistical analysis finds no significant effects of GNI per capita, percent urban and child mortality. In contrast, women's educational attainment and program score have highly significant effects and are the dominant drivers of contraceptive prevalence trends. Voluntary family planning programs can increase contraceptive prevalence at all levels of female education. The best programs with prevalence impact above 30% (relative to no program effort) are found in Zimbabwe, Malawi, Kenya, Rwanda, Zambia and Ethiopia. Without family planning programs prevalence remains low even where education levels have risen substantially.

The links between women's employment and children at home: Variations in low- and middle-income countries by world region.

As fertility declines in low- and middle-income countries, the time women devote to childbearing and rearing may also be reduced. This shift has been described as one of the positive consequences of the demographic transition, as it opens opportunities for women to pursue educational and employment opportunities that were previously constrained by the demands of bearing and raising children. We estimate the numbers of children residing at home (with their mother) for women in 58 countries in Asia, Latin America, the Middle East and North Africa, and sub-Saharan Africa. We then examine the association between women's employment and having children at home. Finally, we assess trends over recent decades in the relationship between employment and childbearing, and differences in this relationship by mother's occupation. We find a negative association between women's employment and having children at home; this association varies substantially by world region, age of child, and mother's occupation.

Trends in contraceptive prevalence in Sub-Saharan Africa: the roles of family planning programs and education

Since the 1990s some countries in Africa have experienced very rapid increases in contraceptive prevalence (e.g. Ethiopia, Malawi, Rwanda), while others (e.g. Nigeria) have seen little change. This study aims to shed light on the causes of these different trends which remain controversial. We assess the role of family planning programs vs. socioeconomic development (especially, women's educational attainment). Estimates of the effects of different explanatory factors are obtained by country level regressions in which the prevalence of modern contraception is the dependent variable and women's educational attainment,Gross National Income (GNI) per capita, percent urban and child mortality as well as the family planning program score are the independent variables. The statistical analysis finds no significant effects of GNI per capita, percent urban and child mortality. In contrast, women's educational attainment and program score have highly significant effects and are the dominant drivers of contraceptive prevalence trends. Voluntary family planning programs can increase contraceptive prevalence at all levels of female education. The best programs with prevalence impact above 30% (relative to no program effort) are found in Zimbabwe, Malawi, Kenya, Rwanda, Zambia and Ethiopia. Without family planning programs prevalence remains low even where education levels have risen substantially

The Role of Public-Sector Family Planning Programs in Meeting the Demand for Contraception in Sub-Saharan Africa.

CONTEXT: Commonly used indicators of contraceptive behavior in a population-modern contraceptive prevalence (mCPR), unmet need for contraception, demand for contraception and demand satisfied-are not well-suited for evaluating the progress made by government family planning programs in helping women and men achieve their reproductive goals. METHODS: Trends in these measures in 26 Sub-Saharan African countries between 1990 and 2014 were examined. Trends in a proposed new indicator, the public-sector family planning program impact score (PFPI), and its relationship to mCPR and the family planning effort score were also assessed. Case studies were used to review public family planning program development and implementation in four countries (Nigeria, Ethiopia, Rwanda and Kenya). RESULTS: The four commonly used indicators capture the extent to which women use family planning and to which demand is satisfied, but shed no direct light on the role of family planning programs. PFPI provides evidence that can be used to hold governments accountable for meeting the demand for family planning, and was closely related to policy developments in the four case-study countries. CONCLUSIONS: PFPI provides a useful addition to the indicators currently used to assess progress in reproductive health and family planning programs.

Trends in the age at reproductive transitions in the developing world: The role of education.

Girls' school participation has expanded considerably in the developing world over the last few decades, a phenomenon expected to have substantial consequences for reproductive behaviour. Using Demographic and Health Survey data from 43 countries, this paper examines trends and differentials in the mean ages at three critical life-cycle events for young women: first sexual intercourse, first marriage, and first birth. We measure the extent to which trends in the timing of these events are driven either by the changing educational composition of populations or by changes in behaviour within education groups. Mean ages have risen over time in all regions for all three events, except age at first sex in Latin America and the Caribbean. Results from a decomposition exercise indicate that increases in educational attainment, rather than trends within education groups, are primarily responsible for the overall trends. Possible explanations for these findings are discussed.

Estimating the current mean age of mothers at the birth of their first child from household surveys.

BACKGROUND: Estimates of the period mean age at first birth are readily available for countries with accurate vital statistics (i.e., in much of the developed world). In contrast, in most developing countries vital statistics are lacking or incomplete and estimates of the period mean age at first birth are therefore often unavailable. The Demographic and Health Surveys (DHS) program provides a large set of demographic and health statistics for many developing countries, but not the mean age at childbearing or the mean age at first birth. METHODS: We propose two different methods for the estimation of the period mean age at first birth from information collected in DHS surveys. The first method is the same as the one used in populations with accurate vital statistics and is based on a weighted average of single year of age first birth rates. The second is the singulate mean age at first birth. RESULTS: A comparison of the two estimates obtained from the latest surveys in 62 countries shows excellent agreement in countries in which there is no evidence of a rise in childlessness. But, as expected on theoretical grounds, there is less agreement in populations that have experienced an increase in the proportion childless. CONCLUSIONS: Based on these results, we recommend the first method. The measure is relatively straightforward to calculate and, since it refers to recent births, is presumably more accurately reported than indicators based on events that occurred in the more distant past. This measure makes it possible for the first time to assess recent trends in the onset of childbearing in developing countries with multiple DHS surveys and to compare recent period estimates of the mean age at first birth among countries.

Global fertility and population trends.

Over the past several decades, the world and most countries have undergone unprecedented demographic change. The most obvious example of this change is the rise in human numbers, and there are also important trends in fertility, family structure, mortality, migration, urbanization, and population aging. This paper summarizes past trends and projections in fertility and population. After reaching 2.5 billion in 1950, the world population grew rapidly to 7.2 billion in 2013 and the projections expect this total to be 10.9 billion by 2100. World regions differ widely in their demographic trends, with rapid population growth and high fertility continuing in the poorest countries, particularly in sub-Saharan Africa, while population decline, population aging, and very low fertility are now a key concern in many developed countries. These trends have important implications for human welfare and are of interest to policy makers. The conclusion comments briefly on policy options to address these adverse trends.

The impact of family planning programs on unmet need and demand for contraception.

Much of the existing literature on the demographic impact of family planning programs focuses on their role in increasing contraceptive use, which, in turn, accelerates fertility decline. What is not clear, however, is whether this effect operates solely through a reduction in unmet need brought about by eliminating obstacles to use or whether and to what extent the programs also affect demand for contraception through messages concerning the benefits of family planning. This article aims to shed additional light on this issue by analyzing data drawn from recent Demographic and Health Surveys conducted in 63 developing countries. The first section reviews general levels and trends in unmet need, demand, and use over the course of the fertility transition. The second section presents different types of evidence of program effects, including results from a controlled experiment and from country case studies. The evidence indicates a program impact on both unmet need and demand.