ABSTRACT
Fertility, health, and family planning are not independent factors, but rather involve a series of biological and social mechanisms in close interaction with one another. The impact that a high fertility rate has on health is reflected mainly in a rise in the rates of maternal and child mortality. Similarly, fertility has a greater negative effect upon the health of groups characterized by high reproductive risk, high parity, short intergenesic intervals, and unwanted pregnancies. On the other hand, family planning -and specifically the use of contraceptive methods-helps to achieve a lowering of the fertility rate and also has a positive effect on maternal-child health. This situation can be observed in the case of Mexico, where fertility rates and tendencies, as well as maternal and child mortality, have been reduced during the past decade.
PIP: Little information is more significant in the field of public health than data on the size, territorial distribution, composition, and demographic behavior of the population. Health is dependent to a considerable extent on the same factors that determine whether population will increase, remain stable, or shrink. The relationship between health and fertility can most effectively be analyzed in countries where mortality has declined but fertility has remained at traditional high levels. Family planning has various impacts on health, including the effects of the methods themselves, the additional effects of family planning service delivery such as the clinical examination prior to prescription of oral contraceptives, effects that result from substituting contraception for abortion, the effects of declining fertility rates, and the effects of changes in reproductive patterns including increased birth intervals, changes in age distribution of births, and declining total parity of women. Each year throughout the world some 500,000 women die during pregnancy and delivery. 4 groups of factors have been identified as related to maternal mortality, including medical, health service, reproductive, and socioeconomic factors. Reproductive factors include maternal age, parity, personal medical and obstetric history, birth intervals, and body size, as well as undesired pregnancy and abortion. Important socioeconomic factors include nutrition, education, place of residence, and income. In Mexico the maternal mortality rate declined from 94/100,000 live births in 1980 to 81/100,000 in 1983, a 7.1% drop. Infant mortality, despite substantial underregistration, is also known to have declined, from an estimated 83.2/1000 live births in 1967-71 to 46.9 in 1982-87, a 43.6% decline. In 1984, rural infants still had mortality rates twice as high as urban infants, and the rural decline in infant mortality was much slower than the urban. Children of illiterate mothers had an infant mortality rate 3 times as high in 1984 as children of mothers with primary educations. Infant mortality rates were 50.9 for children of mothers under 20, 39.2 for mothers 20-29, and 72.3 for mothers 35 and over. Rates were 33/1000 for 1st order births, 36.2 for 2nd and 3rd order births, 55.6 for 4th- 6th order births, and 84.1 for 7th order and above. The infant mortality rate was 71.7 for births occurring less than 24 months after the preceding birth and 42.3 for those occurring 24-47 months later. Mexico's total fertility rate declined from 6.31 in 1973 to 3.84 in 1986, a decline of 40%. Higher educational status, labor force participation, and urban residence are associated with fertility decline. The proportion of fertile-aged women using some form of contraception increased from 47/7% in 1982 to 53% in 1987. Rural levels of contraceptive usage were much lower than urban levels. Mexico's experience demonstrates that family planning helps achieve a lowering of fertility and significant improvement in maternal and child health.