The conflicting effects of delayed marriage and declining divorce rates on cumulative fertility in Indonesia.

PIP: The impact of nuptiality patterns on fertility in Indonesia is examined with multivariate analysis controlling for 8 socioeconomic variables. Data were obtained from the 1987 Indonesian Contraceptive Prevalence Survey. Marriage is usually universal by age 35, and in this study all women 30 years had been married at least once. 20% were married at 15 years and 45% married at 18 years. For those married more than once, prevalence of 1st marriage was 7% for women 15-24 years, 15% for 25-34 years, and 29% for 35-49 years. In 1976 and 1987, the age at 1st marriage and number of times married were both strongly and negatively correlated. The % never marrying between 15-49 years rose from 21.5% to 26.4% between 1980-87. Cumulative fertility w as related to both age at 1st marriage and number of times married. Muslim women, women in Java and Bali, and rural women all marry at younger ages. 27% of the variance in age at 1st marriage is explained by women aged 25-34, current residence, region, religion, language, education, and work or not before marriage. The number of times married is also associated with socioeconomic characteristics without control, i.e., Muslim women 25-34 years were 3 times more likely to have been married more than once than in other faiths. With controls for socioeconomic factors, only 13% of the variance is explained and being Muslim has no statistically significant effect. The important net effects were being interviewed in Balinese, age, and age at 1st marriage. In the analysis of cumulative fertility, age at 1st marriage consistently is related to cumulative fertility in almost every socioeconomic group when age and number of times married is controlled for. Women married more than once have lower fertility. 36% of the variance is explained by all the variables. Being married more than once leads to having 2.1 fewer children. A 5-year delay in marriage leads to .75-1.1 fewer children. When other variables are controlled for, neither educational level nor prior work experience has a statistically significant effect on cumulative fertility. In the contraception analysis, women married more than once used contraception less. Among women 35-49, those marrying later had higher contraceptive use, but in general contraceptive use declined with age. More information is needed on why marriage patterns are changing.^ieng

Determinants of contraceptive method choice in an industrial city of India.

PIP: This study examines the determinants of contraceptive method choice in Jamshedpur, an industrial city in Bihar State, one of the few areas in India that enjoys a "cafeteria approach" to family planning method selection. While contraceptive prevalence in India is about 35%, Jamshedpur has a prevalence rate close to 60%. One of Jamshedpur's special programs is the Tata Iron and Steel Company (TISCO) Family Welfare Programme, which provides an array of services to both employees and nonemployees. In 1983, TISCO commissioned the International Institute for Populations Studies (IIPS) to evaluate its programs. Based on the findings of an IIPS survey of 2376 currently married women between the ages of 15-44, this study attempts to identify determinants of contraceptive method choice. For its analysis, the study used a multinomial method choice. For its analysis, the study used a multinomial logit regression, a model appropriate for studying the relationships between a number of covariates and a dependent variable (the contraceptive method used) that has more than 2 possible outcomes (female sterilization, male sterilization, condom, female temporary method, natural methods, or no method). The survey examined the following covariates: religion/caste, mother tongue, husband's occupation, place of employment, age at consummation of marriage, husband's education, wife's education, marriage duration, survival status of last child, number and sex of living children, and attitude variables. The study found that religion, mother tongue, and educational levels are important determinants of acceptance and method choice. The number of children -- especially sons -- also affected contraceptive use, rising as family size increases. The study revealed that the Jamshedpur population did exercise choice in clear patterns when the choices were made available.^ieng

Contraceptive method choice in the Philippines, 1973-83.

Contraceptive use and method mix were analysed using Philippines national survey data of 1973, 1978, and 1983. The analyses suggest that the reported decline in contraceptive prevalence between 1978 and 1983 was due to under-reporting of use in 1973 and 1983. The shifts in contraceptive method mix were also partly from under-reporting of rhythm and other methods in 1973 and 1983. Nevertheless, the determinants of method choice were similar in all three sets of data. Filipino couples were making rational choices in terms of their contraceptive goals, access, evaluation, and competence. Modifications in the directions and magnitude of the relationships in determining method choice also occurred, partly reflecting the increased use of sterilization by older, higher parity women.

Analyzing fertility histories: do restrictions bias results?

The straightforward tests we have conducted lead to two major conclusions. First, parameter estimates, such as the proportions that practice contraception or that breastfeed, can be biased in data restricted to the last closed and open interval. This is particularly true the further back in time one goes. However, the second conclusion is that these restrictions do not bias estimates of the structure of the relationships predicting fertility. This may seem surprising, and perhaps even magical. The reason is that multivariate life table techniques allow one to reach the same conclusion even if the proportions in various categories are altered by a criterion such as limiting the analysis to intervals begun by the last and next-to-last live births. Limiting the analysis in this way means that there are fewer short intervals and thus fewer cases of intervals with characteristics associated with short intervals (e.g., no contraceptive use, no breastfeeding, or infant mortality). As long as the model specified in the multivariate life table is an appropriate one, that is, it is not misspecified, and as long as the skew produced by the WFS restriction is not too extreme, then the multivariate life table procedures can produce unbiased estimates of the structure of the relationships predicting birth interval dynamics. Thus even though the WFS data are in fact inappropriate for some simple parameter estimation procedures, they appear to be adequate for the more complex multivariate procedures of the sort used here. Several caveats must be added to the foregoing results. First, we have performed this test in only one country, Korea; it is possible that the same results might not be obtained in other countries. We expect, however, that they would. Second, our procedure only looks at the first 40 months of experience in the birth interval. A procedure that incorporates the long tails of the birth interval distribution may obtain different results. In fact, we caution against analyzing the tail of the distributions using data from the normal WFS sample, since these would be most affected by the restriction to last closed and open intervals. Third, the extent to which these results are generalizable to other types of substantive problems is unknown at present. We suspect, however, that examining the determinants of lengths of breastfeeding will produce similar results. Finally, even with multivariate procedures, it would be highly misleading to impose the WFS restrictions and then examine trends in the length of birth intervals.(ABSTRACT TRUNCATED AT 400 WORDS)

Personal networks and the adoption of family planning in rural Korea.

PIP: This study uses network analysis to assess the effects of community level variables on individual level demographic behavior, isolating communication relationships between individuals and their effects, the justification being abundant documentation of opinion leadership on family planning (FP) adoption. The data employed was part of a pilot project to study effects of total contraceptive availability, instituted in a remote area of Korea. Baseline knowledge/attitude/practice information was included in the data. The final analysis included 5 sets of variables: the 1st were FP adoption indicators, inquiring about knowledge or use of methods and abortion experience. The 2nd variable set contained 6 sociodemographic items, e.g. age, education, marital age, found previously to be most relevant to FP adoption. The 3rd set dealt with sources of FP information, the 4th with FP communication and attitudes on an individual level. The 5th set dealt with numbers of information links with other individuals, direction of the links, and respondents' integrativeness. 6 additional network measures studied division into groups according to constructions of the NEGOPY computer program. A multiple regression analysis then examined variable groups to determine to what extent network measures contributed to the explanation of variance (relative to the other 6 sets of variables) in 6 indicators of family planning adoption. The net contribution of 13 network measures was substantial, with 5 showing the better part of the contribution; the most explanatory are personal network based. Despite a difficulty in isolating causal direction (do women seek adoptors or vice versa) this study does show that close contacts are important in family planning decisions.^ieng

Intermediate variables and educational differentials in fertility in Korea and the Philippines.

This analysis compares the effects of contraceptive use and infant and fetal mortality on the pace of fertility in Korea and the Philippines and explores the mediating effects of these intermediate variables on educational differentials in childspacing. For both intervals initiated in a recent period before a sample survey, second, third and higher-order intervals are examined. Transitions within successive segments of interval exposure (qx values) are examined rather than cumulative transitions (1 - lx values). This methodological choice is substantively important because breastfeeding should primarily affect early segments of exposure and because it allows empirical examination of the timing of the effects of other variables such as contraceptive use. Further, this choice allows multivariate analysis within the structure of the life-table perspective. The results show substantial differences in patterns between Korea and the Philippines, indicate clearly the effect of each intermediate variable, and illustrate how educational differentials in fertility are affected by contraception and infant and fetal mortality.

Selectivity and the analysis of birth intervals from survey data.

PIP: Birth interval analysis is used increasingly by demographers because of the precision it allows in studying the effects of intermediate variables on fertility, and because of the new availability of retrospective birth history data from the World Fertility Survey. 3 principal methodological issues surrounding birth interval analysis are identified: data quality, the "censoring" problem, and selectivity bias. This technical report focuses on selectivity in the analysis of birth interval data from retrospective birth surveys. The nature of this generally unrecognized problem is reviewed, and strategies are suggested that will minimize or eliminate the bias in analyses of differentials and trends.^ieng

Impact of contraceptive practice on child spacing. A life table analysis of birth intervals of urban and rural Thai women, 1979.

PIP: The effect of contraceptive utilization on the interval of time elapsing between births (childspacing) for urban and rural married women in Thailand is revealed using a life table analysis. The analysis also computed the childspacing pattern of both samples in 2 periods of time, before (1955-69) and after (1970-78) the beginning of Thailand's National Family Planning Program (NFPP). A sample of 1104 urban and 678 rural women of reproductive age were interviewed between 1978 and 1980. In addition to demographic information, the questionnaire collected data on pregnancy histories, including duration of lactation, and contraceptive practices. The age distribution of the women in both samples is almost identical, and the demographic characteristics follow established urban and rural patterns: urban populations have smaller families, a smaller percentage of live births, and a higher percentage currently practicing birth control. The life table analysis demonstrated that the probability of terminating all birth intervals (i.e., the 1st 6 months after a birth and every 6 months after, up to 60 months exposure) was less for the urban sample than for the rural sample. This is explained in part by the earlier introduction of birth control methods into the urban areas and the more frequent choice of permanent methods, e.g., sterilization, on the part of urban populations. The urban women who practiced contraception showed almost an identical pattern of terminating birth intervals before and after the beginning of NFPP. Compared to urban contraceptors, the percentage of women who delayed terminations was smaller in the subsample of urban women who did not use birth control.^ieng

Impact of contraceptive practice on child spacing. A life table analysis of birth intervals of urban and rural women, 1979.

PIP: Application of life table analysis of birth intervals of rural and urban Thai women to demonstrate the impact of contraceptive practice on child spacing. A questionnaire was used to obtain background information and pregnancy histories, including duration of lactation and contraceptive practices, of 1104 urban and 678 rural married women of reproductive age. The urban sample had a higher proportion of contraceptive acceptors than the rural sample (67% compared to 45%) and more urban couples resorted to sterilization. A higher proportion of urban women had delayed termination of birth intervals for all birth orders compared to rural women. Data on fertility rates, contraceptive use and demographic characteristics of the samples are presented as well as life tables used in the analysis.^ieng

Regression estimates of mortality from incomplete death registration.

PIP: Regression models using data from 280 populations have been used to develop a procedure to estimate life expectancy at birth using incomplete vital registration data under the alternative assumption of constant rules of incompleteness at all ages and all ages over 5 years. The model based on the latter assumption is preferred, since registration is usually less complete at ages below 5 than at older ages. These models were applied to 43 countries with reliable death registration data and 25 countries with incomplete registration data. The estimates of life expectancy at birth were found to be generally consistent with the UN estimates and those of a 1977 study. By use of a tabulation of registered deaths and population by broad age categories, it is possible to estimate with reasonable accuracy a common measure of mortality. The procedures are applicable regardless of the extent of underregistration under the basic assumption of constant rates of registration completeness at ages above 5. Application to data for several countries lends support to the plausability of this assumption and results in fairly accurate estimates. The importance of exploring empirical relationships between demographic indices and the usefulness of publishing vital registration data on a regular basis, even when registration is very incomplete is noted.^ieng

The effect of induced abortion on the incidence of Down's syndrome in Hawaii.

There was a decrease in the recorded number of cases and in the incidence rate of Down's syndrome in Hawaii between 1963-1969 and 1971-1977. Independent of all other factors, induced abortion accounted for 43 percent of the decline in the number of cases, based on the assumption that a substantial number of clandestine abortions were being performed in Hawaii before the 1970 legalization of abortion. However, if we assume that very few illegal abortions were performed prior to 1970, there would have been an actual 3.5 percent increase in the number of cases of Down's syndrome in the absence of legal abortion. Declining pregnancy rates and decreasing age-specific incidence rates of Down's syndrome also contributed to the drop in the number of cases between 1963-1969 and 1971-1977.

PIP: This study uses data from Hawaii birth and death certificates and from the Department of Health Mental Retardation Registry for 1963-69 and 1971-77 to investigate whether there has been a decrease in the number of babies born with Down's syndrome since the legalization of abortion, and to what degree such a decrease may be attributed to legal abortion. High and low estimates of Down's syndrome prevalence and 3 types of measures used to estimate the change in its incidence lead to the conclusion that the number of cases and the incidence rates of Down's syndrome fell by between 24.5% and 48% between 1963-69 and 1971-77. A mathematical decomposition was made of the relative impact on the decline in number of cases observed between the 2 periods of 5 factors: Down's syndrome incidence rates by age, number and distribution of women of childbearing age, and pregnancy, abortion and fetal death rates by age. Four sets of data are derived, the most likely of which assumes that a significant number of induced abortions occurred before legalization and that the recorded cases of Down's syndrome represent almost complete coverage. Under these assumptions the number of cases of Down's syndrome fell by 24 between the 2 periods, and 43% of the total decline was accounted for by a rise in the rate of induced abortions, independent of all other factors. Declining pregnancy rates and decreasing age-specific incidence rates also contributed to the decline in number of cases.

Women who obtain repeat abortions: a study based on record linkage.

The proportion of induced abortions in a year that are repeat procedures rises over time, but this rate is as low as can be expected given the shortcomings of currently available contraceptives. There is no evidence that women substitute abortion for contraception. Teenagers and poor women have greater difficulty avoiding unwanted pregnancies.

The potential reduction of medical complications from induced abortion.

Reducing medical complications resulting from induced abortion by identifying the safest and most appropriate procedures(s) for each gestational age is the purpose of this study. Data on all women who had induced abortions at all hospitals in the State of Hawaii where such procedures were performed between March 11, 1970, when the new abortion law went into effect, and June 30, 1974 were analyzed. Study findings show that if the abortion procedure with the least risk of complications at each length of gestation were selected a reduction in the complication rate of nearly 30% could result.

The Euiryong experiment: a Korean innovation in household contraceptive distribution.

Although contraceptive practice has increased substantially in Korea as a result of a strong national family planning program, surveys indicate the existence of an additional unmet demand. A number of obstacles tend to limit availability of family planning services and supplies. The effects of total availability are being tested in a three-year experiment in household contraceptive distribution, for which an exploratory study was carried out in 1975 in Euiryong gun. Three distribution systems were tried in three areas of Euiryong, each enlisting local women to canvass and distribute pills and condoms (and refer those desiring IUDs or sterilization to physician). Results of the preliminary test showed that household distribution was culturally acceptable and administratively feasible and that it did increase contraceptive use. Cost-effectiveness was considered to be within the range of the national program. The most successful of the three distribution systems is being applied in the main study, begun late in 1976 in Cheju province.

Family planning opinion leadership in Korea, 1971.

The characteristics of Korean family planning opinion leaders are assessed through a secondary analysis of the 1971 national survey conducted by the Korean Institute for Research in the Behavioral Sciences. In effect, what characterized Korean family planning opinion leaders was a rather national and democratic model. Those who had tried methods, discussed them, and knew a lot about them assumed leadership roles more than others. Place of residence, education, and other such variables mattered relatively little unless a woman had credibility imparted by actual use and knowledge imparted by use or discussions with family planning professionals.