The potential role of contraception in reducing abortion.

This study examines the potential role of further increases in contraceptive prevalence and effectiveness in reducing abortion rates. The model used in this analysis links the abortion rate to its direct determinants, including couples' reproductive preferences, the prevalence and effectiveness of contraceptive practice to implement these preferences, and the probability of undergoing an abortion to avoid an unintended birth when a contraceptive fails or is not used. An assessment of the tradeoff between contraception and abortion yields estimates of the decline in the total abortion rate that would result from an illustrative increase of 10 percentage points in prevalence. This effect varies among societies, primarily because the tendency to obtain an abortion after an unintended pregnancy varies. For example, in a population with an abortion probability of 0.5, a 10 percentage-point increase in prevalence would avert approximately 0.45 abortions per woman, assuming contraception is 95 percent effective. If all unintended pregnancies were aborted, this effect would be three times larger. Eliminating all unintended pregnancies and subsequent abortions would require a rise in contraceptive prevalence to the level at which all fecund women who do not wish to become pregnant practice contraception that is 100 percent effective. A procedure is provided for estimating this "perfect" level of contraceptive prevalence.

Potential effects on fertility and child health and survival of birth-spacing preferences in sub-Saharan Africa.

Using Demographic and Health Survey data from 20 sub-Saharan African countries, this article compares the actual lengths of birth intervals to women's reported preferred lengths, and assesses the implications of the difference between the two for selected demographic and health indicators. The results show a clear pattern. In Comoros, Ghana, Kenya, Rwanda, and Zimbabwe, women prefer much longer birth intervals than those they actually have, compared with women in the other 15 countries studied. As a consequence, the potential effects of spacing preferences on the level of fertility and on the prevalences of short (less than 24 months) birth intervals and child malnutrition are greatest in the same five countries. The covariates of preferred birth-interval lengths are also examined. An explanation is offered for this pattern, based on the observed sharp decline in fertility recently experienced by these five "forerunners." In general, women who know, approve of, discuss, and use family planning prefer longer intervals than do their counterparts. The policy and program relevance of these results is discussed.

The consistency and validity of reproductive attitudes: evidence from Morocco.

Information on reproductive attitudes is now routinely collected in fertility surveys in developing countries, and has become very important for understanding fertility behaviour. The quality of this information, however, is rarely assessed, partly due to lack of necessary data. In this paper, the recently completed panel survey in Morocco by the Demographic and Health Surveys (DHS) was used to investigate the consistency of reporting of ideal number of children, reproductive intentions and the planning status of the last birth. The validity of reproductive intentions for subsequent fertility behaviour was also examined. The findings indicate that the three measures of reproductive attitudes are subject to different degrees of measurement error. The measure of reproductive intentions is the most consistent of the three, followed by ideal number of children. The latter is much more consistent at the aggregate level than at the individual level. The reliability of the planning status of the last birth is marred, mainly by an unwanted child being reclassified as 'wanted' with time since the birth of the child. The reproductive intentions of women were also found to be positively related to their subsequent fertility.

PIP: This study examined the validity of responses on ideal family size, reproductive intentions, and planning status of the last birth in Morocco. Data were obtained from a sample of 1664 married women aged 15-46 years who were originally interviewed in 1992 and reinterviewed in 1995 for the Demographic and Health Survey. Findings indicate that family size desired was a consistent measure at the aggregate level, but was inconsistent at the individual level. For example, the mean number desired was 3.85 in 1992 and 3.82 in 1995. However, only 36% gave the same numerical response in both surveys. The number with different responses were distributed equally between women desiring more or less children. 30% differed by at least 2 children. Education and urban residence were directly associated with consistent responses. Planning status of the last birth had serious inconsistencies regardless of level. Unwanted births tended to be rationalized as wanted births after the fact. This tendency increased with time since the birth of the last child. Of the 140 children reported as unwanted, only 38% were reported unwanted in 1995. The most valid measure was reproductive intent, which was especially consistent at the individual level. Desire to have more children was related strongly to the likelihood of having another birth in the 3 years between surveys. Desire to stop childbearing was significantly, negatively related to having another birth in the 3-year interval. Urban women who were uncertain were more likely to behave like stoppers, while rural women who were uncertain were more likely to behave like childbearers.

Intention to use contraceptives and subsequent contraceptive behavior in Morocco.

In this article, the relationship between stated intention to use contraceptives and subsequent use during a three-year period in Morocco is examined. Longitudinal data are drawn from two Demographic and Health Surveys: the 1992 Morocco DHS and the 1995 Morocco Panel Survey. Reported contraceptive intentions in 1992 have a strong predictive effect on subsequent contraceptive use even after controlling for other characteristics of respondents, and the strength of the effect is second only to that of previous contraceptive use. Women who in 1992 said they intended to use contraceptives in the future but did not do so are the most likely to have had an unmet need for contraception in 1995. Weakly held fertility preferences reported by some of the women surveyed in 1992 appear to have been a contributing factor in the subsequent failure of these women to act upon their intention to practice contraception.

PIP: Research carried out in Morocco indicated that stated intentions to use contraception are a strong predictor of subsequent use. The data were derived from the 1992 Morocco Demographic and Health Survey and the 1995 Morocco Panel Survey. Among all categories of nonusers questioned in 1992, 52% stated that they intended to use a method at some time in the future. This intention was strongest among women who were currently pregnant, especially when the pregnancy was mistimed or unwanted (76%). Women who wanted no more children were more likely to intend to use a method (61%) than those who wanted a child soon (28%). Women who had used a method in the past were twice as likely (73%) to intend to use contraception as never-users (37%). Other factors associated with an increased likelihood of future use intentions included spousal communication about family size, radio exposure, female education, and age 35-49 years. When multivariate analysis was performed, odds ratios greater than 2.0 were observed among women who did not want more children compared with those who wanted another child within 2 years, women who found family planning messages in the media acceptable compared with those who did not, and women who listened regularly to the radio compared with those without such access. There was a strong association--second only to the effect of previous contraceptive use--of contraceptive use intentions reported in 1992 with whether any method was used in the 1992-95 interval. Among women who stated they intended to use in the next 12 months, 76% reported subsequent use; 30% of those who stated they did not intend to use contraception changed their minds. The predictive effect of contraceptive intentions was weaker among women who had not given birth in the 5 years preceding the survey than among those with a recent birth.

Mass media messages and reproductive behaviour in Nigeria.

This paper examines the effects of exposure to mass media messages promoting family planning on the reproductive behaviour of married women in Nigeria using cross-sectional data. Longitudinal data are also used to ensure that exposure to media messages pre-dates the indicators of reproductive behaviour. Cross-sectional analysis suggests that: (1) contraceptive use and intention are positively associated with exposure to mass media messages, and (2) women who are exposed to media messages are more likely to desire fewer children than those who are not exposed to such messages. Similarly, analysis of the longitudinal data shows that exposure to mass media messages is a significant predictor of contraceptive use. Thus, exposure to mass media messages about family planning may be a powerful tool for influencing reproductive behaviour in Nigeria.

PIP: Findings are reported from an examination of the effects of exposure to mass media messages promoting family planning on the reproductive behavior of married women in Nigeria. Cross-sectional and longitudinal data are used. The cross-sectional data on 6696 married women were drawn from the 1990 Nigerian Demographic and Health Survey (NDHS), while the longitudinal data come from interviews with a NDHS subsample of 770 married women aged 15-44 years in both 1990 and 1993. These latter residents in Lagos and Oyo states were first interviewed in the 1990 NDHS, then re-interviewed during August-October 1993 to determine the relationship between exposure to media messages in 1990 and the same women's subsequent contraceptive behavior three years later. The analysis of cross-sectional data suggests that contraceptive use and intention are positively associated with exposure to mass media messages and women who are exposed to media messages are more likely to desire fewer children than those who are not exposed to such messages. Analysis of the longitudinal data also indicates that exposure to mass media messages is a significant predictor of contraceptive use.

The concept of unmet need.

PIP: The definition of "unmet need" for contraception (married women who are not using a contraceptive method, are fecund, and do not wish to have any more children) has been extended to include married women who want to postpone another birth for at least 2 years as well as pregnant or amenorrheic women if no contraception was used and the pregnancy occurred earlier than desired or after the last wanted birth. The shortcomings of this definition include the fact that it ignores never-married sexually-active young women, it fails to take abortion into account, and it ignores men altogether. Considerations based on effectiveness of methods and the quality of services would be better left to other measures. Another criticism is that the measure of unmet need overestimates the potential decline of fertility that would be realized if need were met. Thus, the measure of unmet need has different meanings for different investigators. The primary use of the measure has been to provide program administrators with information about the magnitude and characteristics of their market. The measure also provides data on the potential demographic significance of satisfying the demand for contraception. Finally, it is important to remember that not all women with unmet need are ready to use modern contraceptives. Thus, satisfying unmet need also includes an informational and educational effort. It is also important to remember that rapid population growth may cause an increase in the actual number of women in need even though the corresponding percentage decreases.^ieng

Catholicism and fertility in Puerto Rico.

This paper examines the association between fertility and religious affiliation among Puerto Ricans. Bongaarts' proximate determinants framework is used to compare religious categories on behaviors that directly affect fertility. We found no difference in recent fertility between Catholics and non-Catholics in Puerto Rico (total fertility rate = 2.5). We also found Catholics and non-Catholics to be similar on age at first marriage (23.3 and 23.4 years, respectively), contraceptive use (71 percent and 69 percent of married women currently contracepting), and breast-feeding practices (mean duration of breast-feeding of 4.4 and 4.3 months). Differences were observed between less committed and more committed Catholics in total fertility rate, age at first marriage, and contraceptive use, but these differences were not large and were in the opposite direction from the expected. Our findings support the theory of convergence of Catholic and non-Catholic fertility for the US. Our discrepancy with findings from the National Survey of Family Growth is evidence of the cultural diversity in the US Hispanic population and indicates the importance of disaggregating by ethnicity or national origin when studying this population.

Collection of survey data on contraception: an evaluation of an experiment in Peru.

The objective of this analysis is to compare two different approaches to the collection of information on contraceptive use. The data for this comparison are derived from the 1986 Demographic and Health Surveys (DHS) in Peru. Approximately 7,500 women were interviewed with the standard DHS questionnaire, whereas about 5,000 women received an "experimental questionnaire." The major difference between the questionnaires is the inclusion of a six-year monthly calendar in the experimental questionnaire that records pregnancies, contraceptive use, and postpartum information, in contrast to the more common tabular format of the standard questionnaire. The analysis demonstrates that although reports of contraceptive knowledge, ever-use, and current use are relatively robust to the variations in questionnaire design, estimates of past use are dependent on the survey instrument. Several different comparisons indicate that reporting of information on contraceptive histories in the experimental questionnaire is superior to that in the standard one.

Unintended pregnancy in America and abroad.

U.S. women under age 25 are far more likely to become pregnant than are comparable young women in other developed countries; however, there is no such differential among older women. Young American women appear to be no more likely than their European contemporaries to marry or to engage in intercourse at a young age, but they do seem less likely to practice contraception. Why should this be so? There are grounds to argue that young American women have more limited access to effective contraceptives than do comparable Europeans, but the problem undoubtedly has social and economic aspects as well: No other Western nation has the ethnic and socioeconomic diversity of the United States--a diversity that includes the existence of an underclass alienated from middle-class values. Limited evidence also suggests that young Americans, regardless of social class, may be more prone to risk-taking than young people in other countries. Finally, another attribute of American society that undoubtedly contributes to the problem of high pregnancy rates is our ambivalence toward sexuality: Sex saturates American life--in television programs, movies and advertisements--yet the media generally fail to communicate responsible attitudes toward sex, with birth control remaining a taboo subject. In addition, a deep-seated ambivalence toward sexuality has prevented Americans from responding to the problems of unintended pregnancy as rationally as have other Western nations.

PIP: US women under age 25 are more likely to become pregnant than are comparable young women in other developed countries; however, there is no such differential among older women. Young American women appear to be no more likely than their European contemporaries to marry or to engage in intercourse at a young age, but they do seem less likely to practice contraception. The question is why this is the case. There are grounds to maintain that young American women have more limited access to effective contraceptives than do comparable groups of Europeans, but the problem undoubtedly has social and economic aspects as well. No other Western nation has the ethnic and socioeconomic diversity of the US--a diversity that includes the existence of an underclass alienated from middle class values. Limited evidence also suggests that young Americans, regardless of social class, may be more prone to risk taking than young people in other countries. Finally, another attribute of American society that undoubtedly contributes to the problem of high pregnancy rates is ambivalence toward sexuality. Sex saturates American life in TV programs, movies, and advertisements--and yet the media generally fails to communicate responsible attitudes toward sex. Birth control still remains a taboo subject. In addition, a deep-seated ambivalence toward sexuality has prevented Americans from responding to the problems of unintended pregnancy as rationally as have other Western nations.

[A comparison of complete and truncated birth histories to measure fertility and child mortality]. / Comparacion entre las historias completas y truncadas de nacimientos para medir la fecundidad y la mortalidad de la ninez.

"During the latter part of 1986, national probability sample surveys of women of reproductive ages were carried out in... Peru and the Dominican Republic. These surveys were made as part of the Demographic Health Surveys project (DHS). In each country, one survey was conducted with the standard core questionnaire developed for DHS; the other survey was based on an experimental questionnaire. The major difference between the two questionnaires is the inclusion in the experimental one of a monthly calendar, which records pregnancies, contraceptive use, reasons for contraceptive discontinuation, breastfeeding, post-partum amenorrhea, post-partum abstinence, women's employment and place of residence for the period 1981-1986. This paper presents results from the first stage of the analysis of the Peruvian data: a comparison of basic characteristics of the two samples and an assessment of the completeness of reporting of recent births and infant and child deaths, i.e., a comparison of information in the truncated and full birth histories." (SUMMARY IN ENG)

[The potential demand for family planning: new data on unmet needs and estimates for five Latin American countries].

PIP: In light of the data obtained in the Demography and Health Survey currently under way, a new level has been calculated for the current unmet needs for family planning. This analysis allows a calculation of the potential demand for contraceptives for birth limiting or birth spacing, and includes the pregnant or amenorrheic women whose last pregnancy was unintentional. According to the new calculation, the unmet demands in 5 Latin American countries varies from 15% of married women in Brazil and Colombia, to 21% in the Dominican Republic and Ecuador, and 29% in Peru. In all these countries, the unmet need for contraceptives is greater among women who wish to limit births, compared to women desiring birth spacing, except in the Dominican Republic, where sterilization is very widespread. The greatest unmet needs are found among younger women and rural women, and it decreases significantly with educational level. To determine the level of desire for contraception during the decade before the survey, a computation was done for the 4 countries included in the Worldwide Survey of Fertility. A large decrease in the level of unmet desire for contraception was found over that time period, from 20% in Peru, to 55% in Colombia.^ieng

Contraceptive paths toward the reduction of unintended pregnancy and abortion.

Based on data from the 1982 National Survey of Family Growth, exposure to the risk of unintended pregnancy is classified by use of specific contraceptive methods and by nonuse, and average rates of unintended pregnancy are estimated for each type of exposure. Three hypothetical models of improved contraceptive practice are then applied to the data for all women and for age, race and marital-status subgroups. The first two models assume increases in the use of some existing contraceptive methods, but only the second model additionally assumes the introduction of new methods. The third model assumes the complete elimination of nonuse of contraception. These models yield different estimates of the reduction in unintended pregnancy rates which are illustrated for various age-groups, for whites and blacks and for married and unmarried women. Among all women aged 15-44, the changes assumed by Model I imply a 32 percent reduction in unintended pregnancy; Model II implies a 56 percent reduction; and Model III implies a 57 percent reduction. The implied reductions in abortion are in a similar range.

PIP: Based on data from the 1982 US National Survey of Family Growth, exposure to the risk of unintended pregnancy is classified by use of specific contraceptive methods and by nonuse, and average rates of unintended pregnancy are estimated for each type of exposure. 3 hypothetical models of improved contraceptive practice are then applied to the data for all women and for age, race and marital-status subgroups. The 1st 2 models assume increases in the use of some existing contraceptive methods, but only the 2nd model additionally assumes the introduction of new methods. The 3rd model assumes the complete elimination of nonuse of contraception. These models yield different estimates of the reduction in unintended pregnancy rates which are illustrated for various age groups, for whites and blacks and for married and unmarried women. Among all women aged 15-44, the changes assumed by Model 1 imply a 32% reduction in unintended pregnancy; Model 2 implies a 56% reduction; and Model 3 implies a 57% reduction. The implied reductions in abortion are in a similar range.

The potential impact of improvements in contraception on fertility and abortion in Western countries.

PIP: Survey information on fertility intentions, patterns of contraceptive use, contraceptive failures, and abortions is used to develop estimates of unwanted births and of unplanned pregnancies for 7 countries -- Finland, France, Netherlands, Norway, Sweden, UK, and the US, by contraceptive method. European fertility is the primary focus, and the data were derived from 6 European fertility surveys selected primarily because of the inclusion of data such as fertility intentions and contraceptive-exposure status and the availability of abortion data from other sources. The US was included both for comparative purposes and to provide some of the needed information not available from the European surveys. The 1st objective was to estimate the unwanted birthrates to women who want no more births; the 2nd objective involved estimating the unplanned pregnancy rates for all women. In regard to the 1st objective, the ultimate reduction in general fertility that can be achieved by reduction of contraceptive failure is minimal, i.e., under 10%. The reductions in unwanted pregnancy rates can be realized primarily by substantial increases in the proportion of couples contraceptively sterilized and by a reduction in the nonuse of contraception. The main effect of improvements in contraceptive practice will be to reduce high abortion rates, rather than to reduce fertility. Most abortions are to women who ultimately want to have (more) children, suggesting a considerable potential for the reduction of abortions through the improvements of contraceptive practice. Reductions of 1/3 to 1/5 of abortions in the countries studied seem possible, even without new technology. The main source of such reductions lies in the adoption of any contraceptive method on the part of nonusers. For example, if all nonusers in the UK simply shifted to the least effective category -- other methods, which includes withdrawal, rhythm, and the diaphragm, with all else remaining constant, the implied reductions in abortions would be nearly 30%. The hypothetical reductions in abortions significantly underestimate the true potential impact of improvements in contraceptive practice because they do not consider teenage pregnancy. To achieve comparability across national surveys, the age group forming the highest common denominator -- ages 20-44 -- had to be selected. The proportion of abortions that are obtained by teenagers is about 1/6 in Sweden, 1/4 in Norway, and over 1/4 in the US.^ieng

Fertility in the United States.

From the postwar high of 3.8 births per woman at the peak of the baby boom, the total fertility rate in the United States has fallen to 1.8, where it has remained unchanged for nearly a decade. This below-replacement level of fertility has, in recent decades, characterized most Western countries, some of which have shown declines to well below 1.5 births per woman. Were it not for the continued infusion of immigrants, the U.S. population, which already shows the aging characteristic of low fertility, would stop growing and begin to decline before the middle of the next century. The low fertility in the United States has been accomplished by a postponement of marriage and by the widespread use of contraception, with heavy reliance on surgical sterilization as a contraceptive method. Judging from the experience of other Western countries and from our own historical experience of two centuries of fertility decline interrupted only by the baby boom, as well as from the absence of social trends that would counteract those contributing to that decline, the prognosis is for a continued low level of fertility in the United States.

Estimation of fecundability from survey data.

The estimation of fecundability from survey data is plagued by methodological problems such as misreporting of dates of birth and marriage and the occurrence of premarital exposure to the risk of conception. Nevertheless, estimates of fecundability from World Fertility Survey data for women married in recent years appear to be plausible for most of the surveys analyzed here and are quite consistent with estimates reported in earlier studies. The estimates presented in this article are all derived from the first interval, the interval between marriage or consensual union and the first live birth conception.

PIP: The estimation of fecundability from survey data is plagued by methodological problems such as misreporting of dates of birth and marriage and the occurrence of premarital exposure to the risk of conception. The availability of data collected with a standard interview schedule from over 40 countries in the World Fertility Survey (WFS) is an invaluable resource for assessing the potential utility of measures of fecundability derived from single-round surveys as well as for comparing estimates across countries and regions of the world. In this article, data are used from 5 WFSs in Latin America (Colombia, Costa Rica, Panama, Mexico and Paraguay) and 3 in Asia (Korea, Malaysia and Sri Lanka) to determine the general usefulness of single-round survey data for the estimation of fecundability from survey data, given the limited information on contraceptive use available from many surveys and the data quality problems associated with reports of dates of marriage and dates of birth. Explored in the process are several different procedures for estimation and variations in estimates of fecundability by country, time period, and women's age. For most of this analysis, the median waiting time to conception in the absence of contraception is used as a measure of fecundability. All of the estimates presented are derived from the 1st birth interval. The estimates are based on data collected in both the birth and the marriage histories in the WFS individual interviews. The 8 surveys chosen for this analysis are characterized by relatively complete reporting of dates of birth and marriage. The primary conclusion of this exercise is that reasonable estimates of fecundability can be derived from WFS data only if one is careful to avoid numerous methodological pitfalls. The most plausible estimates appear to be for women married in the period from about 2 to 10 years before the survey. The average waiting times to 1st conception range from about 4 to 7 months; the corresponding monthly probabilities of conception lie between 0.17 and 0.26. The effect of age at marriage on fecundability is most apparent for ages below 16; differences between women married at ages 16-17 and at ages 18 and above are more modest. Suggestions for improvement of the estimation of fecundability by including a number of questions in survey questionnaires are presented.

Teenage pregnancy in developed countries: determinants and policy implications.

PIP: Because of the high adolescent fertility rates in the US, the Alan Guttmacher Institute (AGI) conducted a 1985 study of adolescent pregnancy and childbearing in 37 developed countries. This was an effort to unveil those factors responsible for determining teenage reproductive behavior. This article presents the data from that study. Birthrates were collected and separated into 2 age groups: for those under 18 and those women 18 to 19 years of age. A 42 variable questionnaire was sent to the public affairs officer of the American embassy and family planning organization in each foreign country to provide additional socioeconomic, behavioral, and educational data. Childbearing was found to be positively correlated with agricultural work, denoting a socioeconomic influence. Adolescent birthrates showed a positive correlation with levels of maternity leaves and benefits offered in the country. The lowest birthrates were found in those countries with the most liberal attitudes toward sex as demonstrated through media representation of female nudity, extent of nudity on public beaches, sales of sexually explicit literature, and media advertising of condoms. A negative correlation was seen for equitable distribution of income and the under 18 birthrate. The older teenage birthrate was found to be lower for countries with higher minimum ages for marriage. They also suggested a responsiveness to government efforts to increase fertility. Some general patterns emerged to explain the high teenage birthrate for the US: it is less open about sexual matters than countries with lower adolescent birthrates and the income in the US is distributed to families of low economic status. A more subtle factor is that although contraception is available, it is not that accessible to young men and women because of the cost. Case studies were presented to provide a more detailed understanding of the reasons for the high adolescent birthrates. Examined are desire for pregnancy, exposure to risk of pregnancy, contraceptive use, access to contraceptive and abortion services, and sex education.^ieng

Demography of the marriage market in the United States.

PIP: In this paper, a new index designed to measure the relative availability of unmarried men and women is introduced. Termed the "Availability Ratio," the measure is defined as the number of suitable persons divided by the average competition. Suitability, in turn, is defined in terms of race, age and education. After various experimental tests, particular age and eeducational constraints were empirically derived from marriage data. Persons of opposite sex sharing living quarters are tested as unavailable. Estimates are also made of those presumed to be unsuitable on the basis of the % of persons aged 45-74 who have never married. Adjustments for the census undercount are given. 1980 and 1970 estimates are presented for the US population. Subsequent analyses will focus on metropolitan areas, which are more likely to function as actual marriage markets in contrast to the nation as a whole. The substantive evidence indicates that women under 25 are in a good position to find a mate, but that after this age, their prospects deteriorate rapidly. The outlook is especially poor for the more educated women at older ages, especially black women. At ages 40-49, for example, there are fewer than 3 suitable men available for every 10 college-educated women. The results suggest that the combination of preferences of women for older men (or men's tastes for younger women), combined with higher survival rates for women at older ages, results in a very unbalanced market situationn for all but the youngest cohorts of men and women.^ieng

Women's sex preferences in the United States: 1970 to 1975.

This analysis examines the potential effect of sex preselection technology in the United States. The results suggest that controlling the sex of offspring is not the desire of most American women; that if it were employed, there would be a significant increase in sons as first-born and daughters as second children; that the overall sex ratio would be little changed from that occurring naturally except at very low fertility levels with universal use of such technology; and that fertility is only minimally influenced by gender preferences.