Increasing the chances of natural conception: opinion statement from the the brazilian federation of gynecology and obstetrics associations - FEBRASGO committee of gynecological endocrinology / Aumentando as chances de concepção natural: parecer da comissão nacional de ginecologia endócrina da Federação Brasileira das Associações de Ginecologia e Obstetrícia

Abstract Considering that myths and misconceptions regarding natural procreation spread rapidly in the era of easy access to information and to social networks, adequate counseling about natural fertility and spontaneous conception should be encouraged in any kind of health assistance. Despite the fact that there is no strong-powered evidence about any of the aspects related to natural fertility, literature on how to increase the chances of a spontaneous pregnancy is available. In the present article, the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym) Committee on Endocrine Gynecology provides suggestions to optimize counseling for non-infertile people attempting spontaneous conception.

Resumo Uma vez que mitos e equívocos sobre a procriação natural se espalham rapidamente na era do fácil acesso à informação e às redes sociais, o aconselhamento adequado sobre a fertilidade natural e a concepção espontânea deve ser encorajado em qualquer tipo de assistência à saúde. Apesar do fato de não haver evidências fortes sobre qualquer dos aspectos relacionados à fertilidade natural, existe literatura sobre como aumentar as chances de uma gravidez espontânea. No presente artigo, a Comissão Nacional de Ginecologia Endócrina da Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO) oferece sugestões para otimizar o aconselhamento a pessoas que tentam a concepção espontânea, na ausência do diagnóstico de infertilidade.

Análisis longitudinal del comportamiento reproductivo de una población Toba en transición / /Análise longitudinal do comportamento reprodutivo de uma população Toba em transição / /Longitudinal analysis of reproductive behavior of a Toba transition population

Las variaciones demográficas de una población están frecuentemente asociadas a cambios ambientales. Por lo tanto, las particularidades sociales, económicas y culturales de poblaciones indígenas producirían una gran variedad de regímenes demográficos. Si bien en América Latina, en general, y Argentina, en particular, se registró un importante descenso de la fecundidad, las poblaciones indígenas exhiben cambios demográficos que difieren de esta tendencia. Este trabajo analiza parámetros de fecundidad y sus determinantes de la población Toba Cacique Sombrero Negro del norte argentino, la cual atraviesa cambios en su estilo de vida. Se entrevistaron 336 mujeres calculando las tasas de fecundidad, la probabilidad de agrandamiento de la familia y la tasa de esterilidad primaria para las mujeres nacidas entre 1920 y 1966. Se estimó la edad materna al primer hijo, el intervalo intergénesico, la edad materna al último hijo. Los resultados indican que, respecto a las mujeres nacidas entre 1920 y 1945, las mujeres nacidas entre 1946 y 1966, muestran un incremento de la fecundidad, una disminución de la edad materna al primer hijo, un mayor ritmo reproductivo y un incremento de la edad materna al último hijo. Estos resultados sugieren cambios sociales, sanitarios, biológicos y económicos favorables que habrían determinado el incremento de la fecundidad para la cohorte más joven...

As mudanças demográficas na população, muitas vezes, respondem às mudanças ambientais. Portanto, as características sociais, econômicas e culturais das populações indígenas produzem uma variedade de regimes demográficos. Enquanto na América Latina, em geral, e na Argentina, em particular, registrou-se um declínio significativo da fecundidade, as populações indígenas apresentam mudanças demográficas que diferem dessa tendência. Este artigo analisa os determinantes da fecundidade e da população Toba Cacique Black Hat, do norte da Argentina, por meio dos quais ocorreram mudanças em seu estilo de vida. Foram entrevistadas 336 mulheres, calculando-se as taxas de fecundidade, a probabilidade de uma família ampliada e a taxa de esterilidade primária para mulheres nascidas entre 1920 e 1966. Estimaram-se idade materna no primeiro parto, intervalo de nascimento e idade da mãe no último filho. Foram registrados aumento na fecundidade, diminuição na idade materna no primeiro filho, taxa de reprodução mais elevada e um aumento da idade materna no último filho na coorte de nascidas entre 1946 e 1966. Os resultados sugerem mudanças sociais, de saúde, biológicas e econômicas favoráveis, que têm proporcionado o aumento da fecundidade em coortes mais jovens...

Demographic variations in a given population are frequently associated to environmental changes. The social, economic, and cultural particularities of indigenous populations would then produce a great variety of demographic regimes. Although Latin America, in general, and in Argentina, in particular, have experienced an important decline in fertility, indigenous populations in this region show demographic changes that are at odds with this trend. This study evaluates fertility parameters and their determinants in the Toba population of Cacique Sombrero Negro, in northern Argentina, which is undergoing a significant lifestyle change. A total of 336 Toba women were interviewed, allowing the calculation of age-specific fertility rates, total fertility rates, parity progression ratios and primary infertility rates for women born between 1920 and 1966. For these women, we also estimated age of the mother at first birth, interbirth intervals and mother's age at last birth. Our results indicate that, compared to women born between 1920 and 1945, those born between 1946 y 1966 show an increase in fertility values, a decline in age at first birth, a faster reproductive pace and an increase in age at last birth. These results suggest favorable social, sanitary, biological and economic changes that would have determined an increase in fertility parameters in the younger cohort...

Women's labor, fertility, and the introduction of modern technology in a rural Maya village.

PIP: The introduction of mechanized technology into a rural Maya agricultural community in the mid 1970s markedly increased the technology with which maize could be ground and water collected, which in turn introduced a possible savings in the time spent working. This study investigated the response of female fertility to the introduction of this labor-saving technology. Using two proximate determinants of female fertility, the association between the advent of modern technology and changes in the age at which women give birth to their first child and the length of mothers' birth intervals was examined. Analyses showed that women begin their reproductive careers at a younger age after the laborsaving technology was introduced. Estimate of the median age at first birth from the distribution function dropped from 21.2 years before the introduction to 19.5 years after the introduction of the technology. In addition, modeling results show that the probability of a woman giving birth to her first child doubles for any age after the introduction of laborsaving technology. However, changes in birth intervals are less conclusive since the differences of smoothed probability distributions are not significant. Moreover, findings indicate that women who initiate reproduction at a younger age can potentially have longer reproductive careers and larger families.^ieng

Women's roles and family formation in Venezuela: new forms of consensual unions?

This paper assesses the effects of changes in women's education and labor force participation on nuptiality patterns and their implications for fertility decline in Venezuela. Results show that together with delays in union formation, changes in women's education and labor force participation produced a different, more "modern" type of consensual union, which coexists with "traditional" consensual unions. "Traditional" consensual unions remain a substitute for formal marriage among women from rural origins with low levels of education and higher levels of work experience. "Modern" consensual unions appear to be an option for well-educated women of urban origins. As in developed countries, these unions assume the form of a trial period before marriage or an alternative to singlehood. "Modern" consensual unions are more unstable than "traditional" consensual unions and they are associated with lower fertility.

[Knowledge and practice of contraception in Haiti: a factor in fertility decline over the last two decades?]. / La connaissance et la pratique de la contraception en Haiti: facteur de la baisse de la fecondite depuis deux decennies?

PIP: Information on contraceptive knowledge and practice in Haiti is available from four national surveys taken over 20 years: the 1977 Haiti Fertility Survey, the 1983 Contraceptive Prevalence Survey, the 1989 National Survey of Contraception, and the 1994-95 Survey of Mortality, Morbidity, and Use of Services. The proportion of Haitian women in union declaring knowledge of at least one contraceptive method increased from 83% in 1977 to 99% in 1994-95. The influence of educational level and rural or urban residence on knowledge declined over time and was virtually nil by 1995. The surveys indicated that, among women in union, 18% used a contraceptive method in 1977, 7% in 1983, 10% in 1989, and 17% in 1995. Educated and urban women had higher rates of contraceptive usage. The use of traditional methods has declined since 1977, while the proportion of women using modern methods increased from 5% in 1977 to 13% in 1995. Combining the survey results reporting contraceptive practice with analyses of the proximate determinants indicates that contraceptive usage only partially explains the decline in Haiti's total fertility rate from 6 in 1982-83 to 4.8 in 1995. Assuming that the natural fertility rate has remained constant at 17.7 children/woman over the past 2 decades, it was estimated, using the Bongaarts method, that in 1994-95 7.4 births were avoided due to marriage patterns, 3.6 due to breast-feeding and postpartum infecundity, 1.3 due to contraception, and 0.6 due to abortion. It is very likely that the impact of duration of union will decline in the future, as premarital sexual activity increasingly becomes the norm.^ieng

[Fertility in Loja, Bolivar, Esmeraldas, Azuay and El Oro. Series: Provincial reports from the Demographic and Maternal-Child Health Survey, 1994 (ENDEMAIN-94)]. / La fecundidad en Loja, Bolivar, Esmeraldas, Azuay y El Oro. Serie: Informes provinciales de ENDEMAIN / 94.

PIP: During the periods 1965-69 and 1989-94, Ecuador's total fertility rate (TFR) declined from nearly 7 to 3.6, while contraceptive prevalence rose from 33.6% to 56.8%. The 15 provinces of Ecuador were divided into 3 equal groups on the basis of Bongaarts' index of contraception, and their fertility characteristics were compared. The groups discussed here showed moderate differences in the index of contraception from the national average of 0.435. 4 of the 5 provinces in group II had indices higher than the national average: Loja, 0.567; Bolivar, 0.566; Esmeraldas, 0.535; and Azuay, 0.526. El Oro's index of 0.398 was lower. El Oro's TFR of 3.46 was lower than the national average of 3.61, but it still was in the third phase of the fertility transition. Although Loja and Bolivar had nearly identical indices of contraception, the TFR in Loja (4.15) was significantly lower than that in Bolivar (5.12). The TFRs were 4.66 in Esmeraldas and 3.95 in Azuay. The differences in TFRs in provinces with similar indices of contraception are due in part to different age patterns of fertility, distributions of women according to educational and marital status, and other factors. Age-specific fertility rates for women aged 15-19 ranged from a low of 65/1000 in Loja to a high of 120 in Esmeraldas. Maternal education was the single greatest observed influence on the TFR. The TFR at the national level was 6.24 for illiterate women and 2.13 for those with higher education. The TFR in the 5 provinces for women with primary or lower education ranged from 6.1 in Esmeraldas and Bolivar to 4.02 in El Oro. The differential between the most and least educated women ranged from 1.36 in El Oro to 4.27 in Bolivar. The proportion of women single ranged from 29.3% in El Oro to 48.6% in Loja. Calculation of the indices of contraception, marriage, and postpartum infertility showed, as expected, that El Oro had the most favorable indices.^ieng

[Fertility in Imbabura, Los Rios, Carchi, Tungurahua and Manabi. Series: Provincial reports from the Demographic and Maternal-Child Health Survey, 1994. (ENDEMAIN / 94)]. / La fecundidad en Imbabura, Los Rios, Carchi, Tungurahua y Manabi. Serie: Informes Provinciales de ENDEMAIN / 94.

PIP: Ecuador's total fertility rate (TFR) declined from nearly 7 to 3.6 during 1965-69, while contraceptive prevalence rose from 33.6% to 56.8%. The provinces of Ecuador were classified into three equal groups based on Bongaarts' index of contraception, and their fertility characteristics were compared. The 5 provinces in group III with relatively homogeneous indices of contraception were examined in this article. The index of contraception was 0.503 in Imbabura, 0.469 in Los Rios, 0.457 in Carchi, 0.456 in Tungurahua, and 0.430 in Manabi. The 5 provinces were all in phase 3 of the demographic transition, with TFRs of 4.44 in Imbabura, 3.68 in Los Rios, 3.78 in Carchi, 3.68 in Tungurahua, and 3.43 in Manabi. The index of contraception and TFR, respectively, were 0.435 and 3.61 for Ecuador. The fertility differentials in provinces with similar levels of contraceptive usage were attributable in large part to differences in age patterns of fertility, maternal educational levels, marital status, and prevalence of contraceptive methods. Age-specific fertility rates for women aged 15-19 ranged from 76/1000 in Imbabura to 114/1000 in Los Rios and Carchi. The difference between the average number of children of illiterate women and that of women with higher education ranged from 1.66 children in Manabi and 1.69 in Carchi to 2.97 in Imbabura, compared to the difference of 2.44 for Ecuador. The proportion of women single ranged from 30.4% in Los Rios to 39.9% in Carchi. Contraceptive prevalence in the 5 provinces ranged from 50.9% in Imbabura to 56.9% in Tungurahua. The differences were reflected in Bongaarts' indices of nuptiality and postpartum infertility as well as contraception.^ieng

[Mexican families in their homeland and in exile]. / Familles mexicaines du pays et de l'exil.

"The present study takes advantage of the Mexican and American census simultaneity in Spring 1990 to compare the Mexican populations according to their migratory status. The analysis of their composition by age and by sex is completed by an estimation of the undercount of migrants omitted by these statistics.... The fertility of the Mexican immigrants is compared to that of the country of origin and to that of Mexican Americans so as to specify changes induced by the exile. But one of the most interesting mutations deals with the recomposition of the migrant's family in the U.S.: units of residence gain in complexity by the extended integration of relatives or individuals that do not belong to the nuclear family." (SUMMARY IN ENG AND SPA)

[High-fertility groups in Colombia, 1990]. / Los grupos de alta fecundidad en Colombia, 1990.

PIP: Data from the 1990 Demographic and Health Survey (DHS), the 1985 census, and PROFAMILIA and Ministry of Health service statistics were used to analyze persistence of high fertility in different subregions and socioeconomic groups of Colombia. The 1990 DHS sample design divided the country into 13 subregions, allowing greater than usual disaggregation of data. The analytic strategy had three parts: identification of regions exhibiting high fertility during 1987-90; characterization of the regions according to macro level indicators and fertility level; and analysis of the importance of the effects of the contextual and individual variables on recent fertility by means of a multilevel multivariate model. The characterization of the regions and the multivariate analysis tested the hypothesis that contextual conditions influence fertility directly and not just as instruments of the individual characteristics of local populations. Based on demographic transition theory and available information, several contextual indicators were studied: women's status, economic role of children, infant mortality, access to modern family planning methods, and urbanization. The analysis demonstrated the existence of high fertility in 3 of the 13 geographic subregions: northeast, northwest, and Tolima Grande. The characterization of the subregions indicated that those where women had lower status, and where there was less emphasis on children's school attendance, high infant mortality, low access to family planning, and low level of urbanization were not necessarily the areas with the highest total fertility rates, suggesting that a cultural effect might also be present. The northeast and northwest subregions have cultural values and family structures different from those of the rest of Colombia and similar to other Caribbean countries: prevalence of consensual unions, early marriage, and high value of children in the household. The results of the multivariate analysis also indicated the presence of a distinct cultural effect on fertility.^ieng

[Economic adjustment and its demographic consequences in Latin America: an overview]. / Una vision sintetica del ajuste economico y sus consecuencias demograficas en America Latina.

PIP: This work reviews the available literature on short and medium term demographic responses to the economic adjustment processes occurring in Latin America during the 1980s. The first section describes the immediate causes and scope of the economic crisis of the 1980s in Latin America and the measures taken to correct imbalances. An external crisis rendered the current accounts deficit of the early 1980s no longer sustainable, interest rates and commercial conditions deteriorated, and a recessive adjustment of enormous magnitude occurred. The term "adjustment" covers a wide and varied array of economic changes, fiscal and social policy reforms, and changes in international commerce. The structural adjustment measures caused deterioration in investment and in equity. Real purchasing power declined more than per capita product in most Latin American countries between 1980 and 1990. Primary income distribution underwent regressive changes. In most cases the deterioration was not compensated by social spending. As a result of the fiscal adjustment and reduced public sector spending, per capita investment in health and education was less in 1990 than in 1980 in almost all countries. The demographic consequences of the adjustment processes are difficult to gauge precisely because the experiences of individual countries were heterogeneous and because no single definition of adjustment exists that would serve as a point of reference for comparison of situations without adjustment or with different types of adjustment. Nevertheless, some studies have attempted to specify terms of comparison. Some have compared conditions before the crisis or adjustments with conditions later, and others have analyzed short term fluctuations in demographic variables from their medium or long term trends. Such works suggest that nuptiality is the variable responding most intensely, systematically, and immediately to short term economic fluctuations. Fertility also appears to have responded, somewhat less systematically and with some lag due to the nature of reproductive processes. It is still too early to determine whether medium term fertility trends have been affected. Infant mortality has in general continued its decline although at a decelerating rate in many cases. Short term fertility fluctuations in most countries studied have shown a systematic relationship to economic conditions although the effects are of lesser magnitude than those of nuptiality or fertility. Deaths from some specific causes were more frequent than expected on the basis of past trends.^ieng

Introduction.

PIP: This is a summary of 7 papers given at a South American Indian Conference. The papers varied by the training and interests of the authors, but the unifying characteristics were their attention to the quality of data, the concern with placing the Lowland South American Indian societies in historical time, and the focus on the individual in a social context. The trend for tribal societies to abandon traditional practices of birth limitation is worrisome at a time when the balance between population growth and economic resources has deteriorated. Survival risks are high. The traditional societies range over a region stretching from Guyana to Mato Grosso, and have varying degrees of economic and political autonomy. All have been exposed to Western influences. A four-generation account of Barama River Caribs family in Guyana illustrates how marriage choices that appear anomalous were responses to changing demographic pressures. The problems of the definition of a population were revealed in the paper on the Wanano of the Rio Vaupes in Northwest Amazon; the aim was to examine Boas' ideas about the links between language, race, and culture in a region of culturally mixed marriages. High-quality reproductive history data was collected and examined on the Xavante in Pimentel Barbosa in eastern Mato Grosso. The study of household and settlement composition, marriage, fertility, and mortality data among the Bakairi, located west of Shavante, in Mat Grosso, suggests that population increases were kept small due to fertility-inhibiting cultural practices. The combination of detailed examination of cultural practices and statistical analysis provided insights into the demographic behavior of the Canela in central Maranhao, who have had longstanding contact with the West and maintained traditional practices. The difficulties of collecting birth and death records between 1976-86 among the Nambiquara in western Maso Grosso were expressed, and the anomalies of female mortality explained. Statistical analysis of the Shipibo of the Ucayali River Basin in Peru demonstrated that growth was attributed to the abandonment of traditional practices.^ieng

Demographic crisis and recovery: a case study of the Xavante of Pimentel Barbosa.

PIP: This case study of the Xavante of Pimentel Barbosa is an example of an Amazonian Indian group that, when exposed to White society, experienced the common history of diseases and social disruption, and then eventually, recovered from the demographic shock, increased fertility, and reduced mortality. Early contact for the Xavante was during the early 18th century in Goias state, Brazil; by the end of the 19th century the Xavante had migrated west into Mato Grosso in isolation. Brazilian government interests (1940s) and a research expeditionary group (1962) resulted in health posts and extensive genetic, epidemiologic, and demographic studies. The results showed good physical and nutritional status, but stress from epidemic disease and social disruption. Conditions had improved by 1976, and the battle was with encroaching ranchers. Strong indian political action led to the securing of boundaries within the Pimentel Barbosa reservation by 1977. The population doubled from 249 in 1977 to 411 in 1988, and increased to 3 villages. There was evidence of a return to more traditional practices. Data collection for this analysis occurred during 1976-77 and 1988 and 1990. Results were provided for recent demographic change, recent births and deaths, factors affecting fertility, fertility change, parity and infant mortality, life expectancy changes, infanticide, population growth, marriage patterns, and health changes. Fertility histories were collected from 71 women in 1971 and 109 women in 1990. Difficulties were encountered due to Xavante differences in enumeration of children. In the comparison of the surveys in 1977 and 1990, there was close correspondence of reported births, and discrepancies of 4-9 births and in age at death. The difficulties encountered were attributed to problems with interpreters. The demographic analysis showed evidence of introduced diseases, which increased infant mortality and threatened population replacement, followed by decreased infant mortality and a large cohort of reproductive age women increasing population growth. The history of this and similar populations is one of a rise and fall in population since colonial times. The seminomadic nature of this group may have saved them from extinction.^ieng

Potential independent factors of variability of biological status and reproductive history of Yucatecan women.

In this paper, we report the results of the application of principal component analysis (PCA) in a study of the human ecology of rural-to-urban migrantion in Yucatan, Mexico. Socioeconomic, reproductive and anthropometric data from 216 women 32 years of age or older, were obtained in 1989-1990. Seventeen socioeconomic, demographic and environmental properties of the families of such women, plus migrant status, were employed in a PCA, which yielded five independent factors, explaining 57.1% of the total variance of such properties. These factors were employed to made a multiple regression analysis on 19 anthropometric and 21 reproductive traits, age adjusted. According to the multiple regression of women's biological status to independent factors, we found that in better living conditions (Factor 3), women are heavier, taller, with more body surface and subcutaneous fat in the trunk and in the upper extremity, than in worse living conditions. Better educational level of wife and husband (Factor 2) is associated with lower number of pregnancies and alive born children, as well as less reproductive losses. Women living in families with higher income (Factor 4), have a younger age at the first pregnancy, older age at the last pregnancy, greater number of pregnancies, alive born children and alive offspring at the interview, and they experience less reproductive losses in relation to the number of pregnancies. This fact suggests that for the families in this sample, big families are a strategy to cope with poverty and uncertainty in employment and income. Our results are discussed against the reports in the literature.

The fertility incentive of land tenure in Mexico.

PIP: Ejidos are communal holding groups of redistributed land expropriated (generally without compensation) from large private landowners during Mexico's post-1910 land reform. The model in this study of the "ejidal" system's influence on fertility differs from DeVany and Sanchez in providing more current data and including the following more detailed variables: the land area of ejidos and the number of ejidos, the need for children, male income, female income share, and social security coverage. The data pertains to states rather than municipalities. DeVany and Sanchez found that the ejidal system encouraged fertility, because having more children helped an ejido family retain land rights, increased its chances of gaining additional productive land, and gave it increased political power. Children also provided a means of intergenerational transfer of resources. The estimation results of this study revealed that the total proportion of land held as ejidos had a positive, significant effect on fertility. The ratio of ejidos to total number of farms was negative and significant. There was support for the hypothesis that the impact of ejidos land holdings and area was diminished when ejidos were dominant in the state. Fertility declined with the increase in unpaid workers per hectare of land. Elasticity functions were small: 0.075 on ejidal land, -0.222 on ejidal farms, and -0.045 on workers. A positive significant demographic effect on fertility was illiteracy. Infant mortality and female income share each had a negative, significant effect on fertility. Insignificant variables were male income, social security coverage, and the dummy for northern states. There have been changes in the Mexican ejidal system. These changes and the availability of farm labor are expected to reduce urban and rural fertility differentials.^ieng

[Fertility transition in Brazil. Causes and consequences]. / La transicion de la fecundidad en Brasil. Causas y consecuencias.

PIP: This work examines the determinants and most important consequences of the Brazilian fertility decline. Brazil's total fertility rate declined from 6.2 in 1940 to around 3.5 in 1985. the decline began in the 1960s and amounted to 45% in about 20 years. The most rapid drop began in the late 1970s, with much of it concentrated in 2 specific periods: 1970-75 and 1980-85. The early period coincided with Brazil's so-called "Economic Miracle", a period of rapid growth accompanied however by deteriorating living conditions for the poorest population sectors. The second period coincided with the international economic crisis of the early 1980s, which was felt more strongly in Brazil than elsewhere in Latin America because of Brazil's greater degree of industrialization and closer integration into the world economy. Most of the fertility decline has been accomplished by use of just two contraceptive methods, oral contraceptives and sterilization, which together account for around 85% of contraceptive usage throughout Brazil. The third most common method, rhythm, accounts for just 6%. No reliable data on abortion are available, but it appears to be a common practice equally accessible to all socioeconomic strata despite greater associated health risks for poorer women. Brazil's fertility transition appears to have been a response to the process of proletarianization and urbanization underway in the country as well as to particular circumstances in the country. The most evident and immediate consequence of the continuous fertility decline over more than 20 years is the change in the age structure of the population. The proportions of children under 5 will decline from 14.4% in 1980 to 9.2% in 2010. The proportion aged 5-14 will decline from 24.5% to 17.4%, while the proportion aged 65 and over will increase from 4.0% to 5.6%. Brazil's recent demographic changes are scarcely reflected in development plans and political and social projects. There is almost no mention of the new demographic dynamics which entail new problems to be faced, but also new and more favorable conditions for overcoming some old problems. Most planners retain a conception of Brazil's population as very young, rapidly growing, and with a constant age distribution. Some promising areas for social investment are health, nutrition, and preschool education for small children; improvement and expansion of the public educational system; and improvement in the quality of the labor force. The growing elderly population will require health services, pensions, and alternative living arrangements for the increased proportion without close relatives. A regional development strategy should be developed to assure that conditions do not deteriorate in any region as demographic changes progress.^ieng

[Fertility transition in Peru]. / La transicion de la fecundidad en Peru.

PIP: Data from national censuses and sample surveys are the basis for this examintion of differential fertility and the fertility transition in Peru. Changes in the level and structure of fertility in the 3 major geographic regions are compared, and the role of contraceptive usage and nuptiality changes in the fertility decline are analyzed. Peru's total fertility rate was estimated at 6.85 in 1965 and has since declined to 6.56 in 1965-70, 6.00 in 1970-75, 5.30 in 1975-80, 4.65 in 1980-85, and 4.00 in 1985-90. The fertility decline varied in intensity and timing in the geographic regions. A clear fertility decline began among upper and middle income groups in the principal cities in the 1960s, spreading gradually to the urban low income sectors. Not until the late 1970s did the fertility decline spread to the rest of the population, coinciding with the years of severe economic crisis. The urban total fertility rate declined from 6 to 3.77 during 1961-86, but rural fertility increased through 1972 to 8.12, before declining slightly to 7.62 in 1981 and more markedly to 6.65 in 1986. Sociocultural and economic differences between Peru's natural regions are appreciable, and account for the contrasts in fertility trends. The greatest changes occurred in metropolitan Lima, which already had relatively low fertility in 1961. Its total fertility rate declined 44% from 5.6 in 1961 to 3.13 in 1986. Fertility declined by slightly under 40% in the rest of the coast, by almost 25% in the jungle, and by scarcely 14% in the sierra. The total fertility rates in 1961 and 1986, respectively, were 6.38 and 4.13 on the coast, 6.64 and 6.45 in the highlands, and 7.92 and 5.97 in the lowlands. The fertility decline, especially in the lower classes, was a response initially to the process of cultural modernization which in slightly over 2 decades saw a profound transformation of Peru from a rural, Andean, illiterate, and agrarian society to an urban, coastal, literate, and commercial society. From 1972 on, the fertility decline spread in the rural sectors and was intensified as a response to the profound economic crisis experienced in Peru from 1975 to the present. Increased contraceptive usage was apparently the most important cause of Peru's fertility decline. Overall prevalence increased from 31% in 1977-78 to 46% in 1986, and use of modern methods by women in union doubled in the same years. Regional fertility differences are correlated strongly to contraceptive prevalence and especially to prevalence of modern methods. The 3 most recent national fertility surveys and a series of more limited surveys suggest that women have an increasingly strong desire to control their fertility. The greatest barriers to use of modern contraception are fears of health effects and lack of knowledge.^ieng

[Nuptiality trends and the fertility transition in Latin America]. / Las tendencias de la nupcialidad y la transicion de la fecundidad en America Latina.

The author uses census data to examine the impact of nuptiality on the fertility transition in Latin America. He finds that fertility decreased among adolescents during the 1960s, although no trend was observed for later decades. However, "an increase of legal marriages in connection with consensual unions was also observed. Apart from an [increase] in the number of illegitimate children, the impact of the increase of consensual unions upon fertility is uncertain. No regional trend was observed in connection with age at marriage. This stability suggests that Latin American patterns of marriage are determined by cultural factors rather than socioeconomic reasons." (SUMMARY IN ENG)

[Fertility decline and changes in proximate determinants in Latin America and the Caribbean]. / Descenso de la fecundidad y cambios en sus determinantes proximos en America Latina y el Caribe.

"The objective of this paper is to discuss the role that three of the proximate determinants of fertility (marriage, contraception and post-partum insusceptibility) have played in fertility change in Latin America and the Caribbean. First we look at issues of data availability and comparability on measures of the proximate determinants from retrospective surveys. Most of the data utilized come from the World Fertility Survey (WFS) and the Demographic and Health Surveys (DHS) projects. Second, we present results from the most widely applied model for assessing the impact that these proximate determinants have on fertility, that of Bongaarts....Finally, we compare the results from the application of the Bongaarts model with those from an alternative method proposed by Moreno. Both models show that increased use of contraception is by far the most important reason for fertility decline, with marriage and post-partum insusceptibility making much smaller contributions. However, the second model suggests that the role of the marriage and post-partum insusceptibility factors is much smaller than is shown by the Bongaarts model." (SUMMARY IN ENG)

[Fertility and reproductive behavior in Peru: Andes mountains and the Amazon basin]. / Fecundidad y comportamiento reproductivo en la sierra y selva del Peru.

"The article attempts to discuss the historical and contemporary situations of [fertility among] populations residing in the two least studied areas of Peru: the Andes mountains and the Amazon basin. The study starts with a review of the 'demographic catastrophe' that the Spanish presence meant to the people of these areas.... The harmful effects of the 'rubber boom' and, more recently, of the 'oil boom', periods are also reviewed." Fertility trends in the two areas are analyzed, with a focus on marriage, breast-feeding, and contraceptive use. (SUMMARY IN ENG)

[Institutional intervention in the reduction of fertility and infant mortality]. / Intervencion de las instituciones en la reduccion de la fecundidad y la mortalidad infantil.

"This document discusses the impact of the social institutions in the childbearing experience of...families and the reproduction of...society. Despite the difficulties of empirically demonstrating the association of the macro and micro spheres, the paper presents evidence of the relationship, introducing the case of Ecuador, based on broad indices of fertility and child mortality.... The analysis utilizes the Demographic and Health Survey (DHS), individual and community questionnaire." (SUMMARY IN ENG)