Strategies to promote contraception use by female volunteers in Alzheimer's Prevention Initiative Autosomal-Dominant Alzheimer's Disease (API ADAD) Colombia trial.

BACKGROUND/AIMS: Including women of childbearing age in a clinical trial makes it necessary to consider two factors from a bioethical perspective: first, the lack of knowledge about the potential teratogenic effects of an investigational product, and also, the principle of justice not to exclude any population from the benefits of research. The most common way to address this issue is by requiring volunteers to use contraceptives before, during, and a few weeks after the clinical trial. This work presents all the strategies used to promote contraception use and prevent pregnancy during the Alzheimer's Prevention Initiative Autosomal-Dominant Alzheimer's Disease (API ADAD) Colombia clinical trial. Two characteristics of this trial make it of special interest for closely monitoring contraception use. One is that the trial lasted more than 7 years, and the other is that participants could be carriers of the E280A PSEN1 mutation, leading to a mild cognitive impairment as early as their late 30s. METHODS: An individual medical evaluation to select the contraception method that best fits the volunteer was carried out during the screening visit, remitting to the gynecologist when necessary. All non-surgical contraception methods were supplied by the sponsor. Staff were trained on contraception counseling, correctly dispensing contraceptive drugs to volunteers, and identifying, reporting, and following up on pregnancies. Two comprehensive educational campaigns on contraception use were performed, and the intervention included all volunteers. In addition, volunteers were asked on an annual survey to evaluate the dispensing procedure. Finally, the effectiveness of these strategies was retrospectively evaluated, comparing by extrapolation the number of pregnancies presented throughout the trial with the General Fertility Rate in Colombia. RESULTS: A total of 159 female volunteers were recruited. All strategies were implemented as planned, even during the COVID-19 contingency. Ten pregnancies occurred during the evaluation period (2015-2021). Two were planned; the rest were associated with a potential therapeutic failure or incorrect use of contraceptive methods for a contraceptive failure of 0.49% per year. Sixty percent of pregnancies led to an abortion, either miscarriage or therapeutic abortion. However, there was not enough data to associate the pregnancy outcome with the administration of the investigational product. Finally, we observed a lower fertility rate in women participating in the trial compared to the Colombian population. CONCLUSION: The lower rates of contraceptive failure and the decrease in the incidence of pregnancies in women participating in the trial compared to the Colombian population across the 7 years of evaluation suggest that the strategies used in API ADAD Colombia were adequate and effective in addressing contraception use.

The invisible problem of early adolescent pregnancy in the Dominican Republic: a descriptive analysis.

Study objectives: The aim of this article is to describe the problem of pregnancy in girls under 15 years of age in the Dominican Republic in the period 2000-2021, to develop a specific indicator for this age group and describing the related factors. Methods: This is an exploratory ecological study, based on secondary data sources, such as birth records from the National Statistics Office (NSO) and the Ministry of Public Health (MPH). We calculated the rates of fertility and pregnancy in early adolescence, as well as analyzed their main determining factors and consequences. Results: Fertility Rate in Early Adolescence (FREA) decreases from 6.27 to 1.04 per thousand in the period 2001-2021. The average FREA for 2015-2021 was 1.78. The average Estimated Rate of Pregnancy in Early Adolescence (ERPEA) for the same period was 3.39. Disability-Adjusted Life Years (DALYs) were 11,620 years. Years of Life Lost (YLL) were 9,665.9 years. The prevalence of Low Birth Weight (LBW) in the under 15-year-old age group was 14.2 %. Conclusions: Pregnancy in childhood implies risks for both the mother and the child, including low birth weight. The official fertility rate is substantially underreported (2.84 vs. 1.79).The fertility rate indicator traditionally used does not accurately measure the number of pregnancies in women, particularly in specific age groups or populations where pregnancies may be interrupted by various factors. Therefore, the use of ERPEA is recommended.We emphasize the need for implementing the proposed indicator for the target group, as well as monitoring Sustainable Development Goal indicator 3.7.2.

Perfil reprodutivo de uma população de alta vulnerabilidade / Reproductive profile of a high vulnerability population

Introdução: padrões sexuais e reprodutivos são influenciados por fatores biopsicossociais. Dentre esses fatores, há a vulnerabilidade, conceito amplo, complexo e que determina maior atenção das políticas públicas. Objetivo: conhecer o perfil reprodutivo das mulheres que residem em uma área de alta vulnerabilidade na cidade de Curitiba-PR. Metodologia: descritivo, documental de caráter analítico observacional transversal. Coleta e análise de dados das Declarações de Nascidos Vivos (DNV) na Unidade de Saúde do Capanema e análise de dados públicos fornecidos pelo IBGE. Resultados: foram analisados 1199 DNVs, sendo 1011 mulheres com idades entre 13 e 49 anos, compreendidos entre os anos de 2003 a 2018. Foi possível a análise da Taxa de Fecundidade Total (TFT), via de parto, estado civil e escolaridade das parturientes. Discussão: a menor TFT foi apresentada na faixa etária de 13 a 15 anos (1,05 filhos/mulher) e a maior entre 36 a 49 anos (4,47 filhos/mulher). A via de parto vaginal correspondeu a 64% dos partos, enquanto que a via cirúrgica por cesárea aconteceu em 36% dos casos. Em relação à escolaridade, 3% apresentaram-se como analfabetas; 48% possuíam nível fundamental; 40% nível médio completo e 9% possuíam nível superior completo ou incompleto. Houve 0,5% de omissão da que escolaridade no momento do preenchimento dos dados. Os dados coletados sobre o estado civil foram considerados inconclusivos. Conclusão: Conclui-se que a Taxa de Fecundidade da população estudada está acima da Taxa de Fecundidade Total projetada para 2015 no Brasil nas faixas etárias acima de 19 anos e da taxa de fecundidade ideal para que haja uma reposição da população segundo o DATASUS (2021). Tais dados podem estar relacionados com a vulnerabilidade da comunidade em questão, corroborando com estudos que relatam maiores taxas de fecundidade relacionada a menor renda e menor escolaridade.

Introduction: sexual and reproductive patterns are influenced by biopsychosocial factors. Among these factors, there is vulnerability, a broad and complex concept that requires greater attention from public policies. Objective: to know the reproductive profile of women who live in an area of high vulnerability in the city of Curitiba-PR. Methodology: descriptive, documental, cross-sectional observational analysis. Collection and analysis of data from the Birth Certificates (BC) at the Capanema Health Unit and analysis of public data provided by the IBGE. Results: 1199 BCs were analysed, with 1011 women aged between 13 and 49 years old, between the years 2003 and 2018. It was possible to analyse the Total Fertility Rate (TFR), mode of delivery, marital status and level of education of the parturients. Discussion: the lowest TFR was observed in the age group from 13 to 15 years old (1.05 children/woman) and the highest between 36 to 49 years old (4.47 children/woman). Vaginal delivery corresponded to 64% of deliveries, while surgical caesarean section occurred in 36% of cases. Regarding schooling, 3% were illiterate; 48% had a fundamental level; 40% completed high school and 9% had completed or incomplete higher education. There was 0.5% omission of schooling attainment at the time of filling in the data. Data collected on marital status were considered inconclusive. Conclusion: it is concluded that the Fertility Rate of the studied population is above the Total Fertility Rate projected for 2015 in Brazil in the age groups above 19 years and the ideal fertility rate so that there is a replacement of the population according to DATASUS (2021). Such data may be related to the vulnerability of the community in question, corroborating with studies that report higher fertility rates related to lower income and lower education.

Modelación espacial bayesiana de la estructura de los hogares y la fecundidad en municipios de México

El trabajo busca modelar el efecto de diferentes patrones de composición de hogares sobre los niveles observados de fecundidad en los municipios de México al año 2020, se trata de una investigación de tipo cuantitativo de cohorte transversal basada en la aplicación de métodos bayesianos espaciales. La hipótesis sostiene que la presencia de un mayor porcentaje de hogares familiares debería impactar en mayores tasas de fecundidad municipales. La metodología comprende la implementación de dos modelos gaussianos latentes. Un modelo nulo busca determinar si los patrones observados de fecundidad se asocian a algún mecanismo sociodemográfico o, al contrario, surgieron aleatoriamente, y otro modelo con covariables, cuyo objetivo es replicar el comportamiento de la fecundidad evaluando las consecuencias de la proporción de hogares nucleares, ampliados y compuestos presentes en los municipios. Los resultados obtenidos a partir de la estimación del modelo nulo confirmaron la existencia de una relación directa entre el aumento del índice de hogares nucleares y ampliados y el de la fecundidad municipal. Sin embargo, se puede concluir que el nivel alcanzado de fecundidad de reemplazo es producto de marcadas diferencias entre municipios, originadas por la presencia de una tipología heterogénea de hogares inmersos en contextos geográficos, sociales y culturales dispares.

This paper seeks to model the effect that different patterns of household composition have on the observed levels of fertility in the municipalities of Mexico in the year 2020; it is a quantitative cross-sectional cohort research based on the application of spatial Bayesian methods. The hypothesis is that the presence of a higher percentage of family households should have an impact on higher municipal fertility rates. The methodology involves the implementation of two latent Gaussian models. One null model, which seeks to determine whether the observed fertility patterns were generated by some socio-demographic mechanism or, on the contrary, arose randomly, and two, a model with covariates whose objective is to replicate the behavior of fertility by evaluating the effect of the proportion of nuclear, extended and compound households present in municipalities. The results obtained from estimation of null model confirm the existence of a direct relationship between increase in the proportion of nuclear and extended households and the increase of municipal fertility. However, it can be concluded that the level of replacement fertility reached by Mexico in the year 2020 is the product of marked differences between municipalities; differences originated by the presence of a heterogeneous typology of households immersed in disparate geographic, social and cultural contexts.

La fecundidad en la ciudad de Rosario, Argentina: proyecciones y retroproyecciones de la tasa global de fecundidad y las tasas específicas de fecundidad / Fertility in Rosario City, Argentina: Projections and retro-projections of the global fertility rate and specific fertility rates

Resumen El estudio que da lugar al presente artículo surge a partir de los resultados obtenidos en el marco de un convenio de colaboración firmado por la Dirección General de Estadística de la Municipalidad de Rosario y la Escuela de Estadística de la Facultad de Ciencias Económicas y Estadística de la Universidad Nacional de Rosario. Entre sus objetivos, se plantea el de obtener pronósticos probabilísticos de la fecundidad para la Ciudad de Rosario. Para ello, con base en estadísticas vitales, estimaciones y proyecciones de población se construyen escenarios probables, pasados y futuros, tanto para la tasa global de fecundidad como para las tasas específicas de fecundidad. Los resultados de este estudio, basados en la aplicación de modelos probabilísticos de pronóstico, permiten conocer estructuras y tendencias, pasadas y futuras de la fecundidad, de modo que puedan generarse diagnósticos que sean de utilidad para la evaluación y gestión del sistema de salud o bien para el desarrollo de nuevas políticas públicas. Los resultados indican que Rosario tuvo, tiene y seguirá teniendo un cambio en los patrones de fecundidad más rápido y marcado que el promedio nacional. Si bien este hecho es esperable, en un contexto signado por los avances en la salud pública, que permiten acceder a más y mejor atención en salud reproductiva, la metodología aquí empleada se basa únicamente en la extrapolación de las tendencias, por ello la retroproyección debe ser analizada cuidadosamente. Con posterioridad, en la sección metodológica, se presentan los modelos probabilísticos de pronóstico que se emplean para la obtención de resultados.

Abstract The study that gives rise to this article arises from the results obtained in the framework of a collaboration agreement signed by the Statistical Office of Rosario City and the School of Statistics of the Faculty of Economic Sciences and Statistics (National University of Rosario). Among its objectives is to obtain probabilistic fertility forecasts for Rosario City. For this, based on vital statistics, estimates and population projections, probable scenarios, past and future, are constructed, both for the global fertility rate and the specific fertility rates. The results of this study, based on the application of probabilistic prognostic models, allow to know structures and trends, past and future, of fertility, so that diagnoses can be generated that are useful for the evaluation and management of the health system or good for the development of new public policies. The results indicate that Rosario had, has and will continue to have a change in fertility patterns faster and more marked than the national average. Although this fact is to be expected in a context marked by advances in public health (which allow access to more and better reproductive health care), the methodology used here is based solely on the extrapolation of trends, therefore, the backprojection must be carefully analyzed.

The Effect of P4 + eCG Estrus Induction Protocol during the Deep and the Transition Anestrous Period on the Reproductive Performance of Crossbred Dairy Goats.

Seasonal reproduction restricts the offering of goat commodities across the year. Therefore, it is crucial to improve diverse strategies to induce the reproductive response in goats during the anestrus stage. The effectiveness of a short P4 + eCG-based estrus induction protocol during both the deep anestrous (March) or the reproductive transition period (June) upon the reproductive performance of crossbred dairy goats was assessed. Adult, anestrous, 24-30-month- old dairy crossbred (Saanen-Alpine-Nubian × Criollo) goats (n = 123) from two commercial herds and 10 sexually active goat bucks were used. Before the trials, the anestrous status of goats was confirmed. Then, goats were randomly allocated into two different experiments. In Exp. 1, we tested the effect of different doses (D) of intramuscular progesterone (P4; 10 or 20 mg + eCG (100 UI)) and type of breeding (TB), natural mating (NM), or artificial insemination (AI), on two commercial goat herds (H1 & H2), in March (deep anestrous). In Exp. 2, we evaluated the effect of D (P4; 10 or 20 mg + 100 UI eCG) in goats subjected to NM, and either during deep anestrous (March; M) or transitional anestrous (June; J), in two commercial herds. After breeding, conception and pregnancy were diagnosed with ultrasound scanning. The response variables were estrus induction (EI; %), estrus latency (EL; h), ovulation (OVP; %), ovulation rate (OR; units), fertility (FERT; %), and pregnancy (PREG; %). No differences (p > 0.05) in live weight (LW) and body condition score (BCS) occurred between herds in both trials. In Exp. 1, EI, EL, OVP, OR, FERT, and PREG were affected (p < 0.05) by the H-TB-D interaction, whereas in H1 + P4-20 combination had the highest (p < 0.05) EI, EL, and OVP values. Irrespective of TB, H1 had the largest (p < 0.05) OR, independently of TB or D. Also, the lowest (p < 0.05) OVP occurred in the AI + P4-10 group, while the AI had the lowest (p < 0.05) FERT, irrespective of D. FERT and PREG were two-fold higher (p < 0.05) in NM compared with AI. In Exp. 2, EI, EL, OVP, OR, FERT, and PREG were affected (p < 0.05) by the H-M-D interaction. In general, H2 + P4-10 had the lowest (p < 0.05) reproductive outcomes in March, whereas H1 had the largest (p < 0.05) values in either month. No differences (p > 0.05) between P4 doses occurred for EI, OVP, OR, FERT, and PREG. Yet, the largest (p < 0.05) EL occurred with P4-20 in June. No correlations (p > 0.05) occurred between LW and all the reproductive variables. BCS was positively correlated (p < 0.05) with EI (0.34), OVP (0.44), OR (0.58), and PREG (0.20). Also, positive correlations (p < 0.05) occurred between EI with EL (0.83), OVP (0.80), OR (0.64), and PREG (0.56); EL with OVP (0.58), OR (0.44), and PREG (0.42); OVP with OR (0.79) and PREG (0.70), as well as OR and PREG (0.63). Results of these studies confirm a multidimensional response regarding the effectiveness of P4 + eCG for estrus induction in goats mainly modulated by a specific time within the anestrous season, or even by specific management or a particular environment at the herd level (H1), although quite remarkably independent of the animal's LW or BCS at herd level. Moreover, the best reproductive outcomes occurred with NM in June. The most reproductive variables were similar using either 10 or 20 mg P4 + 100 IU eCG, giving the possibility to lessen the scale in the use of exogenous hormones while obtaining acceptable out of season reproductive response.

The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations.

STUDY QUESTION: Can the high rate and associated burden of unintended pregnancy (UP) and adolescent pregnancy in Latin America and the Caribbean (LAC) be reduced through wider access to and use of long-acting reversible contraceptive (LARC) methods? SUMMARY ANSWER: Studies show that impoved access to and use of LARC methods is an effective tool for reducing the high rates of UP, unsafe abortion and abortion-related complications, and maternal deaths (as well as reducing their social and financial burden), and we have provided recommendations to help achieve this in LAC. WHAT IS KNOWN ALREADY: LAC comprises 46 countries with 650 million inhabitants, and shows large disparities in socioeconomic development, access to health services and attention to sexual and reproductive health rights. The exercise of these rights and universal access to sexual and reproductive health (SRH) programmes is a key strategy for improving maternal health by reducing the number of UPs, the rate of women's and child mortality and morbidity, and the number of unsafe abortions. The implementation of SRH programmes in the region has contributed to a decrease in pregnancy rates of more than 50% over 40 years. However, despite this progress, the numbers of UP and adolescent pregnancies are still among the highest worldwide, which can be attributed in large part to the low prevalence of use of LARC methods. STUDY DESIGN SIZE DURATION: This is a position paper with the objective of reviewing the magnitude and burden of UP in LAC, as well as available LARC methods and barriers to their access, with the goal of increasing knowledge and awareness among healthcare professionals (HCP), policymakers and the general public about the potential to reduce UP rates through the increased use of LARC. PARTICIPANTS/MATERIALS SETTING METHOD: We searched the electronic databases of PubMed and EMBASE to identify studies published up to May 2017. We also searched for websites regarding LAC, LARC methods, and UP including, for example, those from the United Nations, the World Health Organization, Pan American Health Organization, the Alan Guttmacher Institute and the United States Agency for International Development. Studies were included if they investigated mainly UP and their consequences as well as the use of LARC methods in the region. During 3 days of meetings, the importance of the studies identified and the appropriateness of inclusion were discussed. MAIN RESULTS AND THE ROLE OF CHANCE: LAC is not one unit and shows great ethnic diversity as well as economic and cultural differences among the various countries. These differences must be taken into account when developing policies related to disseminating information and combatting misinformation regarding the use of LARC among different audiences, such as adolescents and young women, nulligravidas, indigenous populations and women with disabilities. Furthermore, only some governments have made efforts to increase accessibility to LARC methods, and there is a need to implement training programmes for HCPs, launch education campaigns for the general public, increase access and review the cost-benefit analyses specific to LARC, which have already demonstrated that the upfront cost of LARC is less than the cummulative expense of short-term contraceptives. Recommendations to achieve these goals are presented. LIMITATIONS REASONS FOR CAUTION: Knowledge and awareness of the contraceptive method itself and of the mix of individual countries in the region is essential to the development of specific strategies and actions, tailored to each particular country situation, aimed at increasing access to modern contraceptive methods, especially LARC. WIDER IMPLICATIONS OF THE FINDINGS: Healthcare systems in LAC should consider LARC as a primary option for decreasing UP and adolescent pregnancy. Disseminating information, increasing awareness of their efficacy, removing barriers and improving access to LARC methods are the urgent actions recommended for government, academia, professional organizations, insurance companies and policymakers in order to address this major public health problem in LAC. STUDY FUNDING/COMPETING INTERESTS: This manuscript was supported by a grant from the Americas Health Foundation (AHF), a 501(c)3 nonprofit organization dedicated to improving healthcare throughout the Latin American Region. LB and IM received additional support from the São Paulo Research Foundation (FAPESP) award # 2015/20504-9. The authors declare no conflict of interest.

Fertility rates among very young adolescent women: temporal and spatial trends in Brazil.

BACKGROUND: We assessed whether the reported decrease in fertility rates among 15 to 19 years old Brazilian adolescents has met with a parallel decrease in very young adolescent (10 to 14 years old) fertility rates. So we explored temporal trends for fertility rates among very young adolescents between 2000 and 2012 for Brazil as a whole, its regions and states; and also analyzed the spatial distribution of fertility rates among Brazilian municipalities in the years 2000 and 2012. METHODS: We used data from the Information System on Live Births to calculate the rates. To examine the temporal trends, we used linear regression for time series with Prais-Winsten estimation, including the annual percentage change, for the country, regions, and states. To analyze the spatial distribution among Brazilian municipalities, we calculated the Global Moran Index and created a local Moran significance and cluster map through Local Indicators of Spatial Association (LISA). We also elaborated a thematic map with the rates using empirical Bayesian estimation. RESULTS: Brazilian very young adolescent fertility rates remained high and stable throughout the 2000 to 2012 period, and significantly decreased in three out of 26 states, and in the federal district. On the other hand, an increase was observed in two Northern and Northeastern states. The rates were spatially dependent in Brazilian municipalities (Moran Index = 0.22 in 2012; p = 0.05). The maps indicated a heterogeneous distribution of the rates, with high-rate clusters predominant in the North and low-rate clusters predominant in the South, Southeast, and Midwest. CONCLUSIONS: Our findings indicate that Brazilian very young adolescent fertility rates have not decreased in parallel with adolescent fertility rates as they remain high and did not decrease from 2000 and 2012, even though a few states presented a decrease. Thus, these phenomena probably have distinct underlying causes that warrant further elucidation. Progress in this field is crucial for the development of specific policies and programs focused on very young adolescents.

Resposta inflamatória uterina em bovinos após inseminação artificial com sêmen avaliado por associações de sondas fluorescentes: efeitos sobre a fertilidade / Fertility and uterine inflammatory response in cattle after artificial insemination with semen evaluated by associations of fluorescent probes: effectos on fertility

Do ponto de vista da produtividade, a fertilidade é um dos parâmetros de maior importância em um rebanho bovino comercial e esta é influenciada por vários fatores, entre eles estão as condições do trato reprodutivo das fêmeas e a qualidade do sêmen utilizado. O influxo de células inflamatórias no local da deposição do sêmen logo após a inseminação artificial (IA) pode ser intensificada na presença de maior número de espermatozoides lesados durante a IA, caracterizando uma endometrite. Este estudo foi conduzido em três experimentos. Com o objetivo de comparar os métodos de colheita de material endometrial por escova ginecológica (EU) e lavado uterino (LU), bem como a interferência destes procedimentos na hemodinâmica uterina, foi proposto o Experimento 01, onde pode-se constatar que ambas as técnicas permitem o recolhimento de amostras em quantidade e qualidade suficiente para contagem, e que a porcentagem de células polimorfonucleares obtidas pela técnica LU foi superior a EU. Maior fluxo sanguíneo das artérias uterinas foi encontrado no momento de 4 horas após a realização de LU, sugerindo que este influencia na resposta vascular inflamatória. Para avaliar o efeito da LU após a IA em Tempo Fixo (IATF) na fertilidade dos animais, executou-se o Experimento 02 e constatou-se que não há diferença no índice de prenhez entre os animais submetidos ou não à LU, demonstrando que a técnica não interfere na taxa de fertilidade. Com o intuito de investigar a interferência da qualidade do sêmen na fertilidade, resposta inflamatória e hemodinâmica uterina, foi proposto o Experimento 03, onde foi possível observar influência da qualidade do sêmen sobre a taxa de prenhez, verificou-se maior porcentagem de vacas prenhes quando inseminadas com sêmen com maiores percentuais de espermatozoides apresentando integridade das membranas plasmática e acrossomal e função mitocondrial (PIAIC). Notou-se ainda a ocorrência de endometrite em 65,3 % dos animais, os quais apresentaram taxa de prenhez inferior aos que não apresentaram inflamação. Pode-se concluir que a qualidade do sêmen e a endometrite interferem na taxa de fertilidade bovina.

When productivity is taking into account, fertility is one of the most important parameters in a commercial herd. It is influenced by several factors, especially by the conditions of the female reproductive tract and the quality of the semen used. The influx of inflammatory cells at the site of semen deposition after artificial insemination (AI) can be intensified by the deposition of a greater number of dead spermatozoa during AI, which characterized endometritis. This study was conducted in three different experiments. In order to compare the methods of collection of endometrial sampling by swab using a gynecological brush (GB) or uterine flushing (UF), as well as the interference of these procedures in uterine hemodynamics, we designed experiment 01. Our results reveal that both techniques allow collecting samples with good quality and sufficient quantity to be counted; moreover, the average percentage of polymorphonuclear cells obtained by UF was greater compared to those obtained by GB. It may be noted that the increased blood flow was observed in samples collected four hours after the UF procedure, suggesting that it may have an influence on the vascular inflammatory response. To evaluate the effect of uterine flushing after AIFT on animal fertility we designed the experiment 02. Our results revealed that there is no statistical difference in pregnancy rates between flushed and non flushed animals, showing that the UF does not interfere with fertility rate. Experiment 03 was designed in order to assess the inflammatory response induced by different qualities of semen and their interference on uterine hemodynamic and fertility. There was an influence of semen quality on pregnancy rates: higher percentage of pregnancy was found in the group of cows inseminated with semen with plasma and acrossome membrane integrity and mitochondrial function (PIAIC). Endometritis was noticed in 65.3% of the cows and these animals presented lower pregnancy rate compared to those that did not show an inflammatory response. We concluded that semen quality and endometritis interferes with fertility rate in bovine species.

Perfil de mulheres com alta fecundidade em um grande centro urbano no Brasil / The profile of women with high fertility in a major urban center in Brazil

Estudo quantitativo, descritivo que teve como objetivo conhecer e caracterizar as condições sociodemográficas, reprodutivas e de proteção social de mulheres que vivenciam alta fecundidade, em um grande centro urbano. A população pesquisada constituiu-se de 441 mulheres residentes em Curitiba que tiveram o quinto filho, ou mais, no ano de 2005, identificadas pela declaração de nascido vivo do último filho. Realizaram-se visitas domiciliares para entrevistas nos anos de 2006 a 2008. Para a coleta dos dados foi utilizado um questionário semiestruturado. Os resultados foram apresentados em tabelas com frequências absolutas e relativas, médias e desvio padrão, permitindo delinear o seguinte perfil: mulher migrante do interior do estado, residente há mais de dez anos na capital, vinda de família numerosa, com 35 anos em média e cinco anos de estudo, com mais de uma união, vivendo em união consensual, subempregada, com renda média aproximada de R$ 600,00, responsável por sete dependentes ou mais. Confirmando claramente a vulnerabilidade dessas mulheres e suas famílias. Conclui-se que a busca ativa de mulheres com alta fecundidade pelas equipes de saúde da família, priorizando suas necessidades, contribuiria para a redução das desigualdades sociais e em saúde a que elas estão sujeitas.

A quantitative, descriptive study sought to identify the socio-demographic, reproductive and social protection conditions of women in a large city in Brazil. The target population consisted of women living in Curitiba with the last of five or more children born in the year 2005, identified by the registration system of newborn babies. Interviews in households were carried out with 441 women from 2006 to 2008 using a semi-structured questionnaire. Data obtained from the study were presented in tables with absolute and relative frequencies, averages and standard deviations. The following profile was derived from the results: migrant women from the state interior, living for over ten years in the capital, coming from large families, with a mean age of 35 years and five years of schooling, with more than one marriage, living in consensual union, underemployed, with an average income of around US$ 352 to cover the needs of seven or more dependents. This profile clearly confirms the social vulnerability of these women and their families. The study concludes that a proactive search by family health teams for women with high fertility, in order to prioritize their needs, would assist in reducing their social and health inequalities.

Fecundidade das mulheres cabo-verdianas: África Ocidental / Cape verdean women's fertility: West Africa

Os níveis de fecundidade de um país fazem parte de um elenco de indicadores que orientam na formulação de políticas públicas, face à redução do volume da população e do seu envelhecimento. O aumento da fecundidade pode indicar falta de acesso da população a informações e serviços de saúde reprodutiva. Assim, o objetivo é analisar a fecundidade das mulheres cabo-verdianas e a contribuição de determinantes próximos da fecundidade. Realizou-se a análise e a mensuração do comportamento da fecundidade das mulheres a partir de métodos indiretos de estimação da fecundidade com base nos dados dos censos. A análise dos determinantes próximos da fecundidade é baseado no DHS (Pesquisa sobre Saúde e Demografia - 1998). Os dados mostraram uma redução de 1,7, 1,5 e 1,6 filhos por mulher no final do período reprodutivo, de acordo com os três métodos (Brass, Arriaga e Gompertz) entre 1990 e 2000. As taxas foram mais altas para as mulheres das áreas rurais. A fecundidade vem diminuindo no país e com ocorrência mais precoce. O uso de contraceptivos foi o determinante de maior relevância no processo de declínio de fecundidade das mulheres de Cabo Verde, África.(AU)

A country's fertility levels are part of a list of indicators that guide the formulation of public policies, in view of population reduction and population aging. An increase in fertility may indicate the population's lack of access to reproductive health information and services. Therefore, our aim is to analyze Cape Verdean women's fertility and the contribution of proximal determinants of fertility. The analysis and measurement of the behavior of the women's fertility were performed through indirect methods of fertility estimation based on census data. The analysis of the parameters near fertility was based on DHS (1998). The data showed a reduction of 1.7, 1.5 and 1.6 children per woman at the end of the reproductive period according to the three methods (Brass, Arriaga and Gompertz) between 1990 and 2000. Rates were higher for women who lived in rural areas. Fertility has been decreasing in the country and the use of contraceptives was the most relevant parameter regarding the fertility decline process of women from Cape Verde, Africa.(AU)

Peru 1996: results from the Demographic and Health Survey.

PIP: This report presents findings of the 1996 Peru Demographic and Health Survey among 28,951 women 15-49 years old and 2487 men 15-59 years old. Fertility was 3.5 children/woman (5.6 in rural and 2.8 in urban areas). Fertility ranged from 2.1 among higher educated women to 6.9 among women with no formal education. 41.7% wanted the births in the 5 years preceding the survey. 23.2% wanted the birth later. 34.8% wanted no more births. A high percentage of women with 3 or more children wanted no more children. 22.9% currently used modern contraceptive methods. 41.3% used traditional methods. Contraceptive prevalence peaked at ages 35-39 years at 72.9%. Prevalence was 46.0% at 15-19 years old and 40.9% at 45-49 years old. 12% used the IUD. 18% used periodic abstinence. 42.7% of nonusers were menopausal. 12.4% were subfecund. 7.5% feared side effects. The median age at first birth was 21.5 years. Infant mortality was 43/100,000. Infant mortality was very high among rural and uneducated women. Only 1.1% were moderately to severely undernourished, but 25.8% were moderately to severely chronically undernourished.^ieng

Children of Kenya face serious survival challenges.

PIP: Survey findings pointing to the worsening health situation for children in Kenya that were highlighted during the National Dissemination Seminar for the 1998 Kenya Demographic and Health Survey (KDHS). The survey indicates that currently, 1 in 9 Kenyan children does not live to his or her 5th birthday. Under-five mortality stands at 112 deaths per 1000 live births, a 24% increase over the last decade. The high prevalence of childhood mortality is associated with a short preceding birth interval, a low level of maternal education, and rural location (under-five mortality is 23% higher in rural than in urban areas). Moreover, the risk of children dying varies greatly across provinces. A comparison between the results of the 1993 and 1998 KDHS also indicates recent setbacks in the fight against vaccine preventable diseases. Full vaccination coverage has fallen from 79% in 1993 to 65% in 1998. One of the more positive findings is the continuing decline in total fertility rate from 8.1 children per woman in the mid-1970s to current levels of 4.7 children per woman. In addition, knowledge and use of family planning has continued to rise in Kenya. Lastly, participants in the seminar also discussed the need for further dissemination of findings and further analysis of projects.^ieng

Birth delays skew developing world's fertility figures.

PIP: This article explains that birth delays skew developing world's fertility figures. When successive groups of women who have delayed childbearing start having children, the rapid fertility decline stalls. Such change in the timing of childbearing skews the total fertility rate (TFR). Analysis of the tempo component of TFR trends in Taiwan suggests that tempo effects reduced its TFR by about 10% in the late 1970s and early 1990s and by about 19% in the late 1980s. In Colombia, on the basis of increasing mean maternal age at childbirth between the 1970s and the late 1980s, tempo distortions of the TFR during the most of the 1980s seem likely. Moreover, many developing countries are now experiencing rapid fertility declines that are in part attributable to tempo changes. These changes have accelerated past fertility transitions, but they also make these countries vulnerable to future stalls in fertility when the delays in childbearing end. Since fertility reductions caused by tempo effects lead to real declines in birth rates and hence in population growth, countries that wish to reduce birth rates can take actions that encourage women to delay marriage and the onset of childbearing.^ieng

Spotlight: Costa Rica.

PIP: 3.5 million people lived in Costa Rica as of mid-1997. There were 24 births and 4 deaths per 1000 population, respectively, contributing to the annual natural increase rate of 2.0%. Each woman in Costa Rica bears an average of 2.8 children during her reproductive lifespan and men and women were expected to live for 73 and 78 years, respectively. Costa Rica's low infant mortality rate and high literacy and life expectancy rates set it apart from the rest of Central America. Costa Rica is also the only country in the region which maintains no standing army. About 96% of the population is White or Mestizo, 3% is Black, and 1% is indigenous Indian. More than half of the country lives in San Jose and its metropolitan area, 6% of the country's total land area. Unemployment has run near 5% over the past 2 years, but much of the labor force is underemployed. Costa Rica's economy depends upon tourism and agricultural exports such as coffee, beef, and bananas. A large Intel factory opened in 1997. The government and Costa Rican environmentalists are planning a joint campaign to reconvert 80% of Costa Rica's pasture back to forest and tree crops. About 20% of the government's budget is spent upon education and the 93% literacy rate is the highest in the region. Government health services provide low-cost contraceptives to more than 75% of users and 75% of women use some form of family planning.^ieng

[Fertility in Colombia]. / La fecundidad en Colombia.

PIP: Demography, which should be the basis for planning of any program or project, has traditionally been ignored by Colombian governments. No population statistics are available for the pre-Conquest period in Colombia. Statistics during the Colonial era were based on population counts for division of lands, taxation, and similar considerations. The first census was undertaken around 1770. Colombia's most recent census was in 1993, and another is being prepared for 2000. The censuses have been useful for development purposes despite their significant limitations of completeness and accuracy. Colombia's population in 1997 was estimated at 40,300,000, making it the third most populous country of Latin America after Brazil and Mexico. Fertility has declined considerably since 1965. Colombia's crude birth rate is believed to have exceeded 50/1000 in the 18th and 19th centuries and was estimated at 45/1000 by the Latin American Demographic Center for the first half of the 20th century. The crude birth rate was 41.3/1000 in 1968, 33.1/1000 in 1973, 30/1000 in 1980, and around 26/1000 in 1990 and 1995. The total fertility rate was estimated at 7.0 in 1960-65, 6.7 in 1969, 4.5 in 1973, 3.2 in 1985, and 2.9 in 1995. Fertility declined most appreciably before 1975, but rates continue to drop in rural as well as urban areas and in all geographic zones. For Colombia as a whole the total fertility rate is 4.8 for women with less than 5 years of schooling and 2.4 for those with 8 or more years. It is 2.7 in urban and 4.4 in rural areas.^ieng

Fertility remains high in Guatemala despite increasing use of contraception.

PIP: With a total fertility rate of 5.1, Guatemala has one of the highest levels of fertility in Latin America, according to findings from the 1995 DHS survey in Guatemala (Encuesta Nacional de Salud Materno Infantil--ENSMI-95). Fertility is lower among educated women, urban women, and Ladino women. The differences are most striking by education: on average, women with no formal education will have 7 children, compared with 2 or 3 children among women with at least some secondary education. Contraceptive use among currently married women increased from 23% in 1987 to 32% in 1995; however, this level of use is still low compared with other countries in the region. Almost half of contraceptive users (15%) rely on female sterilization; relatively few use the pill (4%) or the IUD (3%). It is estimated that 24% of married women want to space or limit their births but are not using a contraceptive method. The survey indicates that there have been improvements in most indicators of maternal and child health, but many challenges remain. Only about half of the women receive antenatal care and just one-third receive assistance at delivery from trained medical personnel. Less than half of the children aged 12-23 months have received all the recommended vaccinations, and half of the children under 5 years are malnourished (stunted). At the same time, infant mortality has shown a steady decline. In the 5-year period preceding the survey the infant mortality rate was 51/1000 live births (under-five mortality was 68/1000). The ENSMI-95 was implemented by the Instituto Nacional de Estadistica. A total of 12,403 women aged 15-49 years were interviewed. The final report and summary report are available in Spanish.^ieng

Spotlight: Bolivia.

PIP: Bolivia is one of the poorest and least developed countries in South America. As of mid-1997, the country's population was comprised of 7.8 million individuals spread across 418,680 square miles. Bolivia's population size is growing through natural increase at the rate of 2.6% per year, with 36 births and 10 deaths per 1000 population. Bolivia's total population size is projected to reach 13.2 million by 2025. The total fertility rate is 4.8 births per woman even though the 1994 Demographic and Health Survey found that only 45% of pregnancies were wanted and the average woman has reported wanting only 2.5 children. 42% of women at risk of pregnancy use some form of contraception, with 18% using a modern method. There are 71 infant deaths per 1000 live births, child mortality is especially high between ages 1 and 3 years due to widespread child malnutrition after weaning, 650 women die for every 100,000 births, and life expectancy is 59 and 62 years for men and women, respectively. Concern over the high infant and child mortality rates has led to increased interest in family planning in recent years and the government of Bolivia now provides some support for the distribution of contraceptives.^ieng

Spotlight: Nicaragua.

PIP: Nicaragua's previously moderate population growth accelerated after 1940 because of better health care and sanitary practices. Today the death rate is 6/1000, and birth rates remain high at 33/1000; natural increase equals 2.7% per year. Life expectancy for men and women is 62 and 68, respectively. 45% of the population is younger than 15 years. The total fertility rate is 4.6. It is higher among women with no formal education (6.9), and among rural women (6.4). 53% of women are pregnant or have at least 1 child by age 19. 35% of births occur within 2 years of an earlier birth. Although 97% of women aged 15-49 know about at least 1 form of modern contraception, only 49% who were in a union during 1992-1993 used a contraceptive. Rural women, especially those with lower educational status, have the least experience with contraceptives; 63% of urban women report contraceptive use, in comparison to 33% of rural women. Mortality rates for infants (49/1000) and children (72/1000) have decreased. The main causes of infant death are trauma or asphyxia at birth, and complications associated with premature or low-weight babies; those for children are dehydration (from diarrhea), acute respiratory infections, meningitis, and illnesses preventable with vaccines. About 75% of children are immunized, usually at a later age than recommended. The geography, climate, and ethnic composition of Nicaragua, and recent events affecting its economy are briefly described.^ieng

[The effect of contraception on fertility in the border region of Chiapas, Mexico]. / Effecto de las prácticas anticonceptivas sobre la fecundidad en la región fronteriza de Chiapas, México.

OBJECTIVE: To estimate the effect of contraception on fertility in the border region of Chiapas, Mexico. MATERIALS AND METHODS: In 1994 an epidemiological cross-sectional study was carried out on a representative sample of 1,560 non-indigenous women between ages 15 and 49 in the border region of Chiapas. The prevalence of contraception practices and the total fertility rates (TFR) were obtained and stratified by rural, intermediate and urban communities. TFR were compared between women who had never used contraceptives and those who had used them. RESULTS: The estimated TFR was 3.67 and varied from 4.14 in rural areas to 3.36 in urban areas. There were no differences in the TFR (3.74 and 3.88) nor in the average live births (3.47 and 3.48) between women who had never used contraceptives and those who had used them. CONCLUSIONS: The major effect of contraception on fertility was observed in rural areas. Factors which influence the small impact of contraception on fertility include the late use of these methods and the early age of first union among users.

PIP: The objective of this study was to estimate the effect of contraception on fertility in the border region of Chiapas, Mexico. In 1994, an epidemiological cross-sectional study was carried out on a representative sample of 1560 nonindigenous women between the ages of 15 and 49 years in the border region of Chiapas. The prevalence of contraception practices and the total fertility rates (TFR) were obtained and stratified by rural, intermediate, and urban communities. TFR were compared between women who had never used contraceptives and those who had used them. The estimated TFR was 3.67 and varied from 4.14 in rural areas to 3.36 in urban areas. There were no differences in the TFR (3.74 and 3.88) nor in the average live births (3.47 and 3.48) between women who had never used contraceptives and those who had used them. The major effect of contraception on fertility was observed in rural areas. Factors which influence the small impact of contraception on fertility include the late use of these methods and the early age of first union among users. (author's)