Fertility and reproductive health: examining links with the environment

Demographic and public health studies have indicated urban-rural differences in the utilization of antenatal care services. However, factors accounting for the urban-rural differentials in Antenatal Care use are unknown. The study used the 2008 Nigeria Demographic and Health Survey (NDHS) to examine the factors associated with the urban-rural differences in antenatal care utilization in Nigeria. Rural poor, rural non-poor, urban-poor and urban-non-poor models of antenatal care utilization were used in the study. Findings revealed a strong urban-rural differential in antenatal care utilization. The chi-square analysis showed that more urban-non-poor women received antenatal care (87.97%) than urban-poor (61.01%), rural non poor (75.77%) and rural poor women (34.62%). The logistic regression analysis revealed that women’s education and partner’s educational status are strong determinants of differentials in antenatal utilization across the four models in Nigeria. Other significant determinants are region, age of mothers, distance to health facility and number of living children with varying patterns across the four models.

This paper examines the relationship between household income shocks and fertility decisions. Using panel data from Tanzania, we estimate the impact of agricultural shocks on contraception use, pregnancy, and the likelihood of childbirth. To account for unobservable household characteristics that potentially affect both shocks and fertility decisions we employ a fixed effects model. Households significantly increase their contraception use in response to income shocks from crop loss. This comes from an increased use of both traditional contraceptive methods and modern contraceptives. The poorer the household the stronger the effect of income shock on contraceptive use is. Furthermore, pregnancies and childbirth are significantly delayed for households experiencing a crop shock. For both pregnancy and childbirth the likelihood of delay as a result of shocks increases the poorer the household. We argue that these changes in behavior are the result of deliberate decisions of the households rather than income shocks' effects on other factors that influence fertility, such as women's health status, the absence or migration of spouse, and dissolution of partnerships.

Studies on Infertility and its cure in Nigeria have focused largely on traditional, spiritual and orthodox approaches while bio-technology and other Assisted Reproductive Technologies (ART) as treatment options have received negligible attention. Employing both qualitative and quantitative data collection techniques, the study established that several socio-cultural factors encapsulated in patriarchy had impinged on the acceptance and adoption of bio-technological intervention.
The study found that education (χ2 =8.50,df =8,N=732,P>0.05), gender(χ2 =0.09,df =2,N=732,P>0.05) and age (χ2 =1.6,df=4,N=732,P>0.05) respectively have no significance on the acceptability of ART, but ethnographic data revealed otherwise. Income(χ2=276.741,df=8,N=732,P>0.05), cultural belief (χ2=481.823,df=4,N=732,P>0.05), patriarchal relation (χ2=538.043,df=6,N=732,P>0.05), family support (χ2=533.04,df =6,N=732,P>0.05) and location of the care centre (χ2 =0.808,df =2,N=732,P>0.05) act as strong determinant of acceptability of ART

Birth weight below 2500 gr significantly increases chances of infant death and morbidity in childhood and adulthood. Birth weight above 4500 grams has been linked to perinatal complications and ill health later on. Identification of mediators is crucial in reducing infant mortality and health care expenditure. The present study examines associations of socio-demographic factors and immigrant status of the parents with adverse pregnancy outcomes, using multinomial regression modelling of 828,975 births of singletons occurring in Hong Kong over 1995-2009. The analysis considers VLBW (<1500 gr), LBW ( 1500 gr & <2500) and HBW births ( 4500 grams) in comparison to births of normal weight ( 2500 gr & <4500).
The findings indicate the expected significant adverse associations between female gender, primiparity and teenage and advanced age of the mother with compromised birth outcomes. A strong socio-economic gradient is apparent, more marked among LBW births. Regarding immigrant status, women born in South and South-East Asia exhibit consistently higher odds of a compromised outcome. Women born in Hong Kong have significantly higher chances of LBW births while Mainland Chinese and parents from developed countries face higher odds of HBW births. The study identifies vulnerable groups of population in need of support.

The “social gradient to Indian population growth” - whereby people belonging to groups higher up the social ladder had better family planing outcomes than those belonging to groups further down - is essentially a Western construct; there has been very little investigation into whether, in developing countries also. The purpose of this paper is to evaluate the relative strengths of economic and social status in determining the family planing status of persons in India. In other words, even after controlling for non-community factors, did the fact that Indians belonged to different social groups, encapsulating different degrees of social status, exercise a significant influence on the state of their family size? The existence of a social group effect would suggest that there was a “social gradient” to family planing outcomes in India. In investigating this, the paper addresses, in the Indian context, an issue which les at the heart of social epidemiology: estimating the relative strengths of individual and social factors in determining family planing outcomes.
Although a Hindu-Muslim differential in fertility has persisted in India, it is no more than one child, and even this gap is not likely to endure as fertility among Muslims declines with increasing levels of eduation and standards of living.

This study examines the relationship between sexual behaviour and living conditions among adolescent residents of Iwaya, a slum in Lagos, Nigeria. One of the world’s fastest growing cities, Lagos has an estimated population of 16 million. Its unprecedentedly rapid population growth without a commensurate economic expansion has given rise to a disproportionate growth in the number of underpriviledged people within the city. These poor people are forced to reside in any of the over 100 slums, -areas typified by high-density housing and squalid surroundings-, that dot the metropolis. The extreme poverty and desperate social conditions in slum areas have severe health implications for women and adolescent girls. In particular, living in overcrowded slum dwellings is linked with risky sexual behavior among adolescents. In this study, quantitative and qualitative data from a 2011 study reveal that out-of-school adolescent girls residing in Iwaya slum, initiate sex at earlier ages and have more sexual partners than their counterparts nationwide. Contextual evidence from Focus Group Discussions corroborates quantitative data. These findings suggest that any intervention to ameliorate reproductive health behaviour of impoverished girls need to be accompanied with efforts to improve their economic circumstance.

It has been shown that detrimental birth contexts, for instance famines, can exert long-lasting effects over female fertility outcomes. Such events, however, are rare, too extreme with respect to the strength of exposure, and therefore offer few policy implications. Moreover, they instrument just one feature of birth environments – nutritional shortage. The role of non-acute characteristics of birth contexts which encompass more than just the effects of under-nutrition for entry into motherhood is still unknown. This study relates first-time fertility with non-extreme, exogenously-determined contextual characteristics of female birth environments captured by regional-level infant mortality in Sweden in 1970-1976. Doing so allows us to asses not just the nutritional effects, but rather the totality of early health environments, taking pollution, standard of living, and infectious disease burden also into account. Our preliminary results indicate that even mildly severe birth contexts are associated with a reduced hazard of transitioning into motherhood.

Despite the high maternal mortality ratio in Nigeria, utilization of maternal health care services has remained poor. Attempts to explain this situation have focused on individual and household determinants. The role of community characteristics has been largely ignored. Given that individuals live within households and households are embedded within communities, and the fact that individual decisions can be influenced by community characteristics, it becomes imperative to look beyond familial factors influencing the decisions to seek maternal health care. We examined community-level determinants of antenatal and delivery care in Nigeria. The sample population consists of women aged 15-49 years drawn from 2008 Nigeria Demographic and Health Survey. Multilevel models were fitted to identify community factors associated with the use of antenatal and delivery care. Findings indicated that residence in communities with high proportion of women who delivered in a health facility was significantly associated with higher odds of having four or more antenatal care visits (OR=4.2, p<0.001) and health facility delivery (OR=17.2, p<0.001). Findings suggest the need to tailor interventions to the community context and increase women’s education and health facility delivery in disadvantaged communities.

Preterm birth (PTB) remains a major cause of neonatal morbidity and mortality. The pathogenesis of the earliest preterm birth may be affected by bacterial intaurine infections but also still remain not fully elucidated. In high-income countries, it is standard practice to give antibiotics to women with pre-term, pre-labour rupture of membranes (pPROM) to delay birth and reduce the risk of infection. Contradictory findings in efficiency of therapeutic effects on antibiotic therapy will be provided by preliminary therapeutic studies. Multiple births are rarely being subjects of clinical and biodemographic studies. The main purpose of our retrospective study is to analyze the biodemographic mechanism of antibiotic therapy on neonatal vital health outcomes in multiple births with clinical birth registry data from a German University Hospital, collected in between 2006-2011. The data set with more over 581 multiple birth outcomes also provide individual and completely documented biodemographic information on the mothers and infants.

The connections between mortality and fertility have far-reaching implications – for broad subjects like population growth, family building and increasingly, the study of natural disaster. Scholars have long posited familial mechanisms that raise fertility in response to mortality increase, including the “replacement” effect, in which parents increase fertility following a child’s death to achieve a desired family size. Despite having a strong theoretical foundation, the volitional replacement effect has slim empirical support. The gap in evidence is often attributed to the methodological challenge of identifying a causal, behavioral fertility response to shifts in mortality. We revisit the replacement question in the context of an unexpected environmental mortality shock: the 2004 Indian Ocean tsunami. We analyze detailed longitudinal, population-representative data collected before and after the tsunami in Indonesia. Using satellite measures of environmental destruction, we demonstrate a substantial and sustained fertility increase attributable to the tsunami. With data on fertility intentions, family mortality, and women’s completed fertility by 2009, we find robust evidence of a volitional replacement effect. We conclude with a discussion of the implications for disaster-afflicted populations.