RESUMO
PIP: Trends in marital fertility according to rural or urban residence, wife's educational level, and husband's occupation are analyzed for 6 Latin American countries which participated in both the World Fertility Survey and Demographic and Health Surveys. The countries were Colombia, Dominican Republic, Ecuador, Mexico, Peru, and Trinidad and Tobago. The principal methodological tool for this analysis is a statistical model of period marital fertility which expresses fertility as a function of spacing, which is assumed to operate equally in all durations of union, and of limiting, which increases in importance as the duration of union increases. The model permits a summary description of the levels and patterns of marital fertility and yields parameters that may be interpreted in terms of basic behavioral mechanisms, such as lactation and contraception. Total marital fertility in the 6 countries decreased in the recent past, with the magnitude of decline varying from .4 births/woman in Trinidad and Tobago to 2.2 in Mexico. The results indicate that the transition originated in an educated urban minority and has spread to almost all strata studied. Most of the observed fertility decline resulted from birth limitation, but spacing played a surprisingly large role. Despite the diversity of conditions in the 6 countries, the indices of spacing and limiting in the different social strata appeared to have followed a single pattern of increase over time. Although the trajectory followed by the indices of spacing and limiting is sufficiently broad to accomodate substantial differences between the countries, it is well defined, indicating that a common explanation exists. It is demonstrated that the pattern of increase is consistent with a simple mathematical model of social diffusion.^ieng
Assuntos
Fatores Etários , Intervalo entre Nascimentos , Coeficiente de Natalidade , Comportamento Contraceptivo , Escolaridade , Emprego , Serviços de Planejamento Familiar , Fertilidade , Casamento , Modelos Teóricos , Características de Residência , População Rural , Mudança Social , Classe Social , Fatores Socioeconômicos , Estatística como Assunto , População Urbana , América , Região do Caribe , Colômbia , Anticoncepção , Demografia , Países em Desenvolvimento , República Dominicana , Economia , Equador , Geografia , América Latina , México , América do Norte , Peru , População , Características da População , Dinâmica Populacional , Pesquisa , América do Sul , Trinidad e TobagoRESUMO
Fertility, health, and family planning are not independent factors, but rather involve a series of biological and social mechanisms in close interaction with one another. The impact that a high fertility rate has on health is reflected mainly in a rise in the rates of maternal and child mortality. Similarly, fertility has a greater negative effect upon the health of groups characterized by high reproductive risk, high parity, short intergenesic intervals, and unwanted pregnancies. On the other hand, family planning -and specifically the use of contraceptive methods-helps to achieve a lowering of the fertility rate and also has a positive effect on maternal-child health. This situation can be observed in the case of Mexico, where fertility rates and tendencies, as well as maternal and child mortality, have been reduced during the past decade.
PIP: Little information is more significant in the field of public health than data on the size, territorial distribution, composition, and demographic behavior of the population. Health is dependent to a considerable extent on the same factors that determine whether population will increase, remain stable, or shrink. The relationship between health and fertility can most effectively be analyzed in countries where mortality has declined but fertility has remained at traditional high levels. Family planning has various impacts on health, including the effects of the methods themselves, the additional effects of family planning service delivery such as the clinical examination prior to prescription of oral contraceptives, effects that result from substituting contraception for abortion, the effects of declining fertility rates, and the effects of changes in reproductive patterns including increased birth intervals, changes in age distribution of births, and declining total parity of women. Each year throughout the world some 500,000 women die during pregnancy and delivery. 4 groups of factors have been identified as related to maternal mortality, including medical, health service, reproductive, and socioeconomic factors. Reproductive factors include maternal age, parity, personal medical and obstetric history, birth intervals, and body size, as well as undesired pregnancy and abortion. Important socioeconomic factors include nutrition, education, place of residence, and income. In Mexico the maternal mortality rate declined from 94/100,000 live births in 1980 to 81/100,000 in 1983, a 7.1% drop. Infant mortality, despite substantial underregistration, is also known to have declined, from an estimated 83.2/1000 live births in 1967-71 to 46.9 in 1982-87, a 43.6% decline. In 1984, rural infants still had mortality rates twice as high as urban infants, and the rural decline in infant mortality was much slower than the urban. Children of illiterate mothers had an infant mortality rate 3 times as high in 1984 as children of mothers with primary educations. Infant mortality rates were 50.9 for children of mothers under 20, 39.2 for mothers 20-29, and 72.3 for mothers 35 and over. Rates were 33/1000 for 1st order births, 36.2 for 2nd and 3rd order births, 55.6 for 4th- 6th order births, and 84.1 for 7th order and above. The infant mortality rate was 71.7 for births occurring less than 24 months after the preceding birth and 42.3 for those occurring 24-47 months later. Mexico's total fertility rate declined from 6.31 in 1973 to 3.84 in 1986, a decline of 40%. Higher educational status, labor force participation, and urban residence are associated with fertility decline. The proportion of fertile-aged women using some form of contraception increased from 47/7% in 1982 to 53% in 1987. Rural levels of contraceptive usage were much lower than urban levels. Mexico's experience demonstrates that family planning helps achieve a lowering of fertility and significant improvement in maternal and child health.
Assuntos
Fertilidade , Nível de Saúde , Saúde , Serviços de Planejamento Familiar/tendências , Humanos , Lactente , Mortalidade Infantil/tendências , Mortalidade Materna/tendências , MéxicoRESUMO
PIP: Better hygiene, nutrition, housing, health care and education are needed to prevent some of the estimated 15 million deaths in children under 5 and 500,000 maternal deaths that occur each year in the developing countries. The World Fertility Surveys and other studies beginning in the 1970s in Africa, Asia, the Middle East, and Latin America demonstrated the direct relationship between family planning and maternal and child mortality and morbidity. A child born in a high mortality country of Asia or Africa has a 20 times greater risk of dying before age 5 than a child in the US, Japan, or Sweden. Methods for reducing this mortality are known, including spacing of pregnancies, limiting family size, and avoiding pregnancy at unfavorable ages. During 1986, approximately 2 million children under 5 died from causes associated with rapid procreation and short birth intervals. It is estimated that 1 in 5 of these deaths would have been avoided if the interval between births had been longer. The high mortality rate is partly due to maternal exhaustion; mothers have insufficient time to recuperate between births, especially if they practice prolonged breast feeding, are undernourished, or engage in arduous physical labor. Inability to give high quality care to several children at a time may be another factor. From the 3rd birth on, women run 4 times greater risks of abortion or fetal death than in the 1st or 2nd pregnancy. The proportion of low birth weight babies increases significantly after the 4th child, explaining their vulnerability to health problems or death. Large family size may also prejudice the nutritional status of children. Infant mortality in the entire world in mothers under 20 is estimated at 126/1000 live births. The 1st child of an adolescent mother has an 80% greater probability of death than the 2nd or 3rd child of a mother aged 25-34 years. Lack of access to contraception and lack of motivation to use it are factors preventing tremendous infant mortality gains in the developing world. Only about 6000 of the estimated half million maternal deaths each year occur in developed countries. The indirect causes of maternal mortality are related to the unfavorable status of women reflected in poverty, illiteracy, lack of access to health care, and procreation patterns. The World Fertility Surveys indicate that 200,000 maternal deaths would be avoided each year if women not wanting more children had access to contraception. Contraceptive use would also prevent most of the estimated 100,000-200,000 maternal deaths from complications of abortion each year. The 4 basic elements of a maternal health program are primary care, prenatal care, attendance at delivery by trained personnel, and rapid access to emergency medical care.^ieng
Assuntos
Aborto Induzido , Intervalo entre Nascimentos , Causas de Morte , Países em Desenvolvimento , Serviços de Planejamento Familiar , Mortalidade Infantil , Idade Materna , Mortalidade Materna , Centros de Saúde Materno-Infantil , Mortalidade , Características da População , Gravidez na Adolescência , Cuidado Pré-Natal , Fatores Etários , Atenção à Saúde , Demografia , Fertilidade , Saúde , Serviços de Saúde , Serviços de Saúde Materna , Pais , População , Dinâmica Populacional , Atenção Primária à Saúde , Pesquisa , Comportamento SexualRESUMO
PIP: An estimated 15 million children under 5 die each year, most of them in developing countries. Some 1/2 million women die of causes related to pregnancy, leaving at least 1 million children orphaned. The World Fertility Surveys of the 1970s demonstrated the direct relationship between family planning and maternal-child health. Between 1985-2000, some 2 billion children are expected to be born, 87% of them in developing countries. Some 240 million will die before 5 years. The main causes of death in small children are acute diarrheal disease, respiratory infections, transmissible diseases preventable with vaccination, malaria, malnutrition, and high fertility. 3 aspects of reproduction have significant effects on child survival: spacing, parity, and maternal age. In 1986, approximately 2 million children under 5 died because of risks associated with rapid procreation, and it is estimated that 1/5 of all child deaths could have been prevented with longer birth intervals. Maternal exhaustion and the inability to give adequate care to several small children at once are believed to be the main causes. The problem of abortion or fetal death increases significantly beginning at the 3rd birth, and the proportion of low birth weight babies increases at the 4th birth. The risk of malnutrition increases in large families with limited resources. The safest ages for childbearing are 20-34 years; the worldwide infant mortality rate for mothers under 20 is about 126/1000. Adolescent mothers are at increased risk of problems in the pregnancy and delivery. Family planning can reduce risks related to spacing, family size, and maternal age, and also risk of congenital defects that increase for older mothers. According to the World Health Organization, each year there are some 500,000 maternal deaths, only 6000 of which occur in developed countries. Immediate causes of maternal death in developing countries include hemorrhage, sepsis, eclampsia, dystocic delivery, and induced abortion, but the underlying causes are related to the poor situation of the woman: poverty, illiteracy, lack of adequate prenatal health care, and childbearing at extreme ages. Estimates based on the World Fertility Survey suggest that if all women stating they wanted no more children used contraception, 30% of maternal deaths would be avoided. It is estimated that some 15 million women undergo induced abortions each year, with 100,000-200,000 resulting deaths.^ieng
Assuntos
Aborto Criminoso , Intervalo entre Nascimentos , Causas de Morte , Proteção da Criança , Países em Desenvolvimento , Serviços de Planejamento Familiar , Mortalidade Infantil , Idade Materna , Mortalidade Materna , Bem-Estar Materno , Mortalidade , Aborto Induzido , Fatores Etários , Demografia , Saúde , Pais , População , Características da População , Dinâmica PopulacionalRESUMO
PIP: The total fertility rate of women in El Salvador has declined from an average of 6 children per woman in the 1970s to 4.4 in 1985, according to the Demographic and Health Survey report by Westinghouse's Institute for Resource Development. 5200 women aged 15-49, from areas covering 75-80% of the country, were surveyed. Contraceptive usage has risen from 34 to 47%. The usual method chosen is sterilization, by 70% of women. Only 7% of married women use the pill, 3% the IUD, 3% rhythm or withdrawal. Rural women, making up the majority of the population, accounted for a decline in total fertility from 8.4 to 5.9 children. In the capital San Salvador, fertility has risen from 2.6 to 3.3 children, reflecting migration of rural people into the city. The instability in El Salvador is probably responsible for a lowered life expectancy from 60 to 57 years, and for heavy out migration in the 1980s. Vaccination rates have improved recently to 47% of children under 5 years.^ieng
Assuntos
Coeficiente de Natalidade , Comportamento Contraceptivo , Anticoncepcionais Orais , Demografia , Serviços de Planejamento Familiar , Fertilidade , Inquéritos Epidemiológicos , Dispositivos Intrauterinos , Dinâmica Populacional , Pesquisa , Comportamento Sexual , Esterilização Reprodutiva , América , América Central , Anticoncepção , Países Desenvolvidos , Países em Desenvolvimento , El Salvador , Saúde , América Latina , América do Norte , PopulaçãoRESUMO
PIP: In light of the data obtained in the Demography and Health Survey currently under way, a new level has been calculated for the current unmet needs for family planning. This analysis allows a calculation of the potential demand for contraceptives for birth limiting or birth spacing, and includes the pregnant or amenorrheic women whose last pregnancy was unintentional. According to the new calculation, the unmet demands in 5 Latin American countries varies from 15% of married women in Brazil and Colombia, to 21% in the Dominican Republic and Ecuador, and 29% in Peru. In all these countries, the unmet need for contraceptives is greater among women who wish to limit births, compared to women desiring birth spacing, except in the Dominican Republic, where sterilization is very widespread. The greatest unmet needs are found among younger women and rural women, and it decreases significantly with educational level. To determine the level of desire for contraception during the decade before the survey, a computation was done for the 4 countries included in the Worldwide Survey of Fertility. A large decrease in the level of unmet desire for contraception was found over that time period, from 20% in Peru, to 55% in Colombia.^ieng
Assuntos
Intervalo entre Nascimentos , Coeficiente de Natalidade , Demografia , Serviços de Planejamento Familiar , Planejamento em Saúde , Necessidades e Demandas de Serviços de Saúde , Modelos Teóricos , Pesquisa , Estatística como Assunto , América , Brasil , Região do Caribe , Colômbia , Anticoncepção , Países Desenvolvidos , Países em Desenvolvimento , República Dominicana , Economia , Equador , Escolaridade , Fertilidade , América Latina , América do Norte , Organização e Administração , Peru , População , Características da População , Dinâmica Populacional , Gravidez , População Rural , Comportamento Sexual , América do Sul , População UrbanaRESUMO
PIP: M. Peter McPherson, the administrator of the US Agency for International Development, believes that international assistance for family planning programs is necessary to reduce the number of abortions in the world. When couples desire fewer children and family planning services are unavailable, they frequently have recourse to abortion even when the practice is illegal. Data from some countries of Asia and Latin America indicate that 1 of every 3 women have had abortions, many of which would have been avoided if family planning services had been available. An estimated 360,000 abortions have been avoided in Mexico since the governmental family planning program began in 1972. The number of Chilean women seeking treatment for complications of illegal abortion has declined substantially since modern family planning methods became available in 1965. The health and survival of mothers and children is another important reason for supporting family planning. Studies in 26 countries confirm that children born within 2 years of the previous birth have a risk of death twice that of children born 2 or 3 years after the last birth. Mortality among children under 4 would be reduced by 21% if all births were spaced at least 2 years apart. At least 200,000 maternal deaths each year are attributable to too many pregnancies or to pregnancy at too young or old an age. The desire of many Third World families to have fewer children is not merely a product of western speculation, but is confirmed in surveys which demonstrate that couples are unable to limit or space their children because of lack of family planning services. Even though careful study has not yet clarified the exact relationship between population and economic growth, the impact of population growth on the economy is unquestionable. It is rarely argued that rapid population growth contributes to economic development. Family planning would contribute to economic growth by reducing population pressure.^ieng