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Background: Earlier studies have proposed a link between the Interpregnancy Interval (IPI) and unfavorable birth outcomes. However, it remains unclear if the outcomes of previous births could affect this relationship. We aimed to investigate whether the occurrence of adverse outcomes-small for gestational age (SGA), preterm birth (PTB), and low birth weight (LBW)-at the immediately preceding pregnancy could alter the association between IPI and the same outcomes at the subsequent pregnancy. Methods: We used a population-based linked cohort from Brazil (2001-2015). IPI was measured as the difference, in months, between the preceding birth and subsequent conception. Outcomes included SGA (<10th birthweight percentile for gestational age and sex), LBW (<2500 g), and PTB (gestational age <37 weeks). We calculated risk ratios (RRs), using the IPI of 18-22 months as the reference IPI category, we also stratified by the number of adverse birth outcomes at the preceding pregnancy. Findings: Among 4,788,279 births from 3,804,152 mothers, absolute risks for subsequent SGA, PTB, and LBW were higher for women with more adverse outcomes in the preceding delivery. The RR of SGA and LBW for IPIs <6 months were greater for women without previous adverse outcomes (SGA: 1.44 [95% Confidence Interval (CI): 1.41-1.46]; LBW: 1.49 [1.45-1.52]) compared to those with three previous adverse outcomes (SGA: 1.20 [1.10-1.29]; LBW: 1.24 [1.15-1.33]). IPIs ≥120 months were associated with greater increases in risk for LBW and PTB among women without previous birth outcomes (LBW: 1.59; [1.53-1.65]; PTB: 2.45 [2.39-2.52]) compared to women with three adverse outcomes at the index birth (LBW: 0.92 [0.78-1.06]; PTB: 1.66 [1.44-1.88]). Interpretation: Our study suggests that women with prior adverse outcomes may have higher risks for adverse birth outcomes in subsequent pregnancies. However, risk changes due to differences in IPI length seem to have a lesser impact compared to women without a prior event. Considering maternal obstetric history is essential in birth spacing counseling. Funding: Wellcome Trust225925/Z/22/Z.
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BACKGROUND: Short interpregnancy intervals (IPI) are associated with poor birth outcomes. Often, only livebirths are considered to estimate IPI. The objective of our work is to explore whether the associations between demographic, behavioural, and pregnancy variables and IPI change when events other than livebirth are included. METHODS: We used data from the 2006-10 and 2011-13 period of the National Survey of Family Growth (NSFG). We defined IPI using the conception date of the index pregnancy and the event date of the previous one ending in (i) livebirth; (ii) stillbirth; (iii) miscarriage; (iv) abortion; or (v) any of these events. Risk ratios (RR) were estimated for short IPI (<18 months), and demographic, pregnancy, and behavioural variables using log-linear models. RESULTS: When intervening events are included, the association between short IPI and its predictors vary by definition, especially for unintended versus intended pregnancies (only livebirth risk ratio [RR] 1.34, 95% confidence interval [CI] 1.2, 1.5) versus livebirth and miscarriage RR 1.14, 95% CI 1.0, 1.3) and women older than 30 vs. younger than 20 at resolution of the previous pregnancy (only livebirth RR 1.22, 95% CI 1.0, 1.5 versus livebirth and miscarriage RR 1.36, 95% CI 1.2, 1.6). CONCLUSIONS: Including miscarriage as an intervening event in the calculation of IPI changes the association between several risk factors and short IPI. However, the association between short IPI and preterm birth does not vary when different IPI calculations are used.
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Intervalo entre Nascimentos/estatística & dados numéricos , Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo/epidemiologia , Adolescente , Adulto , Interpretação Estatística de Dados , Feminino , Humanos , Razão de Chances , Gravidez/psicologia , Gravidez/estatística & dados numéricos , Resultado da Gravidez , Fatores de Risco , Natimorto/epidemiologia , Inquéritos e Questionários , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Introduction Our aim was to identify beliefs about and specific barriers to use of birth spacing methods that married and cohabitating women in the Trifinio Sur-Oeste region of Guatemala report in order to design future family planning educational programs. Methods We conducted key informant interviews with community health workers and focus groups with married or cohabitating women. We used inductive and deductive coding to identify common themes. Using these themes, we created explanatory models for decision-making context and identified barriers to family planning use, community educational needs, and potential interventions. Results Thirty-seven women, aged 20-47 years, with an average of 3.5 children and a 2nd grade education level, were included in focus groups. Women had accurate knowledge about benefits of birth spacing however had poor knowledge of family planning methods. Most common barriers included lack of spousal approval, difficulty accessing contraceptive methods, lack of knowledge, and fear of adverse effects. Women were interested in increased education for men, adolescents, and themselves. Discussion Targeted education for women, men, and adolescents is needed to improve family planning uptake in the Trifinio region. Programming should focus on increasing knowledge and acceptability of birth spacing methods and increasing constructive dialogue among couples.
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Atitude Frente a Saúde , Agentes Comunitários de Saúde , Comportamento Contraceptivo , Características da Família , Serviços de Planejamento Familiar/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Intervalo entre Nascimentos , Feminino , Guatemala , Acessibilidade aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Casamento , Pessoa de Meia-Idade , Pesquisa QualitativaRESUMO
RESUMEN ANTECEDENTES: El período intergenésico es importante para la planificación de embarazos subsecuentes a partos, cesáreas y abortos. Actualmente existe falta de consenso en cuanto a las definiciones e importancia clínica de la duración del periodo intergenésico; por lo que se realiza esta revisión de la literatura para definir conceptos. MÉTODO: Se realizó una búsqueda bibliográfica en Pubmed y Medline, con periodo de búsqueda del 19992017, con el propósito de identificar publicaciones de relevancia relacionadas a periodo intergenésico. RESULTADOS: Entre los artículos seleccionados, se incluyeron de tipo revisión, originales y guías de práctica clínica. Se considera periodo intergenésico aquel que se encuentra entre la fecha del último evento obstétrico y el inicio del siguiente embarazo. Se sugiere como tiempo recomendado de espera para iniciar un siguiente embarazo mínimo 18 meses (Periodo intergenésico corto, PIC) y no más de 60 meses (Periodo intergenésico largo, PIL), para reducir el riesgo de eventos adversos maternos, perinatales y neonatales. Se debe enfatizar que aunque la dehiscencia de histerorrafia es una grave complicación del PIC menor a 6 meses posterior a una cesárea, no es su única complicación. De igual manera es importante tomar en cuenta el PIL durante la evaluación obstétrica, debido a su asociación con preeclampsia. CONCLUSIONES: Es relevante conocer la terminología adecuada en período intergenésico para evitar complicaciones asociadas a PIC como a PIL. Existe necesidad de estudios clínicos sobre período intergenésico que permitan conocer más consecuencias a corto y largo plazo en nuestra población y tomar medidas para mejorar el desenlace materno-fetal.
ABSTRACT BACKGROUND: Interpregnancy interval is a topic of importance when planning new pregnancies after previous vaginal delivery, cesarean section or abortion. There is currently a lack of consensus in terms of definitions and the clinical importance of interpregnancy interval length, which is the reason to perform a literature review to clarify concepts. METHODS: Published papers from 1999 to 2017 from PubMed/MEDLINE were searched with the purpose of identifying those related to interpregnancy interval. Review articles, original papers, and clinical guidelines in relation to short and long interpregnancy interval were considered. RESULTS: Interpregnancy interval is defined as the period between the last obstetric event and the beginning of the next pregnancy (last menstrual period). Recommended time to initiate the next pregnancy must be at least 18 months (short interpregnancy interval, SII) and no more than 60 months (long interpregnancy interval, LII) to reduce the risk of adverse maternal, perinatal and neonatal outcomes. It is important to emphasize that even though uterine scar dehiscence is a serious complication of SII less than 6 months after a cesarean section, it is not the only complication. It is important to consider LII during obstetric evaluation, due to its association with preeclampsia. CONCLUSION: It is clinically relevant to know the correct definitions of SII and LII to avoid their complications. There is also a need for clinical trials about interpregnancy interval within our population in order to better understand the consequences of SII and LII, thus taking the necessary measures to improve maternal and fetal outcomes.
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Humanos , Feminino , Adulto , Intervalo entre Nascimentos , Complicações na Gravidez/epidemiologia , Trabalho de Parto , Resultado da Gravidez , Fatores de RiscoRESUMO
BACKGROUND: Women with a history of pre-eclampsia have a higher risk of developing pre-eclampsia in subsequent pregnancies. However, the role of the inter-pregnancy interval on this association is unclear. OBJECTIVE: To explore the effect of inter-pregnancy interval on the risk of recurrent pre-eclampsia or eclampia. SEARCH STRATEGY: MEDLINE, EMBASE and LILACS were searched (inception to July 2015). SELECTION CRITERIA: Cohort studies assessing the risk of recurrent pre-eclampsia in the immediate subsequent pregnancy according to different birth intervals. DATA COLLECTION AND ANALYSIS: Two reviewers independently performed screening, data extraction, methodological and quality assessment. Meta-analysis of adjusted odds ratios (aOR) with 95 % confidence intervals (CI) was used to measure the association between various interval lengths and recurrent pre-eclampsia or eclampsia. MAIN RESULTS: We identified 1769 articles and finally included four studies with a total of 77,561 women. The meta-analysis of two studies showed that compared to inter-pregnancy intervals of 2-4 years, the aOR for recurrent pre-eclampsia was 1.01 [95 % CI 0.95 to 1.07, I(2) 0 %] with intervals of less than 2 years and 1.10 [95 % CI 1.02 to 1.19, I(2) 0 %] with intervals longer than 4 years. CONCLUSION: Compared to inter-pregnancy intervals of 2 to 4 years, shorter intervals are not associated with an increased risk of recurrent pre-eclampsia but longer intervals appear to increase the risk. The results of this review should be interpreted with caution as included studies are observational and thus subject to possible confounding factors.
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Intervalo entre Nascimentos , Medicina Baseada em Evidências , Pré-Eclâmpsia/prevenção & controle , Adulto , Estudos de Coortes , Bases de Dados Factuais , Eclampsia/epidemiologia , Eclampsia/etiologia , Eclampsia/prevenção & controle , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Estudos Observacionais como Assunto , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Recidiva , Risco , Prevenção Secundária , Parceiros SexuaisRESUMO
A procedure for assessing birth spacing goals, an important component of fertility preferences, is proposed and applied to 1993 Costa Rican data. Based on a reverse or backward survival analysis, preferred birth intervals are estimated to range between 3.5 and 4.5 years (1.5 years for the interval union to first birth). These intervals are 2 or 3 years shorter than crude estimates from data on open or last closed intervals, which are upwardly biased by selection and left censoring effects. To achieve these spacing preferences, a cohort must spend about two-thirds of the time using contraception (one-third in the interval union to first birth). An inverse association between desired family size and desired birth interval is evident only in parity-specific analyses.
PIP: Couples may use contraception in order to stop childbearing once they have borne their desired number of children and/or to lengthen birth intervals. A procedure for assessing birth spacing goals is proposed and applied to data collected in the 1992-93 Costa Rican Reproductive Health Survey (ESR). The ESR is a nationally representative, Demographic and Health Survey-type survey of approximately 3600 women aged 15-49 years. Based upon backward survival analysis, preferred birth intervals are estimated to range between 3.5 and 4.5 years, 2-3 years shorter than crude estimates of intervals using data on open or last closed intervals, which are upwardly biased by selection and left censoring effects. To achieve these spacing preferences, couples must spend about 40% of their time using contraception. An inverse relationship was identified between desired family size and desired birth interval in only parity-specific analyses.
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Intervalo entre Nascimentos , Costa Rica , Inquéritos Epidemiológicos , Humanos , Estudos RetrospectivosRESUMO
This report approaches the concept of quality of care by looking at the covariates of sterilization regret in the Dominican Republic according to the results from the 1991 Demographic and Health Survey. The main variables observed are the women's satisfaction with sterilization, their decisionmaking process, sterilization experience, use of family planning, and socioeconomic characteristics. The more detailed measurement and analysis of the outcomes of care point to a need for improvement in the public program effort with regard to sterilization. Substantial proportions of women were sterilized who were younger than 30, who had three or fewer living children, and who had the operation before they had used any other method of contraception. Because a greater proportion of sterilization regret is observed among these groups, women must be enabled to make a free and informed decision about sterilization by means of programs that offer a more balanced choice of methods, as well as better counseling, education, and access to high-quality services.
PIP: A quality of care study examined the covariates of sterilization regret by analyzing data from the 1991 Demographic and Health Survey for the Dominican Republic. The leading contraceptive method was female sterilization (about 40% of women in union) followed by oral contraceptives (10%). Over time, an increasing number of younger women chose sterilization. In fact, 60% of all sterilized women underwent sterilization when they were younger than 30. Almost 40% of women in union who underwent sterilization when they were younger than 30 had no more than three living children. Sterilization was the first and only contraceptive method that 34% of sterilized women in union had ever used. 56% of them were younger than 30. 44% had fewer than four children. These women were more likely to report regret, dissatisfaction with their decision to undergo sterilization, and to not choose sterilization again than did all respondents (11% vs. 5%). Some variables significantly associated with dissatisfaction and regret were: age; no other modern family planning methods used; reasons for sterilization (recommended by medical/family planning worker and side effects/health concerns); a less than 6 month interval between last birth and sterilization; sterilization was first method used; family size less than four; sterilized at delivery; and sterilization was discussed with husband. These findings suggest a need for the family planning program to provide information about all contraceptive methods and their effective use, quality counseling, and access to high quality services to optimize levels of satisfaction among clients.
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Atitude Frente a Saúde , Países em Desenvolvimento , Emoções , Garantia da Qualidade dos Cuidados de Saúde , Esterilização Tubária/psicologia , Adolescente , Adulto , Comportamento Contraceptivo , República Dominicana , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-IdadeRESUMO
Fang women are known to practice virtually no contraception but for them induced abortion is not an acceptable option. Their reproductive behaviour consequently is governed by the ability to conceive, spontaneous intrauterine mortality and child spacing (due to prolonged breast-feeding and sexual abstinence). In a sample of 587 women from one hospital and one clinic in Nsork, there was a positive correlation between maternal age and the number of pregnancies, resulting in a mean of 5.52 pregnancies per female and one child born every 2.5 years. The reported spontaneous abortion rate was 28.6%.
PIP: Data were collected in the only hospital built in the Nsork district of Equatorial Guinea. Group A comprised deliveries at Nsork Hospital from March 1988 to July 1990 (29 months). Maternal age, number of previous pregnancies, and number of fetal losses from the fourth month of pregnancy were recorded. The total sample comprised 157 women aged 15-40 years who had a total of 555 pregnancies. Group B data were collected from May 1987 to December 1988 (20 months) from the prenatal clinic at a primary health post from a total of 430 pregnant women aged 14-45 years. Group A women represented 15.6% of all women in the district between 15 and 39 years of age; Group B, 36.5% between 15 and 44 years of age. There was a high level of prenatal attendances in Group B; however, only 20.2% of clinic visitors gave birth at the hospital. In Group A, the number of reported pregnancies continued to rise in direct relation to the woman's age (correlation coefficient r = .91). The reproductive age range of this population was 15 to 40 years with a mean of 5.52 pregnancies. The average number of reported abortions per female was .48 for each age group (p .05). The total incidence of fetal loss was 28.3%, 23.9% of which was reported by women with one abortion and 4.4% by women with at least two abortions. Group A had effective child spacing, achieved by a combination of sexual abstinence and prolonged breast feeding. Sexual abstinence was practiced after the seventh month of pregnancy until breast feeding ceased, and breast feeding was continued until the newborn was aged 16-21 months. The pattern of child spacing calculated from the regression between mean number of conceptions per woman and maternal age (r = .91, p .05) was around one pregnancy every 30 months. The data represented a population with close to natural fertility, since their reproduction was not deliberately controlled and there was no cessation of reproduction once the desired family size had been attained.
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Aborto Espontâneo/epidemiologia , Intervalo entre Nascimentos , Aleitamento Materno/estatística & dados numéricos , Gravidez/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Aleitamento Materno/psicologia , Coleta de Dados , Guiné Equatorial/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , ParidadeRESUMO
PIP: Results of two national surveys were used to study regional patterns of breast feeding and their relationship to birth spacing and infant mortality in Peru. Estimates of the duration of breast feeding were based on the 1984 National Survey of Nutrition and Health. The 1986 Demographic and Family Health Survey (DHS) was the basis for an analysis of factors associated with short durations of breast feeding and of the effect of breast feeding on birth spacing and infant mortality. Mothers who had ever used contraception were excluded from the segments based on the DHS data. Prevalence and life table methods were used to determine regional patterns of breast feeding. The study of risk factors for short duration of breast feeding used a retrospective cohort study comparing infants breast feeding for less than or more than 12 months using bivariate analysis. The effect on birth spacing was assessed using a life table methodology. The infant mortality rate was calculated for the 199 children born between 1980 and 1984 to mothers not using contraception. The duration of breast feeding was relatively short in Lima, perhaps because of the importance of the middle and upper socioeconomic strata. Breast feeding was prolonged in the sierra and of intermediate duration in the lowlands. The coastal area outside of Lima appeared to have an adequate duration of breast feeding. Birth order of 4 or under and urban residence were the only factors significantly related to breast feeding for less than one year. Prolonged lactation was associated with longer birth intervals in women who never used contraception. The median birth interval was increased by around five months according to the life table applied to children born between 1980 and 1984 to women interviewed in the DHS. Prolonged lactation was associated with lower mortality among infants of mothers not using contraception. Infants breast feeding for less than a year had a relative risk of mortality of 3.6 on the coast and 2.7 in the sierra or lowlands. Promotion of breast feeding, it would appear, offers a cost-effective response to the two serious problems of short birth intervals and high infant mortality.^ieng
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Intervalo entre Nascimentos , Aleitamento Materno , Demografia , Geografia , Mortalidade Infantil , Inquéritos Nutricionais , População Rural , Fatores de Tempo , População Urbana , América , Países em Desenvolvimento , Serviços de Planejamento Familiar , Saúde , Fenômenos Fisiológicos da Nutrição do Lactente , América Latina , Mortalidade , Fenômenos Fisiológicos da Nutrição , Peru , População , Características da População , Dinâmica Populacional , América do SulRESUMO
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
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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
Ten independent variables were used to predict death before the first birthday for 4411 births that took place from 1878 to 1976 to 978 women of native ancestry on the island of St. Barthélemy. Significant predictors of death include the death of the mother within a year, the birth year, multiple birth, whether the preceding child also died before 1 year of age, and whether the next child was conceived before the index child was 1 year old. Unlike most prior studies, birth-spacing variables were only weakly related to death in the first year. The relative absence of contraceptive techniques to control birth spacing in the study population and the use of vital records rather than survey data distinguish this project from others and may account at least partly for the unusual findings.
PIP: A study of infant mortality using vital records from the Caribbean island of St. Bart, including 4411 births to 978 island-born women from 1878 to 1976, produced some atypical results. The population comprises poor subsistence farmers with a French culture with virtually no socioeconomic variation or modern contraception throughout the period. Stepwise multiple regression analysis was performed on the following 11 independent variables: birth year, birth order, mother's age at birth, child's sex, sex of previous child, preceding birth interval, previous child's death at less than 1 year, previous child was living at time of child's conception, next child was conceived while index child was living, mother's death during child's 1st year, and single or multiple pregnancy. Significant predictors of infant mortality were: mother's death within 1 year, birth year, multiple year, whether the preceding child died before 1 year of age, and whether the next child was conceived before the index child reached 1 year. This study, which did not rely on interview data, was remarkable for no significant effect of birth spacing variables. Maternal death was highly significant, a finding that rarely appears in interview surveys. Use of vital records and the interpretation of the determinants of birth spacing and infant death were discussed.
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Intervalo entre Nascimentos , Mortalidade Infantil/tendências , Análise de Regressão , Atestado de Óbito , Feminino , Fertilização , Humanos , Recém-Nascido , Mortalidade Materna , Valor Preditivo dos Testes , Gravidez , Gravidez Múltipla , Índias Ocidentais/epidemiologiaRESUMO
The effects of birth spacing on neonatal and post-neonatal mortality in Brazil were found to be very consistent with models based on data from other South American countries. The model for neonatal mortality simplified to three significant variables, whereas the model for post-neonatal mortality included four significant interactions.
PIP: Researchers used 1986 data from the Brazil Demographic and Health Survey to determine the effects of birth spacing on neonatal and post neonatal mortality then compared the results with other countries (World Fertility Survey). 1st births had a higher relative risk (RR) of neonatal death (1.49) than births of order 203 Brazil. A similar pattern existed for Peru, Ecuador, Costa Rica, Colombia, and Guyana. In Brazil, 4-6 birth order had the lowest risk (.62). High order births (7+) for all the countries had an RR almost the same as the baseline 2-3 birth order class. Birth order was significant (p.01). Post neonatal mortality for 1st births in Brazil was more favorable than other countries, but the RR for high order births was less favorable. The RR of neonatal mortality declined with mother's education for Brazil (p.05) as well as it did for Peru, Ecuador, Colombia, and Costa Rica. It did not fall in Guyana, however, where it was elevated (1.19) for mothers with 4-6 years of schooling. The positive effect of maternal education was even stronger for post neonatal mortality in Brazil (.62 for 4.6 years and .27 for 7+ years). The effect was basically the same for all the countries, but mothers with 4-6 years of education in Guyana (1.03) had slightly higher post neonatal mortality. The RR of neonatal mortality for the index child if there were 1 surviving sibling born 0-2 years earlier was only slightly increased (1.25) in Brazil, but if there were 1 dead sibling born 0-2 years earlier, RR stood at 2.4 and was significant. This RR rose further if 2 or more children were born in this interval (3.71). For infants in Brazil who had 2+ siblings born 2-4 years earlier, the RR of neonatal mortality was elevated (1.83). Indeed Brazil had higher neonatal mortality for these children than did the other countries. Birth spacing was highly significant (p.001).
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Intervalo entre Nascimentos , Mortalidade Infantil , Ordem de Nascimento , Brasil , Pré-Escolar , Escolaridade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Idade MaternaRESUMO
PIP: The author examines links between the timing of various major life events (including women's age at marriage and the spacing of children) and the economic and urban development of a society, using Mexico as an example. The focus is on marriage patterns. She finds that nuptiality influences rural-urban migration for women, as do age and socioeconomic factors and husband's employment status. Data are from the Mexican Fertility Survey for the period 1976-1977. (SUMMARY IN ENG)^ieng
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Fatores Etários , Intervalo entre Nascimentos , Estudos de Coortes , Economia , Emprego , Estágios do Ciclo de Vida , Estado Civil , Casamento , Dinâmica Populacional , Fatores Socioeconômicos , Fatores de Tempo , Urbanização , América , Demografia , Países em Desenvolvimento , Emigração e Imigração , Família , Características da Família , Serviços de Planejamento Familiar , Geografia , América Latina , México , América do Norte , População , Características da População , Pesquisa , Classe Social , População UrbanaRESUMO
This paper uses life table methods to analyze the process of family formation in Puerto Rico. Despite a continuing decline in fertility, the pattern of birth spacing is very rapid with a big proportion of short intergenesic intervals. This indicates a clear distinction between spacing and stopping behavior. Some possible health implications are discussed.
PIP: The life table method is used to analyze the process of family formation in Puerto Rico. The method approaches family formation in a cohort of women as a series of transitions between successive statuses in which each transition has a measurable probability of occurring. The method allows detained analysis of changes in fertility by separating changes in the intensity or number of births and the timing or spacing of births. The data were from the 1982 Puerto Rico Fertility and Family Planning Assessment Survey, a retrospective survey with detailed information on 3175 women aged 15-49. The analysis is limited to women ever in union. The births occurred during a period of more than 30 years, from around 1950-82, during which the total fertility rate declined by almost 50%, from 5.2 to 2.7 children/woman. Each birth interval was divided into 4 age groups to avoid the overrepresentation of women marrying younger and with shorter birth intervals. Analysis of the 1st 5 birth intervals for the 4 age categories in each clearly shows that the fertility reduction was reflected in the reduction in higher order births, a reduction already clearly visible in the transition to the 2nd birth. But contrary to the pattern in other low fertility populations, in Puerto Rico there does not seem to be a very consistent relationship between the decline in the probabilities of transition between birth orders and a more prolonged spacing. Women who reach each interval at the younger ages have a higher probability of having another child, and they do it more rapidly, which indicates the close relationship between age at the beginning of family formation, the size of the family, and the speed of the reproductive process. But even among older women the intervals are still very brief, indicating a pattern of rapid spacing independent of the number of children already born and perhaps of desired family size. The pattern indicates a clear distinction between behavior associated with terminating childbearing and that of spacing births. An analysis of changes in the intensity and calendar of births of different orders in 3 time periods, 1965-1969, 11970-1974, and 1975-1982, shows a clear trend toward longer intervals after 1965. Women who began childbearing at younger ages had shorter intervals than those who began later. In view of the abundant existing evidence on the adverse effects of short birth intervals, the process of family formation in Puerto Rico should be studied in greater detail, especially considering its possible impact on infant mortality.
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Intervalo entre Nascimentos , Coeficiente de Natalidade/tendências , Fatores Etários , Humanos , Idade Materna , Porto Rico , Estatística como AssuntoRESUMO
PIP: In 1986 the Third National Survey on Contraceptive Prevalence took place in Colombia. The results of this article are based on the CPR of Colombia's Atlantic Coast. The information demonstrated the high prevalence of female sterilization in the area, but also the lowest CPR among temporary methods. As a result of these outcomes PROFAMILIA, along with The Futures Group/SOMARC and Johns Hopkins University launched a promotional campaign in the Atlantic Region to increase the CPR. However, prior to the campaign, PROFAMILIA instituted 2 surveys to collect baseline data for the promotional campaign. The initial KAP survey was the 1st of its kind in the Atlantic Coast directed at men (15-59) and women (15-49) in fertile ages; while the 2nd KAP survey was directed at the pharmacists in the region. Focus groups were organized to determine attitudes and practices of individual men and women in the area. The social marketing of condoms and orals took place because of the attitudes of men and women towards childbearing. Most women wanted to have their children quickly followed by getting "disconnected" from childbearing through sterilization. While they are having children, they need the pill to properly space each birth. The outcomes of marketing these 2 methods demonstrated that condoms were easier to market than the pill.^ieng
Assuntos
Publicidade , Intervalo entre Nascimentos , Preservativos , Anticoncepcionais Orais , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Marketing de Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa , Esterilização Reprodutiva , Universidades , Instituições Filantrópicas de Saúde , América , Colômbia , Anticoncepção , Coleta de Dados , Países em Desenvolvimento , Economia , Educação , Serviços de Planejamento Familiar , América Latina , Organização e Administração , Organizações , Avaliação de Programas e Projetos de Saúde , Estudos de Amostragem , Instituições Acadêmicas , América do SulRESUMO
Two studies to measure children spacing in western metropolitan Santiago are compared. The first (1984-85) surveyed a sample of 687 mothers and the second 1,000. Deliveries took place at San Juan de Dios and Félix Bulnes hospitals (both state-finance) which provide medical care for medium and low income groups. Long spacing (5 years or more) accounted for the highest proportion of non-first born children (33.8% in 1984-85 with a significant increase to 40.1% in 1988) while short spacing (under 2 years) accounted for 19.2% in 1984-85 and 21.8% in 1988 (not significant). Mean birth weights were over 3,200 g in every spacing group. Despite the low illiteracy rate, predominant urban origin and having at least one child born before, high proportions of children were conceived despite the use of contraceptive measures (19.7% in 1984-85 and 22.5% in 1988). This contraceptive failure was less frequent among children born after longer spacings.
PIP: Results are compared of 2 studies of child spacing undertaken in public maternity hospitals serving middle and lower income populations in the western area of Santiago, Chile. The 1st study surveyed 687 mothers of live-born infants in 1984-85, while the 2nd surveyed 1000 mothers in February-May 1988. All mothers had at least 1 older child. The surveys were undertaken in the 72 hours following delivery. In the 1984-85 and 1988 studies respectively, the birth interval was under 24 months for 19.2 and 21.8%; 24-35 months for 18.9 and 16.0%; 36-47 months for 16.9 and 13.1%; 48-59 months for 11.2 and 9.0%; and 60 months or more for 33.8 and 40.1%. The increase in birth intervals over 60 months was statistically significant. The average birth weight increased from 32.. g to 3330 g between the 2 studies, but the difference was not significant. The average birth weight increased for all birth intervals. The proportion of infants weighing under 2500 g at birth was 5.8% in 1984-85 and 6.9% in 1988. The proportions of mothers who became pregnant despite using a contraceptive method in 1984-85 and 1988 respectively were 28.0 and 30.7% for birth intervals of 24 months or less, 18.3 and 23.1% for intervals of 24-59 months, and 16.8 and 17.5% for intervals of 60 months or more. 22.5% of all infants in the 1988 survey were conceived while their mothers were using a contraceptive method. The factors involved in this apparently high rate, whether related to availability of family planning services, user knowledge, or method efficacy, should be identified and corrected.
Assuntos
Intervalo entre Nascimentos , Demografia , Coeficiente de Natalidade/tendências , Peso ao Nascer , Chile , Feminino , Humanos , Recém-Nascido , Gravidez , População UrbanaRESUMO
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: On September 2, 1988, El Salvador adopted a population policy, key measures (Chapters 4-8) of which are reproduced in the appendix of this document. Chapter 4 defines the policy as a group of measures which aim to harmonize demographic evolution and development and to promote the individual and the family to full and equal participation in this process. Chapter 5 bases the policy directives on 1) conceptual interpretations of the relationships between population and development; 2) philosophical and political directives; 3) the legal context; and 4) orientations and programs contained in the general plan of government. The objectives of the policy are outlined in general and specific terms in Chapter 6 and include improvement of health services, promotion of responsible fatherhood, strengthening the family, promoting the development of women, balancing population distribution, protecting internal and international migrants, fostering population education, improving employment opportunities, improving the work force, protecting the environment through balanced population growth, and strengthening population planning systems. Chapter 7 sets out specific policy measures and strategies in the areas of population and health; population and family; spatial distribution and migration; population, education, and communication; population and the work force; and population and the environment. Chapter 8 discusses the operation of the policy, its implementation measures, and strategies for implementation involving community participation, support for participation of the family, and efficient administration.^ieng
Assuntos
Intervalo entre Nascimentos , Economia , Legislação como Assunto , Centros de Saúde Materno-Infantil , Dinâmica Populacional , Crescimento Demográfico , Atenção Primária à Saúde , Política Pública , Refugiados , Educação Sexual , Mudança Social , Direitos da Mulher , América , América Central , Atenção à Saúde , Demografia , Países em Desenvolvimento , Educação , El Salvador , Emigração e Imigração , Serviços de Planejamento Familiar , Saúde , Serviços de Saúde , América Latina , América do Norte , População , Fatores Socioeconômicos , MigrantesRESUMO
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