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The number of women using long-acting reversible contraception (LARC)-intrauterine devices (IUDs) and implants-is increasing and 14% of contraceptive users in the United States adopt LARC. We examined correlates of LARC never-use in a population-based survey of reproductive-aged women in Ohio.We analyzed data from the 2018-19 Ohio Survey of Women. We examined the prevalence of LARC never-use and reasons for never-use among ever users of contraception (N = 2388). Using Poisson regression to generate prevalence ratios (PRs), we examined associations between selected correlates (demographic factors, healthcare access/quality measures, and religious/political views) and LARC never-use.Most Ohio women (74%) had never used LARC. Commonly reported reasons for not using an IUD or an implant were preferring a different method (46% and 45%, respectively), not wanting an object inside their body (45% and 43%), side effect concerns (39% and 33%), insertion/removal concerns (31% and 25%), and unfamiliarity (13% and 20%). Conservative political views (PR: 1.12, 95% confidence interval [CI]: 1.04-1.22), pro-life affiliation (PR: 1.11, 95% CI: 1.02-1.20), placing high importance on religion in daily life (PR: 1.15, 95% CI: 1.06-1.26), and being non-Hispanic white as compared to non-Hispanic Black (PR: 1.20, 95% CI: 1.02-1.41) were significantly associated with LARC never-use. Findings were generally similar for models analyzing IUD and implant never-use separately.Among ever-users of contraception, LARC never-use was associated with having conservative political views, being religious, and having a pro-life affiliation. Except for race/ethnicity, demographic and healthcare measures were not associated with LARC never-use among women in Ohio.

The past four decades have witnessed an enormous increase in modern contraception in most low‐ and middle‐income countries. We examine the extent to which this change can be attributed to changes in fertility preferences versus fuller implementation of fertility preferences, a distinction at the heart of intense debates about the returns to investments in family planning services. We analyze national survey data from five major survey programs: World Fertility Surveys, Demographic Health Surveys, Reproductive Health Surveys, Pan‐Arab Project for Child Development or Family Health, and Multiple Indicator Cluster Surveys. We perform regression decomposition of change between successive surveys in 59 countries (330 decompositions in total). Change in preferences accounts for little of the change: less than 10 percent in a basic decomposition and about 15 percent under a more elaborate specification. This is a powerful empirical refutation of the view that contraceptive change has been driven principally by reductions in demand for children. We show that this outcome is not surprising given that the distribution of women according to fertility preferences is surprisingly stable over time.

This study examines factors associated with satisfaction with oral pills and injectables among past users in Kenya based on a baseline survey for the 2-year prospective longitudinal study Improving Measurement of Unintended Pregnancy and Unmet Need for Family Planning conducted in 2016. Married women aged 15–39 years were interviewed using a structured questionnaire that captured information on reproduction, contraceptive knowledge and beliefs and attitudes towards contraception in general and towards specific methods. A multivariate logistic regression analysis was used to examine factors that influenced satisfaction with oral pills and injectables among past users in one urban site (Nairobi slums) and one predominantly rural site (Homa Bay in western Kenya). Results showed that dissatisfaction with pills and injectables is common among past users in both rural and urban Kenya (ranging from 39% to 56%). The distinctive contribution of the study lies in its ability to relate method-specific beliefs to overall satisfaction. Perception of effectiveness, ease of use and safety for long-term use had statistically significant influences on satisfaction with pills in both urban and rural sites while partner’s approval was only important in Nairobi. For injectables, the perception of safety for long-term use was significant in the urban but not the rural site. Unlike pills, the belief that members of a woman’s social network had used a method and found it satisfactory was a particularly powerful influence on satisfaction (AOR=2.8 in rural and 3.2 in urban). Perception of accessibility and fears about infertility were not found to be statistically associated with satisfaction for either pills or injectables. Surprisingly, the effects of all perceived contraceptive attributes were the same for major socio-demographic strata of the populations. The findings underscore the need for targeted counselling and community-based communication interventions to address negative and erroneous perceptions about family planning methods.

Despite an extensive evidence base on contraceptive method choice, it remains uncertain which factors are most influential in predisposing women toward certain methods and against others. This paper addresses this gap in knowledge by making use of rarely-measured perceptions about specific methods, perceived social network experience of methods, and women's own past experiences using specific methods. We draw on baseline data from the project, "Improving Measurement of Unintended Pregnancy and Unmet Need for Family Planning." Using conditional logit analysis, we ascertain which perceived method-specific attributes, including past experience of methods by women themselves and by their friends, predict preferred future contraceptive method among 317 women living in Nairobi slums who are using no method but intend to start in the next 12 months. Results show that satisfaction with past use, positive experience of use by a woman's social network, husband/partner's approval, lack of interference with menses, and perception of safety for long term use were all associated with choice of a future method.

This research has two main goals: (i) to examine fertility desires (number of children) in sub-Saharan Africa: levels as compared to other major regions and recent trends; and (ii) to assess the extent to which fertility decline in sub-Saharan Africa is contingent on decline in fertility desires (singly and in combination with other reproductive changes).

Survey data on fertility preferences have played a central but controversial role in fertility research and advocacy for family planning. We summarize evidence from longitudinal studies in 28 Asian and African populations on the relationship between preferences and subsequent childbearing. While we found no consistent association between women's desire to delay childbearing and subsequent fertility, the baseline desire of women to stop childbearing was a powerful predictor of subsequent fertility in all populations and increased in strength as overall contraceptive use in the study populations rose. Partners' desire also exercised some influence but was of modest importance in most populations. However, the correspondence between desire to stop and behaviour was found to be far from perfect. Weak implementation of preferences by contraception is likely to be the major cause of this preference-behaviour discrepancy. Uncertainty and instability in preferences may also contribute to the discrepancy, particularly in sub-Saharan Africa.

Background: 'Unrealized fertility' is a failure to achieve desired fertility. Unrealized fertility has been examined in low-fertility societies but, with the exception of research on infertility, has been neglected in research on non-Western societies. Objective: We conduct a multicountry investigation of one form of unrealized fertility, namely a reproductive career which ends with the woman desiring further children. Methods: We analyze 295,854 women aged 44‒48 in 252 surveys (DHS, RHS, PAP) conducted in the period 1986-2015 in 78 countries. Two indicators of unrealized fertility are constructed: (i) a comparison of ideal versus actual number of children; (ii) the desire for another child. We estimate multilevel regressions with covariates at individual and aggregate levels. Results: Unrealized fertility is far more prevalent according to the first indicator than the second. It is more common among women with fewer living children and women whose first birth occurs after age 20, and it is distinctly higher in sub-Saharan Africa and lower in South Asia. The evidence on trend over the course of fertility transition is mixed: for the second indicator but not the first, the net effect is a reduction in the prevalence of unrealized fertility as fertility declines. Conclusions: Unrealized fertility occurs frequently in most societies and therefore deserves more rigorous research, especially on its consequences for emotional, social, economic, and demographic outcomes. Contribution: We provide the first comprehensive documentation of the prevalence of unrealized fertility across a broad set of contemporary non-Western societies.

The temporal character of cohort fertility is strictly and perfectly a function of three components: the timing of the onset of childbearing the length of intervals between births and the timing of the termination of childbearing (at age and/or parity). These three components comprise the “starting spacing and stopping” familiar to demographers. Despite the abundance of appropriate data—in particular the national demographic surveys conducted regularly from the 1970s to the present (WFS DHS etc.) which contain complete birth histories—we are not aware of any recent rigorous effort to assess the relative contributions of these three components to fertility decline since 1960. Toward such an assessment we examine the spacing of births the component that has received the least attention of the three in the recent research literature. While population change is first and foremost a function of change in total fertility commonly represented by indicators such as the period TFR and cohort completed fertility the tempo of childbearing is itself consequential including effects on maternal and child health kinship configuration and population age structure.

Background Missing from the huge literature on women’s attitudes and beliefs concerning specific contraceptive methods is any detailed quantitative documentation for all major methods in low- and middle-income countries. The objectives are to provide such a documentation for women living in Matlab (rural Bangladesh), Nairobi slums and Homa Bay (rural Kenya) and to compare the opinions and beliefs of current, past and never users towards the three most commonly used methods (oral contraceptives, injectables and implants). Methods In each site, 2424 to 2812 married women aged 15–39 years were interviewed on reproduction, fertility preferences, contraceptive knowledge and use, attitudes and beliefs towards family planning in general and specific methods. We analysed the data from round one of the prospective cohort study. Results While current users typically expressed satisfaction and held more positive beliefs about their method than past or never users, nevertheless appreciable minorities of current users thought the method might pose serious damage to health, might impair fertility and was unsafe for prolonged use without taking a break. Larger proportions, typically between 25% and 50%, associated their method with unpleasant side effects. Past users of pills and injectables outnumbered current users and their beliefs were similar to those of never users. In all three sites, about half of past injectable users reported satisfaction with the method and the satisfaction of past implant users was lower. Conclusions High levels of contraceptive use can clearly co-exist with widespread misgivings about methods, even those that are widely used. Serious concerns about damage to health, long term fertility impairment, and dangers of prolonged use without taking a break were particularly common in the Kenyan sites and these beliefs may explain the high levels of discontinuation observed in Kenya and elsewhere in Africa. This documentation of beliefs provides useful guidance for counselling and informational campaigns. The generally negative views of past users imply that programmes may need not only to improve individual counselling but also strengthen community information campaign to change the overall climate of opinion which may have been influenced by dissatisfaction among past users. Electronic supplementary material The online version of this article (10.1186/s12978-018-0514-7) contains supplementary material, which is available to authorized users.

BACKGROUND: Unmet need for family planning points to the gap between women's reproductive desire to avoid pregnancy and contraceptive behaviour. An estimated 222 million women in low- and middle-income countries have unmet need for modern contraception. Despite its prevalence, there has been little rigorous research during the past fifteen years on reasons for this widespread failure to implement childbearing desires in contraceptive practice. There is demographic survey data on women's self-reported reasons for non-use, but these data provide limited insight on the full set of possible obstacles to use, and one may doubt the meaningfulness of explanations provided by non-users alone. To rectify this evidence gap, this study will gather extensive information on women's perceptions of contraception (generic and method-specific) and their past contraceptive experience, and it will allow for more complexity in fertility preferences than is standard in demographic surveys. METHODS: A multi-site cohort study will be conducted in urban Kenya, rural Kenya, and rural Bangladesh. In each setting trained fieldworkers will recruit and interview 2600 women, with participants re-interviewed at 12 and 18 months. Data will be collected using a questionnaire whose development was informed by a review of existing literature and instruments from past studies in both developed and developing countries. Dozens of experts in the field were consulted as the instrument was developed. The questionnaire has three main components: a sub-set of Demographic and Health Survey items measuring socio-demographic characteristics, reproductive history, and sexual activity; additional questions on prospective and retrospective fertility preferences designed to capture ambivalence and uncertainty; and two large blocks of items on (i) generic concerns about contraception and (ii) method-specific attributes. The method-specific items encompass eight modern and traditional methods. DISCUSSION: Policy and programmes intended to reduce unmet need for contraception in developing countries should be informed by clear understanding of the causes of this phenomenon to better reflect the population needs and to more effectively target planning and investments. To this end, this study will field an innovative instrument in Kenya and Bangladesh. The information to be collected will support a rigorous assessment of reasons for unmet need for family planning.

this high fertility combined with declining mortality has resulted in rapid population growth—2.5 percent per year—and the un projects the sub-Saharan population to grow from 0.86 billion in 2010 to 1.96 billion in 2050 and 3.36 billion in 2100. Such unprecedented expansion of human numbers creates a range of social, economic, and environmental challenges and makes it more difficult for the continent to raise living standards. Hence the growing interest in demographic trends in africa among policymakers. according to conventional demographic theory, high fertility in the early stages of the demographic transition is the consequence of high desired family size. Couples want many children to assist with family enterprises such as farming and for security in old age. in addition, high child mortality leads parents to have additional children to protect against loss or to replace losses. Fertility decline occurs once rising levels of urbanization and education, changes in the economy, and declining mortality lead parents to desire a smaller number of births. to implement these desires, parents rely on contraception or abortion, and family planning programs in many countries accelerate their adoption (notestein 1945

Fertility preferences are revised in the light of changing life and reproductive circumstances. Over time, an individual's fertility preferences may fluctuate along a continuum. In this study, we describe typical patterns of change (or stability) in individual fertility preferences over a period of five years using a prospective panel study of women of reproductive age in six communities in southern Ghana. We investigate whether patterns of change are consistent with women's reproductive life circumstances by first comparing responses between successive interviews and then over multiple interviews using latent class analysis. We find that approximately 20 percent of the sample changed their fertility preference from one interview to the next. Women who had attained or exceeded their ideal family size show considerable stability in their desire to stop childbearing over multiple interviews. This desire does not waver even when they experience unwanted pregnancies. The attainment of ideal family size appears to be an important correlate of preference stability.

The distinction between wanted and unwanted fertility has been crucial in many of the more intense debates in recent decades over the nature of contemporary fertility declines and, in particular, the potential impact of expanded provision of family planning services. In a much-debated article published in 1994, Pritchett argues that decline in desired fertility is overwhelmingly the principal source of fertility decline, with the implication that family planning programmes are of little consequence. I revisit this debate drawing on a far larger body of survey data and, more importantly, an alternative fertility specification which relies on a non-conventional definition of wanted and unwanted fertility rates and which distinguishes rates and composition. Decompositions of fertility decline in the period from the mid-1970s to the present are carried out for 44 countries. The decomposition results indicate that declines in unwanted fertility rates have been at least as important, if not more important, than declines in wanted fertility rates. Surprisingly, shifts in the proportion of women wanting to stop childbearing—i.e., changes in preference composition—has contributed very little to fertility change in this period. Further, decline in wanted fertility and increases in non-marital exposure (due largely to delayed entry into first marriage) have also made substantial contributions, although on average they fall short of the contribution of declines in unwanted fertility rates. That declines in unwanted fertility have been an essential feature of contemporary fertility decline is the main conclusion from this research. This in turn opens the door to new perspectives on fertility pre-, mid-, and post-transition which recognises the inter-dependencies between fertility demand and unwanted fertility rates in the determination of the overall level of fertility. JEL classification: J11, J13, R11 Keywords: Demography, Fertility, Family Planning, Regional Economics

The estimation of unwanted fertility is a major objective of demographic surveys, including DHS surveys conducted in Asia, Africa, and Latin America. Levels and trends in unwanted fertility are important input to the formulation of population policy and the evaluation of family planning programs. Yet existing methods for estimating unwanted fertility are known to be defective, among other reasons because they rely on subjective data whose validity and reliability are questionable. In this article, we propose a new estimator of unwanted fertility—the “aggregate prospective estimator”—so-named because it depends on the stated preference for another child at the time of the survey, the fertility-desires item consistently shown to possess the highest validity and reliability. Under reasonable assumptions, the aggregate prospective estimator produces less biased estimates of unwanted fertility than the most widely used existing methods. The new estimator has the limitation of generating only aggregate-level estimates, but such estimates are the primary data for policy formulation and program evaluation. The new estimator is presented in this article, along with an evaluation of its underlying assumptions and its sensitivity to several sources of error. In an illustrative application to recent DHS data from six countries, the new estimator yields substantially higher estimates of unwanted fertility than existing methods in all six countries.

The factors underlying contraceptive method choice are poorly understood in many countries, including Bangladesh. It is important to understand how Bangladeshi women's perceptions of a method's attributes are associated with their intention to use that method.Data on 2,605 married women aged 15-39 living in rural Matlab were taken from a baseline survey conducted in 2016. Conditional logit analysis was used to examine associations between 12 method attributes and intention to use the pill or the injectable among the 583 fecund women not currently using a method. Method attributes included those relating to ease of obtainment and use, efficacy, health effects, husband's approval, the experiences of the respondent and the experiences of women in the respondent's social network.Women tended to perceive the pill more positively than the injectable. For example, greater proportions of women reported believing that the pill is easy to use (90% vs. 72%) and does not cause serious health problems (75% vs. 38%). The likelihood that a woman intended to use a method was positively associated with her perception that it is easy to use (odds ratio, 2.9) and does not cause serious health problems (1.7) or affect long-term fertility (2.9). Satisfied past users of a method were more likely than never users to report intending to use the method (5.2). Intention to use the pill rather than the injectable was positively associated with education (2.0-3.6) and having a migrant husband (1.7).Negative beliefs not supported by evidence, particularly about the injectable, are associated with women's intention to use a contraceptive method. The results may be useful in improving contraceptive care, counseling and training.RESUMEN Contexto: En muchos países, incluido Bangladesh, los factores en los que se basa la selección del método anticonceptivo son poco comprendidos. Es importante entender la forma en que las percepciones de las mujeres bangladesíes con respecto a los atributos de un método determinado se asocian con su intención de usar ese método. Métodos: A partir de una encuesta de línea de base llevada a cabo en 2016, se tomaron datos de 2,605 mujeres casadas, de 15 a 39 años, que vivían en Matlab rural. Se utilizó análisis Logit condicional para examinar las asociaciones entre 12 atributos del método y la intención de 583 mujeres fecundas, que no estaban usando un método, de usar la píldora o el inyectable. Los atributos del método incluían los relacionados con la facilidad de obtención y uso, la eficacia, los efectos sobre la salud, la aprobación del esposo, las experiencias de las encuestadas y las experiencias de las mujeres expresadas en las redes sociales de las encuestadas. Resultados: Las mujeres mostraron una tendencia a percibir la píldora de manera más positiva que el inyectable. Por ejemplo, una mayor proporción de mujeres reportó que consideraba la píldora como un método fácil de usar (90% vs. 72%) y que no causa problemas de salud graves (75% vs. 38%). La probabilidad de que una mujer intentara usar un método se asoció positivamente con su percepción de que es fácil de usar (razón de probabilidades, 2.9), que no causa problemas de salud graves (1.7) o que no afecta la fecundidad a largo plazo (2.9). Las usuarias satisfechas que ya habían usado un método fueron más propensas que las que nunca habían sido usuarias a informar que intentaban usar el método (5.2). La intención de usar la píldora en lugar del inyectable se asoció positivamente con el grado de escolaridad (2.0–3.6) y con el hecho de tener un esposo migrante (1.7). Conclusiones: Las creencias negativas no respaldadas por evidencia, particularmente sobre el inyectable, están asociadas con la intención de las mujeres de usar un método anticonceptivo. Los resultados pueden ser útiles para mejorar la calidad de la atención anticonceptiva, la consejería y la capacitación.RÉSUMÉ Contexte: Les facteurs à la base du choix de méthode contraceptive sont mal compris dans de nombreux pays, notamment au Bangladesh. Il importe de cerner en quoi l'idée que se font les Bangladaises des propriétés d'une méthode sont associées à leur intention de pratiquer cette méthode. Méthodes: Les données relatives à 2 605 femmes mariées âgées de 15 à 39 ans et vivant dans les milieux ruraux de Matlab ont été obtenues d'une enquête de référence menée en 2016. Les associations entre 12 propriétés de méthode et l'intention d'utiliser la pilule ou le contraceptif injectable parmi les 583 femmes fécondes qui ne pratiquaient alors aucune méthode ont été examinées par analyse logit conditionnelle. Les propriétés des méthodes considérées étaient la facilité d'obtention et d'emploi, l'efficacité, les effets sur la santé, l'approbation du mari, l'expérience de la répondante et celle des femmes membres du réseau social de la répondante. Résultats: Les femmes tendaient à percevoir la pilule de manière plus positive que l'injectable. Par exemple, de plus grandes proportions de femmes ont déclaré croire que la pilule est facile à utiliser (90% par rapport à 72%) et qu'elle ne cause pas de problèmes de santé graves (75% par rapport à 38%). La probabilité qu'une femme ait l'intention d'utiliser une méthode s'est avérée associée positivement à sa perception de la facilité de son emploi (RC, 2,9) et d'absence d'effets secondaires graves pour la santé (1,7) ou d'effet sur sa fécondité à long terme (2,9). Les anciennes utilisatrices satisfaites d'une méthode se sont révélées plus susceptibles que les femmes qui ne l'avaient jamais pratiquée de déclarer avoir l'intention de l'utiliser (5,2). L'intention d'utiliser la pilule plutôt que l'injectable présente une association positive avec le niveau d'éducation (2,0–3,6) et avec le fait d'avoir un mari migrant (1,7). Conclusions: Des croyances négatives non avérées, concernant en particulier le contraceptif injectable, sont associées à l'intention des femmes de pratiquer une méthode contraceptive. Les résultats peuvent être utiles à l'amélioration de la qualité des soins, du conseil et de la formation en matière de contraception.

This article is a revision of the previous edition article by H.M. Yousif, volume 8, 5588–5593, © 2001, Elsevier Ltd.

This study assesses how changes in unmet need for family planning have contributed to contemporary fertility declines, and the implications of this historical record for further fertility decline, especially in sub-Saharan Africa. We examine joint trends at the national level in fertility, unintended fertility, and unmet need. We bring unintended fertility into the analysis because the underlying rationale for reducing unmet need is to avert unintended pregnancies and births. The association over time between unmet need and fertility is investigated using survey data from 45 countries in Africa, Asia, and Latin America and the Caribbean from the mid-1970s to the present. The empirical analysis finds that reduction in unmet need, especially unmet need for limiting, is strongly associated with fertility decline in Latin America and the Caribbean and in Asia and North Africa. Fertility decline in sub-Saharan Africa is weakly associated with trends in unmet need (and satisfaction of demand). We propose that the stark regional difference is due to measurement problems and to the fundamentally different character of fertility decline in sub-Saharan Africa, itself reflective of basic differences in pretransition reproductive regimes.

During the past two decades, estimates of unmet need have become an influential measure for assessing population policies and programs. This article recounts the evolution of the concept of unmet need, describes how demographic survey data have been used to generate estimates of its prevalence, and tests the sensitivity of these estimates to various assumptions in the unmet need algorithm. The algorithm uses a complex set of assumptions to identify women: who are sexually active, who are infecund, whose most recent pregnancy was unwanted, who wish to postpone their next birth, and who are postpartum amenorrheic. The sensitivity tests suggest that defensible alternative criteria for identifying four out of five of these subgroups of women would increase the estimated prevalence of unmet need. The exception is identification of married women who are sexually active; more accurate measurement of this subgroup would reduce the estimated prevalence of unmet need in most settings.

BACKGROUNDPrevious research on interrelations between migration and marriage has relied on overly simplistic assumptions about the structure of dependency between the two events. However, there is good reason to posit that each of the transitions has an impact on the likelihood of the other, and that unobserved common factors may affect both migration and marriage, leading to a distorted impression of the causal impact of one on the other.OBJECTIVEWe will investigate the relationship between migration and marriage in the United States, using data from the National Longitudinal Survey of Youth 1979. We allow for interdependency between the two events and examine whether unobserved common factors affect the estimates of both migration and marriage.METHODSWe estimate a multi-process model in which migration and marriage are considered simultaneously in regression analysis and there is allowance for correlation between disturbances; the latter feature accounts for possible endogeneity between shared unobserved determinants. The model also includes random effects for persons, exploiting the fact that many people experience both events multiple times throughout their lives.RESULTSUnobserved factors appear to significantly influence both migration and marriage, resulting in upward bias in estimates of the effects of each on the other when these shared common factors are not accounted for. Estimates from the multi-process model indicate that marriage significantly increases the hazard of migration, while migration does not affect the hazard of marriage.CONCLUSIONSOmitting interdependency between life course events can lead to a mistaken impression about the direct effects of certain features of each event on the other.1. IntroductionMigration decisions are made in conjunction with decisions about other life course events (Groot, Mulder, Das, and Manting 2011; Kulu and Milewski 2007; Schachter 2001). For example, when young adults leave the parental home and settle in new places in order to pursue educational and occupational opportunities (Garasky, Haurin, and Haurin 2001), some will find partners there and form families (Kulu 2008). Changes in union status (formation or dissolution) and childbearing can also motivate changes in residence, in part due to space requirements (Flowerdew and Al-Hamad 2004; Kulu and Milewski 2007). These and other plausible life course scenarios suggest an interplay between migration and other life course transitions that is far from unidirectional (Kulu and Milewski 2007). Nevertheless, most empirical research to date has examined unidirectional effects only. This has certainly been the case with research on migration and marriage, most of which has simplified the role of the former, with migration serving as an explanatory variable that either promotes or delays union formation (Feijten and Mulder 2002; Guzzo 2006). However, we suspect that the relationship between migration and marriage is more complicated. It is plausible that migration affects marriage and marriage affects migration; ignoring this more complicated interdependency may yield biased estimates of the causal effects of interest, including the effects of other explanatory variables - for example, schooling history (Mulder and Wagner 1993; Kulu and Milewski 2007; Steele, Kallis, Goldstein, and Joshi 2005). In addition, selectivity could be an issue - for example, migrants could be persons who are prone to marry, or vice versa (Kulu and Milewski 2007; Mulder and Wagner 1993).Despite these concerns, the comprehensive set of plausible interrelations between migration and marriage has hardly been examined in empirical research to date. And the few studies that have considered this range of interrelations have relied on data from Europe (Michielin and Mulder 2008). While it may be reasonable to draw implications for the interdependency in the United States from findings in European countries, it is the case that migration and marriage in the U. …

The principal aim of this study is to assess the strength in Pakistan of a set of hypothesized obstacles to practicing contraception. Survey data are analyzed that were collected in Punjab province in 1996 and that contain unusually detailed measurement of various perceived costs of practicing contraception, as well as focused measurement of fertility motivation. The framework guiding the research specifies six major obstacles to contraceptive use: the strength of motivation to avoid pregnancy, awareness and knowledge of contraception, the social and cultural acceptability of contraception, perceptions of the husband's preferences and attitudes, health concerns, and perceived access to services. Net effects of each obstacle are estimated through structural equation modeling of the intention to practice contraception in the near future, in which the six obstacles are treated as latent variables. The estimates indicate that the two principal obstacles to using a contraceptive are the woman's perception that such behavior would conflict with her husband's fertility preferences and his attitudes toward family planning and her perception of the social or cultural unacceptability of contraception. The results confirm the value of taking contraceptive costs seriously, and, in particular, of attempting to measure these costs in empirical research on family planning.

Unmet need for family planning has been a core concept in international population discourse for several decades. In this paper the authors re-evaluate its utility. The authors review the history of unmet need and the development of increasingly refined methods of its empirical measurement. The authors then turn to the main questions that have been raised about unmet need during the past decade some of which concern the validity of the concept and others its role in the post-International Conference on Population and Development environment. The discussion draws heavily on empirical research conducted during the 1990s much of it localized in-depth studies combining quantitative and qualitative methodologies that has significantly advanced our understanding of the nature and causes of unmet need. Of the causes of unmet need other than those related to access to services three emerge from the in-depth studies as especially salient: lack of necessary knowledge about contraceptive methods social opposition to their use and health concerns about possible side effects. The authors argue that the concept of unmet need for family planning by joining together contraceptive behavior and fertility preferences encourages an integration of family planning and broader development approaches to population policy. In its emphasis on individual aspirations and their fulfillment unmet need remains a readily defended rationale for the formulation of population policy and a sensible guide to the design of family planning programs. (authors)

Social demographers must take seriously the challenge to dominant theoretical paradigms that is posed by biosocial models. Accumulating empirical evidence documents the significant contribution of biological variables to the determination of social behaviors, including demographic behaviors. The simplest biosocial models may prove inadequate in social demographic research. More appropriate models may need to allow for causal relationships between biological and social determinants, and for effects that are interactive, non-linear, and discontinuous. While the articulation and testing of such models is unattainable at present, considerable insight can be gained by adding selected biological variables to ongoing demographic research. Demographic surveys should incorporate features of behavioral genetic designs. The chief short-term obstacles to the application of biosocial models in demography are disclinary boundaries; that is, the obstacles are institutional, not scientific.

Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries--the United States, Nigeria, Pakistan, Peru and Mexico--to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations.

Given that fertility rates are high in most sub-Saharan countries, it is critically important to understand the drivers of the demand for children to inform population reduction policies. Yet little is known about the individual-level factors that drive the desire for fertility limitation. The desire to limit births may be driven by the achievement of family size targets. However, since children are born at different stages of the life course, fertility desires may also be influenced by past reproductive, socio-economic experiences, and perceptions about future welfare. In this study, the determinants of the desire to stop childbearing were analyzed at the individual-level using prospective longitudinal data (1998–2003) on the reproductive lives of women in six communities in southern Ghana. Using variation within-woman, we modeled the impact of changes in reproductive life cycle events, health status, perceptions of future household economic conditions, perceptions of the cost of additional children, and spousal interactions on a woman’s fertility preferences. We found that the desire to stop childbearing is influenced by reproductive life stage (such as age, parity); events (marital transitions, child death); perceptions of personal health (particularly anticipated demands of the next pregnancy on the woman’s health); the household’s economic welfare; and the overall subjective cost of children. The economic utility models which emphasize cost/benefit considerations, as well as the anthropological and sociological theories which emphasize norms, appear to be validated in this empirical analysis in that both subjective elements and normative considerations are incorporated into fertility decisions.

Despite extensive research, doubts remain regarding the degree of correspondence between prior stated fertility preferences and subsequent fertility behavior. Preference instability is a factor that potentially undermines predictiveness. Furthermore, if other predictors of fertility substantially explain fertility, then knowledge of preferences may contribute little to explaining or predicting individual fertility behavior. In this study, we examined these aspects of the study of individual fertility preference-behavior consistency. Using a prospective multi-wave panel dataset, we modeled the monthly likelihood of conception, taking into account the dynamic nature of preferences, and controlling for changing reproductive life cycle factors and stable socioeconomic background predictors of fertility. We demonstrate from a sample of fecund married Ghanaian women that fertility preferences retain independent predictive power in the model predicting the likelihood of conception.

The authors describe the living arrangements of the elderly in the Philippines. They find that "only a small fraction of the Filipino elderly are isolated from close kin; however it is not certain that their living arrangements are favourable for their overall well-being. In many cases of co-residence the flow of support is from the elderly parents to their children. The article raises several questions concerning social change in the Philippines that need to be answered in future research." (EXCERPT)

This paper explores how poverty affects childbearing patterns in the contemporary developing world. In considering the association between poverty and fertility we explore one measure of economic status household asset holdings in Demographic and Health Surveys conducted in 51 countries since 1990. The results show that the association between poverty and fertility differs according to the measure of fertility considered. We conclude there is much to be gained from distinguishing between the impact of poverty on fertility aspirations and the implementation of those aspirations. Differentials in fertility aspirations are less common and smaller in magnitude than differentials in the implementation of aspirations. Fertility aspirations reflect strategizing about fertility that is embedded in broader strategizing about the future well-being of individuals and households. For multiple reasons this strategizing need not result in a sharp and monotonic association between fertility aspirations and household economic status. In exploring the literature on poverty we find a growing interest in the role of social capital and how it contributes to the maintenance or attenuation of poverty. The poverty literature could benefit from the considerable body of work on fertility that has articulated a central role of social capital. Moreover our understanding of the association between poverty and fertility would be strengthened by more attention to the role of social capital. (authors)

The timing of first union merits investigation not only because of the close temporal link between marriage and the onset of childbearing, but also because the age when men and women marry has implications for the organization of family life and for gender relations within society. This paper begins by reviewing the contributions of various social science disciplines to an understanding of the timing of marriage. Using current status data from 73 countries provided by the United Nations Population Division and retrospective data from 52 Demographic and Health Surveys conducted between 1990 and 2001, we then examine recent trends in the timing of first marriage or union for men and women in the developing world. With the exception of South America for both sexes and South and Southeast Asia for men, substantial declines have occurred in the proportion of young men and women who are married. Given the differentials in the timing of marriage by educational attainment and residence, we assess whether the decline in the proportion of young people who are married is related to increases in schooling and urbanization. Expansion of schooling for women has had some impact, but a considerable portion of the reduction in early marriage is not explained by changes in levels of education. We consider other factors that might account for the increase in age at marriage. Finally, we review what is known about the consequences of changing age at marriage with a particular focus on risk of HIV infection.

Although unmet need for family planning is a standard measure for evaluating programs' effectiveness in meeting the reproductive needs of individuals, its validity and accuracy in identifying women most at risk of unintended pregnancy have been questioned.Women who participated in the 1995 Egypt Demographic and Health Survey in two governorates in Upper Egypt (Assuit and Souhag) were followed for two years (N=2,444); in-depth data on their fertility preferences, contraceptive use and births were gathered in 1996 and 1997. Transitions among contraceptive need categories from 1995 to 1997 are examined, and rates of unintended (mistimed and unwanted) births are calculated according to contraceptive need status at baseline.In the aggregate, unmet need increased by six percentage points, from 28% to 34%. This change was the net outcome of 14% moving out of unmet need and 20% moving into unmet need (i.e., substantial satisfaction of unmet need was offset by increased demand for contraception). The rate of unintended fertility was far higher among women with unmet need at baseline than among contraceptive users in 1995. Women with unmet need made up about one-quarter of the baseline sample, but they contributed almost one-half of mistimed and unwanted births during the two years. The majority of unintended births were to women who had never practiced contraception, whereas fewer than one-fifth were to women with recent contraceptive experience (including contraceptive failure).: Unmet need for family planning remains a useful tool for identifying and targeting women at high risk of unintended pregnancy.

This paper compares the views about abstinence and condom use expressed by young people in Zimbabwe in focus-group discussions with the views underlying national policies and religious and traditional beliefs. Young people’s decisions to adopt one or the other of these risk-reduction strategies may not necessarily indicate genuine individual choices but rather their deference to adults’ interests as they understand those interests. Policymakers and traditional and Christian leaders promote abstinence as the exclusive strategy for all young people whereas nongovernmental organizations and the private sector promote condom use. Evidence from the focus-group discussions indicates that adolescents are aware of this conflict between choice of strategy and sometimes conceal their condom use in order not to disappoint adults. In some cases their moral conflict gives young people limited choices about reproductive behavior. Clear and open policies regarding condom use and abstinence should be promoted as complementary alternatives. Moreover adults should reconsider their moralizing concerning young people’s sexual activity and support real rather than limited choices with regard to adolescents’ reproductive health. In a country where the level of HIV prevalence among sexually active adults is one of highest in the world and where a large proportion of HIV infections is believed to occur during adolescence this message carries an urgency that can no longer be ignored. (authors)

The objective of this research is to examine the association between social organization and reproductive behavior in one setting in sub-Saharan Africa. The particular focus is on the effects of social organization on the diffusion of innovative reproductive ideas and behaviors. Social diffusion is assumed to be strongly affected by patterns of informal social interaction and these in turn are assumed to be determined in part by the social organization of local communities (gender relations employment activity voluntary organizations). The research draws on data collected in six communities in southern Ghana. The analysis reveals a weaker than expected association between the social organization of the communities and key reproductive indicators (fertility preferences age at first marriage postpartum practices use of modern contraception). Closer examination of the six communities suggests that the weak association is explained by the idiosyncratic histories of several of the communities in particular their histories of health and family planning provision. Explanations for reproductive change that place social organization on center stage must be enlarged to incorporate the potentially powerful influence of community history. (author’s)