Unmet need for contraception in Vietnam: who needs what and when

The Vietnam 1988 survey established the first national estimates for reproductive preferences and behavior. It created a unique baseline for levels and differentials, both for the marked differences between North and South, and for various social and demographic categories. It also provided the first national data for program guidance, including information on unmet need. Unmet need for contraception has been extensively documented for much of the developing world, but its structure is not yet well understood. This study differentiates unmet-need couples by several demographic characteristics, by time since the last birth, and by features identified through a computer search program. Past investigations have emphasized the per cent with unmet need within various population subgroups, but some of those subgroups are small, whereas the national family planning program must be oriented to subgroups with large absolute numbers of unmet need couples. Unmet-need couples are selective, whether by reference to the married population or by reference to other couples who also wish to avoid pregnancy but are using a method. Most unmet-need couples are younger than users, have fewer children and, especially, are closer to their last birth. Surprisingly, most have never used a contraceptive method before, even though Vietnam has had a vigorous family planning program and 49 per cent of all couples in the survey reported some experience with a modern contraceptive method. In terms of sheer numbers, those in need are distributed very widely throughout the country. The most disadvantaged segments of the population have both high percentages and large numbers in need, but the concentration of the national program upon a single contraceptive method restricts their options.

Men, women and the trouble with condoms: problems associated with condom use by migrant workers in rural Zambia

Understanding cultural attitudes to condoms is of the utmost importance in promoting their use as a means of protection against HIV transmission. This article examines condom use in relation to what people see as the purpose of sex, what good sex entails and how this relates to ideas of being a proper woman or man. It seems that the underlying and pervasive ideal is that sex is essentially a procreative act, since an emphasis on male potency and male and female fertility often overrides anxieties about contracting HIV and other sexually transmitted diseases. Hence condom use is usually only negotiated within some short-term relationships and then not consistently. Whilst both men and women have negative attitudes to condoms, women because of their economic and ideological dependence on men are in a much weaker position to negotiate condom use.

Ideal-family-size and sex-composition preferences among wives and husbands in Nepal

This study tests the hypothesis that, in Nepal, measures of ideal family size mask an underlying preference for sons, making some people willing to have families larger than their ideal. Existing evidence suggests that men are likely to have stronger preferences for sons than are women. This research uses empirical evidence to examine the hypothesis that husbands are more willing than their wives to pursue the birth of sons at the cost of an increasingly large completed family size. A Multiple-response Fertility Preference Scale was developed to test these propositions among a sample of couples. The methodology was successful in demonstrating differential patterns of decisionmaking between husbands and wives that are otherwise obscured by more simplistic, single-response measures (for example, ideal family size). The results indicate that husbands are consistently more willing than their wives to pursue the birth of sons at the expense of larger family sizes, and that the birth of daughters is not pursued to a similar degree by wives or husbands.

The male versus female perspective on family planning: kinshasa, zaire

Males have often been neglected in both family planning programmes and in surveys used to design and evaluate such programmes. A 1988 study on fertility, family planning and AIDS in Kinshasa, Zaire, provides comparable data on 3140 men and 3485 women of reproductive age which served as the basis for analysing male/female differences. The study indicated a fair degree of similarity in the attitudes, beliefs, knowledge levels and practices of men and women regarding fertility and family planning. Where they differed (e.g. on expected or ideal number of children, the desire for more children at parity 7 or above), men tended to be more pronatalist than women. The implications of the findings for future family planning programmes are discussed. Programmes should target males because of their role as decision makers within Zairian society.

Endogenous fertility, multiple growth paths, and economic convergence

"This paper extends the Cass-Koopmans optimal growth model to allow for endogenous fertility choice. It is shown that if agents choose their fertility rate, then the net rate of return on capital (marginal product of capital minus the population growth rate) may not be monotonically decreasing in capital. In this case, multiple steady states and growth paths may emerge, which can explain the persistent differentials in income between poor and rich countries, as well as the existence of development miracles and disasters. The paper provides also empirical evidence which supports the existence of multiple convergence groups and is consistent with the theoretical model."

How does childbearing affect fertility motivations and desires?

In this study we assume that fertility decisions are made one birth at a time and use longitudinal data collected from 401 married couples over a two-year period to explore how having a child affects two types of fertility motivation and three types of fertility desires. Using a series of five constrained multiple regression analyses, we tested the effects of two childbearing variables on these five types of motivation and desires in the context of a large set of control variables also hypothesized to affect fertility motivation and desires. The results demonstrate that the childbearing variables have a substantial effect in all five regression models. Specific findings indicate that childbearing stimulates greater positive motivation for childbearing and an increase in the number of children desired. Although this situation would appear to create a positive feedback loop in which each child born further increases the motivation and desire for children, the findings also suggest three different mechanisms whereby childbearing causes a counterbalancing regulation of that loop. These mechanisms include a negative motivation mechanism, a satiation mechanism, and a delay mechanism. The effect of these mechanisms on the termination of childbearing is considered in conjunction with a fourth mechanism, the achievement of desired family size.

Son and daughter preferences in Benighat, Nepal: implications for fertility transition

Married women in Benighat, Nepal stressed old age security and continuity of lineage as prominent reasons for wanting sons. In addition, women clearly desired daughters too--an important finding that is less often stressed. Religious reasons and help with household chores were the most common reasons reported for wanting a daughter. Strong desires for sons could increase fertility in settings where fertility is controlled. Additional desires for daughters could have an additional pronatalist influence. For Benighat we document a pervasive desire for at least two sons and at least one daughter. If realized, these sex composition preferences would increase fertility by 50 per cent. Actual effects are no doubt smaller, but the effects of sex preference on the desire for more children and on contraceptive use are clearly visible.

The effects of HIV and AIDS on fertility in East and Central Africa

Concern has been expressed about the fertility of people infected with HIV: the worry has been that on learning of their condition, HIV-affected individuals may attempt to accomplish unmet reproductive goals knowing that they will not live a normal life span. This article addresses the potential effects of AIDS on fertility and reproductive decisions in East and Central Africa. The problem is seen in terms of a tightly knit continuum of biological, epidemiologic and cultural contexts, and the prevailing conditions of response to the epidemic. AIDS can influence fertility among individuals and groups regardless of any awareness of serostatus by increasing death rates among reproductive populations, and damaging the physical capacities of infected men and women to reproduce. In much of the region, high prevalence of STDs may simultaneously impair the fertility of men and women and increase their risk of contracting HIV. These biological conditions are compounded among those for whom fertility is a highly valued marker of adult status, where the social and economic marginality of young women contributes to reliance on commercialized sex, where the mobility of young men leads to instability in sexual partnerships and frequent partner change, or where women lack the ability to negotiate their fertility with spouses. It appears that even focused programs of testing and counselling with HIV-positive women in Europe and in Africa have not motivated a significant change in reproductive action. Were there a demonstrable effect of counselling on the fertility choices of infected persons, there are numerous practical limitations on the role that interventions can play in affecting the fertility of HIV-positive people.

[Fertility behavior in Quebec, family allowances, and taxes: results and simulations with a discrete choice model for the years 1975-1987]

"We suppose that women (couples), who are less than 40 years old, are faced with three types of sequential decisions: the fertility decision, the decision relative to the number of children to have and the decision concerning labour force participation.... We use a nested polychotomous discrete choice model to estimate the responsiveness of the behaviour of 'married' women in Quebec to variations in the expected flow of revenue resulting from changes in the parameters of the personal income tax and in the level of public monetary transfers conditional on the number of children. The model is estimated with micro-data from 9 repeated cross-sections for the years 1975 to 1987 with a full information maximum likelihood method.... This empirical setting is used to simulate the effects of changes made to the fiscal and transfer policies in favor of families with dependent children on fertility, [women's] labor force participation and the importance of spending costs for the two levels of government." (SUMMARY IN ENG)

Abortion in Vietnam: measurements, puzzles, and concerns

This report summarizes current knowledge about abortion in Vietnam, drawing upon government statistics, survey data, and fieldwork undertaken by the author in Vietnam throughout 1993 and part of 1994. The official total abortion rate in Vietnam in 1992 was about 2.5 per woman, the highest in Asia and worrisome for a country with a still-high total fertility rate of 3.7 children per woman. Vietnamese provinces exhibited substantial variation in both the rate of abortion and the type of procedures performed. Among the hypotheses explored to explain Vietnam's high rate of abortion are the borrowing of family planning strategies from other poor socialist states where abortion is common; current antinatal population policies that interact with a lack of contraceptive alternatives; and a rise in pregnancies among young and unmarried women in the wake of recent free-market reforms. Because family-size preferences are still declining, abortion rates may continue to increase unless the incidence of unwanted pregnancy can be reduced, a goal that Vietnamese population specialists are seeking to achieve.

Family context and adolescents' fertility expectations

Data from the National Longitudinal Surveys of Labor Market Experience of Youth are used to examine and contrast the effects of family context and individual characteristics on adolescents' expectations about adolescent fertility, nonmarital childbearing, family size, and childlessness. The findings indicate that family structure has modest but specific effects on adolescents' fertility expectations. Living with mothers only increases expectations for nonmarital childbearing, and living with fathers (without biological mother) lowers the total number of children expected. Larger subsize raises expectations for nonmarital childbearing and family size. Poverty raises expectations for adolescent childbearing but does not affect other fertility expectations. Adolescent women are less likely than men to expect nonmarital childbearing, and overall, expect fewer children. Blacks are more likely than Whites to expect adolescent and nonmarital fertility and Hispanics are significantly less likely than non-Hispanic Whites to expect childlessness.

Do fertility intentions predict subsequent behavior? Evidence from Peninsular Malaysia

Data from the 1984 Malaysian Population and Family Survey were matched with birth registration records for 1985-87 to determine the accuracy of statements regarding desired family size that were reported in a household survey in predicting subsequent reproductive behavior. The findings of this study were that stated fertility intention provides fairly accurate forecasts of fertility behavior in the subsequent period. In other words, whether a woman has another child is predicted closely by whether she wanted an additional child. Informational, educational, and motivational activities of family planning programs would, therefore, have greater success in reducing family size if fertility intentions were taken into account.