Contributing factors to the total fertility rate declining trend in the Middle East and North Africa: a systemic review

Fertility preservation in female cancer patients: assessing awareness, attitudes, concerns, experiences, and the role of counseling in quality of life

BACKGROUND

Cancer poses significant fertility challenges for women of childbearing age, yet the adoption of fertility preservation (FP) measures remains limited. This study aimed to explore patients' understanding, attitudes, concerns, psychological well-being, and factors influencing their decisions regarding FP during treatment.

METHODS

This prospective cohort study involved women aged 18 to 42 diagnosed with non-metastatic breast cancer or lymphoma, treated at the American University of Beirut Medical Center. Patients completed questionnaires at intervals over a 2- to 3-year period following diagnosis.

RESULTS

Among the 123 women studied, 71.5% were married, and 13.5% had no children. Although 87.8% were informed about the fertility risks of their treatment, only 45.4% expressed a desire for FP. Multivariable analysis revealed that parity was significantly associated with fertility concerns (p = 0.019). Decisions favoring FP were significantly influenced by younger age at diagnosis, lower parity, and higher education levels (p = 0.001, p < 0.001, and p = 0.036, respectively). While 56% of patients received FP counseling-mostly from oncologists (83%)-the preference for FP methods varied, with 47% choosing medical approaches and 53% opting for procedural interventions. Despite recognizing the importance of FP, 91% reported that it did not significantly influence their treatment choices. Patients showed greater satisfaction when oncologists discussed fertility-related topics (p < 0.001). Over time, overall FertiQoL scores and DASS-42 scores indicated improved psychological well-being.

CONCLUSION

Our study highlights the complexities of FP decisions among cancer survivors, emphasizing the need for proper counseling to support their quality of life and psychological well-being.

Patients' perceptions of rheumatoid arthritis and their behaviour towards medications in Saudi Arabia: a qualitative study

BACKGROUND

Medication preferences and associated challenges remain unexplored in Saudi patients with rheumatoid arthritis (RA).

OBJECTIVES

To explore the perceptions, beliefs and experiences of patients with RA regarding the disease and its treatment in Saudi Arabia.

DESIGN

Three focus groups were created in Riyadh, Saudi Arabia through purposeful sampling. Discussions were recorded and transcribed. Subsequently, thematic analysis was performed.

PARTICIPANTS

The groups included women, aged 35-50 years (n=6), men (n=4) and women above 50 years (n=5).

RESULTS

The identified themes included stress and losing a loved one as the primary factors inducing RA, delay in diagnosis and beliefs about certain foods that triggered RA flare-ups. The most common adverse effects were weight gain, nausea and fungal infections. The participants were open to starting new medications. Stiffness was the main unmet need among the participants. Adverse effects, pain management and fertility problems were key factors affecting treatment transitions. Younger participants expressed concerns about prices and availability of medications. Physical exercise and therapy were identified as important complementary therapies for improving the quality of life. The lockdown during the pandemic may have positively impacted patients' symptoms. Younger women highlighted challenges related to the transition of treatment before and after contraception, losing their jobs, meeting their children's and family's needs and pursuing their dreams. Men expressed concerns about fertility and a fear of needles. Psychological and social challenges were the main theme among older participants.

CONCLUSION

This study identified patient preferences and needs that could guide future educational initiatives for physicians and communities.

Inequalities in total fertility rate in Sierra Leone, 2008-2019

BACKGROUND

Total fertility rate measures the average number of children a woman is expected to have during her reproductive age (typically 15-49 years). Despite the national decline in Sierra Leone, significant disparities in total fertility rates persist across socioeconomic and geographic lines. This study investigated the inequalities in total fertility rate among women in Sierra Leone between 2008 and 2019.

METHODS

We utilized data from the three rounds of the Sierra Leone Demographic Health Survey conducted in 2008, 2013, and 2019. The World Health Organization's Health Equity Assessment Toolkit was employed to calculate various inequality measures, including simple difference, ratio, population attributable risk, and population attributable fraction. The assessment focused on inequality across four stratifiers: economic status, level of education, place of residence, and sub-national province.

RESULTS

The total fertility rate declined in Sierra Leone throughout the period, dropping from 5.0 births per woman in 2008 to 4.3 births per woman in 2019. Economic disparity among women in the richest quintile compared with those in the poorest quintile increased from 3.0 births per woman in 2008 to 3.1 births per woman in 2019. The ratio between women in the richest quintile compared with those in the poorest quintile also increased from 1.9 in 2008 to 2.1 in 2019; the confidence interval suggest inequality, with women in the poorest quintile disproportionately affected. Inequality in education among women with secondary education or higher compared with those with no education decreased from 2.7 births per woman in 2008 to 1.9 births per woman in 2019. The ratio between women with secondary education or higher compared with those with no education decreased from 1.9 in 2008 to 1.6 in 2019, and the confidence interval suggest an inequality with women with no education disporportionately affected. Provincial inequality among women who resided in Western area compared with those in Eastern province decreased slightly from 2.3 births per woman in 2008 to 2.2 births per woman in 2019. The ratio between women who resided in Western province compared with those in Eastern province increased from 1.6 in 2008 to 1.7 in 2019 and indicate an inequality among women in the provinces.

CONCLUSION

The results indicate substantial socioeconomic and geographical disparities in total fertility rate among women in Sierra Leone that require targeted policy interventions. The persistent and widening economic gap between women in the richest and poorest quintiles suggests that poverty reduction strategies and economic empowerment programs for low-income women need strengthening. While the decreasing educational inequality is encouraging, the continued disadvantage faced by women with no education indicates a need for enhanced educational access and adult literacy programs. The provincial disparities between Western and Eastern provinces point to a need for balanced provincial development policies and improved resource distribution, particularly in the Eastern province, where women face greater disadvantages. These implications collectively suggest that policymakers should adopt an integrated approach that combines economic empowerment, educational initiatives, and provincial development strategies to address these intersecting inequalities in TFR effectively.

The application of machine learning approaches to classify and predict fertility rate in Ethiopia

Integrating machine learning (ML) models into healthcare systems is a rapidly evolving field with the potential to revolutionize care delivery. This study aimed to classify fertility rates and identify significant predictors using ML models among reproductive women in Ethiopia. This study utilized eight ML models in 5864 reproductive-age women using Ethiopian Demographic Health Survey (EDHS), 2019 data. Phyton programming language was used to develop these models. Predictors of fertility rate were determined using the feature important techniques. The performance of models was evaluated using accuracy, area under the curve (AUC), precision, recall, F1-score, specificity, and sensitivity. The mean age of participants was 32.7 (± 5.6) years. The random forest classifier (accuracy = 0.901 and AUC = 0.961) followed by a one-dimensional convolutional neural network (accuracy = 0.899 and AUC = 0.958), logistic regression (accuracy = 0.874 and AUC = 0.937), and gradient boost classifier (accuracy = 0.851 and AUC 0.927) were the top performing ML models. Family size, age, occupation, and education with an average importance score of 0.198, 0.151, 0.118, and 0.081, respectively were the top significant predictors of the fertility rate. The best ML models to classify and predict fertility rates were random forest, one-dimensional convolutional neural network, logistic regression, and gradient boost classifier. The findings on important factors of fertility rate can inform targeted public health, programs that address disparities related to family size, occupation, education, and other socioeconomic factors.

Impact of COVID-19 pandemic on marriage, divorce, birth, and death in Kerman province, the ninth most populous province of Iran

This study examined the impact of the COVID-19 pandemic on marriage, divorce, birth, and death rates using the Poisson regression model and an interrupted time-series Poisson regression model. Before the pandemic, marriage and birth rates were decreasing, while divorce and death rates were increasing, with only the trend in birth rates being statistically significant. The immediate effect of the pandemic was a significant decrease in the divorce rate, but there were non-significant effects on birth and marriage rates. However, in the months following the onset of the pandemic, there was a statistically significant sustained effect on increasing death and divorce rates. Forecasts based on pre-pandemic data showed that by the end of 2020, marriage, divorce, death, and birth rates were higher compared to pre-pandemic levels. In conclusion, the pandemic has greatly impacted society, particularly in terms of death and divorce rates. Birth rates were not immediately affected to the time lag between decisions and actual births. Fear of COVID-19 may have increased death rates as people avoided seeking medical help. Vaccination and effective treatment strategies are vital in reducing the pandemic's impact on mortality. Supporting families financially is important due to the role of economic issues in couples' decisions.

Development and psychometric evaluation of the questionnaire on the contributing factors of tendency towards voluntary single-childedness and childlessness: a mixed method study

Couples' tendency towards voluntary single-childedness and childlessness (VSCC) has turned into a major challenge in all societies and led to different problems such as population aging. A key step to VSCC management is to determine its contributing factors through valid and reliable instruments. This exploratory sequential mixed method study (qualitative-quantitative) was conducted in 2020-2021. Phases of qualitative consists of all couples aged 15-49 in Babol, Iran, who were single or childless. Sampling is based on the purpose, and the number of samples is 20 couples. To collect data, face-to-face and semi-structured interviews were conducted with the participants. Sampling continued until data saturation. The data were analyzed by the conventional content analysis method and quantitative phase. Initially, a qualitative study was conducted on twenty couples, and were analyzed through conventional content analysis. Findings were used to develop QFT-VSCC and then, the face, content, and construct validity as well as reliability were assessed. Construct validity was assessed through exploratory and confirmatory factor analyses and reliability was assessed through internal consistency and stability assessments. The results of the qualitative part analysis consist of 140 codes, 30 primary categories, and nine main categories and two themes (individual limitations and social limitations). The primary QFT-VSCC had 78 items. Fifty-eight items were omitted during validity assessment and the remaining twenty-two items were loaded on five factors during factor analysis. These factors were threatened priorities, inappropriate familial context for childbearing, sense of occupational and social insecurity for the child, social modeling of childlessness, and tendency towards change or stability in marital life. The five factors explained 52.56% of the total variance. All model fit indices in confirmatory factor analysis were acceptable and the Cronbach's alpha values of QFT-VSCC and all its factors were more than 0.70. The results of convergent validity analysis revealed that all factors had an AVE value greater than 0.5, and the HTMT index for all factors was less than 0.85. This indicated that discriminant validity had been achieved. QFT-VSCC is a simple valid and reliable instrument for VSCC assessment among both men and women.

Analyzing Cancer Incidence Trends in Oman From 1996 to 2019: A Comprehensive Study of the National Cancer Annual Reports

PURPOSE

Previous studies have reported that cancer incidence trends in Oman varied by tumor site and sex. No comprehensive analysis of all cancer sites had been reported. The objective of this study is to analyze cancer incidence trends in Oman and calculate the annual percent change (APC) in age-standardized rates (ASRs) for all-cancer and 61 individual cancer sites in Omani men and women from 1996 to 2019.

METHODS

We gathered incidence data from The Omani National Cancer Registry for all cancers combined and individual tumor sites. We estimated the APC using Poisson regression.

RESULTS

The cancer ASR in the Omani population increased by 23% (from 95/100,000 in 1996 to 117.2/100,000 in 2019), with the increase being more pronounced in females (48% v 7% in males). Among the male population, there was significant increase in the ASRs of colon, rectum, thyroid, and prostate cancers, with APCs of 6.92%, 4.24%, 4.19%, and 2.03%, respectively. Among females, all-cancer incidence showed significant increase (APC = 1.39%), and increasing trends were observed in uterine, colon, rectum, thyroid, and breast cancers (APCs = 7.57%, 7.08%, 5.19%, 5.16%, and 4.19%, respectively).

CONCLUSION

The ASR of all-cancer increased significantly in Omani women but not in men. Uterine cancer had the highest APC. Colorectal cancer and thyroid ASR increased in both males and females. Breast and prostate cancers showed increasing trends. Further research is needed to explore factors contributing to increasing cancer incidences.

Nonhormonal Male Contraceptive Development-Strategies for Progress

Despite the widely demonstrated public health benefits of contraception, limited contraceptive options are available for men, placing both the contraceptive burden and opportunity solely on women. This review outlines the need for an increased focus on male contraceptive development and highlights several related topics, including the perspectives of women and men on male contraceptives, historical challenges, and reasons behind the persistent delays in male contraceptive development. It also discusses the importance of serendipitous observations in drug discovery and the limitations of depleting sperm or spermatogenic cells as a contraceptive approach. It further provides an overview of ongoing research and development on novel methods, with a goal to offer insights into the multifaceted aspects of nonhormonal male contraceptive development, addressing its implications for the health of men and women. SIGNIFICANCE STATEMENT: Despite well over half a century of effort in developing male contraceptives, there are no approved male contraceptive drugs on the market. This review aims to present strategies for progress in nonhormonal male contraception based on lessons learned from history, with the hope of expediting development and bringing a male contraceptive drug closer to reality.

Immediate Antecedents of Intentions for Having Children in Southeast Iranian Women

BACKGROUND

Over the last decade, Iran has experienced a declining birth trend. Identifying the proximate determinants of fertility intentions among married women is informative for population studies. This study aimed to examine the importance of three immediate antecedents of fertility intention.

METHODS

We invited 1,100 married women to complete a well-validated questionnaire based on the theory of planned behavior (TPB). The sampling framework consisted of visitors attending hospitals in two cities in southeastern Iran. Intention for having children was measured using the item "Do you intend to have a/another child during the next 3 years?" Attitude, subjective norms, and perceived behavioral control were measured using eight, three, and three items, respectively. Structural equation modeling was used to specify the model and to test the predictive ability of the TPB constructs.

RESULTS

The response rate was 90.7% (N=998), and the mean±standard deviation age of the respondents was 34.8±7.4 years. More than 50% of the respondents reported intending to have a child in the next 3 years. All three TPB model constructs showed significant associations with fertility intentions. The standardized beta coefficients for attitudes, subjective norms, and perceived behavioral control were 0.74, 0.41, and 0.55, respectively.

CONCLUSION

The TPB model showed that psychological mechanisms play an important role in predicting the childbearing intentions of married women in Iran. Of the three TPB constructs, attitude was the strongest predictor of the intention to have a child.

Heterogeneous effects of socio-economic and cultural factors on fertility differentials in Burundi and Morocco during their fertility transition periods: a retrospective, cross-sectional and comparative study

Introduction

few studies have examined the factors influencing fertility differentials and the variation in their effects in countries with different socioeconomic and cultural backgrounds and different fertility transition paces. To address this gap, our study sought to first identify the factors that influenced fertility differentials in Morocco and Burundi during their fertility transition periods, and then to compare the effects of these factors between the two countries.

Methods

using data from the 2003-4 Morocco and 2010 Burundi Demographic and Health Surveys, bivariable and multivariable Poisson regression analyses offset by the natural logarithm of the women´s age were performed to identify the socioeconomic and cultural factors that influenced fertility differentials in Morocco and Burundi during their fertility transition.

Results

our main findings showed that the total number of children ever born ranged from 0 to 17 with a mean of 2.71 ± 2.89 in Burundi and from 0 to 16 with a mean of 1.88 ± 2.80 in Morocco. In Burundi, both socioeconomic and cultural factors like rural residence adjusted incident rate ratio (AIRR) = 1.159, 95% CI: 1.103 - 1.217, P=0.020), women´s illiteracy (AIRR=1.465, 95% CI: 1.241- 1.729, P <0.001) and agricultural profession (AIRR=1. 332, 95% CI: 1.263 - 1.401, P = 0.004), household poverty (AIRR= 1.381, 95% CI: 1.223 - 1.431, p<0.001), infant mortality (AIRR= 1.602, 95% CI: 1.562 - 1.643, p<0.001), early marriage (AIRR= 1.313, 95% CI: 1.264 - 1.364, p<0.001), lack of knowledge of any contraceptives (AIRR= 1.263, 95% CI: 1.125 - 1.310, p = 0.003) and failure to use modern contraceptives (AIRR= 1.520, 95% CI: 1.487 - 1.611, p<0.001) were associated with high number of children ever born. However, in Morocco socioeconomic factors like residence place, women´s agricultural profession and household poverty were not significant. In this country, women´s illiteracy (AIRR=1.428, 95% CI: 1.315 - 1.551, P <0.001), lack of access to mass media (AIRR= 1.241, 95% CI: 1.108 - 1.375, p = 0.006), infant mortality (AIRR=1.222, 95%CI: 1.184 - 1.361, p<0.001), early marriage (AIRR1.481, 95% CI: 1.435 - 1.529, p<0.001), lack of knowledge of any contraceptives (AIRR1.508, 95% CI: 1.409 - 1.613, p<0.001) and failure to use modern contraceptives (AIRR1.745, 95% CI: 1.627 - 1.863, p<0.001) were associated with high fertility but with different effects than in Burundi.

Conclusion

the evidence from this study suggests that interventions to accelerate the fertility transition processes in Burundi and many other countries with slow fertility transitions should be designed and implemented according to each country's local context.

Role of women's empowerment in determining fertility and reproductive health in Bangladesh: a systematic literature review

INTRODUCTION

Research on fertility and reproductive health has expanded rapidly. However, questions regarding the association between women empowerment and fertility in terms of the reproductive health status in Bangladesh remain unanswered. This study aimed to address these questions through a systematic literature review.

METHODS

In this review study, the PubMed, Scopus, Banglajol, and Google Scholar databases were searched systematically and screened in terms of the inclusion and exclusion criteria. Data from 15 articles included in this review were extracted for further assessment.

RESULTS

Fifteen studies with a total of 212,271 participants from Bangladesh met our selection criteria. Most of the articles were conducted on ever-married women aged 15 to 49 years using nationally representative Bangladesh Demographic and Health Survey data. The major religions were Islam (86.8%-90.2%) and Hinduism (10%-13%). The age of women at first marriage varied from 14 to 20 years, and the age at first birth ranged from 16 to 22 years. The fertility rate in Bangladesh has reduced remarkably over the period from 1975 to 2022. After controlling for other social and health factors, the study found that empowerment factors such as women's education, working status, involvement in household decision-making, participation in economic decision-making, and freedom in movement influenced the fertility and reproductive health status in Bangladesh.

CONCLUSION

As an initial step, this study found a negative relationship between women's empowerment and the control of fertility and reproductive health. Greater policy focus should be directed toward women empowerment factors to improve the fertility situation and reproductive health status in Bangladesh and other countries with similar sociodemographic profiles.

Qualitative document analysis on Iranian contents and trends of population policies: Lessons learned and avenues for future

Population-related policies are among macro-strategic policies considered by all governments in the world. To achieve the desired population structure, it is first necessary to identify the general policy approach over time. This article aims to identify the main requirements of population policies during the last 70 years in Iran. This is a qualitative content analysis study conducted via the analysis of all relevant national policy documents from 1951 to 2022. To retrieve the relevant documents, we searched the official website of eight policymaking bodies in Iran. After identifying the documents, their eligibility was evaluated using Scott's method, and as a result, 40 documents were selected for analysis. Finally, we used a qualitative content analysis to synthesize the data using MAXQDA version 10. The findings showed that the political requirements for population reduction can be classified into four main themes of "Religious, scientific, and legal infrastructure", "Changes in the rules", "Institution building, programming and division of tasks", and "Information and service provision", with 11 sub-themes. Furthermore, the political requirements for an increasing population can be divided into six main themes of "Education & acculturation", "Legal dos, and don'ts", "Financial and non-financial support for families", "Structural and information infrastructure", "Health services", and "Stewardship", with 30 sub-themes. In this study, by an all-round look, and the analysis of policies of the last 70 years of Iran, it was determined how the population policies originate from the political-cultural background of society, and provide the ground for the changes in the cultural-social, political, and economic structures and as a result demographic change. In other words, the main requirements to formulate the population increase and decrease policies in Iran as a country with golden experiences to implement the population policies were shown; which can be helpful as a guide to formulate the population policies in Iran and provide a model for successful policy making in the countries with a similar background to Iran.

The Effect of Family Fertility Support Policies on Fertility, Their Contribution, and Policy Pathways to Fertility Improvement in OECD Countries

The cost of childbirth has been confirmed as a vital factor in families' fertility decision-making, and family welfare policies are capable of compensating for the increase in household living expenses regarding childbirth, such that the country's fertility situation can be optimized. In this study, the fertility promotion effects of family welfare policies in OECD(Organization for Economic Co-operation and Development) countries are investigated through regression analysis, grey correlation (GRA), and the fuzzy set qualitative comparative analysis fsQCA method. As indicated by the results: (1) Family welfare policies notably boost fertility, and the boosting effect is long-lasting. However, this boost will be weakened in countries where fertility rates remain below 1.5. (2) The contribution of welfare policy measures to the fertility-promotion effect varies by country. The contribution of cash benefits is highest in over half of the countries worldwide, the contribution of relevant services and in-kind expenditure is highest in 29% of the countries, and that of tax incentive expenditure is highest in 14% of the countries. (3) The policy mix to boost fertility also varies according to the social context, with three policy groups derived using the fsQCA method. To be specific, the core antecedent conditions comprise cash benefits, relevant services, and in-kind expenditure. On that basis, China should pay attention to the following three points when formulating family welfare policies to tackle their demographic challenges. First, a system of family welfare policies should be developed as early as possible in the context of increasingly severe demographic issues since the incentive effect of family welfare policies will be weakened in countries with chronically low fertility rates. Second, the effects of improvements vary by country, and China should comprehensively consider its national circumstances when formulating and dynamically adjusting the mix of government fertility support policies in accordance with its social development. Third, employment is the main means of securing family income and takes on critical significance to sustaining families. Unemployment exerts a significant disincentive effect, such that it is imperative to reduce youth unemployment and enhance the quality of youth employment. On that basis, the disincentive effect of unemployment on fertility can be reduced.

Main actors in the new population policy with a growing trend in Iran: a stakeholder analysis

The total fertility rate in Iran has declined to below replacement level recently, and a new approach has been taken to tackle this issue. Thus, this study aimed to identify the involved stakeholders and their characteristics in the new population policy change in Iran. We employed a qualitative approach using the purposive sampling of key informants and the identification of relevant documents. The main stakeholders were divided into seven key groups: religious, political, governmental, professional, international sectors, media, and nongovernmental organizations. In addition, there was no centralized, clear, and comprehensive mechanism to guide the activities of stakeholders to coordinate and bring the total fertility rate to the replacement level in Iran. Despite the importance of the new population policy in Iran, in recent years, we still experience dispersion and inconsistency among various actors in this area. It is imperative to go through a consensus and coalition at macro-level authorities alongside evidenced-based population policymaking.

Bisphenols A and F, but not S, induce apoptosis in bovine granulosa cells via the intrinsic mitochondrial pathway

With the gradual decline in global fertility rates, there is a need to identify potential contributing factors, their mechanisms of actions and investigate possible solutions to reverse the trend. Endocrine disrupting compounds (EDCs), such as bisphenol A (BPA), are environmental toxicants that are known to negatively impact reproductive functions. As such, the use of BPA in the manufacturing industry has slowly been replaced by analogs, including bisphenol S (BPS) and bisphenol F (BPF), despite limited knowledge available regarding their impact on health and their safety. The following study investigates the effects of BPA, BPS and BPF at a concentration of 0.5 μg/mL and 50 μg/mL on bovine granulosa cell apoptosis, with the ultimate goal of determining how they may impact oocyte competence and, thus, overall fertility. The underlying hypothesis is that bisphenols disrupt the granulosa cell environment surrounding the oocyte inducing excessive apoptosis via the intrinsic mitochondrial pathway. To test this hypothesis, apoptosis was measured following a time- and dose-dependent exposure to all three bisphenols by flowcytometry paired with annexin V/PI staining as well as by quantification of key genes belonging to the intrinsic apoptotic pathway both at the mRNA and protein levels. The results of this study report that BPA and BPF reduce cell viability through reduced cell counts and increased apoptosis. This increase is due, in part, to the induction of apoptotic genes of the intrinsic pathway of apoptosis. Additionally, this study also suggests that BPS may not act on the intrinsic mitochondrial apoptotic pathway in bovine granulosa cells. Overall, this study allows us to establish potential apoptotic pathways activated by bisphenols as well as compare the relative apoptotic activities of BPA to its most widespread analogs.

A second demographic transition in Indonesia?

As a predominantly Muslim and ethnically diverse new democracy in Asia, Indonesia is a timely case to study how the contending forces of development and social change are reflected in changing norms and practices around family formation. This paper examines the extent to which the second demographic transition (SDT) theory can provide a primary framework to understand contemporary patterns of fertility, marriage and family change in Indonesia. Against the backdrop of socio-political change following Reformasi in 1998, we found emerging demographic features typically associated with societies in later stages of fertility transition. These include fertility below replacement in some regions; increasing age at first marriage, non-marriage, and divorce rates; and growing diversity in household/family forms. As the vast regions of Indonesia is economically, culturally, and demographically heterogeneous, these key features of SDT are not likely to emerge and unfold in a uniform manner. Further, these demographic shifts are taking place amidst multiple tensions and contradictions in the nature and direction of ideational change pertaining to marriage and the family. We argue that the prevailing ideational change driving the shifts in marriage, fertility, and the family within Indonesia is neither unilinear nor singular in nature. Emerging ideational change embodying individualism, secularism, and post-materialism—originally proposed in SDT theory to be the primary drivers of fertility decline in post-industrial Western Europe—can overlap with popular values promoting de-secularization and the strengthening of familial institutions. As a demographic framework, the SDT theory is an important and useful starting point. But it needs to be reevaluated by considering the complex socio-political and increasingly precarious economic terrains behind fertility transition, as well as marriage and family change in post-Reformasi Indonesia.

MULTIPLE ACUTE POSTERIOR CIRCULATION STROKE WITH LESIONS IN THE PONS AND BOTH HEMISPHERES OF THE CEREBELLUM ASSOCIATED WITH OVARIAN HYPERSTIMULATION SYNDROME: A CASE REPORT OF A WHITE EUROPEAN ADULT IN UKRAINE

We have presented a brief literature overview of the disease, supported by a clinical case of multiple acute posterior circulation strokes with lesions in the pons and both hemispheres of the cerebellum associated with ovarian hyperstimulation syndrome in a white young European adult in Ukraine. Specific features of posterior circulation stroke associated with ovarian hyperstimulation syndrome were determined, analyzed, and described. Complex posterior circulation cerebral infarction in the pons and both hemispheres of the cerebellum associated with ovarian hyperstimulation syndrome has not been reported before but has devastating consequences for both mother and fetus. Strokes in patients with OHSS must be timely prevented, promptly diagnosed, and treated to avoid high morbidity and mortality associated with it.