Contraception and Reproduction Health Consequences for Women and Children in the Developing World (1989) / Chapter Skim
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6 Changes in Reproductive Patterns
6 Changes in Reproductive Patterns
Pages 76-89
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From page 76... ...
In this chapter we change the focus of our attention and examine the degree to which reproductive patterns vary among developing countries and the extent to which these patterns have changed as societies move through demographic transition. This chapter reviews evidence of changes in the proportions of high-risk births occurring in countries as their levels of fertility decline.
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From page 77... ...
The increasing availability of more than one national sample survey of fertility in many developing countries will make it easier for future studies to examine changes in reproductive patterns. At the same time, it should be recognized that one of the factors that can contribute to a fertility decline and changing reproductive patterns is the level of infant mortality, so that there are reciprocal effects.
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From page 78... ...
FERTILITY DECLINES AND BIRTH ORDER DISTRIBUTION Total fertility rates in the developing world have declined from an estimated average of 6.1 during the first half of the 1950s to an estimated average of 4.1 during the first half of the 1980s (United Nations, 1988c)
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From page 79... ...
have estimated mean ages at first birth by age groups for the 40 developing countries participating in the WFS. It is difficult to be certain that these data reflect change over time because of the tendency for women, especially older women, not to report their first birth if it did not survive.
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From page 80... ...
. Mean ages are based on data derived from the World Fertility Surveys and are estimated based on statistical models developed by Coale and McNeil (1972)
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From page 81... ...
Declines were substantial in some cases from 20 to 6 percent in Hong Kong and marginal in TABLE 63 Changes in the Distribution of Births by Matemal Age in Selected Countries Over the Course of Fertility Decline by Percent Decline in Total Fertility Rates Between 1960 and 1980 Proportion of All Births Proportion of All to Women Under 20 Births to Women 35+ Percent 1960s 1970s- 1960s 1970s- Decline Country 1980 1980 in TFR Singapore .08 .04 .14 .05 65 Hong Kong .05 .() 4 .20 .06 64 Barbados .21 .25 .15 .06 54 Mauritius .13 .14 .15 .07 52 Costa Rica .13 .20 .18 .09 50 Chile .12 .17 .17 .09 49 Trinidad and Tobago .17 .19 .1 1 .08 43 Puerto Rico .18 .18 .11 .07 42 Panama .18 .20 .11 .09 42 Malaysia .1 1 .07 .14 .13 42 Fiji .13 .11 .12 .08 41 Source: United Nations Demographic Yearbook, various years.
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From page 82... ...
SPACING OF BIRTHS As shown in Chapter 5, births following a previous birth by less than 24 months are associated with increased risk in many developing countries, in developed countries, and in high-mortality historical populations. Although scientists have not yet specified the precise mechanisms involved in these relationships, the association is so widespread that it is prudent to be concerned about the potential effects on infant health of short birth intervals.
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From page 83... ...
These data are admittedly limited, but they do present a picture opposite from that given by cross-sectional data showing that the proportion of intervals that are short is negatively associated with total fertility rates over time. If birth intervals do lengthen as fertility levels decline, improvements in maternal and child health should occur.
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From page 84... ...
There is a wide range in periods of postpartum abstinence, with mean durations of more than a year in several countries. In most developing countnes, more women have breastfed than have used modem contraception; therefore declines in breastfeeding could greatly increase the proportion of short birth intervals (DaVanzo and Starbird, 1989)
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From page 85... ...
Survey data from many countries indicate Tat many women desire to space their births. In Africa, spacing children has been a dominant reason for using contraception, although prevalence of modern contraception remains extremely low (London et al., 1985~.
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From page 86... ...
Births within 24 months of a previous birth are at increasing risk, but no clear picture emerges on the association between declining fertility and changes in the proportion of short birth intervals. The proportion of short intervals decreased as fertility declined in the six Latin American countries in Table 6.5, as was also the case in Sri Lanka and Thailand.
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From page 88... ...
Although published evidence on changes in birth spacing is surprisingly scarce, cross-sectional relationships between the proportion of short birth intervals and the total fertility rates of countries indicate that spacing tends to be closer in societies with lower fertility. However, in ~ of the 10 countries in which data on spacing are available for two or more times, the proportion of short intervals declined as fertility declined.
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From page 89... ...
The overall health of a population may improve as fertility declines, both because of the direct and indirect effects discussed in this report, and because of factors such as improved nutrition and improved delivery of health care. Thus, the level of risk associated with first births or close birth spacing may decrease over time.
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