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The frequency of definitive childlessness in women with multiple sclerosis (MS) may be higher than in the general population. MS may also affect decisions on the delivery procedure and on breast-feeding issues. Aim of the study was to assess the frequency of childlessness and its possible causes, the proportion of cesarean deliveries (CD), and the frequency of breast-feeding in patients and controls who have reached the end of their reproductive period. Female MS patients (>43 years) and controls (>45 years) filled out a questionnaire. We enrolled 303 patients and 500 controls. MS was associated with a higher frequency of childlessness (22 vs 13%) and less patients were in a stable relationship (83 vs 89%). There was no difference in the reported rates of infertility and miscarriages, while elective abortions were more frequent in patients (20 vs 12%). MS did not significantly affect the frequency of CD or of breast-feeding. MS-related reasons for childlessness, reported by 16% of childless patients, included disability/fear of future disability, fear of genetically transmitting MS, fear of not starting/discontinuing treatments, and discouragement by physician. Definitive childlessness is more frequent in women with MS compared to controls. A portion of voluntary childlessness may be avoided through correct/tailored information to patients.

ABSTRACT BACKGROUND Potentially teratogenic medications are frequently prescribed without provision of contraceptive counseling. OBJECTIVE To evaluate whether computerized clinical decision support (CDS) can increase primary care providers’ (PCPs’) provision of family planning services when prescribing potentially teratogenic medications. DESIGN Cluster-randomized trial conducted in one academic and one community-based practice between October of 2008 and April of 2010. PARTICIPANTS/INTERVENTIONS Forty-one PCPs were randomized to receive one of two types of CDS which alerted them to risks of medication-induced birth defects when ordering potentially teratogenic medications for women who may become pregnant. The ‘simple’ CDS provided a cautionary alert; the ‘multifaceted’ CDS provided tailored information and links to a structured order set designed to facilitate safe prescribing. Both CDS systems alerted PCPs about medication risk only once per encounter. MAIN MEASURES We assessed change in documented provision of family planning services using data from 35,110 encounters and mixed-effects models. PCPs completed surveys before and after the CDS systems were implemented, allowing assessment of change in PCP-reported counseling about the risks of medication-induced birth defects and contraception. KEY RESULTS Both CDS systems were associated with slight increases in provision of family planning services when potential teratogens were prescribed, without a significant difference in improvement by CDS complexity (p = 0.87). Because CDS was not repeated, 13% of the times that PCPs received CDS they substituted another potential teratogen. PCPs reported significant improvements in several counseling and prescribing practices. The multifaceted group reported a greater increase in the number of times per month they discussed the risks of medication use during pregnancy (multifaceted: +4.9 ± 7.0 vs. simple: +0.8 ± 3.2, p = 0.03). The simple CDS system was associated with greater clinician satisfaction. CONCLUSIONS CDS systems hold promise for increasing provision of family planning services when fertile women are prescribed potentially teratogenic medications, but further refinement of these systems is needed.

Girls' school participation has expanded considerably in the developing world over the last few decades, a phenomenon expected to have substantial consequences for reproductive behaviour. Using Demographic and Health Survey data from 43 countries, this paper examines trends and differentials in the mean ages at three critical life-cycle events for young women: first sexual intercourse, first marriage, and first birth. We measure the extent to which trends in the timing of these events are driven either by the changing educational composition of populations or by changes in behaviour within education groups. Mean ages have risen over time in all regions for all three events, except age at first sex in Latin America and the Caribbean. Results from a decomposition exercise indicate that increases in educational attainment, rather than trends within education groups, are primarily responsible for the overall trends. Possible explanations for these findings are discussed.

This study used national registries in Norway to identify children of different gestational-age categories who were born between 1967 and 1983 and to follow them through 2003. The risks of medical and social disabilities increased with decreasing gestational age at birth. Even among those who did not have medical disabilities, the gestational age at birth was associated with the education level attained, income, the receipt of social security benefits, and the likelihood of establishing a family. The risks of medical and social disabilities increased with decreasing gestational age at birth. The gestational age at birth was associated with the education level attained, income, the receipt of social security benefits, and the likelihood of establishing a family. Recent advances in the care of premature infants have resulted in increasing rates of survival. However, the increased prevalence of medical disabilities, learning difficulties, and behavioral and psychological problems among surviving preterm infants has raised concerns that these infants may have difficulties in coping with adult life. 1 – 6 Some primarily hospital-based cohorts of infants with very low birth weight who have been followed to young adulthood have shown reduced scores on cognitive and psychological tests as compared with controls with normal birth weights. 7 – 16 Other follow-up studies have shown more encouraging results. 17 , 18 However, the long-term social and behavioral outcomes . . .

Global population trends The increasing wealth of nations is accompanied by a fall in fertility, so that in many developed (and developing) nations, fertility rates have dropped below the replacement value of about 2.1 births per woman. This 'birth dearth', together with the ageing of populations, presents many difficult social and political problems. But, based on new cross-sectional and longitudinal analyses of the relationship between the total fertility rate and the human development index, Myrskylä et al . show that above a certain degree of economic development, fertility once again begins to rise, slowing the rate at which populations age. As a consequence, in contrast to the current popular and scientific debates, it seems likely that countries at the most advanced development stages will face a relatively stable population size, if not an increase in total population in cases where immigration is substantial. The increasing wealth of nations is accompanied by a fall in fertility such that in many developed and developing nations fertility rates have dropped below replacement value (less than 2.1 children per woman). Rapid population ageing, and in some cases the prospect of significant population decline, present difficult social and political problems. However, it is now shown that above a certain degree of economic development fertility begins to rise once again. During the twentieth century, the global population has gone through unprecedented increases in economic and social development that coincided with substantial declines in human fertility and population growth rates 1 , 2 . The negative association of fertility with economic and social development has therefore become one of the most solidly established and generally accepted empirical regularities in the social sciences 1 , 2 , 3 . As a result of this close connection between development and fertility decline, more than half of the global population now lives in regions with below-replacement fertility (less than 2.1 children per woman) 4 . In many highly developed countries, the trend towards low fertility has also been deemed irreversible 5 , 6 , 7 , 8 , 9 . Rapid population ageing, and in some cases the prospect of significant population decline, have therefore become a central socioeconomic concern and policy challenge 10 . Here we show, using new cross-sectional and longitudinal analyses of the total fertility rate and the human development index (HDI), a fundamental change in the well-established negative relationship between fertility and development as the global population entered the twenty-first century. Although development continues to promote fertility decline at low and medium HDI levels, our analyses show that at advanced HDI levels, further development can reverse the declining trend in fertility. The previously negative development–fertility relationship has become J-shaped, with the HDI being positively associated with fertility among highly developed countries. This reversal of fertility decline as a result of continued economic and social development has the potential to slow the rates of population ageing, thereby ameliorating the social and economic problems that have been associated with the emergence and persistence of very low fertility.

Background Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women’s participation in decision-making and its influence on reproductive health behaviors. Methods Cross-sectional survey with married women (15–49 years, N  = 2,672) in Maradi and Zinder Niger assessed women’s participation in household decision-making in health and non-health issues. Analyses examined [ 1 ] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [ 2 ] what individual, interpersonal, and community-level factors were associated with women’s participation in decision-making. Results Only 16% of the respondents were involved—either autonomously or jointly with their spouse—in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06–1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage. Conclusion Women’s engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women’s involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women’s decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women’s voice either before women enter marital partnerships or after (for instance, using health and social programming).

Background Women’s high-risk fertility behavior, marked by short birth intervals, higher birth order, and early maternal age at childbirth, has been scientifically proven to have detrimental health effects on both the mother and child. Despite the recognized consequences, there is a limited body of research examining the factors that contribute to high-risk fertility behavior in Tanzania. Hence, this study seeks to identify the prevalence of high-risk fertility behavior and associated factors among women of reproductive age within the Tanzanian context. Method This study analyzed data from the 2022 Tanzania’s Demography and Health Survey, focusing on 11,380 women of childbearing age. To deal with the survey’s clustered structure and the binary nature of the outcome variable, a multi-level mixed-effect generalized linear model (Poisson regression with robust error variance) was employed. The Statistical significance of the predictor was assessed using adjusted prevalence ratios (aPR) with 95% confidence intervals. Results The prevalence of high-risk fertility behavior among Tanzanian women was 71.55% (95% CI = 70.71, 72.37). Women’s educational levels, Age of women, wealth index, media exposure, decision-making autonomy, contraceptive use, and rural residence were found to be predictors of high-risk fertility behavior. Conclusion a considerable number of women in Tanzanian have encountered High-risk fertility Behaviors. This is a significant concern, posing a notable challenge to the healthcare system. Addressing this issue requires a comprehensive and coordinated approach that involves all stakeholders. Policymakers should consider developing programs that take into account predictors like wealth, education, and residence, which contribute to women’s vulnerability to high-risk fertility behavior. Focusing on women residing in areas with a high prevalence of high-risk fertility behavior could be instrumental in tackling the root causes of the problem.

In 2012, the London Summit on Family Planning adopted the ambitious goal of increasing access to contraception for 120 million additional women and girls in the world’s poorest countries by 2020. Family Planning 2020 (FP2020) was established as a coordinating body to monitor progress. In order to monitor country progress and to change course in the event of stagnating or declining use, data were needed more frequently and more quickly than data provided by typical surveys. Performance Monitoring and Accountability 2020 (PMA2020) was created to provide rapid and frequent estimates of modern contraceptive use in FP2020 priority countries. Currently operational in ten countries (Burkina Faso, DRC, Ethiopia, Ghana, India, Indonesia, Kenya, Niger, Nigeria, and Uganda), PMA2020 conducts surveys every six months to one year, providing FP2020, governments, and other stakeholders frequent information on contraceptive use, demand, and supply that can inform policies and programs and identify areas for improvement.

Background Despite progress in various aspects of women’s rights and health, a significant gap persists in the area of reproductive health decisions among women in Sub-Saharan Africa. This study seeks to address this gap by investigating the interplay between educational access, economic autonomy, and digital systems on the sexual and reproductive health (SRH) outcomes of married women in the Sub-Saharan African context. Methods Leveraging cross-sectional data obtained from the latest demographic and health surveys conducted across 16 Sub-Saharan African nations between January 2015 and December 2021, the study’s focus centred on 67,437 married women. Through the utilization of binary logistic regression, model-adjusted odds ratios accompanied by a 95% confidence interval were calculated. Results Compared to their counterparts in Benin, married women in Madagascar (aOR = 4.95, 95% CI = 4.29–5.71) and Uganda (aOR = 3.42, 95% CI = 2.99–3.90) exhibited the highest levels of agency in making SRH decisions among the 16 countries studied. Factors like higher education (aOR = 2.37, 95% CI = 2.13–2.64), familiarity with modern contraception (aOR = 3.19, 95% CI = 1.99–5.13), utilization of mobile phones for financial transactions (aOR = 1.21, 95% CI = 1.14–1.28), possession of a bank account (aOR = 1.17, 95% CI = 1.10–1.25), current employment (aOR = 1.19, 95% CI = 1.08–1.32), and engagement with the internet (aOR = 1.16, 95% CI = 1.08–1.24) were found to significantly influence SRH decisions-making across all countries. Conclusions Enhancing the sexual and reproductive health outcomes of married women in Sub-Saharan Africa necessitates targeted efforts, particularly among those without higher education, limited contraceptive knowledge, reliance on mobile phones for financial transactions, without bank accounts, lacking internet access, and currently unemployed. By addressing these specific areas, interventions can be more effective in bridging the existing gaps in SRH decision-making among married women in this region.

This study aimed to assess the prevalence, sociodemographic factors, reproductive consequences, and heritable disease burdens associated with consanguineous marriage (CM) in Bangladesh. A total of 7,312 families, including 3,694 CM-families, were recruited from 102 locales of 58 districts of Bangladesh. Using a standard questionnaire, we collected medical history and background sociodemographic data of these families. Family history was assessed by pedigree analysis. Fertility, mortality, secondary sex ratio, selection intensity, lethal equivalents were measured using standard methods. The mean prevalence of CM in our studied population was 6.64%. Gross fertility was higher among CM families, as compared to the non-CM families (p < 0.05). The rate of under-5 child (U5) mortality was significantly higher among CM families (16.6%) in comparison with the non-CM families (5.8%) (p < 0.01). We observed a persuasive rise of abortion/miscarriage and U5 mortality rates with the increasing level of inbreeding. The value of lethal equivalents per gamete found elevated for autosomal inheritances as compared to sex-linked inheritance. CM was associated with the incidence of several single-gene and multifactorial diseases, and congenital malformations, including bronchial asthma, hearing defect, heart diseases, sickle cell anemia (p < 0.05). The general attitude and perception toward CM were rather indifferent, and very few people were concerned about its genetic burden. This study highlights the harmful consequences of CM on reproductive behavior and the incidence of hereditary conditions. It essences the need for genetic counseling from premarital to postnatal levels in Bangladesh.