Some recent data are presented on the size and selected sociodemographic characteristics of the Afghan refugee population in Pakistan. Although the official figures show that there were 3·27 million registered Afghan refugees in Pakistan, it is estimated that the actual number may be as high as 3·6 million. There is an excess of females over males, mainly due to war-related activities and excessive casualties particularly among males. While infant and childhood mortality rates are declining and are lower than the levels prevalent in Pakistan, as well as in Afghanistan during the prewar period, the fertility levels among Afghan refugees seem very high indeed.

Vol. 21, No. 2 (April 1989), pp. 169–177

AGE AT FIRST INTERCOURSE

Hanne Wielandt & Jesper Boldsen

In the first paragraph on page 174, Walløe (1978) was erroneously cited. The data analysed by Walløe were not incompletely known. Consequently, the estimated median ages at sexual debut are not spurious, as stated, since the whole sample was included in the denominator.

We sincerely regret this miscitation and offer our apologies to our distinguished Norwegian colleagues.

Over the last four decades in Sri Lanka, age at first marriage for males increased marginally, and for females it rose considerably, but there has been no recent increase in female age at marriage. Among the younger cohorts, estimated ages at which some married indeed show a declining mean age at marriage. Coale-McNeil estimates indicate that there is no real decline in female age at marriage in Sri Lanka. Marriages were delayed as a result of economie hardship or increased mortality to the mid-1970s, but once the overall economy improved after 1977, more marriages took place. Female age at marriage in Sri Lanka remained slightly below 24 years, the age which is anticipated by younger cohorts, and this level is likely to persist for some time.

In a comparison of present and past users of contraceptive implants (Norplant) or injectables (DMPA) and discontinuers of Norplant or DMPA, information concerning the women's knowledge and perception of, and attitude to, implants and injectable contraceptives, was studied. The long duration of action (5 years) of implants was perceived positively by all groups as compared to the shorter 3-month duration of injectables, though this was seen as an advantage over the pill. It appears that the Norplant system has potential for wider use in Singapore in the future.

This paper examines the changing nuptiality pattern of rural China, particularly rural Anhui in relation to the planned social changes since 1949 and their effect on fertility. The data are from the 1/1000 Fertility Survey of China, conducted by the Family Planning Commission in 1982. Before the family planning programme was introduced to rural Anhui (1972), the changing nuptiality pattern was indirectly affected by the planned social changes; after 1972, the substantial increase in age at first marriage was mainly due to the family planning programme. More recently, the centrally controlled social structure is loosening, due to the economic reform and the nuptiality pattern seems to join the 1972 trend, suggesting that the dramatic change of nuptiality pattern during the early 1970s to early 1980s was a temporary one. But its effect on fertility is clear, and the shortening interval between marriage and first birth may bring difficulties for future population control in rural China.

Users of the six major methods of contraception are compared across a broad range of variables using data from a community sample. Differences between the groups were apparent for a range of socioeconomic and reproductive variables, and current users of the various methods also differed in their past use of contraception. Users of barrier methods fared particularly well. Few differences were observed for current health status or for the sociocultural variables examined, although users of natural methods differed from all others in their religious affiliation and commitment.

Discriminant analysis showed that the most predictive variables distinguishing women who had opted for permanent methods of contraception (female sterilization and vasectomy) were the woman's stated reason for using her current method and her past contraceptive patterns; the inclusion of social, health and reproductive indicators did little to improve the prediction. It is argued that heightened expectations for contraceptive efficacy in the face of increasing concerns about long-term health consequences have contributed to the increased use of permanent methods.

Data for a sample of 50 developing countries are analysed to investigate the social correlates of the teenage birth rate. Of five major factors considered as predictors of national birth rates (socioeconomic development, family planning programmes, women's status, the sex ratio, and marriage patterns), regression analyses reveal that only the average age at marriage for women has a significant effect on the teenage birth rate. In contrast, all variables except the sex ratio and the average age at marriage for women have a significant effect on the total fertility rate.

Among the married female population in rural areas of 19th century Sweden infertility and subfertility were found in 7·5% and 6·1% respectively with increasing incidence during the latter half of the century. In relation to the age group 20–24, fecundity declined by 42% and 92% in the age groups 35–39 and 40–45 respectively. One-third of married women died before age 50. Re-marriages and step-parents were common. Less than half of the married women brought up the majority of the children in the community.

A longitudinal study of twenty-six breast-feeding and twelve non-breast-feeding postpartum women was conducted in Assiut, Egypt in order to determine the time that ovulation resumed after childbirth, and the effect of breast-feeding frequency on the period of lactational anovulation. Breastfeeding women experienced the onset of follicular development, vaginal bleeding, ovulation and pregnancy significantly later than women who did not breast-feed. Ovulatory and non-ovulatory breast-feeders reported similar frequencies of breast-feeding episodes. The introduction of dietary supplements commonly preceded ovulation. An algorithm using three simple variables observable to the breast-feeding mother was found to predict up to 100% of the first ovulations. All breast-feeding women who did not give supplements and did not have a vaginal bleeding episode by 6 months postpartum were anovular by strict criteria for ovulation. Ovulation did not precede bleeding or supplementation in the women who experienced these events before 6 months, yielding a highly effective formula for preventing unplanned pregnancy by the informed use of breast-feeding.

Analysis of perinatal mortality attributed to congenital malformations in England and Wales, using data from birth and death registration over the years 1974–81 showed significant declines in England and Wales as a whole and in the individual Regional Health Authority (RHA) areas. A greater decrease in death rate from congenital malformations, particularly central nervous system malformations, was seen among stillbirths than among early neonatal deaths. There were marked regional differences in perinatal mortality due to central nervous system malformations over the period but not in cardiovascular system malformations or in other malformations. The highest mortality rates due to central nervous system malformations occurred in the North, North-West, West and South-West of England and in Wales, and the lowest rates in the South and South-East. The larger percentage reductions in the mortality rates were found in most of the regions which had had the highest rates. Possible explanations for the decline in regional rates are suggested.

Whatever proximate variables are examined, their differential effects on rural and urban fertility are small. This indicates that no major disturbance has taken place in urban or rural reproductive norms. However, two possible reasons for the converging pattern of rural and urban fertility in Nigeria are identified. One is that urban mothers in the first half of the childbearing age range have higher fertility than their rural counterparts. The other is that breast-feeding and post-partum abstinence, which are the major determinants of marital fertility, exert a more depressing influence on rural than urban fertility.

Data from 157 men in Nepal who had vasectomy reversal are analysed. Most sought reversal within 5 years of vasectomy. Half of the men sought reversal because of the death of a male child, and about one-fourth because of the loss of a female child. Re-marriage was the primary reason for only 10% of the men. Those having reversal because of the loss of a male child were generally younger, and for almost half of this group, the age of their last child at the time of their vasectomy was under 2 years. The results suggest that the demand for reversal could be considerably reduced by more careful screening of the potential vasectomy acceptors.

The effects of initiation of solid and liquid supplementation on resumption of post-partum menstruation are examined, 0using data from a 2-year prospective study of birth interval dynamics from central Java, Indonesia. The sample analysed consisted of 444 women who experienced resumption of menses while breast-feeding, women who were breast-feeding and amenorrhoeic at the end of the study, or women who resumed menstruation or were censored after infant mortality and weaning which preceded the resumption of menses. Multivariate hazard model analysis was used to assess the significance of supplementation, various breast-feeding covariates, and age and parity of the dependent variable. Because the timing of supplementation varies, the supplementation variables were introduced into the analysis as time-varying covariates. For the mothers in the sample, solid and liquid supplementation was initiated at medians of 2·1 and 8·0 months respectively. The former had a significant effect on resumption of menses, while the latter was only marginally significant. Earlier supplementation meant shorter durations of amenorrhoea for the majority of women. However, the effect was not consistent across all categories of women. For the small group of mothers who were low intensity breast-feeders (≤6 minutes per nursing episode) or as low frequency day-time breast-feeders (≤6 nursing episodes per day-time), earlier supplementation had no additional effect on their rate of resumption of menses post-partum.

This paper examines the patterns of timing of births of women using data from the Canadian Fertility Survey of 1984. Semi-Markovian schemes are applied to the maternity histories of the 5315 sample women in their reproductive ages in order to measure the intensity and timing of childbearing. Age-and-duration-specific transition probabilities are found to have substantially changed for the more recent birth cohorts compared to the older cohorts.

In 1986, a survey was conducted to assess knowledge, health concerns and experience with marketing (retailers) and use (consumers) of Gulaf and Nilocon pills and Kamal vaginal tablets distributed by the Nepal Contraceptive Retail Sales Company (CRS). A sample of 763 consumers of Gulaf, Nilocon and Indian pills and Kamal vaginal tablets, and 361 retailers from a stratified sample of urban medical shops were interviewed. The CRS marketing programme is reaching people who have previously never used family planning; most of the users were practising contraception to limit, not space, births; a high proportion of pill users over 35 smoked; only about a third of CRS pill users had prescriptions or consulted a physician prior to use; CRS training of retailers was found to have increased their knowledge. Recommendations are made for improving communication, education and marketing of CRS contraceptives to ensure their safe and effective use and increase the acceptability of this mode of service delivery.

In a survey in Ankole (Uganda) in 1985, 1664 women in samples of the three socioeconomic groups (pastoralists, cultivators and mixed farmers) were asked questions on their reproductive history, and 1029 men questions on educational and wedding costs and their expectations of help from relatives and obligations to help relatives. It is shown that the extended family system allows a great deal of mutual support, while the power of the elders allows them to influence younger married relatives to follow the pronatalist traditions of the society.

Between 1966 and 1983 the percentage of women who smoked or consumed alcohol during pregnancy increased considerably. Tobacco use was negatively, and alcohol consumption positively, correlated with the mother's level of education. Markedly more adolescents than older women smoked during pregnancy. Beer, wine and liquor consumption were highest among older pregnant women. The majority of women did not alter their smoking and drinking behaviour during their successive pregnancies.

In a comparative study to enquire whether parents of twins, especially of dizygotic twins, have a higher frequency of sexual intercourse than parents of singleton infants, data on sociodemographic status, coital frequency and other variables were collected using a postal questionnaire. Parents of all twins born alive in Denmark in 1984 or 1985 were included as cases and a random sample of parents of singleton infants born in the same period were controls. No evidence of any difference in coital frequency was found between parents of twins (neither dizygotic twins nor monozygotic) and parents of singleton infants.

This report evaluates the decrease in maternal mortality and its relation to family planning methods in Sweden during the years 1911–80. In the 1930s fertility was low but illegal abortions were at a high level and the associated maternal death rate was 18·5 per 1000 women. With the legalization of abortion and the introduction of modern contraceptive methods, the crude reproductive mortality rate in 1965–70 was 1·7 per 100,000 women and this was reduced still further, especially for younger women, by the late 1970s. Standardized reproductive mortality was then 80% higher than the crude rate, indicating the importance of modern family planning methods. Mortality associated with oral contraceptive or IUD use in Sweden during the 1960s and 1970s was lower than in England and the US. Mortality associated with sterilization was 6·2 per 100,000 procedures.

This paper analyses the relative importance of demographic and socioeconomic factors with respect to their role in reducing infant mortality in Egypt.

Logit analyses of data from a nationally representative sample of Egyptian households, and for urban and rural households separately, indicate that demographic factors have more effect on infant mortality than socioeconomic factors. The results also show the need to improve housing in urban areas and sewerage systems in rural areas in order to reduce infant mortality. One of the most important policy conclusions, however, concerns the importance of providing a vigorous educational campaign to enlighten mothers and prospective mothers in both rural and urban areas on the positive effects of breast-feeding, longer birth intervals, and fewer children on the survival of infants.