Evidence for a ‘healthy pregnant woman effect’ in Niakhar, Senegal?

Ronsmans, Carine; Khlat, Myriam; Kodio, B.; Bâ, Mariame Guèye; Bernis, Luc de; Etard, J F

doi:10.1093/ije/30.3.467

Cited by 33 publications

(25 citation statements)

References 17 publications

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“…In their systematic review of the literature on the effect of the number of births on women's mortality, Hurt et al (2006) do not find any negative effect of parity on mortality. And this is also true within our study area, as documented in Ronsmans et al (2001). We argue that the direct effect of fertility on child mortality is likely to be negligible compared to the opposite effect.…”

Section: Model Specificationssupporting

confidence: 67%

“…The drivers of fertility are obviously not the same as the factors determining infertility. Moreover, infertility and voluntary childlessness are very rare in the study area (Ronsmans et al 2001). The long time-span of the data also allows us to distinguish between six different birth cohorts of five-year intervals (1932)(1933)(1934)(1935)(1936) for the earliest cohort, and 1957-1961 for the latest).…”

Section: Data: the Niakhar Health And Demographic Surveillance Systemmentioning

confidence: 96%

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The effect of child mortality on fertility behaviors is non-linear: new evidence from Senegal

Bousmah

2014

Rev Econ Household

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ACL-3International audienceThe present paper examines the relationship between child mortality and fertility at the micro level. We use individual data collected quarterly within the health and demographic surveillance system of the rural community of Niakhar (Fatick, Senegal). Birth histories of 2,884 women born between 1932 and 1961 are analyzed. The determinants of completed fertility are investigated using a standard Poisson Regression Model. The global effect of child mortality on total and net fertility is found to be positive. To our knowledge, this is the first paper to provide evidence for the child survival hypothesis—an effect of child mortality on net fertility—at the micro level. We further identify an inverted-U shaped relationship between child mortality and net fertility. The implication is that health policies aiming at reducing child mortality have indirect effects on desired fertility; yet only a steep decrease in child mortality would be likely to trigger fertility declines

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Section: Model Specificationssupporting

confidence: 67%

Section: Data: the Niakhar Health And Demographic Surveillance Systemmentioning

confidence: 96%

The effect of child mortality on fertility behaviors is non-linear: new evidence from Senegal

Bousmah

2014

Rev Econ Household

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“…Prima facie our results seems to be contradicted by the findings of Ronsmans et al 29 who investigated all female deaths in the population of Niakhar, Senegal, from 1983 to 1998. By comparing death rates in pregnant or recently pregnant women (exposed) with death rates in other women (unexposed), they found that between ages 20 and 44, pregnancy did not confer additional risk to the women.…”

Section: Discussioncontrasting

confidence: 92%

Maternal mortality: only 42 days?

Høj

Silva

Hedegaard

et al. 2003

BJOG

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aObjective A maternal death is defined by WHO as 'the death of a woman while pregnant or within 42 days of termination of pregnancy. . .'. The origin of the 42 days is no longer clear. In developing countries, the burden imposed by pregnancy and birth on a woman's body may extend beyond 42 days as pregnancyrelated anaemia can persist for longer and vaginal haemorrhaging and risk of infections are not necessarily over after six weeks. We therefore examined duration of excess mortality after delivery in rural Guinea-Bissau. Design In a prospective cohort study, we followed 15,844 women of childbearing age with biannual visits over a period of six years, resulting in a total of 60,192 person-years-at-risk. To establish cause and timing in relation to termination of pregnancy, verbal autopsy was carried out for all deaths. Mortality rates were calculated for short time intervals after each delivery or miscarriage. Results During the observation period we registered 14,257 pregnancies and 350 deaths. One hundred and ninety-four deaths followed termination of a registered pregnancy and thus were eligible for the analysis. Eighty-two deaths occurred during the first 42 days after delivery/miscarriage. A further 16 women died in the period from 43 to 91 days after parturition, 16 between 92 and 182 days and 18 between 183 and 365 days after delivery. Compared with baseline mortality 7 -12 months after delivery, women who had recently delivered had 15.9 times higher mortality (95% CI 9.8-27.4). From days 43 to 91 the mortality was still significantly elevated ). Conclusion Where living conditions are harsh, pregnancy and delivery affect the health of the woman for more than 42 days. Using the WHO definition may result in an under-estimation of the pregnancy-related part of the reproductive age mortality. Extending the definition of maternal death to include all deaths within three months of delivery may increase current estimates of maternal mortality by 10 -15%.

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“…However, several women choose not to have children due to other reasons. Studies comparing death rates in pregnant women with death rates in other women have showed a health selection possibly combined with an apparent protective effect of pregnancy on women's health [38]–[40]. Women who have given birth may thus have a greater proportion of healthy women.…”

Section: Discussionmentioning

confidence: 99%

Associations between Childbirth, Hospitalization and Disability Pension: A Cohort Study of Female Twins

et al. 2014

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BackgroundAs the literature on long-term effects of childbirth on risk of morbidity or permanent work incapacity (DP) is limited, we aimed to study associations of childbirth with hospitalization and DP, adjusting for familial factors.MethodsThis cohort study included female twins, i.e. women with twin sister, born 1959–1990 in Sweden (n = 5 118). At least one in the twin pair had their first childbirth 1994–2009. Women were followed regarding all-cause and cause-specific (mental or musculoskeletal diagnoses) DP during year 2–5 after first delivery or equivalent. Associations between childbirth, hospitalization and DP were calculated as hazard ratios (HR) with 95% confidence intervals (CI).ResultsWomen who did not give birth had markedly higher number of DP days/year compared to those giving birth. Hospitalization after first childbirth was associated with a higher HR of DP. Those hospitalized at least once after their first childbirth had a three-fold DP risk (HR: 3.2; 95% CI 1.1–9.6), DP due to mental diagnoses (HR: 3.2; 1.2–8.8), and of DP due to musculoskeletal diagnoses (HR: 6.1; 1.6–22.9). Lower HRs in the discordant twin pair analyses indicated that familial factors may influence the studied associations.ConclusionsWomen who did not give birth had a much higher risk for DP than those who did. Among those who gave birth, the risk for DP was markedly higher among those with a previous hospitalization, and especially in women with repeated hospitalizations. The results indicate a health selection into giving birth as well as the importance of morbidity for DP.

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Evidence for a ‘healthy pregnant woman effect’ in Niakhar, Senegal?

Cited by 33 publications

References 17 publications

The effect of child mortality on fertility behaviors is non-linear: new evidence from Senegal

The effect of child mortality on fertility behaviors is non-linear: new evidence from Senegal

Maternal mortality: only 42 days?

Associations between Childbirth, Hospitalization and Disability Pension: A Cohort Study of Female Twins

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