Having fewer children makes it possible to educate them all: an ethnographic study of fertility decline in north-western Tigray, Ethiopia

Mjaaland, Thera

doi:10.1016/s0968-8080(14)43768-6

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…Studies in other countries have shown some measure of success with this type of intervention. 34-36 Additionally, the Indian Government needs to increase attention to improving policies and practice regarding provision of contraceptive services to improve the ability of women and couples to prevent unintended pregnancy.…”

Section: Discussionmentioning

confidence: 99%

The incidence of abortion and unintended pregnancy in India, 2015

Singh

Shekhar

Acharya

et al. 2018

The Lancet Global Health

231

229

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Summary Background Reliable information on the incidence of induced abortion in India is lacking. Official statistics and national surveys provide incomplete coverage. Since the early 2000s, medication abortion has become increasingly available, improving the way women obtain abortions. The aim of this study was to estimate the national incidence of abortion and unintended pregnancy for 2015. Methods National abortion incidence was estimated through three separate components: abortions (medication and surgical) in facilities (including private sector, public sector, and non-governmental organisations [NGOs]); medication abortions outside facilities; and abortions outside of facilities and with methods other than medication abortion. Facility-based abortions were estimated from the 2015 Health Facilities Survey of 4001 public and private health facilities in six Indian states (Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu, and Uttar Pradesh) and from NGO clinic data. National medication abortion drug sales and distribution data were obtained from IMS Health and six principal NGOs (DKT International, Marie Stopes International, Population Services International, World Health Partners, Parivar Seva Santha, and Janani). We estimated the total number of abortions that are not medication abortions and are not obtained in a health facility setting through an indirect technique based on findings from community-based study findings in two states in 2009, with adjustments to account for the rapid increase in use of medication abortion since 2009. The total number of women of reproductive age and livebirth data were obtained from UN population data, and the proportion of births from unplanned pregnancies and data on contraceptive use and need were obtained from the 2015–16 National Family Health Survey-4. Findings We estimate that 15·6 million abortions (14·1 million–17·3 million) occurred in India in 2015. The abortion rate was 47·0 abortions (42·2–52·1) per 1000 women aged 15–49 years. 3·4 million abortions (22%) were obtained in health facilities, 11·5 million (73%) abortions were medication abortions done outside of health facilities, and 0·8 million (5%) abortions were done outside of health facilities using methods other than medication abortion. Overall, 12·7 million (81%) abortions were medication abortions, 2·2 million (14%) abortions were surgical, and 0·8 million (5%) abortions were done through other methods that were probably unsafe. We estimated 48·1 million pregnancies, a rate of 144·7 pregnancies per 1000 women aged 15–49 years, and a rate of 70·1 unintended pregnancies per 1000 women aged 15–49 years. Abortions accounted for one third of all pregnancies, and nearly half of pregnancies were unintended. Interpretation Health facilities can have a greater role in abortion service provision and provide quality care, including post-abortion contraception. Interventions are needed to expand access to abortion services through better equipping existing facilities, ensuring adequate and continuous suppl...

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Section: Discussionmentioning

confidence: 99%

The incidence of abortion and unintended pregnancy in India, 2015

Singh

Shekhar

Acharya

et al. 2018

The Lancet Global Health

231

229

View full text Add to dashboard Cite

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“…The number of school years for women increased markedly after 1970 in most regions, but increased less in Africa [63]. The decrease in TFR might also arise indirectly via school year correlations with improved economy, family planning (FP) programs, and media attention to FP, factors which may also lead to smaller families [64][65][66][67].…”

Section: Discussionmentioning

confidence: 99%

Human fertility in relation to education, economy, religion, contraception, and family planning programs

2020

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Background: The world population is expected to increase greatly this century, aggravating current problems related to climate, health, food security, biodiversity, energy and other vital resources. Population growth depends strongly on total fertility rate (TFR), but the relative importance of factors that influence fertility needs more study. Methods: We analyze recent levels of fertility in relation to five factors: education (mean school years for females), economy (Gross Domestic Product, GDP, per capita), religiosity, contraceptive prevalence rate (CPR), and strength of family planning programs. We compare six global regions: E Europe, W Europe and related countries, Latin America and the Caribbean, the Arab States, Sub-Saharan Africa, and Asia. In total, 141 countries are included in the analysis. We estimate the strength of relationships between TFR and the five factors by correlation or regression and present the results graphically. Results: In decreasing order of strength, fertility (TFR) correlates negatively with education, CPR, and GDP per capita, and positively with religiosity. Europe deviates from other regions in several ways, e.g. TFR increases with education and decreases with religiosity in W Europe. TFR decreases with increasing strength of family planning programs in three regions, but only weakly so in a fourth, Sub-Saharan Africa (the two European regions lacked such programs). Most factors correlated with TFR are also correlated with each other. In particular, education correlates positively with GDP per capita but negatively with religiosity, which is also negatively related to contraception and GDP per capita. Conclusions: These results help identify factors of likely importance for TFR in global regions and countries. More work is needed to establish causality and relative importance of the factors. Our novel quantitative analysis of TFR suggests that religiosity may counteract the ongoing decline of fertility in some regions and countries.

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“…Premarital sex in general and premarital pregnancy in particular are, in many places, regarded as highly inappropriate (see for examples [9, 10]), and the unacceptability of premarital sex is found to be a major reason for unmarried girls to avoid seeking advice and using reproductive health services even if they are available [10]. The dominant reproductive discourse in Ethiopia, propagated both by religious institutions and within families, seems particularly powerful in its condemnation of premarital pregnancy [7, 11–13]. Coupled with a strong demand to control social behavior in public [14], and highly authoritarian parent-child-relations [15, 16] sexuality-related subjects are surrounded by silence and shame both in private and public spheres, leading young people to keep problems within these domains to themselves [14].…”

Section: Introductionmentioning

confidence: 99%

When abortion is not within reach: Ethiopian university students struggling with unintended pregnancies

Zenebe

Haukanes

2019

Int J Equity Health

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BackgroundIn spite of increasing international commitment to young people’s sexual and reproductive health, unintended pregnancies remain a major problem for young women worldwide. This article explores the issue of unintended pregnancies among Ethiopian university students and investigates narratives of students who carried their pregnancy to term. Ethiopia’s relatively permissive abortion law forms part of the backdrop for the exploration. We also consider how socio-cultural and religious norms surrounding female premarital sex/pregnancy, and gendered and urban-rural inequities, play a role in how students handle the challenge.MethodsThe article is based on research conducted among students at Addis Ababa, Jimma and Mekelle Universities in Ethiopia between September 2016 and June 2017. Drawing on an interpretative, phenomenological approach to science and employing a qualitative methodology, the authors conducted in-depth interviews with 53 students and 24 selected staff at the three universities, and held two focus group discussions with students at Addis Ababa University.ResultsThe study findings show three possible scenarios for how students can deal with an unwanted pregnancy. The first is to have the pregnancy terminated secretly, and thereby avoid the stigma linked to premarital pregnancy. The second is to make a deliberate decision to keep the pregnancy and face the consequences to come. The third scenario is found in cases where the student seems paralyzed by feelings of shame, and where she ends up keeping the pregnancy due to her inability to act.Students who end up carrying their pregnancy to term face many problems. Few support structures at the university are in place to cater for their needs. Moreover, family support is endangered by pregnancy, as it puts the student at risk of being ostracized from her family due to the shame she has imposed on them. Shame and silence are thus important social forces in these students’ lives, underpinned by gendered inequities and patriarchal norms.ConclusionsAlong with rural-urban and gendered inequities, the article demonstrates how a shame-silence nexus forcefully operates in the lives of female students struggling with reproductive challenges, and the serious consequences a pregnancy may have for those who carry it to term.

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Having fewer children makes it possible to educate them all: an ethnographic study of fertility decline in north-western Tigray, Ethiopia

Cited by 4 publications

References 5 publications

The incidence of abortion and unintended pregnancy in India, 2015

The incidence of abortion and unintended pregnancy in India, 2015

Human fertility in relation to education, economy, religion, contraception, and family planning programs

When abortion is not within reach: Ethiopian university students struggling with unintended pregnancies

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