Objetivo: Determinar la asociación entre los factores sociodemográficos y reproductivos, y la fecundidad adicional no deseada (FAND) en el Perú según la Encuesta Demográfica y de Salud Familiar (ENDES) del 2018. Materiales y métodos: Se realizó un estudio observacional, analítico transversal, a partir de la ENDES del Perú del año 2018. La FAND es una variable que se creó a partir de la diferencia numérica entre la fecundidad obtenida y la fecundidad deseada. Se categorizó la variable FAND en dos categorías: la diferencia numérica positiva correspondió a presencia de FAND; y la diferencia numérica negativa o nula correspondió a ausencia de FAND. Se realizó una regresión de Poisson, tanto cruda como ajustada. Resultados: Se analizaron los datos de 6944 mujeres entre 40 y 49 años, con una edad promedio de 44,3. Se halló una prevalencia de FAND de 72,5% (IC95%: 70,4%-74,4%). En el modelo ajustado, se observó que pertenecer al quintil superior de riqueza (RPa: 0,80; IC95%: 0,69-0,93) disminuía la probabilidad de FAND con respecto al quintil intermedio. Por otro lado, provenir del ámbito rural (RPa: 1,07; IC95%: 1,01-1,14), aumenta la probabilidad de FAND con respecto al provenir del ámbito urbano. Conclusiones: La prevalencia de FAND en mujeres peruanas de 40 a 49 años que participaron de la ENDES 2018 es alta. Provenir del área rural aumenta la probabilidad de FAND; y el pertenecer al quintil superior de riqueza, la disminuye. / Objectives: To establish sociodemographic and reproductive factors associated with unwanted additional fertility (UAF) in Peru, as measured in the 2018 Demographic and Health Survey (DHS). Methods: An observational, analytical cross-sectional study was carried out based on Peru’s 2018 DHS. UAF is a variable that was created by subtracting the desired fertility from the obtained fertility. Then, it was categorized as present (positive) or absent (negative or null). Multivariable analysis was done through a Poisson regression, both crude and adjusted. Results: This study included 6944 women between 40 and 49 years old, with a mean age of 44,3. We found a prevalence of UAF of 72,5% (CI95%: 70,4%-74,4%), mainly in the coastal region and in urban areas. In the adjusted model it was found that, belonging to the top welfare quintile (aPR: 0,85; CI95%: 0,76-0,95) was associated with less probability of UAF when compared with the intermediate quintile. On the other hand, coming from rural areas (aPR: 1,07; CI95%: 1,01-1,14), was associated with increased UAF risk. Conclusions: The prevalence of UAF in Peruvian women from 40 to 49 years old who responded to DHS 2018 is high. Coming from rural areas is associated with a higher chance of UAF, whereas belonging to the top welfare quintile is associated with lower UAF probability. / Trabajo de investigación

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Federally qualified health centers (FQHCs) provide essential contraceptive services to low-income individuals; yet, access to all method options, notably intrauterine devices (IUDs) and implants, may be limited at non-Title X FQHCs. The South Carolina (SC) Choose Well initiative is a statewide contraceptive access initiative that was launched in 2017 and extends into 2022. Choose Well established a collaborative network between training and clinical partners and is aimed at facilitating implementation of contraceptive care best practices through capacity-building and training of clinical and administrative staff in partner organizations. The initiative provided funding for workforce expansion and contraceptive methods. We examined perceptions of staff from Choose Well-participating FQHCs regarding contraceptive access during the first 2 years of the initiative, including factors that facilitated or posed access challenges as well as sustaining factors. This study informs the process evaluation of Choose Well while providing data critical for uncovering and scaling up contraceptive access initiatives. Interviews were conducted with FQHC staff ( = 34) in 2018 and 2019 to assess Choose Well implementation and were recorded, transcribed, and double-coded at least 80% interrater reliability or consensus coding. Data were analyzed according to clinical and administrative factors influencing contraceptive access. Increased capacity for contraceptive counseling and provision through training and external funding for IUDs and implants were the most noted clinical factors facilitating access. Streamlining workflow processes was also a facilitator. Buy-in and engagement among staff and leadership emerged as a facilitator at some clinics and as a barrier at others. Policy/structural factors related to costs of devices and insurance coverage were identified as threats to sustainability. The Choose Well initiative contributed to the perception of an increase in contraceptive access at participating FQHCs in SC. Statewide contraceptive access initiatives have the potential to support FQHCs in meeting their clients' contraceptive needs. Organizational buy-in, sustainability of funding, and training are key to realizing the full potential of these initiatives.

Decisions about marriage and childbearing, and the subsequent interactions between members of a family unit can have important individual and societal impacts on income, well-being, and economic mobility. This is especially true for women in developing countries, given limited female formal labor force participation, the economic significance of marriage markets, and the reliance on kin networks in the absence of formal safety nets. This dissertation consists of three essays that analyze how individuals form families, how those family members interact, and the subsequent impacts on the well-being of the family unit. The first chapter studies the effects of a rapid university expansion on access to education and family formation for women. The second chapter examines the long-term effects of a primary schooling expansion program on the prevalence of child marriage. The final chapter examines the long-term consequences of early life exposure to armed conflict on family formation. In the first essay, I analyze the impact of increased access to higher education on family formation outcomes for women in developing countries. Using a difference-in-differences design that accounts for the staggered nature of university openings, and a combination of household surveys and administrative data, I examine the impact of women’s exposure to a rapid university expansion in Nigeria in the 2000s on three key aspects of the family formation process - the likelihood and timing of first marriage and birth, their spouses’ characteristics, and the quantity and “quality” of any children produced in the marriage. I find that university openings improved years of schooling and educational attainment among school-aged women, and delayed the timing of the first marriage and childbirth of women. Women also had fewer births, and their children were more likely to have better development outcomes. I show suggestive evidence that these outcomes are driven by increased autonomy - women delay sexual activity and are more likely to work, use contraception and have the final say over important decisions. My second essay analyzes the impact of a 1976 universal primary education reform that provided free primary education to all school-aged children in Nigeria on the prevalence of child marriage. Using data from household surveys, I implement a difference-in-difference empirical strategy that exploits variation in exposure to the reform across birth cohorts and localities. I find that women exposed to the reforms acquired more schooling and the probability that women marry before the age of 15 reduces. However, there are no significant effects of exposure to the policy on the overall age of marriage, or the likelihood of marriage before the age of 18 on average. I present evidence on other marriage outcomes - men’s education increases, as does the spousal education gap. Furthermore, women desire and have fewer children, and are also more likely to be engaged in paid work. However, I find no effects on the spousal age gap or the husband’s age. My third and final essay explores the long-term effects of exposure to violent conflict onfamily formation in developing countries. Using a difference-in-differences empirical design that exploits variation in the intensity of war exposure by ethnicity and age, I analyze the long-term impacts of the 1967-1970 Biafran War on the family formation outcomes of men and women who were exposed to the war during their pre-adolescent years. I find that conflict induces men to delay first marriage and first birth, but there are no significant impacts on the timing of these activities for women. Both men and women who are exposed to the war have fewer children, and women also desire fewer children overall. Additionally, women who were exposed to the war have a smaller age difference from their husbands and are less likely to be married to men who have other wives. They are also less likely to experience domestic violence, on average. War exposure has no effect on the education difference between spouses, but women’s educational attainment increases, on average, while that of men decreases. Finally, I find no effects of war exposure on women’s relational empowerment, in terms of their attitudes to domestic violence and intra-household decision-making, but they are less likely to be engaged in paid work. This study contributes new evidence on the long-term impact of armed conflict on family formation in sub-Saharan Africa and shows how these impacts vary by gender and the age and duration of war exposure.

La littérature suggère que le type de mariage joue un rôle important dans l’utilisation des services de planification familiale en Afrique subsaharienne et que les femmes impliquées dans les mariages polygynes sont moins susceptibles d’utiliser des méthodes contraceptives. Certaines d’entre elles s’exposent au risque de grossesses non désirées et de besoins non satisfaits en contraception. Cependant, l’association entre le type de mariage et le besoin non satisfait en planification familiale reste encore peu étudiée. Cette étude vise à analyser l’influence de la polygynie sur le besoin non satisfait en contraception et à explorer également comment elle est associée aux raisons sous-jacentes à ce besoin chez les femmes en union au Bénin. Pour ce faire, nous avons utilisé les données de l’enquête démographique et de santé (EDS) de 2017-2018 et estimé des modèles de régression logistique binaire et multinomiale. Les résultats indiquent que parmi les femmes en union au Bénin, 38% étaient impliquées dans des mariages polygynes et que 32% avaient un besoin non satisfait en contraception. Ils révèlent que les femmes issues de mariages polygynes, notamment les épouses juniors (RC=1,134; p<0,10) étaient plus susceptibles d’exprimer un besoin non satisfait que les épouses de mariages monogames, mais ce résultat n’est que marginalement significatif. En ce qui concerne les motifs des besoins non satisfaits, ils montrent que les épouses des mariages polygynes avaient un risque plus élevé d’exprimer les besoins insatisfaits en espacement, en particulier les épouses juniors (RRR=1,157; p<0,10), et en report de naissances (RRR=1,196; p<0,10) que les épouses des unions monogames. Toutefois, ces associations sont marginalement significatives. À noter qu’aucune différence significative n’a été observée entre les épouses seniors et les épouses en unions monogames. Cette étude souligne la nécessité de mener des recherches complémentaires pour approfondir ce sujet et de fournir des explications précises à ce constat. Les résultats suggèrent aussi qu’on doit prendre en compte le rang des épouses dans les analyses futures. / The literature suggests that the type of marriage plays an important role in the use of family planning services in sub-Saharan Africa, and that women involved in polygynous marriages are less likely to use contraceptive methods. Some of them are at risk of unwanted pregnancies and unmet need for contraception. However, the association between type of marriage and unmet need for family planning remains largely unexplored. This study aims to analyze the influence of polygyny on unmet need for contraception and explore how it is associated with the reasons underlying this need among women in unions in Benin. Therefore, we estimated binary and multinomial logistic regression models using data from the 2017-2018 Demographic and Health Survey (EDS) and estimated. The results indicate that 38% of women in union in Benin were involved in polygynous marriages and 32% had an unmet need for contraception. We also find that women from polygynous marriages, especially junior wives (OR=1.134; p<0.10), were more likely to express an unmet need than wives from monogamous marriages; however, this result is only marginally significant. Regarding the reasons for unmet need, we show that wives in polygynous marriages, particularly junior wives (RRR=1.157; p<0.10), had a higher risk of expressing unmet needs for spacing, and postponement of births (RRR=1.196; p<0.10) than wives in monogamous unions. However, these associations are marginally significant. No significant difference was observed between senior wives and wives in monogamous unions. This study highlights the need for further research to explore this subject, and to provide specific explanations for this finding. The results also suggest that we must consider the rank of wives in future analyses.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

The purpose of this research study is to determine the factors influencing reproductive health choices of women living with HIV attending primary health care services. The need for this research study is evident in that most women attending health care services at primary health care clinics, and who are HIV positive report unintended pregnancy. The study sought to provide answers to factors influencing their reproductive choices. A quantitative, descriptive and cross-sectional research study was used in this study. The sample consisted of 83 females between the ages of 18 and 40. The findings of the research study provided the researcher with adequate evidence on the factors influencing reproductive health choices of women living with HIV attending primary health care services. The approach to reproductive health services was still acceptable but needs to be improved. Moreover, the identified factors therefore influenced one’s perceptions on reproductive health decisions among HIV-infected women. / Health Studies / M.A. (Public Health)

A quantitative, descriptive, explorative, contextual study was conducted to determine pharmacists and drug vendors' level of knowledge, attitude towards and practice on Emergency Contraceptive (ECl in Addis Ababa. Forty licensed service providers in Addis Ababa were randomly selected during 2008 and interviewed using a structured interview schedule. Data were analysed using a computer software package. The findings revealed that although these service providers were knowledgeable on the purpose and dOSing schedule of EC, they lacked knowledge on side-effects, contra-indications, and types of ECs. Most respondents portrayed a subjective attitude towards easy EC access of especially adolescent girls, since they believed that it will encourage promiscuity and unprotected intercourse. Their knowledge and practice need to be improved, as it has a direct effect on potential users and reducing unwanted pregnancies among young. / Health Studies / M.P.H. (Health Sudies)

Reproductive health and induced abortion in Latin America and the Caribbean Abstract The objective of this study is to give a comprehensive overview of the reproductive health of the population living in Latin America and the Caribbean, and to evaluate the level of induced abortion in the region at the same time. In the theoretical part of the study the term reproductive health is defined and indicators evaluating its level are described. As well the difference between safe and unsafe abortion is explained and the state of abortion law is expounded in this part. Next part is devoted to the promotion of family planning programs. In the analytical part Latin American and Caribbean countries are divided into four groups by using cluster analysis. Within each group one selected country is characterized in more detail. Indicators entering into the analysis show the level of reproductive health, the level of fertility and the economic performance of countries in the early 21st century. In the part related to the induced abortion rate in the region is discovered that despite the fact that in Latin America and the Caribbean there is one of the highest levels of contraceptive prevalence, there is also the highest level of induced abortion in the world. In the last part of the study the relationship between level of...