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Limited data exists concerning the fertility desires of young people living with HIV/AIDS (PLWHA) in China, making it difficult to develop appropriate reproductive health service policies and interventions for them. Extensive fieldwork was carried out from April to May 2021 in 10 selected survey sites across five provinces, targeting all young men aged between 18 and 24 years living with HIV. The association between independent variables and fertility desires was determined using Chi-square tests and Multivariate binary logistic regression models. In total, we obtained valid responses from 436 individuals, yielding a response rate of 74.9%. Nearly half of the respondents (48.6%) expressed a future desire to have children. The multivariate logistic regression models pointed to rural registered residence (AOR = 1.595, CI: 1.073, 2.371), heterosexual (AOR = 3.098, CI: 1.523, 6.301) or bisexual orientation (AOR = 2.302, CI: 1.396, 3.794), among others, as significant correlates of fertility desires. This study represents the first exploration of fertility desires among young men living with HIV in China. Evaluating these desires allows healthcare providers to anticipate patients' potential marriage and family plans, thereby facilitating timely provision of reproductive services designed to prevent HIV transmission. [ABSTRACT FROM AUTHOR]

Introduction: Childbearing and childrearing challenge parents' physical, social and emotional capacities. Childbearing motivations and desires are indicators of person's psychological readiness to meet these challenges and to establish a healthy bond with the child. Yet, much uncertainty still exists on how childbearing motivations and desires develop in the life course and to what extent early experiences in the family of origin contribute to their development. Objective: The overall goal of the present study was to understand the relationship between early caregiving responsibilities (i.e. childhood parentification) in the family of origin and childbearing motivations and the desire to have a first child. Methods: In the cross-sectional design study, childless Polish adults (N = 384; 20–35 years old) completed a set of self-report measures. Different dimensions of parentification experienced in childhood were measured retrospectively using the Parentification Inventory, and childbearing-related variables were assessed using the Childbearing Questionnaire. Data were analysed using mediation analyses. Results: We found that past experiences of parent- and sibling-oriented parentification were positively associated with the desire to have a child, and these relationships were fully mediated by positive childbearing motivation. Further, our results showed that satisfaction with childhood caregiving responsibilities positively predicted childbearing desire, and this effect was partially mediated by positive and negative childbearing motivation. Conclusion: Individuals' early caring activities, especially when they evoke feelings of satisfaction and appreciation in the child, may play an important role in shaping childbearing motivations and desires that underlie their future reproductive behaviours. [ABSTRACT FROM AUTHOR]

The desires for marriage and fertility among people living with HIV (PLWH) are increasing worldwide because of improved treatment and prognosis; yet they remain understudied in China, which has a family-oriented culture. This study aimed to investigate these desires for marriage and fertility among Chinese PLWH and explore their correlates. A cross-sectional study was conducted among 1,504 Chinese PLWH to assess their desires for marriage, fertility, and other variables through an online questionnaire. Logistic regression models were used to analyze factors associated with desires for marriage and fertility. Among the 1,504 participants, 53.9% aspired to marry at 34.7665.26 years old, whereas 62.0% desired parenthood at 36.4365.11 years old. Factors associated with these desires included age, gender, residence, education level, HIV transmission route, CD41 T-cell count, time since HIV diagnosis, disclosure of HIV status, social support, and mental health indicators. [ABSTRACT FROM AUTHOR]

Ideal family sizes remain at or above two in most low-fertility settings, but sub-replacement fertility ideals have been reported for urban China. The presence of restrictive family planning policies has led to a debate as to whether such ideals are genuine. This study exploits the ending of the one-child policy and the beginning of a universal two-child policy in October 2015 to investigate whether relaxing the restrictions led to an increase in ideal family size. We apply difference-in-differences and individual-level fixed-effect models to longitudinal data from a near-nationwide survey. For married individuals aged 20–39, relaxing the restrictions from one to two children increased the mean ideal family size by around 0.2 and the proportion who desired two or more children by around 19 percentage points. Findings suggest that although reported ideal family sizes have been reduced by policy restrictions, sub-replacement ideal family sizes in urban China appear to be genuine. [ABSTRACT FROM AUTHOR]

Yijing Xie,1 Chenge Liao,2,* Xiaomei Zhai1,* 1School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China; 2School of Rehabilitation Medicine, Binzhou Medical University, Yantai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chenge Liao, School of Rehabilitation Medicine, Binzhou Medical University, 346 Guanhai Road, Laishan District, Yantai, People’s Republic of China, Email Liaochenge@bzmc.edu.cn Xiaomei Zhai, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 31, 3 Tiao, Bei-Ji-Ge Street, Dongcheng District, Beijing, People’s Republic of China, Email xmzhai@pumc.edu.cnPurpose: Controversy exists on whether or not elective oocyte cryopreservation (eOC) can be conducted in public hospitals in China. Policymakers should take into account the benefits and risks in the Chinese population. This study explored basic data concerning the awareness, attitudes of eOC, and fertility desire of eOC in China to offer evidence for policy making.Methods: A total of 442 people in four areas of China responded to a survey. The questionnaire was divided into three parts: awareness, attitude, and fertility desire of eOC. Descriptive analysis and multivariable regression analysis were used in the study.Results: Generally, the respondents had a positive or neutral attitude towards eOC. However, about 90% of respondents did not know the cost of eOC. In general, a more positive attitude was found towards eOC among participants who had heard of the procedure compared with those who had not. Most women did not desire to reproduce by eOC. After adjusting for access to information, we found that female, older age groups, and singles were more likely to have increased awareness than their counterparts. The awareness of participants who accessed information from any source had a higher relative probability of having good awareness levels compared to participants who had not accessed the information. Undergraduates exhibited significantly higher levels of cognitive understanding, as indicated by their increased familiarity and comprehension, compared to high school students (relative risk ratio = 1.44, confidence interval = 0.48,4.29).Conclusion: Continued discussion is needed regarding the ethical, legal, and social aspects of performing eOC in public hospitals. Furthermore, policies are needed to regulate eOC to protect the reproductive freedom of healthy women.Keywords: elective oocyte cryopreservation, awareness, attitude, fertility desire

The National surveillance data showed that homosexual transmission played a considerable role in new HIV infections in China. The emphasis on antiretroviral therapy and prevention of mother-to-child transmission provided chances for reproduction among people living with HIV/AIDS. Issues of fertility desire have a paucity of data among HIV-positive men who have sex with men (MSM). This cross-sectional study has assessed fertility attitudes and associated factors, as well as the reproductive knowledge among HIV-positive MSM. Analysis was mainly based on the multinomial regression model. The study included 129 participants, and almost all of the participants (96.1%) were between 18 and 30 years old and 82.2% of them were single. About 35.6% expressed a fertility desire. MSM without siblings tended to have fertility desire (OR = 0.236, 95%CI: 0.078∼0.712, p = 0.010). Surrogacy (36.4%) was the most desired method among the 86 respondents who had the desire or did not make a decision. While the accuracy of the reproductive knowledge was only 69.6%. In summary, we recommend that providers offer much more professional information and develop assisted reproductive technology to meet the reproductive aspirations of HIV-positive MSM. [ABSTRACT FROM AUTHOR]

Background The desire to have children among mothers living with HIV remains a serious public health issue in nations with low coverage for antiretroviral therapy and the prevention of mother-to-child transmission, even if it is feasible to have an HIV-negative child. Therefore, this study aimed to assess fertility desire and associated factors among antiretroviral therapy-attending HIV-positive women at Hiwot Fana Specialized University Hospital, in Harari, Ethiopia. Methods A facility-based cross-sectional study design was employed among 639 anti retro-viral therapy attending HIV - positive women by systematic random sampling method selected from June 15 to November 30, 2020. A binary logistic regression model was fitted to identify the associated factors with fertility desire. Descriptive results were presented in percentages, whereas analytical results were reported in adjusted ORs (AORs) with a 95% CI. At p=0.05, statistical significance was declared. Results A total of 639 participants were included in the study; 69.5%(95% CI 65.7 to 72.9%) of the participants had fertility desire. Younger age (<35 years) (AOR=2.35, 95% CI 1.27 to 4.35), married women (AOR=3.02, 95% CI 1.32 to 12.25), childless women (AOR=2.86, 95% CI 1.17 to 4.82) and women whose duration of HIV diagnosis was ≤5 years (AOR=0.41, 95% CI 0.20 to 0.71) were significantly associated with fertility desire. Conclusion The majority of the study participants have a desire to have children. In light of the high prevalence of fertility desire among antiretroviral therapy-attending HIV-positive women, it is recommended to counsel younger women on reproductive planning and encourage partner testing. [ABSTRACT FROM AUTHOR]

Over the past few years, there has been a significant focus on air pollution due to its various detrimental effects on human health. However, its influence on people's tendency to have children remains uncertain, as only a few studies have examined the correlation between public perception of air pollution and the desire to start a family. This article introduces a theoretical framework utilizing a two-stage interval iteration model to explore the connection between children's relative utility and the perception of air pollution. Data for this study were gathered from the "Chinese General Social Survey" (CGSS 2013). The CGSS 2013 project employed a four-stage stratified random sampling technique and conducted household interviews using questionnaires. The sample covered 28 provincial-level cities across China. The hypothesis was tested using a Probit regression model. The findings indicate that individuals considering air pollution a significant issue are 8.62% less likely to have more than one child. The variation in fertility desire sensitivity to air pollution points to heterogeneity among residents, such as registered residents and those living in various residential areas, as well as individuals with different characteristics like education levels. The study concludes that air quality significantly influences human fertility desire, highlighting the urgent necessity to raise awareness of environmental protection issues among both the public and authorities. In particular, there are two key steps to address this issue. Firstly, the government should establish clear air pollution control objectives and refine policies to enhance governance efficiency. Secondly, there is a need to encourage environmentally friendly behaviours among the public, promote more significant involvement in public environmental matters, and ensure effective oversight of the government's responsibilities in managing air pollution. [ABSTRACT FROM AUTHOR]

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BackgroundThe fertility desire of women living with HIV to have children can have significant implications for public health. Despite the increase in the number of HIV-positive women, the issues of their fertility desire have not been well-studied. This study aims to assess fertility desire and associated factors among women living with HIV/AIDS.MethodsA facility-based cross-sectional study was conducted from 1 May to 30 July 2021. The researchers employed a systematic sampling technique. The data were gathered and entered into EpiData 3.1 software, and subsequently exported to the statistical package for social science version 25 for analysis. Binary logistic regression analyses were used to identify the factors involved, and a p-value of

Generally, men in sub-Saharan Africa make reproductive decisions that affect their partners. We examined the predictors of fertility desires among married men across three age cohorts: 20–35 years, 36–50 year, and 51–59 years. Using the 2014 Ghana Demographic and Health Survey dataset, we conducted ANOVA and multivariate binary logistic regressions on 1431 monogamous married men aged 20–59 years. Two indicators of fertility desire are constructed: (i) the comparison of men's ideal versus women's ideal family size, and (ii) the desire for more children. The results indicate that the fertility desire of men is stronger than that of women. The predictors of fertility desire are age, parity, religion, contraceptive use, wealth quintile, couples' age difference and couples' difference in education. At ages 20–35 years, men using modern contraceptives were more likely to desire more children compared with those not using any modern contraceptives. However, at ages 36–50 years, men using modern contraceptives were less likely to desire more children. This finding suggests that men change their fertility desires in response to changes in their ages. [ABSTRACT FROM AUTHOR]

For women living with HIV (WLH) in serodiscordant partnerships, decisions about childbearing can challenge condom use and antiretroviral adherence. In a prospective cohort of 148 WLH in serodiscordant partnerships, 58 (39%) wanted more children in the future but were not currently trying to conceive (fertility desire), and 32 (22%) were currently trying to become pregnant (fertility intent). Detection of prostate specific antigen (PSA) in vaginal secretions, a marker for recent condomless sex, was lowest in women with fertility desire and highest in women with fertility intent. Detectable viral load followed a similar pattern. Risk of HIV transmission, when condomless sex and PSA detection occurred concurrently, was three to fourfold higher at visits with fertility intent compared to visits with fertility desire. Qualitative interviews underscored the importance women place on childbearing and suggested that they had limited information about the role of antiretroviral therapy in reducing sexual HIV transmission. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of the Human Immunodeficiency Virus (HIV) among men who have sex with men (MSM) has increased exponentially in Indonesia. This population is vulnerable to mental disorders due to biological and psychosocial factors. Multiple forms of coping mechanisms might be utilized to deal with these stressors. This study aimed to determine the relationship between coping mechanisms with emotional and behavior problems in HIV-positive MSM as well as the influence of clinical and social attributes including family factors. Methods: A cross-sectional survey in the HIV Unit of Cipto Mangunkusumo Hospital was performed using the Symptom Checklist-90 to identify emotional and behavioral problems and the Brief Coping Orientations to Problems Experienced Scale to determine types of coping mechanisms. Results: Of the 96 participants, 45.8% of them suffered from at least one emotional and behavior problems and the most common was depression (36.5%). Twelve of 15 participants with children did not have any emotional and behavior problems which translated into significantly reduced odds for emotional and behavior problems in bivariate analysis. Dysfunctional coping was found to have moderate to strong positive correlations with all domains of emotional and behavior problems. In multivariate analysis, duration of contracting HIV and dysfunctional coping also displayed augmented odds for developing overall emotional and behavior problems. Discussion or conclusion: The present research exhibited the influence of coping mechanism type to the risk of emotional and behavior problems among HIV-positive MSM. Additional research is required to understand the impact of heteronormative conforming and effective therapy to improve employment of adaptive coping. [ABSTRACT FROM AUTHOR]

The low fertility rate has become a major hidden danger in China's social development, so it is particularly important to pay attention to the fertility desire of reproductive age population. Based on the data of the China General Social Survey (2017), this study uses the binary logistic regression model and the sequential logistic regression model to divide the childbearing willingness into the desire of reproductive age population and the residents'desire for the number of children. The relationship between urbanization, concept of supporting the elderly and fertility desire of reproductive age population is empirically analyzed. It is found that: firstly, urbanization is the best "contraceptive pill"; secondly, different concept of supporting the elderly has different effects on the willingness to bear children. The idea of children-based elderly care obviously crowds in the child-bearing willingness of child-bearing age population, while the idea of self-based elderly care obviously crowds out; thirdly, the idea of the elderly support plays a moderating role in the relationship between urbanization and childbearing desire, and the idea of self-based elderly care can alleviate the negative impact of urbanization on the willingness to bear children. [ABSTRACT FROM AUTHOR]

Abstract Background Fertility desire is one of the predictors of contraceptive behavior and fertility-related outcomes. However, information is scarce on individual and community-level factors of women’s fertility decisions in sub-Saharan Africa. Objective To assess fertility decisions and their associated factors in Sub-Saharan Africa. Methods The 35 Sub-Saharan African country’s most recent demographic and health surveys (DHS) data conducted from 2008 to 2020 was used. A total of 284,744 (weighted) married women were used for analysis. The proportion of fertility decisions with their 95%CI was estimated. To assess the factors associated with fertility decisions, both random effect and fixed effect analyses were conducted. In the fixed analysis, particularly in the multivariable analysis, adjusted relative risk ratio (aRRR) with its 95% confidence interval (CI) was reported and variables with a p-value

Abstract Background In Ethiopia, about two-third of women in the reproductive-age do not use any method of contraception. Moreover, evidence on non-use of contraceptives among women who do not have future fertility desires are limited. Therefore, this study intended to identify both individual and community-level determinants of non-use of contraceptives among this group in Ethiopia using a multilevel mixed effect analysis. Methods Data retrieved from the demographic and health survey program official database website ( http://dhsprogram.com ) were used in this study. The suvey was conducting using a multistage cluster sampling technique and a weighted sample of 4398 reproductive-age women with no fertility desire was used in this study. Four models were fitted using a multilevel multivariable logistic regression to identify determinants of non-use of contraceptives and model with the lowest Akaike’s Information Criterion was selected as a best fitted model. Adjusted odds ratio with its corresponding 95% confidence interval was used to declare the statistical significance of the independent variables. Results Overall, 65.3% [95% CI (63.9%, 66.7%)] of women with no fertility desire were not using any contraceptive method. Living in large central [AOR (95% CI) 0.45 (0.31, 0.67)] and metropolitan regions [AOR (95% CI) 0.39 (0.22, 0.68)] and being from household with middle [AOR (95% CI) 0.65 (0.42, 0.93)] and rich wealth index [AOR (95% CI) 0.67 (0.44, 0.98)] were negatively associated with non-use of contraceptives. Besides, being from a community with high women illiteracy [AOR (95% CI) 1.38 (1.15, 1.67)], being Muslim [AOR (95% CI) 1.86 (1.22, 2.85)], having history of pregnancy termination [AOR (95% CI) 1.59 (1.10, 2.31)], having a husband who desire to have more children [AOR (95% CI) 1.46 (1.02, 2.09)] were the positive determinants of non-utilization of contraceptives. Conclusion Nearly two-third of reproductive-age women with no fertility desire in Ethiopia do not use any contraceptive method. Awareness creation interventions on the benefits of contraceptives targeting Muslim religion followers and improving women education and their economic empowerment at household level may decrease the proportion of non-use of contraceptives at a national level.

This study examined the role of women's education in birth control in Rwanda from 1995 to 2000. It was conducted in four provinces, including Kigali City, using a survey questionnaire to collect data using a descriptive methodological approach. The population size is estimated to be 1067 n, comprised of women aged 15 to 49. Results indicated that younger women with fertility desire between 2-3 children are 75.07%; the rural area cohabitation rate among college students is 37.82%, while the Western model cohabitation in urban areas and universities is 19.23%; and contraceptive use is 46.3% among young women and 72.34%; among married women. Therefore, there was a significantly higher correlation between women with a high level of education and a lower fertility desire, which resulted in an increase in the age of first marriage. [ABSTRACT FROM AUTHOR]

On May 31, 2021, the Chinese government announced the three-child policy. However, unlike the prophase investigation, the policy to encourage more children did not significantly impact couples' desires to have more children. Fertility desire represents a person's childbearing wishes when all potential obstacles are disregarded. The fertility desire of Chinese parents for a second or third child should be more specifically known. This qualitative research was used with a content analysis approach based on in-depth and semi-structured interviews with 40 parents and predesigned questions according to the Traits-Desires-Intentions-Behavior (T-DI-B) framework. Fertility desire of participants to have more children covered three themes: the attraction of multiple offspring to the fertility desire, the desire to have more children but dare not have, and the encouragement of the desire to give birth to more children. Based on these, the supportive encouragement measures of the three-child policy need to be considered. Specifically, incentive measures are adopted regarding the cost of living, investment in education, public welfare and services, and social stereotypes of parental roles to promote more parents' desire to have more children. From a parental view, the three-child policy lacks practical support measures, which should be an obstacle to fertility. [ABSTRACT FROM AUTHOR]

Background: High proportion of people living with HIV (PLHIV) who are in the prime of their reproductive years desire to have children. There are limited studies that explore the range of fertility intentions for PLHIV. This study investigated the fertility desires and intentions of PLHIV and the associated factors. Methods: This was a cross-sectional study of 442 PLHIV receiving antiretroviral treatment (ART) in health facilities in Soweto, an urban township that is situated in the City of Johannesburg in South Africa. STATA version 13 was used to analyze the data. Results: The participants' mean age was 36.3 years, 70% were females, 79.6% had at least one biological child, and 36% had 3+ children. Almost half (47%) expressed the desire for children, saying that this was because they had no biological children, or their partners wanted children, or they wanted children of a particular sex, or were feeling healthy after taking ART. An increased fertility desire was associated with absence of biological children (AOR = 5.06, 95% CI: 2.11–12.1) and with being married (AOR = 2.63, 95% CI: 1.31–5.27). A decreased fertility desire was associated with being aged 36+ (AOR = 2.63, 95% CI: 1.31–5.27), having primary education (AOR = 0.11, 95% CI: 0.01–1.30) and having ≥4 years of ART duration (AOR = 0.45, 95% CI: 0.24–0.81). Conclusion: Individual factors played a significant role in shaping the fertility desires of PLHIV in this setting. The high desire for children underscore the need to integrate reproductive health services in HIV and AIDS care and treatment services and develop safer conception programmes to help PLHIV to conceive and have children safely.

Introduction: Among people living with HIV (PLHIV), fertility desire which is the desire to have more children is increasing due to the improvement in quality of life and survival resulting from anti-retroviral treatment and also improved sexual and reproductive health services. Fertility desires can result in increased risk of HIV transmission, especially in unprotected heterosexual intercourse. There is limited information regarding the fertility desires and predictors among PLHIV in our environment. Methods: This study was aimed at assessing the fertility desires and predictors in PLHIV in Northcentral Nigeria. Study was descriptive cross-sectional. Semi-structured interviewer administered pretested questionnaires was used to get information from 170 PLHIV accessing care in a secondary health-care facility selected by the systematic sampling technique. Data were analyzed using the SPSS software version 23.0. At 95% confidence interval (CI), a P < 0.05 was considered to be statistically significant. Chi-square and logistic regression. Results: Fertility desire was found among 64.1% of the respondents. Younger age (odds ratio [OR] = 0.2270; 95% CI = 0.0662–0.7791, P = 0.0184), having no child or a smaller number of children (OR = 0.0432; CI = 0.0046–0.4050; P = 0.0059) and suppressed viral loads (OR = 4.1069; CI = 1.1650–14.4784; P = 0.0280) were the predictors for fertility desire. Conclusion: This study showed that PLHIV had high fertility desires but do not know any safe method of conception, hence intensified effort should be made by primary care providers and other health-care workers to include sexual and reproductive health counselling during routine HIV clinic visits to enable PLHIV make informed decision about their fertility desires.

Objectives: To report the technique of Laparoscopic Isthmocele (Niche) Correction and surgical outcomes. Material and methods: The retrospective study included only patients with current or potential fertility desire who had laparoscopic surgery for an isthmocele at the Academic Hospital Cologne Weyertal between the beginning of 2014 and the end of 2020. A total of 28 patients were included. Sonographic follow-up of myometrial thickness was performed in 67% cases. Results: In 18% cases myometrial thickness was 5-7 mm, in 11% cases > 7-10 mm and in 39% cases > 10 mm. In the group with postoperative myometrium of 5-7 mm, two patients had preoperative residual myometrium of 2 mm, one patient of 2.5 mm and in one patient residual myometrium was not measurable (< 1 mm). In 11 patients, the postoperative myometrium was either greater than 10 mm and/or no isthmoceles were detectable. There was an increase in mean preoperative myometrial thickness from 2 mm to a mean myometrial thickness of 8.7 mm (myometrial thickness increase to 335%). Conclusions: In this study, laparoscopic correction of the isthmocele resulted in an increase in myometrial thickness from 2 mm to 8.7 mm (average values). This represents an increase in myometrial thickness of 335%. According to the literature review performed and based on our own results, we recommend prophylactic isthmoceles correction in patients with fertility desire by means of laparoscopic procedure. Laparotomy should be performed only in special cases. Surgical hysteroscopy is not suitable for this purpose, but sufficient studies are still lacking. [ABSTRACT FROM AUTHOR]

Abstract Background The knowledge of the key factors associated with fertility desire among people living with HIV/AIDS is crucial for the efficient planning of maternal and child health care programs. Fertility desire has generally increased among women of reproductive age in Rwanda. However, its level and determinants among women living with HIV/AIDS (WLHA) are currently not well known in the context of Rwanda. The present study aimed to fill in this knowledge gap. Methods Data were extracted from the 2015 Rwanda demographic and health survey (RDHS) for 243 HIV-positive women of reproductive age. Univariate and multivariable logistic regression analyses were conducted in order to identify the most influential factors. Results The prevalence of desire to have another child in HIV-positive women was found to be as high as 40.7%. Multivariable logistic regression analyses showed that the woman’s age of 35–49 years (AOR = 0.051, 95% CI: 0.013–0.204), woman’s parity of 3 children or above (AOR = 0.177, 95% CI: 0.037–0.837), being employed (AOR = 0.298, 95% CI: 0.113–0.782) and currently using contraceptives (AOR = 0.146; 95% CI: 0.057–0.375) were significantly associated with low odds of fertility desire among HIV- positive women in Rwanda. Women younger than 25 years, with no living child, or who were unemployed or who were not using any contraceptive were significantly associated with greater odds of desire to have another child than did other HIV- positive women. A woman whose partner's desire for children is different from hers was associated with about four times higher odds (AOR = 3.752; 95% CI: 1.203–11.702) of desire for more children than women who desire the same as their partners. Conclusion Fertility desire in WLHA is currently high in Rwanda. It is significantly influenced by demographic and socioeconomic factors. The Rwanda’s health care system should be prepared to intensify the required services for the prevention of the vertical transmission of HIV, the delivery of maternal and child health care services, and the support to WLHA in planning their fertility. Interventions should target low-parity young women, with a particular focus on meeting their contraceptive needs.

Abstract Background Fertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries. Methods We analysed cross-sectional data on women aged 15–49 years who participated in the recent Demographic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level. Results The median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR = 0.93; CI: 0.89–0.97), Ethiopia (aHR = 0.64; CI: 0.61–0.67) and South Africa (aHR = 0.51; CI: 0.47–0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status. Conclusion Findings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA.

Gurmesa Daba Dina, Bikila Tefera Debelo, Daniel Belema, Kababa Temesgen Danusa, Rebuma Muleta Midwifery Department, College of Medicine and Health Science, Ambo University, Ambo, EthiopiaCorrespondence: Bikila Tefera Debelo Email werkitef@gmail.comBackground: Globally, the human immunodeficiency virus (HIV) affects young people in their reproductive years. Most of the studies conducted in Ethiopia focus on the fertility desire of women of reproductive age and did not give due consideration to the men’s fertility perspective. Thus, this study aimed to assess the fertility desire, knowledge of prevention of mother to child of HIV (PMTCT), and associated factors among HIV-positive men and women attending ART clinic at west Shewa zone, Oromia region, Ethiopia, 2020.Methods: Facility-based cross-sectional study design was applied to identify fertility desire, PMTCT knowledge, and associated factors among 590 HIV-positive reproductive age group men and women attending ART clinics at public health institutions of West Shewa zone. Data were collected by pre-tested structured questionnaires and analyzed using SPSS version 22. Binary logistic regression analysis was used to examine the association of predictors on fertility desire and knowledge about PMTCT. Odds ratio, 95% CI, and P value 0.05 were used to measure the statistical association.Results: The prevalence of fertility desire and knowledge of PMTCT in the study area were 58.8% and 30.7%, respectively. The odds of fertility desire were higher among the respondents aged > 25 years [AOR=4.64, 95% CI (2.75– 7.85)], housewives [AOR=3.14, 95% CI (1.90– 5.21)], merchants [AOR=5.31, 95% CI (2.55– 11.05)], ART use for ≤ 5 years [AOR=5.13, 95% CI (2.37– 11.12)] and among those voluntarily tested to know their HIV status [AOR=2.16, 95% CI (1.30– 3.58)]. Besides, the odds of fertility desire were low among husband who cannot read and write [AOR=0.07, 95% CI (0.02– 0.23)], primary education [AOR=0.22, 95% CI (0.09– 0.56)], and secondary education [AOR= 0.32, 95% CI (0.14– 0.73)] when compared with husband education of college and above. Likewise, the odds of PMTCT knowledge were higher among the respondents aged less than 25 years [AOR=2.53, 95% CI (1.32– 4.86)] who undergone voluntary testing during HIV diagnosis reasons [AOR=1.55, 95% CI (1.03– 2.35)], and ART use for more than five years [AOR=1.94, 95% CI (1.26– 2.98)].Conclusion: Younger age, husband education, occupation, recent HIV test, and voluntary testing were significantly associated with fertility desire. Likewise, the younger age group, voluntary testing and counseling, and those on ART for more than five years had higher odds of PMTCT knowledge. Therefore, strengthening voluntary testing and counseling strong counseling on PMTCT throughout the follow-up care and involvement partners is of paramount importance should be insured to decrease MTCT.Keywords: PMTCT knowledge, fertility desire, west Shewa, Ethiopia

Plain Language Summary Reduction in ideal number of children has been suggested as a necessary condition for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the effects of individual, household as well as community characteristics on fertility desires among young men and women aged 15–24 years in Nigeria. We analysed data for 2674 males and 9637 females aged 15–24 years extracted from the 2018 Nigeria Demographic and Health Survey. The outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Results showed that DLFS was 71% among men and 53% in women. Individual-level factors associated with DLFS among men include Islam religion, household size and wealth status. Geo-political region and high level of negative attitude to family planning were the main community-level factors associated with DLFS. For women, individual-level positively associated with DLFS were Islam religion, and being currently married. Compared to Yoruba, other ethnic groups were more likely to favour DLFS. The negative factors associated with DLFS among young women include higher education and wealth status. At the community-level, Northern geo-political regions, child mortality experience and negative attitude to family planning were positively associated with DLFS. The influence of religion, household wealth and attitude to family planning differ between young men and women. Multi-dimensional strategies with active communication and programmatic interventions are needed so that desire for large family size by young men and women do not slow down fertility transition in Nigeria.

Background: Fertility desire is one of the predictors of contraceptive behavior and fertility-related outcomes. However, information is scarce on individual and community-level factors of women's fertility decisions in sub-Saharan Africa.Objective: To assess fertility decisions and their associated factors in Sub-Saharan Africa.Methods: The 35 Sub-Saharan African country's most recent demographic and health surveys (DHS) data conducted from 2008 to 2020 was used. A total of 284,744 (weighted) married women were used for analysis. The proportion of fertility decisions with their 95%CI was estimated. To assess the factors associated with fertility decisions, both random effect and fixed effect analyses were conducted. In the fixed analysis, particularly in the multivariable analysis, adjusted relative risk ratio (aRRR) with its 95% confidence interval (CI) was reported and variables with a p-value < 0.05 were considered significant predictors of fertility decisions.Results: In this study, 64.35% (95%CI: 64.2%, 64.5%) of the study participants had fertility desire. However, 5.4% (95%CI: 5.3, 5.5) of the study participants had undecided fertility behavior. In the multivariable analysis, desire for more children and undecided fertility desire were relatively lower among older women, women with primary, secondary, and higher education, working women, women who currently use contraceptives, women with a higher number of living children, women with higher parity, women from eastern and southern Africa, and women from wealthy households. While, the ideal number of children, women who had decision-making autonomy, and women from the rural residence were all associated with a relatively higher desire for more children and undecided fertility desire. Furthermore, respondents' education and sex of household head were associated with the desire for more children while media exposure was associated with undecided fertility desire.Conclusion: In this study, around two-thirds of women had a desire for more children and only 5.4% of women had undecided fertility desires. Both individual and community-level factors were associated with both desires for more children and undecided fertility desires. As a result, the aforementioned factors should be considered while developing reproductive health programs. [ABSTRACT FROM AUTHOR]

Introduction: Among people living with HIV (PLHIV), fertility desire which is the desire to have more children is increasing due to the improvement in quality of life and survival resulting from anti-retroviral treatment and also improved sexual and reproductive health services. Fertility desires can result in increased risk of HIV transmission, especially in unprotected heterosexual intercourse. There is limited information regarding the fertility desires and predictors among PLHIV in our environment. Methods: This study was aimed at assessing the fertility desires and predictors in PLHIV in Northcentral Nigeria. Study was descriptive cross-sectional. Semi-structured interviewer administered pretested questionnaires was used to get information from 170 PLHIV accessing care in a secondary health-care facility selected by the systematic sampling technique. Data were analyzed using the SPSS software version 23.0. At 95% confidence interval (CI), a P < 0.05 was considered to be statistically significant. Chi-square and logistic regression. Results: Fertility desire was found among 64.1% of the respondents. Younger age (odds ratio [OR] = 0.2270; 95% CI = 0.0662–0.7791, P = 0.0184), having no child or a smaller number of children (OR = 0.0432; CI = 0.0046–0.4050; P = 0.0059) and suppressed viral loads (OR = 4.1069; CI = 1.1650–14.4784; P = 0.0280) were the predictors for fertility desire. Conclusion: This study showed that PLHIV had high fertility desires but do not know any safe method of conception, hence intensified effort should be made by primary care providers and other health-care workers to include sexual and reproductive health counselling during routine HIV clinic visits to enable PLHIV make informed decision about their fertility desires. [ABSTRACT FROM AUTHOR]

Background: Fertility is associated with the desire to have children. The impacts of HIV and antiretroviral therapy (ART) on fertility are well known, but their impacts on the desire for children are less well known in Tanzania. We used data from two studies carried out at different periods of ART coverage in rural Tanzania to explore the relationship between HIV infection and fertility desires in men and women. Methods: We conducted secondary data analysis of the two community-based studies conducted in 2012 and 2017 in the Magu Health and Demographic system site, in Tanzania. Information on fertility desires, HIV status, and social–economic and demographic variables were analyzed. Fertility desire was defined as whether or not the participant wanted to bear a child in the next two years. The main analysis used log-binomial regression to assess the association between fertility desire and HIV infection. Results: In the 2012 study, 43% (95% CI 40.7-45.3) of men and 33.3% (95% CI 31.8 - 35.0) women wanted another child in the next two years. In 2017 the percentage rose to 55.7% (95% CI 53.6 - 57.8) in men and 41.5% (95% CI 39.8 - 43.1) in women. Although fertility desire in men and women were higher in HIV uninfected compared to HIV infected, age-adjusted analysis did not show a statistical significance difference in both studies (2012: PR=1.02, 95%CI 0.835 - 1.174, p

Background: In Ethiopia, about two-third of women in the reproductive-age do not use any method of contraception. Moreover, evidence on non-use of contraceptives among women who do not have future fertility desires are limited. Therefore, this study intended to identify both individual and community-level determinants of non-use of contraceptives among this group in Ethiopia using a multilevel mixed effect analysis. Methods: Data retrieved from the demographic and health survey program official database website (http://dhsprogram.com) were used in this study. The suvey was conducting using a multistage cluster sampling technique and a weighted sample of 4398 reproductive-age women with no fertility desire was used in this study. Four models were fitted using a multilevel multivariable logistic regression to identify determinants of non-use of contraceptives and model with the lowest Akaike's Information Criterion was selected as a best fitted model. Adjusted odds ratio with its corresponding 95% confidence interval was used to declare the statistical significance of the independent variables. Results: Overall, 65.3% [95% CI (63.9%, 66.7%)] of women with no fertility desire were not using any contraceptive method. Living in large central [AOR (95% CI) 0.45 (0.31, 0.67)] and metropolitan regions [AOR (95% CI) 0.39 (0.22, 0.68)] and being from household with middle [AOR (95% CI) 0.65 (0.42, 0.93)] and rich wealth index [AOR (95% CI) 0.67 (0.44, 0.98)] were negatively associated with non-use of contraceptives. Besides, being from a community with high women illiteracy [AOR (95% CI) 1.38 (1.15, 1.67)], being Muslim [AOR (95% CI) 1.86 (1.22, 2.85)], having history of pregnancy termination [AOR (95% CI) 1.59 (1.10, 2.31)], having a husband who desire to have more children [AOR (95% CI) 1.46 (1.02, 2.09)] were the positive determinants of non-utilization of contraceptives. Conclusion: Nearly two-third of reproductive-age women with no fertility desire in Ethiopia do not use any contraceptive method. Awareness creation interventions on the benefits of contraceptives targeting Muslim religion followers and improving women education and their economic empowerment at household level may decrease the proportion of non-use of contraceptives at a national level. [ABSTRACT FROM AUTHOR]

Abstract Background The persistently high and stalled total fertility in Sub-Saharan Africa, including in Nigeria, calls for new efforts towards fertility reduction. Most efforts on fertility desire in sub-Saharan Africa have focused either on individual men or women with little focus on couples as a unit of analysis. Moreover, the influences of different types of marriages in which couples reproduce have not been adequately explored. Therefore, this study examined fertility desires among couples in Nigeria. Methods This paper used data from the Nigeria Demographic and Health Survey (NDHS) of 2018 to assess fertility desire by marriage type among couples in Nigeria. In addition, the association between fertility desire and disparity in couples’ educational attainment, place of residence, region, religion, occupation, wealth status, children ever born and contraceptive use were considered. The participants consisted of 6813 couples aged between 15–49 years. Couples’ characteristics were reported using frequency and percentage distribution tables. Descriptive and logistic regression analyses were conducted. Results Overall, the study revealed that 73.8% of couples were in monogamous relationships while 26.2% were in polygynous relationships. The mean ideal number of children for men and women were 7.2 and 6.1, respectively. Also, 49.3% of the couples reported husbands desired more children, 43.9% claimed wives desired more children, while 6.8% indicated equal number of desired children among wives and husbands. The results of binary logistic regression showed that couples in polygynous relationships were 4.3 times as likely to desire more children, compared to couples in monogamous relationships (OR = 4.3; 95% CI: 3.5, 5.3). Couples in polygynous relationships wanted as many as four times the number of children desired by couples in monogamous relationships. Fertility desire was significantly higher among couples who indicated the following: either was using contraceptives (OR = 2.3; 95% CI: 1.6–3.4), both were not using contraceptives (OR = 2.8; 95% CI: 1.9, 4.1), lived in North East (OR = 2.0; 95% CI: 1.5, 2.6) and North West (OR = 1.7; 95% CI: 1.3, 2.3), both were not working (OR = 1.33, 95% CI; 1.1, 1.6) and were adherents of Islam (OR = 1.8; 95% CI; 1.5, 2.4). Conclusion These findings reflect the role of region, use of contraceptives, work status and religion in the fertility desire of couples. Implementing programmes and policies on sexual education and reproductive rights of couples and individuals may reduce high fertility desire and its adverse consequences, such as child and maternal morbidity and mortality in Nigeria.

Background: Obstetric fistulas are a high burden globally, especially in developing regions. Despite their experiences, many affected women have a high fertility desire., Objectives: This study aimed to assess fertility desires and associated factors among women with obstetric fistulas in Northwest Nigeria and explore their experiences., Methodology: Using a cross-sectional mixed-method approach, quantitative data was gathered from 420 women of reproductive age via an interviewer-administered questionnaire, and qualitative data from 24 women using focus group discussions. Participants were selected from three hospitals using a two-stage sampling technique. The quantitative data was analyzed using SPSS version 21, employing descriptive and inferential statistics to identify predictors of fertility desire. Thematic analysis was used for the qualitative data., Results: Respondents' mean age (± SD) was 26.4 (±8.4) years. The majority (88.8%) had only vesico-vaginal fistulas, while 3.3% had both vesico-vaginal and recto-vaginal fistulas. Although less than half (43.8%) had no surviving children, 74.3% desired more children. No protective association was found in the multivariable analysis. Age, number of surviving children, and family influence significantly predicted fertility desires. Qualitative findings highlighted cultural norms contrib uting to delayed treatment and poor home-based services, with social stigma, divorce, and lack of family and social support being common. However, some women received encouragement from their maternal family and community members., Conclusion: Obstetric fistulas not only significantly affect women's fertility desires but their social and personal lives. Integrating fertility counselling and community-based support into comprehensive fistula care is crucial for addressing these challenges effectively., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2024 by West African Journal of Medicine.)

Background: High proportion of people living with HIV (PLHIV) who are in the prime of their reproductive years desire to have children. There are limited studies that explore the range of fertility intentions for PLHIV. This study investigated the fertility desires and intentions of PLHIV and the associated factors. Methods: This was a cross-sectional study of 442 PLHIV receiving antiretroviral treatment (ART) in health facilities in Soweto, an urban township that is situated in the City of Johannesburg in South Africa. STATA version 13 was used to analyze the data. Results: The participants' mean age was 36.3 years, 70% were females, 79.6% had at least one biological child, and 36% had 3+ children. Almost half (47%) expressed the desire for children, saying that this was because they had no biological children, or their partners wanted children, or they wanted children of a particular sex, or were feeling healthy after taking ART. An increased fertility desire was associated with absence of biological children (AOR = 5.06, 95% CI: 2.11-12.1) and with being married (AOR = 2.63, 95% CI: 1.31-5.27). A decreased fertility desire was associated with being aged 36+ (AOR = 2.63, 95% CI: 1.31-5.27), having primary education (AOR = 0.11, 95% CI: 0.01-1.30) and having =4 years of ART duration (AOR = 0.45, 95% CI: 0.24-0.81). Conclusion: Individual factors played a significant role in shaping the fertility desires of PLHIV in this setting. The high desire for children underscore the need to integrate reproductive health services in HIV and AIDS care and treatment services and develop safer conception programmes to help PLHIV to conceive and have children safely. [ABSTRACT FROM AUTHOR]

Background: The knowledge of the key factors associated with fertility desire among people living with HIV/AIDS is crucial for the efficient planning of maternal and child health care programs. Fertility desire has generally increased among women of reproductive age in Rwanda. However, its level and determinants among women living with HIV/AIDS (WLHA) are currently not well known in the context of Rwanda. The present study aimed to fill in this knowledge gap.Methods: Data were extracted from the 2015 Rwanda demographic and health survey (RDHS) for 243 HIV-positive women of reproductive age. Univariate and multivariable logistic regression analyses were conducted in order to identify the most influential factors.Results: The prevalence of desire to have another child in HIV-positive women was found to be as high as 40.7%. Multivariable logistic regression analyses showed that the woman's age of 35-49 years (AOR = 0.051, 95% CI: 0.013-0.204), woman's parity of 3 children or above (AOR = 0.177, 95% CI: 0.037-0.837), being employed (AOR = 0.298, 95% CI: 0.113-0.782) and currently using contraceptives (AOR = 0.146; 95% CI: 0.057-0.375) were significantly associated with low odds of fertility desire among HIV- positive women in Rwanda. Women younger than 25 years, with no living child, or who were unemployed or who were not using any contraceptive were significantly associated with greater odds of desire to have another child than did other HIV- positive women. A woman whose partner's desire for children is different  from hers was associated with about four times higher odds (AOR = 3.752; 95% CI: 1.203-11.702) of desire for more children than women who desire the same as their partners.Conclusion: Fertility desire in WLHA is currently high in Rwanda. It is significantly influenced by demographic and socioeconomic factors. The Rwanda's health care system should be prepared to intensify the required services for the prevention of the vertical transmission of HIV, the delivery of maternal and child health care services, and the support to WLHA in planning their fertility. Interventions should target low-parity young women, with a particular focus on meeting their contraceptive needs. [ABSTRACT FROM AUTHOR]

Background: Fertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries.Methods: We analysed cross-sectional data on women aged 15-49 years who participated in the recent Demographic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level.Results: The median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR = 0.93; CI: 0.89-0.97), Ethiopia (aHR = 0.64; CI: 0.61-0.67) and South Africa (aHR = 0.51; CI: 0.47-0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status.Conclusion: Findings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA. [ABSTRACT FROM AUTHOR]

Introduction: Human immune deficiency virus (HIV)-infected individuals experience significant implications in terms of having children due to transmission of human immune deficiency. However, fertility desire has given little attention, and the uptake of prevention of mother-to-child transmission services is low in Ethiopia, particularly in Afar region. Thus, this study aimed to assess fertility desire and associated factors among human immune virus-positive women attending ART clinics. Material and methods: An institution-based cross-sectional study was conducted with 402 HIV-positive women attending anti-retroviral therapy clinics in selected hospitals of Afar region. Logistic regression analysis was employed to identify factors associated with fertility desire. Statistical association was measured, with a p-value < 0.05 considered statistically significant. Results: The prevalence of fertility desire was 63.9% (95% CI: 59.1-68.8%). Young ages women, i.e., 15-24 years (AOR = 11.98; 95% CI: 4.04-35.5) and 25-34 years (AOR = 2.93, 95% CI: 1.46-5.86), who did not have living children (AOR = 5.1; 95% CI: 1.31-20.2) and women with 1 or 2 children alive (AOR = 2.7; 95% CI: 1.39-5.27), and disclosed sero-status (AOR = 5.89; 95% CI: 2.33-14.9) were associated with increased odds of fertility desire. However, contraceptives use was associated with decreased odds of fertility desire (AOR = 0.11; 95% CI: 0.05-0.22). Conclusions: In this study, six in ten study subjects had fertility desires. Young age, not having living child, having 1 or 2 children alive, disclosing sero-status to partner, and contraceptive use were predictors for fertility desire. [ABSTRACT FROM AUTHOR]

Namuna Shrestha, 1 Rajani Pokharel, 2 Anil Poudyal, 3 Ranjeeta Subedi, 3 Namra Kumar Mahato, 3 Nitisha Gautam, 3 Dirghayu KC, 3 Govinda Prasad Dhungana 4 1Chitwan Medical College, Chitwan, Nepal; 2Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal; 3Nepal Health Research Council, Kathmandu, Nepal; 4Department of Community Medicine and Public Health, Chitwan Medical College, Chitwan, NepalCorrespondence: Namuna Shrestha Tel +977 9841611718Email namunashrestha12@gmail.comBackground: Pregnancy in people Living with HIV/AIDS (PLHIV) involves significant public health risks, including the risk of HIV transmission to uninfected partners and the fetus. Despite the growing importance of fertility issues for HIV-infected people, little is known about their fertility desires in Nepal. This study, therefore, aimed to determine the magnitude of and factors associated with the fertility desire of PLHIV.Patients and Methods: A cross-sectional study was conducted among 280 PLHIV attending the antiretroviral therapy (ART) clinic in Teku Hospital, Nepal. A standard semi-structured questionnaire was administered to participants using systematic random sampling. Data were entered using Epi-data 3.1 and analyzed using SPSS software version 20.Results: Out of the total participants, 12.1% desired to have a child. Among those having this desire, 44.1% had not decided when to have a child. Reasons for desiring a child were having no children (44.1%), wanting to have a child of different sex than the previous one (29.4%), followed by wanting to have another child (26.5%). Factors such as being male (COR: 3.1, 95% CI: 1.3– 7.0), being ≤ 40 years of age (COR: 3.8, 95% CI: 1.5– 9.4), higher age at marriage (COR: 7.7, 95% CI: 1.5– 39.6), middle socio-economic status (COR: 3.5, 95% CI: 1.7– 7.3), having no children (COR: 22.9, 95% CI: 8.6– 60.8) or fewer children (COR: 74.8, 95% CI: 9.7– 575.1), greater CD4 count (COR: 2.8, 95% CI: 1.3– 5.9) and having moderate knowledge of prevention of mother-to-child transmission (COR: 5.4, 95% CI: 2.3– 12.7) had higher odds of having fertility desire.Conclusion: Around one in every ten participants had a desire for fertility despite their HIV status. This calls for special attention in promoting integrated services for HIV and reproductive health. It will be important to include counseling and other services for those with fertility desire alongside providing ART.Keywords: ART, factors, fertility desire, Nepal, PLHIV

Bilen Mekonnen,1 Amare Minyihun2 1Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Amare MinyihunDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, EthiopiaEmail amarebdr@gmail.comBackground: “Fertility desire” is the intention of people to have more children despite being diagnosed with HIV, whereas intentions denote a commitment to implement that desire. Despite the overwhelming effects of HIV on a fetus, there is a desire for fertility among people positive for the virus/disease worldwide. Therefore, this study aimed to assess fertility desires and factors associated with sexually active HIV positive reproductive-age women attending ART clinics at Amhara region referral hospitals, Northwest Ethiopia.Methods: An institution-based cross-sectional study was conducted on reproductive-age women attending the clinics at the hospitals. A total of 427 eligible women were systematically included in the study. A semi-structured questionnaire was used to collect data via interviewer-administered techniques. EpiInfo7 and STATA 14 software was used for data entry and analysis, respectively. The logistic regression analysis method was used to identify factors associated with fertility desire. Factors that had p-values of ≤0.05 were considered statistically significant.Results: The findings indicated that 40.3% (95% CI; 35.7%, 45.0%) of the participants reported they had the desire to have children in the future. Variables such as women in the age group of 25–34 years (AOR= 2.80, 95% CI; 1.68, 4.68), participating with their sexual partner (AOR=3.52, 95% CI; 1.36, 9.13) and married women (AOR=2.32, 95% CI; 1.05, 5.10) had a positive association with the outcome variable, whereas having one or more live children (AOR=0.19, 95% CI; 0.09, 0.39) and having no formal education (AOR= 0.51, 95% CI; 0.29, 0.89) had a negative association with fertility desire.Conclusion: The proportion of sexually active HIV-positive women with desire for children was high among women visiting referral hospitals. Therefore, programmers and policymakers need to expand new PMTCT services throughout the region and consider the effects of these factors on HIV-positive women, as they develop interventions.Keywords: fertility desire, ART clinic, women, Amhara region, Ethiopia

Abstract Background Fertility choice is a critical women’s right. Although researchers have studied the positive effects of fertility desire, its different components have, unfortunately, been neither established nor implemented for parents. A reliable and valid scale is required to measure this vital aspiration of a couple. This study aims to develop and evaluate the psychometric properties of the Fertility Desire Scale (FDS), which is designed to assess fertility desire among Iranian parents. Methods A multi-phase instrument developmental approach was used to develop this scale in 2017. The items for the questionnaire were generated using three approaches: a qualitative study, an interview with an expert panel, and a comprehensive literature review. To provide a draft form of the questionnaire, we performed face and content validity analyses. The questionnaire validation was conducted on a sample of married women and men, recruited from public places affiliated with the Mazandaran province. Finally, measurement and analyses of exploratory and confirmatory factors, internal consistency reliability, item-scale correlation, and test-retest reliability of the questionnaire were performed to complete the validation process. Results Thirty-five items were initially developed on the basis of the interviews with the expert panel and the literature review. The questionnaire was subsequently reduced to include 27 items after performing the content and face validity testing. The exploratory factor analysis (EFA) identified four factors (positive childbearing motivations, preferences, childbearing worries, and social beliefs) comprising 19 items that jointly accounted for 55.44% of the observed variance. The confirmatory factor analysis (CFA) also revealed the suitable model fit for the data. The Cronbach’s alpha coefficient for the subscales ranged from .83 to .86, and the intraclass correlation coefficient (ICC) ranged from .88 to .92; these coefficients are well above the acceptable thresholds. Conclusion Results from this validation study demonstrated that the FDS is a valid and reliable questionnaire for measuring fertility desire that can be used in clinical practice, as well as in similar future studies.

Abstract Background Fertility desire for a second child has been a lively topic since the implementation of the two-child policy in China. Chinese researchers have explored various factors influencing the fertility desire for a second child. However, there have not been studies on the individual differences in the relative fertility costs and fertility benefits and their effects on fertility desire for a second child. Methods A total of 396 participants rated four kinds of relative fertility costs, four kinds of fertility benefits and their fertility desire for a second child. Latent profile analysis (LPA) was used to explore the individual differences in the relative fertility costs and fertility benefits and their effects on fertility desire for a second child. Results Stepwise regression analysis showed that parenting joy, health risks, mutual care among siblings, the flourishing of family, and time pressure and opportunity cost significantly predicted the fertility desire for the second child. According to the latent profile analysis, the participants were classified into four classes. Participants in the lowest-cost/lowest-benefit and high-cost/medium-benefit classes had low fertility desire for a second child, while those in the low-cost/high-benefit and highest-cost/highest-benefit classes had high fertility desire. Conclusion Fertility benefits have a stronger effect on the fertility desire for a second child than relative fertility costs. Fertility benefits should be paid more attention to than relative fertility costs.

Background: Reduction in ideal number of children has been suggested as a necessary precursor for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the social contexts of fertility desires by documenting the efects of individual, household as well as contextual characteristics among young men and women in Nigeria. Methods: Data source was the male and female recode fle of 2018 Nigeria Demographic and Health Survey. Analytical sample comprised 2674 males and 9637 females aged 15–24 years. The main outcome variable was desire for large family size (DLFS) defned as ideal number of children greater than four. Analysis involved use of descriptive statistics and random-efect logit models ftted in four stages. Results: DLFS was 71% among young men and 53% in women. Individual-level factors associated with DLFS among men includes Islam religion (OR=3.95, CI 2.68–5.83), household size (OR=1.05) and richer (OR=0.47, CI 0.29–0.75) or richest wealth index (OR=0.28, CI 0.16–0.75). Geo-political region and high level of negative attitude to family planning (OR=1.72, CI 1.23–2.40) were the main contextual factors associated with DLFS. For women, individual-level correlates were education, religion, ethnicity, marital status, household size, and wealth index. Contextual factors include geo-political region, community education (OR=0.68, CI 0.52–0.89), child mortality experience (OR=1.29, CI 1.11–1.51) and negative attitude to family planning (OR=1.36, CI 1.13–1.65). The infuence of religion, household wealth and attitude to family planning difer between young men and women. Conclusion: Active communication and programmatic interventions are needed so that desire for large family size by young men and women do not become a clog for fertility transition in Nigeria. [ABSTRACT FROM AUTHOR]

Studies on the family often assume that the normative expectations of having children are straightforward. However, in societies with sustained lowest-low fertility, each childbirth is seen as a thoroughly calculated decision. Using data from the Taiwan Youth Project (TYP), this study examines young adults' reasons and sex preference for having children in Taiwan, where the total fertility rate is among the lowest in the world. We examine whether the values of children in Taiwan capture fertility desires and which ones do so, and how the importance of each value varies by birth parity. The findings show that young adults attach different values to the first, second, and third child. Additionally, while young adults in Taiwan do not consider economic utility as a primary value for having children, economic resources significantly shape their levels of desire to have children. Moreover, son preference has been largely replaced by the preference for a balanced sex composition. These results suggest that non-economic values, economic resources and sex preference intertwine to shape fertility desire in a context of lowest-low fertility. Implications for fertility policies within and beyond Taiwanese society are discussed. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between sex-composition of children and women’s fertility desire in Vietnam. Materials and methods: Using data from the 2014 Vietnam Multiple Indicator Cluster Survey (MICS), we investigate the association between sex composition of children and desire for additional children among women in reproductive age (15 to 49 years) across Vietnam (N=5,605). Results: Multivariate logistic regression models showed statistically significant association between sex composition of children and women’s fertility desire, after controlling for social norms of fertility preference, demographic and socioeconomic factors. For each group of women (those with one child, two children, and three or more children) women with no sons are more likely to have higher fertility desire compared to women with at least one son. However, women with both son (s) and daughter (s) tend to have lower fertility desire compared to those who have all sons. Conclusion: Vietnam’s traditional cultural norm of son preference has a strong influence on fertility desire. Besides, mix-gender preference is also documented. The government should enforce the law more strictly regarding the prohibition of ultrasounds to detect fetal sex to reduce the feasibility of sex selection abortion. In addition, the government should improve the social ideology of the role of women in the family and society through mass media.

Abstract Objectives HIV remained the major cause of death in women of reproductive age worldwide. There is limited evidence regarding the fertility desire of HIV positive women receiving HIV care in the study area. Therefore, facility based cross-sectional study was conducted from March to April 2017 to assess fertility desire of HIV positive women and associated factors among mothers in receiving HIV care Jimma town, Southwest Ethiopia. Simple random sampling technique was taken to draw the sample after stratification. Data were analyzed using SPSS version 21 and statistical significance was declared at P value less than 0.05. Results This finding showed that, 175 (46.8%) of the Antiretroviral therapy users had fertility desire with those significantly associated factors; women in the age 18–29 years [AOR = 4.05, 95% CI 1.24–13.33], being married [AOR = 0.32, 95% CI (0.13–0.78)], having diploma educational level [AOR = 5.34, 95% CI 1.10, 15.60], having only boys or girls children [AOR = 2.79, 95% CI (1.24–6.25)], having 18–36$ monthly income [AOR = 1.27, 95% CI (1.56–10.67)], Partner’s HIV status [AOR = 3.56, 95% CI (3.02–9.33)] and non use of contraceptives [AOR = 2.57, 95% CI (1.08–6.13)]. Fertility desire in the study area was high. Strengthening PMTCT service should consider fertility desire of mothers living with HIV.

Abstract Background Addressing family planning (FP) needs of people living with HIV is an effective response to HIV prevention. Healthy timing and spacing of births help ensure the health and well-being of all women and infants, regardless of their HIV-infection. In addition, preventing unintended pregnancies is an important strategy for prevention of mother to child transmission of HIV. The main purpose of this study was to explore the knowledge of family planning methods and identify factors affecting the utilization of such methods among HIV infected men and women attending two Anti-Retroviral Therapy (ART) sites of Kathmandu, Nepal. Methods This was a descriptive cross-sectional study. Two ART sites of Kathmandu were purposively chosen and a sample of 265 respondents (both men and women) was selected based on proportionate probability random sampling. A structured questionnaire was administered face to face to all of the eligible participants. Results The mean ± SD age of the participants was 36.62 ± 7.58 years. Sixty five percent of the respondents’ spouses were HIV positive. A majority of the respondents (72%) had heard of seven modern family planning methods. Considerably high number (72%) of the respondents or their spouses were using at least one of the method of family planning. The most common method was condom (83%) and the least common was IUCD (0.50%). The use of short acting (pills, depo-provera) and long acting (implant, IUCD) family planning methods other than condom dropped from 56.6 to 2% after diagnosis. Utilization of family planning methods was significantly associated with gender, education and HIV status of spouse. Males (Adjusted Odds Ratio (AOR) = 2.48, 95% CI = 1.20–5.07, p = 0.01) educated respondents (AOR = 3.27, 95% CI = 1.41–7.54, p =