Spousal age differences are highest in Sub-Saharan Africa, where trends in age at first marriage indicate an increase for both men and women. However, the net outcome for spousal age difference is difficult to predict without explicit analysis of these distributions. This study examines differentials in spousal age for women in first union. Further, it examines differences within population sub-groups and across countries, focusing on the influence of age at marriage and educational attainment. The analysis pools 144 survey datasets from the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 1980 and 2020 in 34 countries. OLS regression analysis was used to predict the spousal age difference at marriage with five-year cohorts used to study time trends. The analysis finds a decline of 1.7 years in the spousal age difference at first marriage between the earliest (1980-1984) and most recent (2014-2019), indicating that there has been minimal reduction in age at first marriage over four decades, despite rising ages at marriage for females. Increasing age at first marriage and educational attainment of women partly explain the decline observed over time.

The desire to avoid pregnancy-to delay the next birth or have no further births-is a fundamental sexual and reproductive health indicator. We show that two readily available measures-prospective fertility preferences and the demand for contraception [Demand] construct-provide substantially different portraits of historical trends. They also yield correspondingly different assessments of the sources of contraceptive change. We argue, with supporting empirical evidence, that Demand enormously overstates the historical trend in the desire to avoid pregnancy because Demand as currently constructed is in part a function of contraceptive prevalence. This makes for "reverse causality" in decompositions of contraceptive change, producing an upward distortion on the order of 25 percentage points in the amount of contraceptive change attributed to a change in fertility desires. Decomposition of contraception change free of the distortion reveals that contraceptive change has been due almost entirely to more complete implementation of fertility preferences. This is explained in part by the surprisingly slight historical change in preferences, a fact we document and then show is a consequence of a historical shift in parity composition toward lower parities.

BACKGROUND:The number of women using long-acting reversible contraception (LARC)-intrauterine devices (IUDs) and implants-is increasing and 14% of contraceptive users in the United States adopt LARC. We examined correlates of LARC never-use in a population-based survey of reproductive-aged women in Ohio.METHODS:We analyzed data from the 2018-19 Ohio Survey of Women. We examined the prevalence of LARC never-use and reasons for never-use among ever users of contraception (N = 2388). Using Poisson regression to generate prevalence ratios (PRs), we examined associations between selected correlates (demographic factors, healthcare access/quality measures, and religious/political views) and LARC never-use.RESULTS:Most Ohio women (74%) had never used LARC. Commonly reported reasons for not using an IUD or an implant were preferring a different method (46% and 45%, respectively), not wanting an object inside their body (45% and 43%), side effect concerns (39% and 33%), insertion/removal concerns (31% and 25%), and unfamiliarity (13% and 20%). Conservative political views (PR: 1.12, 95% confidence interval [CI]: 1.04-1.22), pro-life affiliation (PR: 1.11, 95% CI: 1.02-1.20), placing high importance on religion in daily life (PR: 1.15, 95% CI: 1.06-1.26), and being non-Hispanic white as compared to non-Hispanic Black (PR: 1.20, 95% CI: 1.02-1.41) were significantly associated with LARC never-use. Findings were generally similar for models analyzing IUD and implant never-use separately.CONCLUSIONS:Among ever-users of contraception, LARC never-use was associated with having conservative political views, being religious, and having a pro-life affiliation. Except for race/ethnicity, demographic and healthcare measures were not associated with LARC never-use among women in Ohio.

Background : Rates of contraceptive discontinuation are high in many low and middle countries contributing to unmet need for contraception and other adverse reproductive health outcomes. Few studies have investigated how method specific beliefs and strength of fertility preferences affect discontinuation rates. This study examines this question using primary data collected in Nairobi and Homa Bay counties in Kenya. Methods : We used data from two rounds of a longitudinal study of married women ages 15-39 years (2812 and 2424 women from Nairobi and Homa Bay respectively at round 1) from two communities in Kenya. Information on fertility preferences, past and current contraceptive behavior, and method-related beliefs about six modern contraceptive methods were collected, along with a monthly calendar of contraceptive use between the two interviews. The analysis focused on discontinuation of the two most commonly used methods in both sites, injectable and implants. We carry out competing risk survival analysis to identify which method related beliefs predict discontinuation among women using at the first round. Results : The percentages of episodes discontinued in the 12 months between the two rounds was 36%, with a higher rate of discontinuation in Homa Bay (43%) than in the Nairobi slums (32%) and higher for injectables than implants. Method related concerns and beliefs were the major self-reported reasons for discontinuation in both sites. The competing risk survival analysis showed that the probability of method related discontinuation of implants and injectables was significantly lower among respondents who believed that the methods do not cause serious health problems (SHR=0.78, 95% CI 0.62-0.98), do not interfere with regular menses (SHR=0.76, 95% CI 0.61 - 0.95) and do not cause unpleasant side effects (SHR=0.72, 95% CI 0.56-0.89). By contrast, there were no net effects of three method related beliefs that are commonly cited as obstacles to contraceptive use in African societies: safety for long-term use, ability to have children after stopping the method, and the approval of the husband. Conclusion : This study is unique in its examination of the effect of method specific beliefs on subsequent discontinuation for a method-related reason, using a longitudinal design. The single most important result is that concerns about serious health problems, which are largely unjustified and only moderately associated with beliefs about side effects, are a significant influence on discontinuation. The negative results for other beliefs show that the determinants of discontinuation differ from the determinants of method adoption and method choice.

Since childbearing desires, and trends in these desires, differ across populations, the inclusion of women who want to become pregnant in the denominator for unintended pregnancy rates complicates interpretation of intercountry differences and trends over time. To address this limitation, we propose a rate that is the ratio of the number of unintended pregnancies to the number of women wanting to avoid pregnancy; we term these conditional rates. We computed conditional unintended pregnancy rates for five-year periods from 1990 to 2019. In 2015-2019, these conditional rates per 1,000 women per year wanting to avoid pregnancy ranged from 35 in Western Europe to 258 in Middle Africa. Rates with all women of reproductive age in the denominator have concealed stark global disparities in the ability of women to avoid unintended pregnancies, and they have understated progress in regions where the fraction of women wanting to avoid pregnancy has increased.

A key barrier to the consistent use of condoms is their negative effect on sexual pleasure. Although sexual pleasure is a primary motivation for engaging in sex and is an integral part of overall sexual health, most programs to improve sexual health operate within a pregnancy and disease-prevention paradigm. A new condom, CSD500 (Futura Medical Developments; Surrey, UK), containing an erectogenic drug was developed for use among healthy couples to improve sexual pleasure by increasing penile firmness, size and erection duration. We conducted a randomized controlled trial to test whether promoting the novel condom CSD500 for improved sexual pleasure is effective in reducing condomless sex compared to the provision of standard condoms with counseling for pregnancy and disease prevention. We randomized 500 adult, heterosexual, monogamous couples in Thanh Hoa province, Vietnam to receive either CSD500 (n = 248) or standard condoms (n = 252). At enrollment and after 2, 4, and 6 months, we interviewed women and sampled vaginal fluid to test for the presence of prostate-specific antigen (PSA), an objective, biological marker of recent semen exposure. We registered the protocol before trial initiation at ClinicalTrials.gov (identifier: NCT02934620). Overall, 11.0% of women were PSA positive at enrollment. The proportion of follow-up visits with PSA-positivity did not differ between the intervention (6.8%) and control arms (6.7%; relative risk, 1.01; 95% confidence interval, 0.66–1.54). Thus, we found no evidence that promoting an erectogenic condom to women in a monogamous, heterosexual relationship in Vietnam reduced their exposure to their partner’s semen. These findings might not hold for other populations, especially those with a higher frequency of condomless sex.

The distinction between wanted and unwanted fertility has been crucial in many of the more intense debates in recent decades over the nature of contemporary fertility declines and, in particular, the potential impact of expanded provision of family planning services. In a much-debated article published in 1994, Pritchett argues that decline in desired fertility is overwhelmingly the principal source of fertility decline, with the implication that family planning programmes are of little consequence. I revisit this debate drawing on a far larger body of survey data and, more importantly, an alternative fertility specification which relies on a non-conventional definition of wanted and unwanted fertility rates and which distinguishes rates and composition. Decompositions of fertility decline in the period from the mid-1970s to the present are carried out for 44 countries. The decomposition results indicate that declines in unwanted fertility rates have been at least as important, if not more important, than declines in wanted fertility rates. Surprisingly, shifts in the proportion of women wanting to stop childbearing—i.e., changes in preference composition—has contributed very little to fertility change in this period. Further, decline in wanted fertility and increases in non-marital exposure (due largely to delayed entry into first marriage) have also made substantial contributions, although on average they fall short of the contribution of declines in unwanted fertility rates. That declines in unwanted fertility have been an essential feature of contemporary fertility decline is the main conclusion from this research. This in turn opens the door to new perspectives on fertility pre-, mid-, and post-transition which recognises the inter-dependencies between fertility demand and unwanted fertility rates in the determination of the overall level of fertility. JEL classification: J11, J13, R11 Keywords: Demography, Fertility, Family Planning, Regional Economics

We tested whether CSD500 (Futura Medical; Guildford, UK), a novel condom containing erectogenic gel designed to increase penile firmness, penile size, and erection duration, results in greater sexual pleasure. In 2017-2020, we randomized heterosexual couples in Thanh Hoa, Vietnam to use CSD500 (N = 248) or standard condoms (N = 252) and followed them up for six months. Women completed the Quality of Sexual Experience (QSE) scale; men completed the QSE, Sexual Experience Questionnaire (SEX-Q), and 11 condom acceptability items. Female participants' mean age was 32.1 years (SD = 0.24; range 21-46). QSE scores were higher among women (B, 0.12; 95% CI, 0.03-0.21) and men (B, 0.21; 95% CI, 0.08-0.35) in the CSD500 relative to the control arm. SEX-Q scores were higher among men in the CSD500 compared to the control arm (B, 3.22; 95% CI, 1.53-4.91). Higher proportions of men in the CSD500 relative to the control arm reported the condom felt "natural" during sex (68.6% vs. 32.3%; p < .01) and that sex with the condom felt "a lot better" than condomless sex (15.5% vs. 5.3%; p < .01). Compared with standard condoms, CSD500 use was associated with higher reports of sexual pleasure and condom acceptability.

BACKGROUNDIn most societies, childbearing is largely confined to women in formal marital unions, but in a subset of contemporary low-fertility Western societies, extramarital fertility has become common.However, extramarital fertility is often ignored in fertility research in contemporary low-and middle-income countries (LMICs). OBJECTIVETo document recent levels, trends, and differentials in extramarital fertility (both premarital and postmarital) in LMICs. METHODSWe employ Schoumaker's (2013) Stata program tfr2 to calculate two fertility measures from Demographic and Health Surveys in 63 countries: (1) the standard total fertility rate (TFR), which is based on all births in the three years before the survey date, and (2) the marital total fertility rate (MTFR), which is based on all births within marital unions in the three years before the survey date.The percentage of fertility that is extramarital (PEM) is estimated as 100 x (TFR-MTFR)/TFR. RESULTSThe unweighted average PEM for the most recent surveys in the 63 DHS countries equals 11.3%, with 7.9% premarital and 3.4% postmarital.By far the highest percentage premarital is found in southern Africa (43%) and the lowest in Asia/North Africa (0.9%).Postmarital fertility is most common in sub-Saharan Africa and Latin America. CONCLUSIONSChildbearing outside of marriage is an important feature of contemporary reproductive regimes in sub-Saharan Africa and Latin America.By contrast, less than 2% of births are extramarital in most Asian and North African societies.

The springboard for this wide-ranging examination of connections between religion and demography by Philip Jenkins, a comparative religion scholar, is a simple empirical association: “High-fertility societies … tend to be fervent, devout, and religiously enthusiastic. Conversely, the lower the fertility rate … the greater the tendency to detach from organized or institutional religion. Fertility rates provide an effective gauge for religious behavior and commitment” (p. 3). Jenkins acknowledges that the causation that generates this correlation probably runs in both directions, or it may be the product of joint causation by other factors. But his emphasis in this volume, and its contribution, is fertility as a determinant of religiosity. Jenkins attributes this to fertility's impact on gender roles, sexuality, and societal age structure. A further overarching factor is security: the insecurity that is ubiquitous in pre-transition low-income societies largely disappears in affluent low-mortality contemporary societies, undermining traditional religious belief and practice as more personalized non-religious quests for meaning come to dominate. Following a first chapter that lays out his argument in brief, Jenkins devotes two chapters to the decline of fertility in Europe from the nineteenth century to the present and its various effects on religious beliefs and practice. Chapter 4 considers the decline of fertility in Asia and Latin America that occurred in the latter half of the twentieth century, with concomitant changes in religiosity (diverse in both regions). Chapter 5 examines the United States, sometimes characterized as exceptional with respect to the fertility–religiosity association; Jenkins argues that it is not so exceptional after all. Chapters 6–8 are devoted to Sub-Saharan Africa and the Islamic world, where the remaining high fertility and religiously fundamentalist societies are now situated. Chapter 7 highlights heterogeneity in fertility within the Islamic world, with low-fertility Iran epitomizing one nexus of contemporary Islam and fertility. A theme running throughout the volume is that international migration, especially from high fertility more religious countries to low fertility secular countries, complicates the demography and religiosity of both sending and receiving countries, generating significant political repercussions. In the concluding chapter, Jenkins speculates on the implications of fertility–religiosity connections for the future of both phenomena, emphasizing implications for the “future of faith” of a demographically post-transitional world. Jenkins suggests that low fertility compels the major religions to develop new approaches to sexuality, gender, and family, in the process revising ethical systems in an effort to adapt to present demographic realities.

The addition of the hormonal intrauterine device to the product catalogue of the US Agency for International Development is a game changer that will allow millions more women in low-income and middle-income countries (LMICs) to have access to a highly effective, long-acting reversible contraceptive method, albeit two to three decades after their counterparts in Europe and the USA.1 Already, the International Contraceptive Access Foundation in Nigeria and the Expanding Effective Contraceptive Options project in Zambia have been working with partners to introduce the hormonal intrauterine device in both private and public sector outlets, as well as mobile outreach systems.

OBJECTIVES:We describe the prevalence and correlates of nonuse of preferred contraceptive method among women 18-44 years of age in Ohio using contraception. STUDY DESIGN:The population-representative Ohio Survey of Women had 2529 participants in 2018-2019, with a response rate of 33.5%. We examined prevalence of preferred method nonuse, reasons for nonuse, and satisfaction with current method among current contraception users (n = 1390). We evaluated associations between demographic and healthcare factors and preferred method nonuse. RESULTS:About 25% of women reported not using their preferred contraceptive method. The most common barrier to obtaining preferred method was affordability (13%). Those not using their preferred method identified long-acting methods (49%), oral contraception (33%), or condoms (21%) as their preferred methods. The proportion using their preferred method was highest among intrauterine device (IUD) users (86%) and lowest among emergency contraception users (64%). About 16% of women using permanent contraception reported it was not their preferred method. Having the lowest socioeconomic status (versus highest) (prevalence ratio [PR]: 1.47, 95% CI: 1.11-1.96), Hispanic ethnicity (versus non-Hispanic white) (PR: 1.83, 95% CI: 1.15-2.90), reporting poor provider satisfaction related to contraceptive care (PR: 2.33, 95% CI: 1.02-5.29), and not having a yearly women's checkup (PR: 1.31, 95% CI: 1.01-1.68) were significantly associated with nonuse of preferred method. Compared to preferred-method nonusers, higher proportions of preferred-method users reported consistent contraceptive use (89% vs. 73%, p < 0.001) and intent to continue use (79% vs. 58%, p < 0.001). CONCLUSIONS:Affordability and poor provider satisfaction related to contraceptive care were associated with nonuse of preferred contraceptive method. Those using their preferred method reported more consistent use. IMPLICATIONS:Cost is an important barrier for women in obtaining their preferred contraceptive methods. Low quality birth control care may also be a barrier to preferred-method use. Removal of cost barriers and improvement in contraceptive counseling strategies may increase access to preferred contraceptive methods.

Rejection of science—or what is labeled as rejection of science—is a notorious feature of the contemporary cultural and political landscape in the United States. Highly visible instances are dismissals of evolutionary theory, climate change denial, and antivaccine movements. In this deeply researched and thoughtful book, Andrew Jewett describes tensions about science over the past century, with a focus on the 1920s, the 1960s and 1970s, and the present. Jewett argues that the 1920s witnessed the first intense and widespread disputes in the United States over scientific authority. The controversies in this period concerned not only evolutionary theory (e.g., Scopes Trial) but also, and more importantly, modern psychology, which became a fixture in widely read newspapers and periodicals, to the dismay of those attached to religiously grounded understandings of human personality and what constitutes proper child socialization. The second period of tension about science Jewett identifies and examines in depth was the post-WWII decades, especially the 1960s and 1970s. Ironically from the standpoint of the present, it was if anything public intellectuals on the left who expressed dismay and distrust of science. “scientism” was viewed as intrinsically hostile to humanistic values, with soulless technology and an implicitly materialistic worldview posing at least as much risk to the achievement of a just and compassionate society as conservative religious institutions. The final period that Jewett considers is the first two decades of the twenty-first century. The tensions he describes are entirely familiar, but they take on a fresh appearance with the historical backdrop he provides, and his nuanced portrait of the positions of the key protagonists produces a welcome respect for the complexity of ongoing intellectual and political controversies. Over the entire century from the 1920s to the present, the unifying theme in the questioning of scientific authority has been the allegation that scientists, while ostensibly value-neutral, have injected social philosophies into American life that have damaged the social and moral order. Jewett concludes with a plea to approach science more matter-of-factly. Scientific tools can be credited with producing tremendous gains in human well-being but within rather circumscribed domains. Much that is highly valued in the human experience lies outside the reach of modern science.