Recently, we published a blog post about our paper “Sexual and Reproductive Health Literacy, Misoprostol Knowledge and Use of Medication Abortion in Lagos State, Nigeria: A Mixed Methods Study” in the FemQuant blog.
Please click here to read the post, which summarises some of the main results of our study.
In a recent study (Väisänen 2017), I examined how women make decisions to terminate a pregnancy within the wider context of their lives – including the state and quality of their romantic relationships.
Please read my report about this study on the N-IUSSP online news magazine website.
It’s been a while since my last post. A lot has happened in the last half-a-year-or-so. I became a lecturer at the University of Southampton in October, submitted my thesis to LSE in February and a couple of papers came out one of which was featured in Helsingin Sanomat (the biggest newspaper in Finland; see here in Finnish).
These last two papers that I published out of my thesis were about the association between labour market position (being employed, unemployed, student or inactive in the labour market) and the likelihood of abortion; and about the educational gradient in the likelihood of having more than one abortion. The former came out in the Finnish Yearbook of Population Research and the latter in Journal of Biosocial Science.
Both papers show that women’s socioeconomic position is associated with the likelihood of having an abortion and this has been the case since the 1970s until nowadays. Women who were unemployed were more likely to have an abortion than employed women in particular if they were not married or cohabiting. This indicates that women are concerned about the economic wellbeing of their family in an uncertain situation. During the recession of the 1990s the likelihood of abortion was higher among those who already had children and who were employed than it was before or after the recession. This implies that women may have been concerned about their position in the workplace in case they became pregnant. Given the economic situation we are facing today, it is something to consider.
When it comes to the likelihood of having more than one abortion during one’s reproductive life course, the likelihood is higher among those who have low levels of education, and the gap between the highly educated and those with no more than compulsory education has increased over time. Not many highly educated women had more than one abortion and the time since the first abortion, their relationship status or number of children they had were not associated with the likelihood. Women who had completed only compulsory education, however, had their second and third abortions sooner after the previous procedure than highly educated women and their other characteristics altered the likelihood as well. It may be that women with high education benefit more from post-abortion contraceptive counselling than women with low education.
Taken together, both of these studies show that abortion access in Finland depends on women’s standing in the society regardless of family planning provision in all municipalities since the 1970s and sexuality education in all schools. Although these are important policies and should be continued, there is a need to evaluate whether something could be done to better reach those in more precarious situations in the society.
Sources:
Väisänen, Heini (2016). “Educational inequalities in repeat abortion: A longitudinal register study in Finland 1975-2010.” Journal of Biosocial Science, doi:10.1017/S002193201600016X.
Väisänen, Heini (2015). “Labour Force Participation and the Likelihood of Abortion in Finland over Three Birth Cohorts.” Finnish Yearbook of Population Research, 50: 5-20.
Edit 18 Noveber 2015
Some people have asked me what is wrong with using Nigeria as an example or the type of reasoning used in Soininvaara’s post. The problem is that it uses the same type of reasoning that led people in the 1970s to believe that there will be a population bomb. People looked at the fertility levels at the time, assumed they would stay constant and predicted how long it would take for the world population to double, triple, quadruple etc. However, this assumption has been proven to be invalid (fertility rates decrease when people are better off) and even UN does not provide the “constant fertility rates scenario” in its projections anymore. The mechanisms that affect population growth are complex and when projecting population growth, we must make complex assumptions based on those mechanisms. Nigeria is not a very good example of the most prevalent fertility trajectories in Sub Saharan Africa, since its fertility levels have decreased less than in most other countries of the area and thus give the wrong impression that when projecting population growth we could assume the current rates stay constant for long periods of time.
Original post
A Finnish Green Party Politician Osmo Soininvaara recently stated that the world population bomb is not over like some people claim (see here in Finnish). He based his argument in showing that in Sub Saharan Africa fertility rates (the average number of children per woman) are still high. He argued that people in for example Nigeria keep having lots of children, because religious leaders tell them to. He also noted that people in Nigeria have children in order to have someone to take care of them when they are old.
I agree with the latter point and anyone who doubts can watch Hans Rosling explain why ending poverty will lead to lower fertility rates.
When it comes to other views Soininvaara has about Sub Saharan Africa (SSA), I am not sure he thought his argument through.
First, he based his argument on the fertility rates of one country (Nigeria), which seems to be an exception rather than a rule when each SSA country is examined individually. Most countries show a downward trend in their fertility rates (see below). Moreover, basing one’s argument on one country only is hardly convincing giving the huge variation in fertility rates in the region: from 1.44 in Mauritius to 7.56 in Niger.
All Sub-Saharan African Counties (click for a better graph).
According to World Economic Forum (WEF), the most promising economies in SSA are found in Mauritius, South Africa, Rwanda, Botswana, Namibia, Kenya, Seychelles, Zambia, Gabon and Lesotho. WEF’s ranking includes measures of education, health care and infrastructure in addition to more traditional economic measures. Fertility rates have decreased markedly in all these countries, six out of ten being at around three children per woman or less, emphasising the importance of fighting poverty and providing health care and education in order to reduce fertility rates.
Top ten economies in the region (click for a better graph).
According to UN population projections, it is true that the world’s population will keep growing for some time still and the fastest growth is in Sub Saharan Africa. The smallest changes in fertility may cause big differences in population size a few decades later, so projecting population is a very difficult task, like the graph below, put together by the most prominent professionals in the field, shows.
Instead of throwing out arguments about Nigerians or anyone else not being able to “achieve” lower fertility rates due to following the instructions of their religious leaders, it would be more useful to think why fertility rates differ so drastically around the world. The important thing is to figure out how we could ensure a better future for everyone in terms of economic prosperity, health care, education and social safety nets.
Inspired by a blog post by Patrick Dunleavy about citation practices in different disciplines I wanted to update my understanding of which journals belong to the top of my discipline, demography.
Traditionally I have checked this using the impact factor scores listed in ISI Web of Social Science’s Journal Citation Reports under group “Demography”. I knew that impact factor is in fact quite a bad indicator of a journal’s prestige, but I kept focusing on that anyway. I simply assumed that everyone else was doing that as well and thus the socially constructed understanding of which journals are the best ones would be based on impact factor rankings despite its problems. As a young researcher I have to be constantly thinking about my CV and I thought submitting to journals that rank high on this indicator would impress a potential employer reading my list of publications.
However, Professor Dunleavy wrote that anyone still looking at impact factors is “mathematically ignorant”, whereas h-indices listed in Google Scholar’s Metrics are “robust and meaningful average indicators”. In addition, he said that coverage of social science journals is much better in Google’s than ISI Web’s database. Consequently, I decided to see what Google Metrics had to say about demography.
Unfortunately Google Metrics does not have a subcategory for demography, so I was only left guessing whether the coverage actually is any better in my discipline. Instead, I decided to search for the top 20 journals listed by ISI Web and see what happens to the rankings when h-index is used instead of impact factor.
The table below shows that regardless of the metric the top two journals in demography are Demography and Population and Development Review. There is more variation in the raking of other journals, for instance the open source Demographic Research’s rankings vary from 5 to 11 and the London based Population Studies’ from 8 to 17.
So, what did we learn from all this? Where should I submit my next article? I guess we are still in search of the perfect metric and journal database, but the results seem to be fairly robust at least when it comes to the few journals at the very top of the rankings.
If one wants to maximise the h-index/impact factor of their publications, and happens to work in an interdisciplinary field like demography, they’re probably better of publishing in journals listed under other disciplines, such as sociology (e.g. American Sociological Review has H5 index of 47) or epidemiology (e.g. H5 of American Journal of Epidemiology is 73).
I guess in the end it all comes down to varying citation traditions discussed in Dunleavy’s blog post. Perhaps we all should just start vigorously citing research published in our field?
Spain is about to pass a bill called “The Organic law for the protection of the life of the conceived and the rights of the pregnant woman” into the parliament for debate. The bill suggests restricting access to abortion only in rape cases or if the woman’s health is at risk. The bill not only violates human rights, but will also put a number of women into a severe risk. Unsafe abortion is often fatal.
Studies have shown that restrictive abortion laws do not reduce the number of abortions. In a paper published in The Lancet in 2012, Gilda Sedgh and colleagues showed that abortion rate was lower in those regions of the world, where legislation was liberal.
In many countries, where access to safe abortion is restricted, women use life threatening methods to terminate unwanted pregnancies. These range from black market drugs to inserting unhygienic objects, such as sticks, to vagina in order to induce the abortion. Around 13% of maternal deaths are due to unsafe abortion, resulting in the death of almost 50,000 women every year. In developing countries, where access to abortion is often restricted by legislation, lack of appropriate health care facilities, or both, around five million women per year are treated due to complications due to unsafe abortion.
Adverse health consequences of unsafe abortion can easily be prevented by providing easy access to contraceptives and safe abortion services.
Please sign Amnesty’s petition against Spain’s abortion bill. Finns can do it here, others please check your local Amnesty International, or write directly to Spanish Politicians (see instructions here) before 24 July 2014.
Academic articles:
Other sources:
In the media, Finland is often displayed as an example of a country where society has taken big steps in ensuring equality in children’s upbringing: the world’s leading education system is free, parents are well supported financially, and able to choose between a long parental leave and working full time. At the same time their children are taken care of in one of the many public nurseries with university educated kindergarten teachers and parents only have to pay a small fraction of the costs.
When adolescents reach their teens and begin to explore elements of the adult world such as sex, it is important to ensure that they are equipped with enough information regarding sexual health, contraception and the emotions involved. Apart from a few recession years in the 1990s, sex education has been a compulsory part of the curriculum in Finland since 19701. That, among other reasons, has resulted in internationally low teenage pregnancy rates despite a temporary increase in the late 1990s2,3. In addition, contraceptives have been easily available from a variety of sources including school health centres and the public healthcare system since the early 1970s4.
Studies in the US and UK5,6 have found that teens who lack the possibility of pursuing certain careers, may wish to start childbearing at a young age because they see that as a legitimate pathway to adulthood. Perhaps the low teen pregnancy rates in Finland indicate that the policies mentioned above have been successful in providing alternative pathways to adulthood, making the remaining teen pregnancies happen due to other reasons than one’s socioeconomic position?
Although I do think that these policies are needed and should continue, it looks like they have not been very successful in decreasing the socioeconomic gap in teenage childbearing and abortions. Evidence for this is based on the results of our study looking at fertility behaviour of three birth cohorts of Finnish women when they were aged 15 to 19 (born in 1955-59, 1965-69 and 1975-79).
The likelihood of teenage childbearing or abortion was the highest for the adolescents from low socioeconomic status households, in particular if the head of the household was a manual worker. Among the teenagers who experienced a pregnancy the odds of choosing an abortion rather than childbearing were two to three times higher for teens from white-collar backgrounds, indicating a will to postpone childbearing – perhaps in order to pursue higher education and a career.
Interestingly, the socioeconomic differences were the largest for the 1960s cohort, even though they were the ones who should have enjoyed the best family planning services and sex education. The 1950s cohort was already in their teens when sex education and family planning services became compulsory in all municipalities, whereas the 1970s cohort suffered from cuts in these services due to the severe recession in the 1990s.
The results of the study do not claim that teens are better off without sex education and family planning services – in fact teen pregnancy rates started to increase soon after cuts were made to these services and started to decline again after the services were re-introduced. However, there is a need for tailored policies taking into account the different backgrounds of the adolescents. Although targeted family planning services and sex education should be in the core of these policies, it is equally important to provide support for teens who conceive regardless of whether they decide to carry the pregnancy to term. All adolescents, irrespective of their pregnancy history should be able to attend school and pursue the career of their choice.
This text has also been posted to Demotrends blog (an amazing blog I highly recommend!). For more information, check the article on the journal’s website.
References
Inspired by a friend’s rant in Facebook regarding the media’s way of presenting poll results and by a public lecture of Nate Silver at LSE, where similar problems were discussed, I decided to investigate the news regarding the popularity of the largest parties in Finland. I wondered, what the polls actually say about the popularity and is that reflected in the language used in the news.
I limit my mini-investigation to the four largest parties: Social-democrats (SDP), National Coalition Party a.k.a. Kokoomus (KOK), Centre Party a.k.a. Keskusta (KESK) and True Finns Party a.k.a. Perussuomalaiset (PS), because the polls usually only give the margin of error for the largest parties. Therefore, I can only try to estimate the accuracy of popularity of these parties.
I searched for a few latest polls in the two biggest news institutions’ websites in Finland: Yle.fi (the National Broadcasting Company) and HS.fi of Helsingin Sanomat (a broadsheet with the largest number of readers). In the end I chose seven polls, conducted between December 2012 and April 2013. Yle uses Taloustutkimus and HS TNS Gallup to conduct the analysis.
The figure clearly shows that if we consider the margins of error reported by Yle and HS, most of these polls cannot distinguish, which one of these four parties is the most popular one. However, arriving to this conclusion is not easy due to four reasons:
The first poll (Yle 2 Dec 2012) was titled “Support for Centre Party in rapid increase“, which is not far from truth, since their popularity was 2.5%-points higher than in a previous poll and the margin of error was 1.4%-points. Therefore the overlap of the 95% confidence interval is marginal: the upper limit for the old poll’s estimate is 16.9% and the lower limit for this poll’s estimate is 16.6%. So, maybe their support actually has increased. Later they state that KOK is clearly the largest party, which is not the case, not at least clearly: looking at the figure we can see that the confidence intervals of KOK and SDP overlap. Therefore, the difference in their popularity might be only a coincidence (or noise) due to sampling. In another sample we might have gotten estimates presenting similar popularity for the two, or even higher percentages for SDP. The correct interpretation thus is: KOK is more popular than PS or KESK, but not significantly different from SDP. SDP seems to be more popular than PS but we’re not confident that there is a significant difference between PS and KESK or SDP and KESK.
The reasoning for all of the polls is similar, so I won’t present it in as much detail as above for the rest of the polls. Instead I’ll focus on the most inaccurate reports I found. If you’re interested in comparing these further, please take a look at the list of links below. As long as you have fluent Finnish skills, you should be able to do it based on this blog post.
“The Centre Party is the second most popular” (HS 24 April 2013)*. Really? Looking at the figure, we quickly observe that the popularity of all four parties is really similar. We cannot even distinguish between the most and the least popular among these four — all the confidence intervals overlap. Thus, one should say: according to the latest poll, all the four biggest parties have similar levels of support.
“The Centre Party is the most popular, SDP crashed” (Yle 29 April 2013). Guess what? I don’t agree with the statement. It indeed looks like KESK is more popular than SDP, but based on these results, it is impossible to say, whether it is KESK, KOK or PS, which currently is the most popular. The estimates differ only a tiny bit and the confidence intervals clearly overlap. The statement is not just exaggerating. It is false. What about SDP then, did it crash? Well, I don’t think so. The point estimate of their popularity is indeed lower than it has been in previous Yle polls in the figure. However, we have no way of knowing, if that was due to chance (remember the sampling thing!) or if there actually is a difference, since the confidence intervals overlap in all but the earliest poll in 2 December 2012. Therefore, my interpretation of this poll is: there is little difference in popularity of KESK, KOK and PS, whereas SDP may be less popular than the three other parties and also less popular than it was in the beginning of December 2012.
Okay, the rest of the interpretations you have to conduct yourself. I’m left wondering, why false information is so commonly presented in the media. Is it due to lack of understanding of statistics? Or maybe due to a belief that people are not interested in news, which do not rank the parties? Would it be so bad to truthfully say that we don’t know, which party among certain candidates currently is the most popular? I cannot think of a reason, which justifies false statements, when the journalist clearly should know better.
* If there’s anything lost in translation, blame me, I was the one, who translated these from Finnish to English.
Liberal abortion legislation was introduced in Finland in 1970. Every now and then, there is discussion regarding, whether the law should be changed in any way. Some would like to see a day, when abortion is available on request (as in Sweden for instance) and others wish to make it more difficult to obtain abortions.
Recently, a few members of parliament from the Christian party, the Centre party and the True Finns party suggested that the legislation should be changed so that medical doctors and other hospital personnel should be given a right to refuse performing abortions, if that’s against their conviction.
Last Thursday, the parliament discussed the suggestion. Quite rapidly the discussion shifted from the rights of hospital staff into whether abortions are morally justified. An MP from the True Finns party, Mika Niikko, referred to a study showing that more than 50 percent of the women, who went through a termination of pregnancy were depressed a year after the termination and that two percent suffered from severe depression. Later he tells that the study was conducted by “a researcher called Söderberg” and also mentions that there is a Finnish study by Gissler, Hemminki and Lönnqvist that found the risk of suicide being three times higher for women, who had had an abortion, compared to the women, who had a childbirth.
Given that I have worked on abortion-related topics for a while, the results of the studies seemed somewhat surprising to me and I decided to track down these papers. Since the citations are not more specific than what I’ve described above, I cannot be sure I found the right papers, but I managed to identify two, which fit the criteria (Söderberg et al.; Gissler et al.). After having looked at the results of these studies, I have to say I’m quite concerned about the relationship between academic research and policy making.
The paper by Söderberg and colleagues is a study of 854 women, who had had an abortion in Malmö, Sweden in 1989. The researchers identified a case group of 139 women that had experienced emotional distress and doubts regarding abortion decision and compared them to a control group of 114 women not having these feelings. Given that I only have access to an not-so-clearly-written abstract rather than a full text, I cannot say much about the study design, but the conclusions of the study are clear: the researchers identified risk factors of experiencing emotional distress (such as poor support from family and friends and underlying ambivalent attitude to abortion) and state “[t]he risk factors identified suggest that it may be possible to ameliorate or even prevent such distress”.
The other study compared suicides after pregnancy in Finland between 1987 and 1994. The researchers were able to identify 73 suicides within one year after the end of the 667,572 pregnancies observed during the study period. Women, whose pregnancy had ended in abortion, were six times more likely to commit a suicide than women, who had a childbirth. The researchers state clearly at the end of the paper that the study was not able to study causality between these two events, because they had no information of pre-pregnancy mental health conditions of the women. Thus, the causal relationship could go either way: suicides and abortions are caused by similar things or abortions cause mental health problems to some women. In addition, I’d bear in mind the small number of suicides observed, which adds uncertainty to any conclusions.
Had Niikko read a more recent paper from Gissler and colleagues, he would have discovered that having mental health problems is associated with a higher risk of abortion. Therefore it seems like experiencing difficult life events is associated with higher risk of abortion rather than the other way around. Also this paper ends with caution: more research is needed, before claiming causality in this complex relationship. Many previous studies have suffered from severe problems in research design and thus cannot be trusted.
So, the studies Niikko referred to were from late 1980s and early 1990s. It goes without saying that they are old and that there are more recent studies he could have referred to. Moreover, the results of the studies were clearly misinterpreted. The really sad part is that in the discussion Niikko was the only MP, who even tried to refer to academic studies to justify his point of view.
Where are the policy implications of policy relevant academic studies hiding?
Last Monday an interesting series of documentaries called Why Poverty? started on BBC (FYI: also broadcasted by YLE in Finland). The first film was called Welcome 2 the World – 4 Born Every Second. As the title suggests, the film was about babies, their mothers in different parts of the world, and their struggle of survival in circumstances that carry the highest risk of maternal and child mortality.
The film tells a story of pregnant women living in poverty in countries such as Sierra Leone, Cambodia, the US, and UK. Even thinking about the stillborn babies, complications and suffering presented still brings tears to my eyes. This is probably one of the most depressing, and yet, one of the most interesting documentaries I’ve ever seen.
According to the UN and WHO, 800 women die annually from preventable causes related to pregnancy and childbirth, due to lack of skilled medical staff, resources, or knowledge on reproductive health. The causes of death most commonly are bleeding, infections, high blood pressure, or unsafe abortion. 99 percent of all maternal deaths occur in the developing world, mostly in Sub-Saharan Africa. There are three million infants that die annually in addition to 2.6 million stillbirths. Within countries, the poorest women and their children in rural areas carry a higher risk of death than others.
These problems still exist, since there are not enough money to organise sufficient family planning services and education in many countries. The level of the family planning funds has declined between 2000 and 2008, according to the UN, despite tho growing need for help. Although maternal mortality has dropped worldwide by almost 50 percent between 1990 and 2010, more funds are needed to help the most deprived areas.
The film brought alive the facts described above. There were two stories that struck me the most. First, there was a pregnant Cambodian mother, infected by HIV, taking care of her biological son and a younger adopted girl.Their only mean of survival was to send the son to collect garbage (instead of going to school) to get money to feed the family. Finally, she gives birth to her new baby, Ly Ly and her 12-year-old son makes a commitment to continue collecting garbage, so that his sisters could go to school and eventually have a better life. However, two months after her birthday, Ly Ly dies. This allows the mother to go work in a construction site, and thus her son gets to go to school. The brutality of the situation really struck me. The youngest member of the family had to die to allow the others to have a little bit better chance in life.
The second thing that opened my eyes was a story about 22-year-old Londoner, who was a single mom for a girl and a boy, who had different fathers. Despite the lack of help from the boy’s father, she was able to provide food, shelter and an education for her family. Despite the fact that in the UK she might be considered poor, the chances of her children to live a normal life were many times better than any of the other children in the film. She was the only mother in the film saying that she has everything she needs and that she is happy.
I’m not trying to say that inequalities do not exist in the Western world, since that would not be true. The point I’m trying to make is that despite the problems that always exist no matter what we do, inequalities can be reduced to a lot smaller level than what we experience worldwide right now. It is just a matter of political decisions and allocation of resources. We should be more willing to share. Improving the condition of young children and their families is a good place to start.
I recommend watching the film (please see the links below).
UN Millenniun Development Goal reports 2010 and 2012 (PDF)
WHO Maternal Mortality fact sheet, May 2012
WHO Trends in Maternal Mortality: 1990 to 2010 (PDF)
Heini Väisänen 