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Abstract Background A variety of international organizations, professional groups and individuals are promoting evidence-informed obstetric care in China. We measured change in obstetric practice during vaginal delivery that could be attributed to the diffusion of evidence-based messages, and explored influences on practice change. Methods Sample surveys of women at postnatal discharge in three government hospitals in Shanghai and one in neighbouring Jiangsu province carried out in 1999, repeated in 2003, and compared. Main outcome measures were changes in obstetric practice and influences on provider behaviour. "Routine practice" was defined as more than 65% of vaginal births. Semi-structured interviews with doctors explored influences on practice. Results In 1999, episiotomy was routine at all four hospitals; pubic shaving, rectal examination (to monitor labour) and electronic fetal heart monitoring were routine at three hospitals; and enema on admission was common at one hospital. In 2003, episiotomy rates remained high at all hospitals, and actually significantly increased at one; pubic shaving was less common at one hospital; one hospital stopped rectal examination for monitoring labour, and the one hospital where enemas were common stopped this practice. Mobility during labour increased in three hospitals. Continuous support was variable between hospitals at baseline and showed no change with the 2003 survey. Provider behaviour was mainly influenced by international best practice standards promoted by hospital directors, and national legislation about clinical practice. Conclusion Obstetric practice became more evidence-informed in this selected group of hospitals in China. Change was not directly related to the promotion of evidence-based practice in the region. Hospital directors and national legislation seem to be particularly important influences on provider behaviour at the hospital level.

AbstractWhether the decline of birth weight (BW) reported in developed countries in the early 2000s is ongoing remains unknown. Furthermore, despite recent sharp increases in twin births, comparing secular trends of BW between singletons and twins is difficult, as studies have rarely examined secular trends of BW in twins and singletons simultaneously. Therefore, this study aimed to investigate the most recent 20-year trends (2000–2020) of BW in twins and singletons in South Korea. Annual natality files from 2000 to 2020 obtained from the Korean Statistical Information Service were analyzed. A yearly decrease of BW was 3 g among singletons and 5 to 6 g in twins from 2000 to 2020, indicating a widening gap of BW between twins and singletons with increasing years. Gestational age (GA) also decreased in twins and singletons with yearly decreases of 0.28 days in singletons and 0.41 days in twins. Whereas BW decreased in term (GA ≥ 37 weeks), and very preterm groups (28 weeks ≤ GA < 32 weeks) from 2000 to 2020 in twins and singletons, it increased in moderate to late preterm (32 weeks ≤ GA < 37 weeks) groups, indicating a non-linear relationship between BW and GA. The prevalence of macrosomia (BW > 4000 g) in singletons decreased from 2000 to 2020, whereas low birth weight (LBW; BW < 2500 g) increased in twins and singletons. LBW is associated with adverse health outcomes. Effective public health strategies aiming at reduction in the incidence of LBW in the population should be developed.

Seasonal birth weight has been identified across different climate zones. Finland has wide seasonal and regional variation in climate within the country. We explore the potential seasonality of birth weight in singleton full-term births in Finland, and its variations across time and within the country. We apply descriptive time-series graphs, linear regression across regions, and linear regression with mother fixed effects using Finnish register data consisting of more than 1,800,000 infants born from 1987 to 2021. The descriptive findings indicate a decline in birth weight from 1987 to 2021. A monthly seasonal trend with peaks in spring and autumn and troughs in summer and winter is observed. The pattern gets less distinct with time and shows within-country variations. The seasonal pattern is also present when applying mother fixed effects. We suggest that the seasonal variation is more related to variations in climate than stable characteristics at the family level.

The expansion of female education has been promoted as a way to postpone the age at first birth. In sub‐Saharan Africa, the first cohorts to benefit from policies that expanded access to education are now reaching adulthood and beginning childbearing. I investigate whether the expansion of education in Malawi, which implemented a free primary education policy in 1994 and subsequently expanded secondary schooling, has led to a later age at first birth and whether the education gradient in fertility timing has remained stable over time. Despite increases in female grade attainment over the past twenty years, the age at first birth has not changed. Using instrumental variables analysis, I find a significant negative association between grade attainment and age at first birth, suggesting that the deterioration of school quality and the shift in the age pattern of enrollment that accompanied educational expansion may have compromised the transformative potential of education.

"The NBER Bulletin on Aging and Health provides summaries of publications like this. You can sign up to receive the NBER Bulletin on Aging and Health by email. Trends in BMI values are estimated by centiles of the US adult population by birth cohorts 1886-1986 stratified by ethnicity. The highest centile increased by some 18 to 22 units in the course of the century while the lowest ones increased by merely 1 to 3 units. Hence, the BMI distribution became increasingly right skewed as the distance between the centiles became increasingly larger. The rate of change of BMI centile curves varied considerably over time. The BMI of white men and women experienced upsurges after the two World Wars and downswings during the Great Depression and again after 1970. However, among blacks the pattern is different during the first half of the century with men's rate of increase in BMI values decreasing substantially and that of females remaining unchanged at a relatively high level until the Second World War. However, after the war the rate of change of BMI values of blacks resembled that of the whites with an accelerating phase followed by a slow down around the 1970s. In sum, the creeping nature of the obesity epidemic is evident, as the technological and lifestyle changes of the 20th century affected various segments of the population quite differently"--National Bureau of Economic Research web site

Background: This article questions the demographic consequences of birth postponement in Europe. Objective: Starting from the fact that there is no obvious link between the timing of first births and fertility levels in Europe, we find that under certain circumstances, birth postponement potentially facilitates rather than impedes starting a family. Methods: We apply a synthetic cohort approach and distinguish between different socioeconomic determinants of the timing of first births by using the European Union Statistics on Income and Living Conditions (EU-SILC). Data is compiled specifically to reduce endogeneity and to eliminate structure effects. Results: We find that the probability of becoming a mother is higher for women who postpone first childbirth due to education and career investment than for women who postpone due to unrealized labour market integration. Conclusions: Educated and economically active women certainly postpone first childbirth in comparison to women who are less educated and who are not working, but they end up with a higher probability of starting a family. Contribution: The article contributes to the academic discussion of circumstances that may lead to birth postponement resulting in higher fertility for younger cohorts in European countries.

SummaryThis paper enquires whether education and age at first birth, both strongly associated with completed fertility, are related to the timing of fertility, in particular the timing of the first three births, among once married white women. Analysis of data from the June 1985 United States Current Population Survey indicates that education is related to the timing of fertility; this relationship has remained relatively constant over time. Age at first birth is associated with the timing of fertility among older but not younger women.