title: Contraceptive confidence and timing of first birth in Moldova: an event history analysis of retrospective data.
abstract: OBJECTIVE
  To test the contraceptive confidence hypothesis in a modern context. The hypothesis is that women using effective or modern contraceptive methods have increased contraceptive confidence and hence a shorter interval between marriage and first birth than users of ineffective or traditional methods. We extend the hypothesis to incorporate the role of abortion, arguing that it acts as a substitute for contraception in the study context.
  
  
  METHODS
  Moldova, a country in South-East Europe. Moldova exhibits high use of traditional contraceptive methods and abortion compared with other European countries.
  
  
  METHODS
  Data are from a secondary analysis of the 2005 Moldovan Demographic and Health Survey, a nationally representative sample survey. 5377 unmarried women were selected.
  
  
  METHODS
  The outcome measure was the interval between marriage and first birth. This was modelled using a piecewise-constant hazard regression, with abortion and contraceptive method types as primary variables along with relevant sociodemographic controls.
  
  
  RESULTS
  Women with high contraceptive confidence (modern method users) have a higher cumulative hazard of first birth 36 months following marriage (0.88 (0.87 to 0.89)) compared with women with low contraceptive confidence (traditional method users, cumulative hazard: 0.85 (0.84 to 0.85)). This is consistent with the contraceptive confidence hypothesis. There is a higher cumulative hazard of first birth among women with low (0.80 (0.79 to 0.80)) and moderate abortion propensities (0.76 (0.75 to 0.77)) than women with no abortion propensity (0.73 (0.72 to 0.74)) 24 months after marriage.
  
  
  CONCLUSIONS
  Effective contraceptive use tends to increase contraceptive confidence and is associated with a shorter interval between marriage and first birth. Increased use of abortion also tends to increase contraceptive confidence and shorten birth duration, although this effect is non-linear-women with a very high use of abortion tend to have lengthy intervals between marriage and first birth.
authors.affiliation: Department of Quantitative Social Science, Institute of Education, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Lyons-Amos
authors.affiliation: Faculty of Social & Human Sciences, Centre for Global Health, Population, Poverty & Policy, University of Southampton, Southampton, UK.
authors.forename: Sabu S
authors.initials: SS
authors.lastname: Padmadas
authors.affiliation: Faculty of Social & Human Sciences, Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK.
authors.forename: Gabriele B
authors.initials: GB
authors.lastname: Durrant
mesh_terms: D000028:Abortion, Induced / Q000523:psychology / Q000706:statistics & numerical data; D001722:Birth Order / Q000523:psychology*; D003267:Contraception / Q000523:psychology* / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008393:Marriage / Q000523:psychology / Q000706:statistics & numerical data; D008966:Moldova; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: REPRODUCTIVE MEDICINE; SOCIAL MEDICINE
references.citation: Soc Sci Med. 1996 Feb;42(4):521-30
references.pmid: 8643978
references.citation: Fam Plann Perspect. 1995 Mar-Apr;27(2):71-3, 96
references.pmid: 7796899
references.citation: Stud Fam Plann. 1999 Mar;30(1):28-42
references.pmid: 10216894
references.citation: Demography. 1996 Feb;33(1):12-23
references.pmid: 8690136
references.citation: Eur J Popul. 1986 May;2(1):43-70
references.pmid: 12159017
references.citation: Stud Fam Plann. 1993 Jul-Aug;24(4):227-35
references.pmid: 8212092
references.citation: J Biosoc Sci. 1985 Jan;17(1):31-46
references.pmid: 3972855
references.citation: Int J Gynaecol Obstet. 1997 Jul;58(1):69-75
references.pmid: 9253668
references.citation: Stud Fam Plann. 1991 Nov-Dec;22(6):368-77
references.pmid: 1792676
references.citation: Demography. 1994 Feb;31(1):115-32
references.pmid: 8005338
references.citation: Stud Fam Plann. 2002 Sep;33(3):237-48
references.pmid: 12385085
references.citation: Contraception. 2010 Jan;81(1):22-9
references.pmid: 20004269
references.citation: Popul Stud (Camb). 2004;58(2):161-76
references.pmid: 15204251
references.citation: J Biosoc Sci. 2011 May;43(3):305-27
references.pmid: 21303582