Conclusions
The aim of this analysis was to examine the influences on the first birth timing of Moldovan women. The analysis tested the contraceptive confidence hypothesis, which states that women using less effective contraceptive methods space their births in order to achieve a desired completed family size. The hypothesis was
extended to the first birth interval. This analysis also incorporated the key role of induced abortion in Moldova. It was hypothesised that a high propensity to use induced abortion should increase the confidence of natural method users, facilitating a compression of the first birth interval. The analysis also investigated the influences of economic factors on the timing of first births in Moldova. In particular, the
analysis tested the validity of the crisis and adjustment explanations.
The first research hypothesis stated that the first birth interval should be longer among women with low contraceptive confidence (natural method users) than among modern method users. The results of the modelling partially supported this hypothesis, as the hazard of first birth was higher among modern reversible method users than among natural method users. The implication of this is that women with low contraceptive confidence have a longer first birth interval than women with moderate contraceptive confidence. However, the specification of the high level of contraceptive confidence is problematic, and although there is some indication that permanent method users have a rapid transition to first birth, the effect is small and should be interpreted with some caution. Overall, the conclusion is that there is some support for the contraceptive confidence hypothesis, but that this is limited by data constraints.
The second research hypothesis extended the conventional contraceptive confidence hypothesis to examine the importance of induced abortion. Higher propensity to use induced abortion should be associated with higher contraceptive confidence and a shorter birth interval. Women with no abortion history had the lowest hazard of first birth and hence the longest wait until first birth. The use of induced abortion was associated with a higher hazard of first birth - indicating a quicker entry into motherhood. However this trend was not monotonic - women with the highest abortion ratio had a lower hazard of first birth than women with low and medium abortion ratios. Therefore, the conclusion is that results from regression modelling support this hypothesis, although only partially.
The results indicate a clear postponement effect among post-independence
marriage cohorts. There is no significant interaction between the cohort of marriage and asset wealth, which would have indicated the suppression of first birth due to economic crisis. Therefore, this analysis concludes that there is no evidence for the crisis effect or, at the very least, that the effect was homogenous across economic strata. Women with a higher educational level were more likely to have a birth rapidly following marriage during the Socialist (pre-1991) marriage cohorts when compared to women with ‘secondary or lower’ education. However, in the post- independence era, women with higher education have increasingly lengthy intervals between marriage and first birth. This pattern is consistent with increasing
adjustment, and a greater convergence on a Westernised fertility regime in Moldova - at least among the more highly educated women. In many Western countries, non- marital childbearing is increasingly common. However, Moldovan women still experience high marriage rates and first birth is almost universal (Sobotka 2003) – although the timing does vary by educational attainment. This indicates that while marriage is not a barrier to career progression in Moldova, entry into motherhood still entails some withdrawal from the labour force - perhaps reflecting the removal of state childcare facilities post-independence. While this has less of an impact on women with lower educational attainment, women who are more highly educated find the disruption to career progression more significant.
Discussion
The major aim of this analysis was to establish whether the contraceptive confidence hypothesis applied to first births in Moldova. Broadly, the results support the
existence of the contraceptive confidence effect, since natural method users have a longer duration between marriage and first birth than modern (reversible) method users. The persistence of natural methods in Moldova means that this is pertinent to variation in Moldovan first birth timing in a modern context. Additionally,
establishing the effect of contraceptive confidence on first birth intervals is a substantial advance on previous work (e.g. Ní Bhrolchaín 1988, Keyfitz 1980) which was unable to control for external influences - which this analysis does explicitly.
There are caveats to the conclusions. In particular, the behaviour of permanent method users is inconsistent, since the highest level of contraceptive confidence does not exhibit the shortest birth intervals. This perhaps indicates the problems in measuring the level of contraceptive confidence from method used at survey - in particular, the high number of abortion experienced by permanent method users could indicate the use of permanent method due to contraceptive failure consistent with Zavier and Padmadas (2000). Additionally, the behaviour of non-users at survey is difficult to explain. The very slow progression to first birth among this group has been attributed to sub-fecundability, an effect which is robust to age
standardisation. However, the lack of any information pertaining to the first birth interval is a severe limitation in explaining this behaviour. Therefore, it is not possible to completely explain the patterns of first birth in Moldova via the contraceptive confidence hypothesis, although there is partial support for this conclusion.
Induced abortion is a key component of the fertility control regime in Moldova, and interacts strongly with the fertility patterns of natural method users. However, evidence from the analysis indicates a dichotomous relationship between abortion ratio and birth intervals. Although the extension of the contraceptive confidence hypothesis to incorporate the effect of induced abortion builds on previous theory (e.g. Ní Bhrolchaín 1988, Keyfitz 1980), the results do not correspond exactly with the expected relationship. Two explanations are possible. Firstly, the variable measuring abortion ratio could be misspecified. The MDHS did not collect a
propensity to use induced abortion at time of marriage, and it is therefore difficult to assess whether the abortion ratio is accurately capturing the information required. The second explanation is that the effect of abortion truly is dichotomous: the contrast in examining the effect of abortion on first birth interval among natural method users is simply a contrast between women who are prepared to use induced abortion and those who are not. Often recourse to one abortion is associated with an increased likelihood of subsequent abortions due to rationalisation processes
(Westoff 2005). This is also the case in Moldova, where the progression ratio from first to second abortion is 40.9% (author’s calculations, MDHS 2005).