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Journal of Biosocial Science
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GENDER SATURATION IN THE SOUTHERN CAUCASUS:
FAMILY COMPOSITION AND SEX-SELECTIVE ABORTION
MICHEL GARENNE and SOPHIE HOHMANN
Journal of Biosocial Science / FirstView Article / March 2014, pp 1 - 11
DOI: 10.1017/S0021932014000078, Published online: 21 February 2014
Link to this article: http://journals.cambridge.org/abstract_S0021932014000078
How to cite this article:
MICHEL GARENNE and SOPHIE HOHMANN GENDER SATURATION IN THE SOUTHERN
CAUCASUS: FAMILY COMPOSITION AND SEX-SELECTIVE ABORTION . Journal of Biosocial
Science, Available on CJO 2014 doi:10.1017/S0021932014000078
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J. Biosoc. Sci., page 1 of 11, 6Cambridge University Press, 2014
doi:10.1017/S0021932014000078
GENDER SATURATION IN THE SOUTHERN
CAUCASUS: FAMILY COMPOSITION AND
SEX-SELECTIVE ABORTION
MICHEL GARENNE*†‡
1
and SOPHIE HOHMANN§
*Institut Pasteur, Epide
´miologie des Maladies Emergentes, Paris, France, †IRD,
UMI Re
´siliences, Bondy, France, ‡Witwatersrand University, Johannesburg,
South Africa and §CNRS, CERCEC, Paris
Summary. The study investigates the complex relationships between sex-
selective abortion and family composition in two countries of the Southern
Caucasus: Armenia and Azerbaijan. Data were drawn from maternity histories
recorded in Demographic and Health Surveys (DHSs). In both countries, the
relationship between the sex ratio of the next birth and the number of girls
already born changed from negative to positive after 1992, when sex-selective
abortion became prevalent. In Azerbaijan, but not in Armenia, a similar
change was noticed for the relationship between the sex ratio of the next birth
and the number of boys already born, this time from positive to negative. All
changes in slopes were highly statistically significant. These findings indicate
that sex-selective abortion was prevalent in both countries, and could work
both ways in Azerbaijan. The results are interpreted in terms of ‘gender satura-
tion’, that is a desire of families to better balance the composition of the family
when too many children of the same sex are already born, which is consistent
with opinion surveys indicating a preference for balanced families.
Introduction
Emerging techniques of sex determination in early pregnancy offer opportunities for
sex selection in countries that permit both induced abortion and sex determination in
early pregnancy (Avent & Chitty, 2006; Cheng, 2008). Techniques of sex determination
have developed since the 1970s, and have been further refined in recent years. The most
popular techniques are ultrasonography and amniocentesis, although more and more
people now rely on DNA probes on blood samples (Avent & Chitty, 2006). Whatever
the technique, women can learn the probable sex of their fetus at the end of the
first trimester of pregnancy, and if desired may undergo a sex-selective abortion. Sex-
selective abortion (SSA) developed rapidly in the 1980s and 1990s in several Asian
countries (India, China, Korea, Vietnam), and more recently in countries of the Southern
1
1
Corresponding author. Email: Michel.Garenne@pasteur.fr
Caucasus (Armenia, Azerbaijan and Georgia) (Zeng et al., 1993; Das Gupta & Bhat,
1997; Chu, 2001; Das Gupta et al., 2003; Cai & Lavely, 2007; Chung & Das Gupta,
2007; Guilmoto, 2009; Jha et al., 2011; Duthe
´et al., 2012).
Most documented cases of sex selection target female fetuses, so that an increase in
the sex ratio at birth (defined as the ratio of male to female births) is seen in countries
where female SSA is practised on a wide scale. In fact, since there are no reliable statis-
tics on SSA, it is through changes in the sex ratio at birth that these changes in behav-
iour are usually noticed. For instance, in some areas of India and China, the sex ratio
at birth has jumped from a baseline around 105 to high values of 115, 120 or even
more, indicating widespread female SSA. Sex-selective abortion in China is special
because of the one-child policy that has been in place since the early 1980s, so that sex
selection applies primarily to the first and only birth, and less frequently to the second
birth in places where it is tolerated. In India, where completed family size is larger and
where families commonly have two, three or four or more babies, sex selection is
closely linked to birth order, and in particular to the number of girls already born, so
that it applies typically to higher birth order pregnancies (Das Gupta & Bhat, 1997).
There is no reason why sex selection could not also apply to male fetuses, when too
many boys are already born. In fact, most families value more a balance between boys
and girls than imbalance or single-sex families, assuming that they have an even
number of children (two, four, six or more). When they have an odd number of
children (three, five, seven or more), a majority of families prefer more boys than
more girls, although some prefer more girls than more boys (see Fuse, 2010, for details).
So, in theory sex-selective abortion could work both ways, and is likely to depend
primarily on the number of girls already born (for selecting out female fetuses) or on
the number of boys already born (for selecting out male fetuses).
This study aims at investigating these complex relationships between sex-selective
abortion and family composition in countries of the Southern Caucasus, where prefer-
ence for boys is not different from nearby countries, where induced abortion is legal
and widely used for contraception, and where sex-selective abortion is also acceptable
and widely used since the early 1990s. The study uses data from demographic surveys
with comprehensive birth histories to investigate these relationships. In the analysis, a
stand different from that of earlier studies on sex-selective abortion is taken (UNFPA,
2012). A more balanced approach between boys and girls is adopted, accepting the
idea of sex selection for both sexes, and introducing a new concept of ‘gender satura-
tion’, characterized by a behaviour of sex selection by families who perceive that they
have too many children of one sex, and want a change for the next child.
Framework for analysis
Sex-selective abortion is basically the only way to manipulate the sex ratio at birth,
although selective in vitro fertilization could potentially lead to similar effects, but
remains a rare phenomenon. Sex-selective abortion usually depends on birth order
and sex composition of the family. Therefore, a method of choice for assessing the
extent of sex-selective abortion is to compare sex ratios at birth before and after SSA
was practised, and to study these changes according to birth order, or better according
to the number of children of the same sex, boys or girls, already born.
M. Garenne and S. Hohmann2
Several studies have documented a natural heterogeneity in the probability of bear-
ing a boy or a girl (Malinvaud, 1955; Edwards, 1958). In the heterogeneous case, the
sex ratio varies among couples: some couples tend to have more boys while others tend
to have more girls for biological reasons. The extent of this heterogeneity in European
and African populations has been shown elsewhere (Garenne, 2009a, b). As a result, in
the absence of SSA, the sex ratio of the next child tends to increase with the number
of boys already born, and tends to decrease with the number of girls already born. If
anything, SSA is assumed to have a counter-effect on these relationships, since couples
are likely to abort a female fetus when they have already had too many girls, and may
also be likely to abort a male fetus when they have already had too many boys. There-
fore, SSA is expected to change the natural relationships between the sex ratio of the
next birth and the number of boys and girls already born. This is the rationale for this
study.
Data and Methods
Two countries of the Southern Caucasus with known practice of sex-selective abortion
were selected: Armenia and Azerbaijan. Both conducted Demographic and Health
Surveys (DHSs) with full maternity histories, which were made available for further
research. Armenia conducted three DHSs in 2000, 2005 and 2010, which were merged
together for final analysis. Azerbaijan conducted only one DHS in 2006. In these two
countries, as in nearby Georgia, sex ratios recorded in vital registration statistics
increased markedly after 1992 because of widespread use of sex-selective abortion, so
the year 1992 was used as a cut-off for analysis. The 1992 date was confirmed by dis-
cussions with key informants by one of the authors (SH), who conducted a series of
interviews on these issues in the three Southern Caucasian countries. Sex-determination
techniques were apparently not available for the population before the collapse of the
Soviet Union.
The statistical analysis of maternity histories was straightforward, using cross-
tabulation and linear-logistic regression on the probability of bearing a boy, i.e. the
logarithm of the sex ratio at birth. In earlier studies, the linear-logistic model was
found to fit properly the pattern of heterogeneity, identified as a positive slope of the
sex ratio of the next birth according to the number of boys already born, and as a neg-
ative slope according to the number of girls already born. These slopes were even
larger in absolute values when single-sex families were considered (only boys or only
girls born before the index child; see Garenne, 2009a, b, for details). In the present
study, three regression models were used: one for all families, the others for single-sex
families of either sex. In formula this gives:
All families:
logitðpÞ¼aþb1Males þb2Females:
Single-sex families (only males or only females born before the index birth):
logitðpÞ¼aþb1Males;
logitðpÞ¼aþb2Females;
Gender saturation in the Southern Caucasus 3
where pis the proportion of male births, and therefore logit( p) is the logarithm of the
sex ratio of the index birth, Males is the number of previous male births, and Females
the number of previous female births.
The change in slopes in these relationships before and after the cut-off point, if
statistically significant, will be considered as a signature of sex-selective abortion. In
the case of female fetus abortion, the sex ratio of the index child is expected to increase
when too many girls are already born, and conversely, in the case of male fetus abor-
tion, the sex ratio is expected to decline when too many boys are already born. If a
fraction ‘p’ of female fetuses are aborted, then the number of female births is multiplied
by (1 p), and the sex ratio is divided by (1 p), which allows the proportion of
female fetuses aborted to be directly measured. The same type of relationship applies
when male fetuses are selectively aborted.
In order to make the case of the Southern Caucasus more convincing, the same
analysis was replicated in all nearby countries with similar DHS data. Since most of
these samples were quite small, they were also grouped by area: Eastern Europe (Albania,
Moldova, Ukraine), Middle East (Jordan, Turkey) and Central Asia (Kazakhstan,
Kyrgyzstan, Tajikistan, Uzbekistan). For countries with several DHSs, data were grouped
together, as was done for Armenia. The details of each survey can be found on the
Measure-DHS website (www.measuredhs.com).
Results
Theanalysiswasbasedon13,565birthsinAzerbaijanand30,007birthsinArmenia,
of which about half (51.2%) occurred before 1992. These are rather small samples for
studying sex ratios, but as will be seen below the effects of sex-selective abortion were
so large that differences were still statistically significant (Tables 1 and 2).
Table 1. Net effect of the number of boys and girls already born on the sex of the next
child (from linear-logistic regression), Azerbaijan and Armenia
Children already born
Births <1992 Births b1992 Change
p-valuebSE bSE
Azerbaijan
Boys þ0.01244 0.03466 0.09597 0.03025 0.018*
Girls 0.01571 0.03102 þ0.10385 0.02595 0.003*
Constant 0.08098 0.03517 0.11921 0.03120
Armenia
Boys þ0.02917 0.02355 0.00457 0.02546 0.478
Girls 0.04443 0.02033 þ0.16037 0.02164 5.3 10
–12*
Constant 0.09762 0.02098 0.06463 0.02326
Coefficients estimated from maternity histories in demographic surveys (Azerbaijan: 2006 DHS;
Armenia: 2000, 2005, 2010 DHS). Test measures the statistical significance of the changing
slopes between ‘before’ and ‘after’ 1992.
*p<0.05.
M. Garenne and S. Hohmann4
Azerbaijan
In Azerbaijan before 1992, the relationship between sex ratio of the next birth and
the number of boys and girls already born was as expected: positive with number of
boys and negative with number of girls, fully consistent with underlying heterogeneity,
and of the same magnitude as in other populations such as France or Germany (Garenne,
2009a). In contrast, after 1992 both relationships were inversed, indicating sex-selective
abortion in both directions. The changes in slope before and after 1992 were highly sig-
nificant: p¼0.018 for number of boys, and p¼0.003 for number of girls. Therefore,
the data indicate a widespread use of selective abortion both ways, when too many girls
or too many boys were born in a family. Estimates from the regression model indicate
that some 24% of female fetuses were selected out after two girls, and 32% after three
girls. Conversely, some 16% of male fetuses were selected out after two boys and 25%
after three boys. These last two values of male-selective abortion seem to be over-
estimated by the regression model. Indeed, the changing slope after 1992 for boys was
in part due to the higher sex ratio when no male birth had occurred (due either to data
artefact or to female fetus abortion for the first birth), and in part due to the lower
sex ratio when two or more boys were already born (due to male fetus abortion). If the
effect of the first male is ignored (it is not statistically significant), then the fall in the sex
ratio after two boys appears smaller (observed sex ratio 104.4, instead of 90.7 predicted
by regression, and compared with 111.1 before 1992), and the proportion of male
fetuses aborted will also be much smaller (6.0%), which seems more realistic, and more
consistent with the overall increase in sex ratios.
Table 2. Sex ratios and sex selection according to the number of boys and girls
already born
Sex ratio
Number of previous
births of same sex
Boys born before Girls born before
Births
<1992
Births
b1992
Births
<1992
Births
b1992
Males
aborted (%)
Females
aborted (%)
Azerbaijan
0 108.4 112.7 108.4 112.7
1 109.8 102.4 106.7 125.0 6.8 14.6
2 111.2 93.0 105.1 138.7 16.4 24.2
3 112.6 84.5 103.4 153.8 24.9 32.8
4 114.0 76.7 101.8 170.7 32.7 40.3
Armenia
0 108.9 106.5
1 104.2 125.0 16.7
2 99.6 146.7 32.1
3 95.3 172.2 44.7
4 91.2 202.2 54.9
Calculated from regression models presented in Table 1. No statistical evidence of male-selective
abortion in Armenia. Net effect of male-selective abortion exaggerated by high value of sex ratio
of the first birth in Azerbaijan. See text for details.
Gender saturation in the Southern Caucasus 5
Armenia
In Armenia, the pattern was similar for selection of girls, but not for boys. Here
also, the relationship between sex ratio of the next birth and the number of girls
already born (negative slope) was as expected for births that occurred before 1992.
The coefficient of the number of girls changed significantly after 1992 ( p<10
10
),
indicating abortion of female fetuses when too many girls were born. The magnitudes
of the changes, and therefore the proportion of female fetuses selected out, were similar
to those found in Azerbaijan, with some 32% aborted after two girls and 44% after
three girls. This, however, was not true for male fetuses, for whom there was no change
in behaviour, and therefore no evidence of male-selective abortion.
Figure 1 displays the changing pattern of the sex ratio according to the number of
girls already born, with both the observed data and the fitted data by the linear-logistic
regression. Single-sex families were selected for direct comparison between observed
and fitted values. Both countries were merged together for drawing this figure, in order
to increase sample size and to reduce random fluctuations. This was justified because
the slopes before 1992 were similar ( p¼0.968), and because the changes after 1992
were in the same direction and of the same magnitude, although more pronounced in
Azerbaijan ( p¼0.013). The figure shows the dramatic change in the pattern before
and after 1992, a clear signature of female SSA.
Note that some of these events were rather rare. With a baseline sex ratio of 106,
the probability of having three girls in a row is only 11.4%, and that of having three
boys in a row is about the same (13.6%), therefore the high rates of selective abortion
associated with high numbers of children of the same sex apply only to a small fraction
of the population. Furthermore, the proportion of families with four children or more
is also small in both countries, since the average completed family size is rather small
for these cohorts of women (2.8 children per woman in Azerbaijan, 2.6 children per
woman in Armenia), and only 28% of women in Azerbaijan and 18% in Armenia
6H[UDW
L
RR
I
QH[W
EL
UW
K
1XPEHU RIJLUOVDOUHDG\ERUQ
)LWWHG
)LWWHG!
2EVHUYHG
2EVHUYHG!
%HIRUH
$IWHU
Fig. 1. Changing sex ratios of the next birth, before and after 1992, in single-sex families
with no boys, Azerbaijan and Armenia combined.
M. Garenne and S. Hohmann6
have four children or more by age 40–49. A large majority of women have either two
or three children (62% in Azerbaijan, 74% in Armenia). Therefore, sex-selective abor-
tion seems to apply mostly to the second and third pregnancy, with much lower pro-
portions aborted. There was no evidence of sex selection for the first birth in either
country, the sex ratio of the first birth being identical ( p¼0.983) for births that occurred
before 1992 (SRB ¼109.8) and those that occurred after 1992 (SRB ¼109.4). The high
value of the sex ratio of the first birth was probably due to the high proportion of births
to very young women (68% occurred before age 22) (see Garenne, 2008, for details).
Comparison countries
Findings from Azerbaijan and Armenia were compared with those from nearby
countries with similar DHS data: Albania (2008 DHS), Moldova (2005 DHS), Ukraine
(2007 DHS), Kazakhstan (1995, 1999 DHS), Kyrgyzstan (1997 DHS), Tajikistan (2012
DHS), Uzbekistan (1996, 2002 DHS), Jordan (1990, 1997, 2002, 2007, 2009 DHS) and
Turkey (1993, 1998, 2003 DHS). The first three countries belong to a group of Euro-
pean countries from the Eastern Bloc under soviet influence until 1991. The next four
countries belong to a group of Central Asian countries, members of the Soviet Union
Table 3. Change before and after 1992 in regression coefficients of log sex ratio of
index birth on number of male and female births born before, comparison countries
(data from DHS surveys)
Area/country No. of births
Previous male births Previous female births
Change p-value Sig. Change p-value Sig.
Central Asia
Kazakhstan 14,972 0.0009 0.984 ns 0.0059 0.888 ns
Kyrgyzstan 8781 0.0484 0.278 ns 0.0279 0.519 ns
Tajikistan 19,938 0.0484 0.343 ns þ0.0735 0.172 ns
Uzbekistan 21,257 þ0.0565 0.050 * þ0.0107 0.690 ns
Middle East
Jordan 164,010 þ0.0012 0.855 ns 0.0054 0.380 ns
Turkey 77,436 0.0378 0.010 * þ0.0262 0.057 ns
Eastern Europe
Albania 12,766 0.0246 0.644 ns þ0.0033 0.947 ns
Moldova 9903 0.0309 0.610 ns 0.1155 0.058 ns
Ukraine 8007 0.0118 0.888 ns þ0.1460 0.105 ns
Summary by geographical area
Central Asia 64,948 0.0015 0.922 ns þ0.0029 0.848 ns
Middle East 241,446 0.0036 0.568 ns 0.0055 0.372 ns
Eastern Europe 30,676 0.0135 0.701 ns þ0.0059 0.862 ns
When gender saturation occurs, change in male coefficient is negative (selection for females), and
change in female coefficient is positive (selection for males). The case of Turkey is discussed in
the text.
*p<0.05; ns ¼not significant.
Gender saturation in the Southern Caucasus 7
until 1991. The last two countries are Middle Eastern countries, geographically close to
the Southern Caucasus.
In these comparison countries, there was no statistical evidence of changing slopes
before or after 1992 in the relationship between sex ratio of the next birth and the
number of girls already born ( p¼0.947 in Albania; p¼0.058 in Moldova; p¼0.105
in Ukraine; p¼0.888 in Kazakhstan; p¼0.519 in Kyrgyzstan; p¼0.172 in Tajikistan;
p¼0.690 in Uzbekistan; p¼0.380 in Jordan; p¼0.057 in Turkey). The lack of signifi-
cance could be due to the small sample size, but the results were also not significant
when countries were grouped by geographical area (Eastern Europe; Central Asia and
Middle East; Table 3).
Likewise, in most of the comparison countries, there was no change in the slopes
before and after 1992 in the relationship between sex ratio of the next birth and the
number of boys already born ( p¼0.644 in Albania; p¼0.610 in Moldova; p¼0.888
in Ukraine; p¼0.984 in Kazakhstan; p¼0.278 in Kyrgyzstan; p¼0.343 in Tajikistan;
p¼0.855 in Jordan). In Uzbekistan, the change in slope was opposite to that correspond-
ing to gender saturation, and was only borderline ( p¼0.050). However, in Turkey, the
change in slope was statistically significant for boys, from positive before 1992 to nega-
tive after 1992 ( p¼0.010). This result seems to be due to erratic values of the sex ratio
of first birth after 1992 (112.3) compared with that before 1992 (106.5). The difference
between the former and the latter was not statistically significant ( p¼0.100), and could
be explained by random fluctuations.
Discussion
The behaviour of couples in countries of the Southern Caucasus appears to be very
rational, and more so in Azerbaijan than in Armenia, because it is more symmetrical
between the two genders. Couples appear to take the opportunity of using the newly
developed sex-selective abortion techniques to reach their goal of a more balanced
family sex composition, avoiding too many births of the same sex. The effect was
more pronounced when too many girls were born, leading towards a higher sex ratio
at birth in the whole population.
One could discuss endlessly the ethics of this behaviour, as is the case for induced
abortion in general (Johnston, 2001; Van Balen, 2006). Given that it could be sym-
metrical, as in Azerbaijan, sex-selective abortion no longer appears to be solely biased
against female fetuses, and rather appears as a desire for more balanced families,
a wish expressed in most opinion surveys throughout the world (Williamson, 1996;
Fuse, 2010).
Since there are several countries around the world, in Europe, Latin America and
southern Africa, where more women express a preference for girls than for boys,
changes in the coming years can be anticipated if sex-selective abortion becomes more
accepted in these parts of the world. If this is the case, a significant change in the sex
ratio at birth might not be noticed, or there might even be a decline in the sex ratio,
so current screening methods focusing on increasing sex ratio values might become
obsolete. On the contrary, this study’s method of comparing sex ratio by family com-
position is more likely to enable the identification of changes in any direction, and
should be preferred when data are available.
M. Garenne and S. Hohmann8
This study has limitations because of the small sample size in the DHSs, and it
would be good to conduct similar studies on larger samples in order to achieve smaller
confidence intervals. However, the consistency of the data in the two countries, with
large increases in the sex ratio at birth, and the lack of change in nearby countries
where SSA was not documented or remained very limited in scale, gives further value
to the empirical analysis based on DHS data.
The high prevalence of sex-selective abortion implied by the higher (or lower) sex
ratio at birth associated with many girls (or boys) indicates a very determined behav-
iour from large segments of the population. These high values are consistent with the
high prevalence of induced abortion in the two countries (0.18 abortions per live birth
in Azerbaijan in 1992–2006; 0.41 abortions per live birth in Armenia in 1992–2010
according to official statistics). Sex-selective abortion is applied in only a small fraction
of families who have several children of the same sex. The ratio of sex-selective abor-
tion to the total number of induced abortions appears very high in Azerbaijan, indicat-
ing very strong motivations for sex selection.
There was no obvious reason for not finding male-selective abortion in Armenia,
given what was found in Azerbaijan. Both countries are very tolerant of induced abor-
tion, both were part of the former Soviet Union, gained independence at the same time
and have similar demographic, social and public health histories, despite different ethnic
and religious backgrounds. Given the fact that female-selective abortion is similar in
both countries, the difference in attitude towards male-selective abortion is more likely
to be explained by symbolic values or by economic factors, which need to be further
explored. For instance, Armenia was affected by a severe economic crisis in the 1990s,
which led to a large drop in fertility (TFR ¼1.8 in 2001–2002, compared with 2.8
in 1990) and massive use of induced abortion between 1992 and 1999 (ratio of 0.65
abortions per live birth in 1996, compared with 0.32 in 1990). This crisis led to serious
population decline and massive out-migration of men, and families relied more and
more on the earnings of male migrant workers for their survival. This might have
increased the perceived economic value of male children, and might have been a further
incentive to keep as many boys as possible, hoping that they would move away to work
abroad and send money back to their parents.
This study addressed the issue of gender saturation characterized by sex-selective
abortion after several births of the same sex. Other behaviours could also happen
when sex-selective abortion is acceptable in a society, such as selection for the sex of
the first birth. Among the countries investigated in this study, three exhibited an un-
expected (though not significant) change in the sex ratio of the first birth after 1992:
Azerbaijan (116.5 against 108.5 before 1992; p¼0.199), Moldova (114.4 against 106.7
before 1992, p¼0.244) and Turkey (112.3 against 106.5 before 1992; p¼0.100). None
of these differences was statistically significant, so no conclusion could be drawn from
these survey data. Overall, for the whole set of countries investigated, there was no
change in the sex ratio of the first birth (108.1 after 1992 against 107.7 before 1992,
p¼0.776). However, sex selection for the first birth remains a possibility in countries
where a first boy is seen as desirable for the family.
The desire for balanced families when even numbers of children are born (two
and four children in particular), and a higher sex ratio in the case of an odd number
of children (three and five children in particular), seem to be very frequent, although
Gender saturation in the Southern Caucasus 9
not universal, in the Southern Caucasus. More sex-selective abortion (both male and
female) might be seen in the future if this behaviour becomes more acceptable. Chang-
ing sex-selection behaviour might also be seen in the case of rapid fertility decline
(leading to smaller families and more families with one or two children) and during
periods of economic hardship, as well as in the case of fertility increase (leading to
larger families, and more families with three or four children) when the economic situa-
tion becomes better. These new trends could be further monitored to better understand
new families’ desires and choices, and how they adjust their reproductive strategies to
changing economic situations.
Acknowledgment
The authors would like to thank Professor Ce
´cile Lefe
`vre, Universite
´Paris V-Descartes,
for useful comments on the draft manuscript.
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