Nutrition-fertility interactions in developing countries: implications for program design.

This report synthesizes recent research findings in areas where controversy continues brings together a consideration of the different levels of nutrition fertility interaction that have implications for policy formation and program designs and defines program implications in practical terms. Physiological interaction between nutrition and fertility are reviewed with particular attention to the contraceptive effects of breast feeding the impact of nutritional improvements on fertility and the effects of uncontrolled fertility on nutritional status and mortality. Demographic transition and the changing value of children as socioeconomic development proceeds is discussed. Also replacement insurance and investment strategies are discussed in terms of child mortality and the role of nutrition. An overview is given of the ways to integrate nutrition and family planning programs. Implications for policy programs are: 1) improved nutritional status may be related to increased fecundity because infants may receive supplementary food and breast feeding may decrease or they may nurse less intensively because they are receiving less milk 2) strength and duration of infant suckling are important elements in the relationship between lactation and amenorrhea 3) the integration of family planning into nutrition assistance programs can offset possible increases in fecundity 4) programs to reduce mortality in order to bring down fertility must pay attention to replacement insurance and investment in determining family size 5) strategies for encouraging smaller family size include reinforcing modern sector aspirations encouraging investment in children promoting parent-child bonding reducing the social security function of children and expanding womens labor force participation and 6) improving health and welfare involves integrating family planning health and nutrition components and expanding community based maternity services.