Abstract
Previous studies have shown that aspects of reproductive history, such as earlier parenthood and high parity, are associated with poorer health in mid and later life. However, it is unclear which dimensions of health are most affected by reproductive history, and whether the pattern of associations varies for measures of physical, psychological and cognitive health. Such variation might provide more insight into possible underlying mechanisms. We use longitudinal data for men and women aged 50–79 years in ten European countries from the Survey of Health, Ageing and Retirement in Europe to analyse associations between completed fertility history and self-reported and observed health indicators measured 2–3 years apart (functional limitations, chronic diseases, grip strength, depression and cognition), adjusting for socio-demographic, and health factors at baseline. Using multiple imputation and pattern mixture modelling, we tested the robustness of estimates to missing data mechanisms. The results are partly consistent with previous studies and show that women who became mothers before age 20 had worse functional health at baseline and were more likely to suffer functional health declines. Parents of 4 or more children had worse physical, psychological and cognitive health at baseline and were more likely to develop circulatory disease over the follow-up period. Men who delayed fatherhood until age 35 or later had better health at baseline but did not experience significantly different health declines. This study improves our understanding of linkages between fertility histories and later life health and possible implications of changes in fertility patterns for population health. However, research ideally using prospective life course data is needed to further elucidate possible mechanisms, considering interactions with partnership histories, health behaviour patterns and socio-economic trajectories.
Highlights
Studies investigating the life course determinants of health in older age have found that aspects of reproductive history, such as timing of entry to parenthood and completed family size, are associated with post-reproductive morbidity and mortality (Doblhammer 2000; Einioet al. 2015, 2016; Grundy and Kravdal 2010; Grundy and Tomassini 2005; Hank 2010)
It is unlikely that social selection is a complete explanation, because the early parenthood-poor health association has been observed in several studies which adjust for early life factors (Grundy and Kravdal 2007; Grundy and Foverskov 2016; Henretta 2007), or which use sibling designs to minimise confounding by family of origin (Barclay et al 2016; Einioet al. 2015, 2016)
We found some evidence that men with a high parity (3 or more) had worse overall health at baseline if they were never married, compared to other marital status groups (LLT P value = 0.047)
Summary
Studies investigating the life course determinants of health in older age have found that aspects of reproductive history, such as timing of entry to parenthood and completed family size, are associated with post-reproductive morbidity and mortality (Doblhammer 2000; Einioet al. 2015, 2016; Grundy and Kravdal 2010; Grundy and Tomassini 2005; Hank 2010). Having no or in some contexts many children (four or five or more) and, among parents, earlier age at first birth, is associated with poorer later life physical (Barban 2013; Grundy and Read 2015; Grundy and Tomassini 2005; Hank 2010; Henretta 2007) and in some studies mental health (Kalil and Kunz 2002; Kravdal et al 2017; Mirowsky and Ross 2002; Read et al 2011). Potential explanations include social selection factors, possible direct influences (mainly for women), and possible indirect influences of fertility on subsequent life circumstances, which in turn affect later life health Those who become parents at young ages are more likely to come from deprived backgrounds, disrupted families, and have lower pre-parenthood education Assortative mating on health status and other social factors may, in turn, strengthen and amplify individual disadvantage
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